[PC-BH-Integration] One more plea for failures

Tue Apr 3 11:26:10 EDT 2012

This has been a most interesting conversation. I completely endorse the observations made by Bill Rosenfeld and the comments re training.

Here in Philadelphia, we have an established network of health centers implementing the BHC model (18 sites and growing). We have benefited from training/consultation/modeling from Kirk Strosahl, Neftali Serrano as well as our many brilliant colleagues associated with Collaborative Family Healthcare Association. To support our local network, we have also developed a practice-based training program. There are online certificate programs at UMASS, Fairleigh Dickinson and others that are emerging. Some of our BHCs have participated in these;  however, what we offer in addition is ongoing professional development, peer support, group supervision, leadership development, problem solving and technical assistance to maintain model integrity and ongoing program development. We have provided initial orientation to every site that implements the program, including medical staff, as well as targeted training for PCPs. We conduct periodic opportunities for reciprocal shadowing, on-site observation and coaching. We have a network google group to maintain communications between monthly BHC meetings. We keep a library of print materials for loan. And, we use other web methods to help support newly hired BHCs more intensively for their first several months of practice. It seems to me that even when more academic programs begin to offer degrees, tracks or certificates in primary care behavioral health practice, until the standards for integrated healthcare are fully established as the norm, we will need regional training centers to reinforce, spread and sustain the model.

Natalie Levkovich
Chief Executive Officer
The Health Federation of Philadelphia
1211 Chestnut Street, Suite 801
Philadelphia, PA 19107
215.567.8001 ext. 3001
natlev at healthfederation.org
www.healthfederation.org<http://www.healthfederation.org>

From: Scott Gilman [mailto:sgilman at shiacmh.org]
Sent: Monday, April 02, 2012 4:29 PM
To: pc-bh-integration at lists101.his.com
Cc: Sarah Bannon
Subject: Re: [PC-BH-Integration] One more plea for failures

Wondering if a summary has been put together on the plea?

Thank you.
Scott Gilman

From: pc-bh-integration-bounces at lists101.his.com<mailto:pc-bh-integration-bounces at lists101.his.com> [mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Sarah Bannon
Sent: Tuesday, January 03, 2012 1:01 PM
To: pc-bh-integration at lists101.his.com<mailto:pc-bh-integration at lists101.his.com>
Cc: Sarah Bannon
Subject: Re: [PC-BH-Integration] One more plea for failures

Hello:

Mr. Rosenfeld's summary is excellent and it hits on all of the key points that I would echo from doing integrated care training for behavioral health providers in FQHC settings for HRSA over six years except one:

The Behavioral Health Clinician has to break his/her habits and perception of how they were trained regarding length (and focus) of session. One of the singular and recurring failures is BHCs" not getting" that they need to copy of the pace and methodical approach of primary care. This means shorter sessions, more functionally and short-term focused, and the willingness to be interruptable and flexible to handle higher acuity cases, etc.

The ability and the willingness to transform to match the culture of the (primary care) environment and fully act like a member of the (primary care) team is very tough, especially for traditionally-trained behavioral health professionals. To be fair, it is also very hard for most medical staff to cross the cultural divide too...

It would be interesting to see a summary of your work if you would be willing to share it Dr. Kern.

Best Regards--Sarah Bannon
CEO, Lakeview Consultants, LLC

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From: brosenfeld at mphc-az.org<mailto:brosenfeld at mphc-az.org>
To: pc-bh-integration at lists101.his.com<mailto:pc-bh-integration at lists101.his.com>
Date: Tue, 3 Jan 2012 16:31:01 +0000
Subject: Re: [PC-BH-Integration] One more plea for failures
Dr. Kern,
My name is Bill Rosenfeld and I am the Director of Integrated Behavioral Health at Mountain Park Health Center in Phoenix, Arizona.  We have a thriving integrated practice, with 30 people in our department working with 70 Medical Providers.  Here is a short list of failures that I would love to have other folks avoid in their endeavors to create integrated practices.  Good luck!
1.)     Part time presence of a Behavioral Health Provider failed in multiple trials.  It is nearly impossible to request a medical provider to practice differently one or two days a week.  No-shows were rampant, and warm handoffs seldom.
2.)    Placing a Behavioral Health Provider outside of the clinic areas that the medical providers use was also a failure.  It seems like many practices commit to integrating services, but place the Behaviorist in the furthest broom closet from clinical traffic areas....they almost all fail.
3.)    Success of the Behavioral Health Providers is largely personality driven.  It takes a person with a strong constitution and excellent communication skills to be accepted as part of the primary care team.
4.)    Setting up shop and waiting for referrals in one's office has also proven to fail in multiple trials.  The Behaviorist that has a strong sense of self marketing and the boldest open door policy seems to fare much better.
5.)    Lack of executive level support would have been tragic, and would have led to failure.  Luckily, we were strongly supported.  We have seen many other health centers fail as a result of poor support from their leaders.
I hope this helps.  We are in our tenth year of this project, and it truly took a good two years to catch fire.
-Bill

From: pc-bh-integration-bounces at lists101.his.com<mailto:pc-bh-integration-bounces at lists101.his.com> [mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of John Kern
Sent: Friday, December 30, 2011 6:20 AM
To: 'pc-bh-integration at lists101.his.com'
Subject: [PC-BH-Integration] One more plea for failures

My final act of 2011 will be to reach out again to all of you to share with me / us any experiences of failures so far in the implementation of your programs, things that you would recommend that others not do, to spare them your own personal agony.

 I am collecting these for a training presentation, and PROMISE that I won't use any identifying information without permission. AND that my own failures will be well-documented in the presentation - that's what makes it fun.

Thanks in advance. Happy New Year!

BTW, if you are willing to share, but not to the listserv, I am at john.kern at regionalmentalhealth.org<http://john.kern%40regionalmentalhealth.org/>

John S. Kern, M.D.
Chief Medical Officer
The Regional Mental Health Center
8555 Taft Street
Merrillville, IN 46410
219-736-7232

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