[PC-BH-Integration] PC-BH-Integration program implementationobstacles

[Kessler, Rodger S]

Sandy, Obviously agree completely. That said, the other side of the coin is also concerning. The field and survey data I am collecting suggests that in integrated primary care, it is really integrated mental health, with little or no attention to substance abuse. That does not work either. Rodger

From: pc-bh-integration-bounces at lists101.his.com [mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Blount, Alexander
Sent: Wednesday, January 04, 2012 12:10 PM
To: [National Council's Behavioral Health - Primary Care IntegrationListserve]
Subject: Re: [PC-BH-Integration] PC-BH-Integration program implementationobstacles

This actually raises another "don't do it" and that is:  don't integrate only substance abuse services and not behavioral health even if the most acute need is around substances.  There was a conference recently in Washington sponsored by the White House Office of Substance Abuse (I don't have the name exactly right) and SAMHSA.  It included physicians and behavioral health folks, both from the specialty substance abuse field and from primary care. Some of the folks from the specialty world thought that integrating substance abuse into primary care as a program was a good idea.  None of the people, physian or behavioral health professional, who work in primary care thought that was a tenable idea.  It just continues the dichotomizing of patients, using a different dichotomy.  I hope you are in touch with the folks at the Hogg Foundation who have done so much work in promoting integrated care in Texas.  I suggest you look at starting again with a generalist approach and SA can be a part of that.


Alexander Blount, EdD
Director, Center for Integrated Primary Care
Professor of Family Medicine and Psychiatry
University of Massachusetts Medical School
Director of Behavioral Science
Department of Family Medicine and Community Health
Editor, Families, Systems, & Health
55 Lake Ave, N
Worcester, Massachusetts 01655
O. 774.443.2147,   F. 774.441.7799
alexander.blount at umassmemorial.org
http://www.IntegratedPrimaryCare.com<http://www.integratedprimarycare.com/>
http://www.umassmed.edu/fmch/faculty/Blount.cfm

________________________________
From: pc-bh-integration-bounces at lists101.his.com [mailto:pc-bh-integration-bounces at lists101.his.com] On Behalf Of Linda Benitez Tavel
Sent: Wednesday, January 04, 2012 11:01 AM
To: pc-bh-integration at lists101.his.com
Subject: Re: [PC-BH-Integration] PC-BH-Integration program implementationobstacles
Good Morning Dr. Kern and colleagues,  I am in Texas and recently collaborated with a group of pain management physicians who reported concerns with their patients who exhibit drug seeking behaviors for other than pain management.  We discussed a co-located behavioral health care model whereby a behavioral health component could be co-located within their clinics to add substance abuse screenings, assessments, prevention, intervention and treatment services as part of their health care management plans, including drug screenings and breathilizers at each visit.  Due to the high incidence of prescription abuses that occurs within this population, and in our society, the doctors thought this would be a great idea.  Many obstables occurred with existing medical facilities policies and once we consulted with an attorney specializing in the area of health care law, it appeared that present Texas laws will not allow for this concept.  There are a couple of integrated primary care-mental health care models in Texas among non-profit entities but none with a primary care-substance abuse integrated model.  Within the area of substance abuse, co-occurring disorders often emerge and management of these mental health disorders have to occur simultaneously while treating addiction.

According to NIDA MED, prescription abuse is quickly becoming a significant health care issue.  Present laws in Texas do not support the integration of private primary care, speciality care clinics with behavioral health care.

Linda Benitez Tavel
Vice President
Amexica International Consultants
Tel: 210-446-4606 ext 102
Fax: 210-446-4549

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Today's Topics:

1. Re: One more plea for failures (Bradley, Wendy D)


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Message: 1
Date: Wed, 4 Jan 2012 04:23:36 -0900
From: "Bradley, Wendy D" <wdbradley at SouthcentralFoundation.com<mailto:wdbradley at SouthcentralFoundation.com>>
To: "'[National Council's Behavioral Health - Primary Care Integration
Listserve]'" <pc-bh-integration at lists101.his.com<mailto:pc-bh-integration at lists101.his.com>>
Subject: Re: [PC-BH-Integration] One more plea for failures
Message-ID:
<F7D46789D91A08489F0CC2629550F0481D39E2EA19 at SCFExch3.southcentralfoundation.com<mailto:F7D46789D91A08489F0CC2629550F0481D39E2EA19 at SCFExch3.southcentralfoundation.com>>

Content-Type: text/plain; charset="us-ascii"

Great lists so far....
I will add

1) The best thing we ever did was to have the BHCs sit with the providers in the same space. They end up sharing work rather quickly because BHCs are able to show providers where they can be helpful and consults happen naturally throughout the day. Also, it reinforces that BHCs are part of the team and shifts the BHCs perception from traditional BH to the primary care culture.

2) I also cannot stress enough the importance of finding the right "fit' for this position. We have found that flexibility, strong communication skills (confidence), ability to be a team player and having a systems, solution-focused approach in clinical work is imperative.

3) Spend time making sure PCPs know how and are comfortable introducing BHCs to patients. (not as a saying therapist, social worker etc.)

4) Make sure there are "triggers" that get BHCs into the room. (i.e. screeners). This gets PCPs used to using BHCs.

5) Spend enough time training BHCs in the beginning. We have found "shadowing" is most helpful. Have them shadow all members of the PCP team (especially PCPs) to help them understand the culture. They should shadow BHCs and then be shadowed to ensure stated competencies.
I attached a few tools we use.

Wendy D Bradley, LPC
Improvement Advisor-Clinical
Organizational Development
Southcentral Foundation
Anchorage, Alaska
wdbradley at scf.cc<mailto:wdbradley at scf.cc>
work 907 729-3378
cell 907 250-9325

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 8:20 AM
To: 'pc-bh-integration at lists101.his.com<mailto: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<mailto:john.kern at regionalmentalhealth.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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