INTEGRATED BEHAVIORAL HEALTH Behavioral Health Integration Complex Care Initiative INTEGRATED BEHAVIORAL HEALTH Elizabeth Morrison LCSW, MAC Michael Mabanglo LCSW, PhD

We are integrated BH clinicians ourselves 

What is the core of integrated behavioral health?

We can bring our real life into the visit!

Under one roof… one team… one plan.

Why in primary care?

01 02 03 04 Why in primary care? Patient preference Defacto MH We are whole people 04 Evidenced- Based

Primary care visits driven by psychosocial factors

Blending of Cultures Medical Model BH Model Diagnosis Driven Prescriptive Treatment Target based on illness Conclusive communication BH Model Client driven Strength and relationship -based Target based on patient goals Explorative communication

BH Clinician: Qualities High level of interpersonal skills Relationship focused Cultural humility Leadership skills

BH Clinician: Knowledge & Skills Deep and broad range of assessment and treatment skills for mental health conditions Skills to engage in a range of treatment lengths, (single sesion, brief treatment, co- management, cycling courses of therapy…) At minimum, SUD screening, assessment and OP skills; MAT knowledge MI and related skills to engage clients in health related behavior changes Excellent relationship building and maintenance skills (team and patients)

BH Clinician: Culture Change Leader Patient experience the center of our work Employee experience and wellbeing as a core focus Privileging empathy, relationships and connection in clinical, operational and administrative decisions Advancing the importance of evidenced based communication as a fundamental treatment

IBH: The defining feature of ICCM Traditional Complex Care Focus Medical condition Medical hospitalizations Medication management Behavioral health needs viewed as part of a specialty referral Integrated Complex Care Focus Behavioral Health understood as an integral part of whole health BHC is part of the complex care team All team members engage client about behavioral health issues

Distinction between IBH and BHICCI All clinic patients 100% BH Integration 60% Integrated complex care management (BHICCI): 5-10%

Empathy Exercise

Empathy Affirmation- noticing strengths Acknowledgement –repeat feelings Normalizing – assuring commonality Non-judgement– articulating directly This is where you define each of these things. It is necessary to have examples for each for participants to understand what they really mean, so if having some examples in your pocket is important. Affirm: noticing and articulating someone's strengths. Often starts with ‘I’m impressed with your…’ ‘I’m inspired by your....’,’ I appreciate your....’ (in giving examples, need to finish the sentence) Acknowledgement: this is acknowledgment of feeling, whetther someone said it or just ‘showed’ it. ‘I hear you are feeling......’ or ‘that sounds really tough’ Normalizing: Letting someone know they are normal ‘Anyone would feel that way’ ‘I’d feel the same’ ‘relapse is so common with this disease’ ‘most of us struggle with our weight...’ Non-judgment: All of the above demonstrate non-judgement, this is a technique where we directly say it ‘I’m not judgeing you’ ‘i don’t have judgments about that, I just wanted to reassure you’

PRACTICE!

THANK YOU!