CVIM Behavioral Health Clinic & Case Management Utilizing comprehensive care Kristi Mattzela, MSW, LSW Clinical Services Director

Objectives Introduction to CVIM Explore CVIM’s model of case management View some of the services CVIM case managers provide Discuss CVIM’s Behavioral Health Model Understand why patients may struggle with compliancy

Mission “Centre Volunteers in Medicine will serve and advocate for the medically underserved living or working in Centre County.”

CVIM Provides Primary Medical Care Primary Dental Care Case Management Services Medication Assistance Program

Case Management Basic Needs Case Management Assist with enrollment applications for public assistance programs Assist with Affordable Care Act enrollment Case management available to any individual regardless of eligibility

CVIM Case Management Model New Patient Case Management Basic Needs Assessment Referral to local resources Create an Action Plan Insurance Assessment Apply for Qualified Insurance Follow up with patient and applications Mental Health Assessment Refer to CVIM Mental Health Clinic Refer to Centre County Mental Health Refer to CANHELP

What else do case manager’s do? Dialing for Dollars Medical Bill Assistance Smoking Cessation Funding Procedures and Treatments Hearing Aid Assistance Drug & Alcohol Coordination Insurance Coordination/ Application Compass Applications Budgeting Behavioral Health Management and Screening

Behavioral Health Management & Screening Case managers discuss prior history or concern of behavioral health with all new medical patients If a need is addressed, case managers will complete a behavioral health screening assessment Patient will be referred to behavioral health clinic or counseling if a behavioral health concern is identified If patient is insurance eligibly, case managers will refer to local mental health resources

Mental Health Resources Centre County MH/ID/DA/EI Meadow’s Psychiatric Center in-patient/out-patient Penn State Psychological Clinic (Moore building) Private Psychologists/Psychiatrists Shortage of Service Providers Resources < Demand

CVIM Behavioral Health Clinic Physician & Therapist Case Manager & Counselor Consult Psychiatrist

Physician & Therapist Patient will first meet a therapist and medical provider for an initial intake Provider will complete a routine physical and rule out any medical concerns Therapist will complete a base line evaluation and explore behavioral health concerns with patients Therapist and provider will determine a diagnosis or schedule a follow up appointment for further exploration Provider will write for any recommended prescriptions

Case Manager & Counselor After meeting with the physician & therapist patient will meet with bot the case manager and counselor Patient will be reassessed for insurance options (a diagnosis may change insurance eligibility) Case manager will coordinate any care that was recommended from the provider or therapist Counselor will meet patient and set up a follow up appointment if needed

Psychiatrist As needed, a psychiatrist will be contacted for telephonic consult to manage difficult medication or situations that may arise

Follow Up Patient will be seen for follow up sessions with the therapist or counselor as needed Clinician will meet with patient to regulate and monitor medications Patient will meet with the case manager as needed to complete insurance applications and assist with other service needs as they arise

Termination Patient will meet with therapist/counselor for a final termination appointment Patient will meet with the case manager to transition to insurance Coordination of providers and setting up appointments Understanding insurance plan Transition care

Developing a Care Team Recruiting Volunteers Our team Psychologists Counselors Data Analysts Administrators Psychiatrists Be creative with the local resources Take a leap of faith!

Case Scenario 19 y/o Schizophrenic male No social security number/ birth certificate No income/ can’t work No access to mental health services/ medication

How can a behavioral health program assist with patient compliancy?

Understanding your Patients Person-In-Environment System (PIE) Social Functioning Whole Person is considered Biological, intellectual, emotional, social, familial, spiritual, economic, communal etc.. Viewing the person within an environmental context Systems, Structures, conditions, friends, family, neighborhood, workplace, human services

Compliance/ Roadblocks What may be high priority to the patient may not be high priority to the provider or vice versa Missing appointments Fear of Care Mental Health Health Literacy Not understanding how to be a patient Not understanding medication/ diagnosis Not understanding preventative care

Not only understanding but being able to do something about it Psychosocial Assessment to identify the patient Talk with patient to find the roadblocks Educating patient Refer patient to available resources Create a plan with patient Communicate with provider about what is causing roadblocks in the patients care

Motivational Interviewing A counseling technique focused on invoking change and building rapport with patients Seeks the patients motivation to change and commit Collaboration vs Confrontation Partnership between patient and case manager Facilitates trust and a mutual understanding Evocation Draws out the patients thoughts and ideas rather than imposing their opinions Autonomy Recognizes that it is the up to the patient to make the change

QUESTIONS