PBHCI Start up: Challenges and Opportunities Dr. Anthony Salerno

The Presenters Anthony Salerno Ph.D. National Council Corey Lakins, leading and overseeing the integration of the Healthcare Home Project Cheryl Davis Project Director Catholic Charities/MCICC (Mercer County Integrated Care Collaborative) Trenton, NJ. Kathleen Boyle, Family Nurse Practitioner Care Plus NJ Katelyn Andresen, Primary Care Nurse Case Manager Care Plus NJ

Goals of this webinar: To address one of the critical challenges during startup and beyond 1. To increase understanding of the client engagement process The importance of communicating for buy in with all practitioners and support staff who interact with the client 2. Generate practical ideas that grantees may select and apply effectively

How is the webinar organized? Part 1: Informing and engaging the client Part 2: Informing and engaging the workforce These two domains are inextricably linked!

Part 1:Engaging the client Step 1 Hear from two new grantees who will help us frame the topic: What are the challenges? Strategies under consideration? Step 2 Hear from a cohort 1 grantee who has been addressing this issue for a year or more. Share their lessons learned Step 3 Open discussion with attendees (ask questions, make comments and especially, share strategies that have been helpful)

What is client engagement? Process of informing and involving a client in making an informed decision and taking action related to heath care services that match his/her felt need. You know a person is engaged when they make use of available resources, activities and resources and are active participants who take increasing responsibility for their health.

Step 1: Framing the challenge: Milestone Center Inc. Corey Lakins HOW DO YOU MOTIVATE CLIENTS TO PARTICIPATE? Our ideas: a.Direct personal contact with clients is necessary. b.Be where the clients are: groups, waiting room, etc. c.Promote trust and safety: Become the “safe” place for the clients – be the go to person/department d.Use motivational interviewing approaches

INITIAL ENGAGEMENT IDEAS New Clients: Design the intake process and the role of the intake specialist to begin the engagement process leading to referral to the Healthcare Home Project. Current Clients: clinicians, service coordinators and nurses to begin a dialogue about primary care with EVERY client.

Catholic Charities: Trenton New Jersey Cheryl Davis Challenge: Informing clients about health care services How to insure that the information about services is understandable, inviting and focuses on personally meaningful benefits Clients may have concerns or worries about what is being offered. We need to find ways to make clients feel comfortable and minimize disruption to their usual routine as much as possible. We need to find ways to offer primary healthcare services that are flexible and convenient in light of the consumer’s life circumstances. Offering help, and being resourceful will be necessary. For those consumers who are utilizing primary healthcare with off-site providers, we will need to emphasize coordination, collaboration and complementary services. Focus on how we can support the work of these providers (e.g., keeping appointments, specialty care follow up)

Engagement strategies we are planning Engage consumers by communicating the change effectively through flyers and posters Open House/Health Fair where consumers can get food and information about the program. Those involved in the initiative will be present to introduce themselves and answer questions regarding the program. We plan to have appointment cards to set up visits and other cards to “get to know” the client’s current providers if it is off-site.

Step 2: Lessons learned about engaging clients Care Plus New Jersey Cohort 1 Grantee Kathleen Boyle, Family Nurse Practitioner Katelyn Andresen, Primary Care Nurse Case Manager

Engaging Consumers…… Consumers are already comfortable in the behavioral health setting. RN Care Manager Flexible availability Must understand full set of needs Visible and approachable Liaison to the County Hospital – Credentialed to go onto units both medical and psychiatric. Works closely with other Case Management Staff.

Engaging Consumers…… Family Nurse Practitioner Must be visible and approachable for the consumers. Broader understanding of Behavioral Healthcare clients. Flexible understanding that there are many different ways to get to a positive outcome. Help consumers feel welcomed and comfortable. Understands that every meeting is an opportunity to help someone move toward wellness.

Engaging Consumers….. Staff must understand how to: Convey respect toward the individual and the decisions they make. Understand that this is not a person with a “cluster of symptoms”. Develop an understanding of each individuals likes and dislikes, interests and hobbies TV shows Animals Sports teams Using our Wellness Room to engage consumers

Engaging Consumers… Collaborating M.D. Follows consumers in need of medical hospitalization on the Community Hospital inpatient medical units. –This ability increases trust not only with consumers but with staff learning about the program. Strong advocate for those struggling with a mental illness. Approachable to both consumers and other staff. Enjoys teaching.

Engaging Consumers… Peer Counselor Develops WRAP plans with consumers. Chairs the consumer committee which provides program feedback and suggestions. Meets with consumers who may be hesitant about health care needs. Touches base with program staff frequently.

Engaging Consumers… Diabetes Educator Meets individually and in groups with those struggling with diabetes. Tremendous support for the NP. Teaches all aspects of managing diabetes medication, blood sugars, glucometers etc.. Keeps the conversation going after the consumer is seen by the NP. Is visible and approachable. Works out of a “Wellness Room” which has a scale, wellness posters, hand outs, a treadmill etc.

Engaging Consumers…. Nutritionist Meets with consumers individually and in groups. Assists with a food preparation group which focuses on preparing affordable and healthy meals. Groups are very well attended. Often provides healthy snacks, giving people an opportunity to try out different options. Works out of the “Wellness Room” which has a scale, wellness posters, hand outs, a treadmill etc.

Step 3: open discussion Begin with a Poll question How much of a challenge is engaging the client as active participants in primary care and related services? 1.Not much of a challenge 2.Moderate challenge 3.Big challenge 4.Very big challenge

Open discussion Open discussion with attendees (ask questions, make a comment and especially, share strategies that have been helpful)

Part 2: Engaging the workforce What is it? An ongoing process to inform and engage the behavioral health and primary care workforce in a way that promotes buy in. Considerations: Who is the audience? Who is the messenger? What is the message? How is the message delivered? Where and when is the message delivered?

Framing the Challenge: Milestone Centers Inc. Challenge: Finding practical and effective strategies to engage existing staff and departments in our agency Some of our ideas: a.Must communicate for buy in across ALL agency staff/departments b.Develop a shared language that everyone identifies with and uses. The language communicates a set of values such as : a.recovery and health means addressing mental, substance use and physical health at the same time. They’re all connected b.That a team of people working together to address multiple problems is the key to successful treatment. The concept of holistic treatment c.That wellness, health promotion and prevention of illness is as important as treatment c.Develop an integrated team that exemplifies these values

How to communicate for buy in? Milestone Center ideas: We plan to attend existing meetings with behavioral health teams and use this forum as an opportunity to discuss the importance of primary care and how they play a key role in engaging and involving clients to make use of health promoting resources and services. Strategies a.Persistent and consistent approach. b.Kindness goes a long way. c.Brochures and marketing within agency in crucial – place everywhere.

How to communicate and promote buy in Catholic Charities Ideas Frame a message that emphasizes the behavioral health and primary care similarities versus the differences. Formation of multidisciplinary teams to discuss on-going issues and concerns around systems and consumers. Joining: as we introduce ourselves, we feel it will be necessary to avoid separating ourselves from their already created and functioning system. Attending staff meetings and offering support where needed will be beneficial. Running, co-facilitating, guest speaker role in health focused

Engaging the Workforce Care Plus Strategies Our primary care team is visible and approachable for staff. Primary care Nurse Practitioner and Nurse Case Manager attend the weekly meeting held by the Partial Care/Residence staff. We asked the behavioral health staff how we could help them, not how they could help us. Every Friday there is a meeting between the psychiatrists and medical staff.

How much of a challenge is engaging the workforce to buy into the importance of an integrated behavioral health and primary care system? 1.Not much of a challenge 2.Moderate challenge 3.Big challenge 4.Very big challenge

Open Discussion: Engaging the workforce Open discussion with attendees (ask questions, make a comment and especially, share strategies that have been helpful)

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