Behavioral Health Skills for Primary Care Team Members: Increased capacity to meet the need Larry Mauksch, M.Ed Senior Lecturer, Family Medicine, Univ of Washington Consultant

Presentation Objectives

Behavioral Health Role(s): Integration Steps Referral to BH offsite No collaboration BH part of team Disease mgmt for Complex patients Supervision of BH care management Referral for BH offsite Shared records Referral to BH onsite No collaboration Referral to BH onsite Shared records Referral to BH onsite Shared records, shared planning Team Training and System Transformation

Mental Disorders in Primary Care J of Fam Practice (1), 41-47

Primary Care Realities

Teamwork The solution

Patient Centered Medical Home: Two interdependent components Rogers, PCMH Movement: Promise and peril for family medicine. JABFP, (5) Larry Mauksch, M.Ed University of Washington Department of Family Medicine

Why Are High Functioning Teams Essential To Primary Care

Role versus Function Toward transdisciplinary teamwork

Continuum of Role Function

Behavioral Health Functions

Transdisciplinary Functions and Roles in Primary Care Role Function PCPNurseMedical Assistant PharmBehavioral health Care Management Relationship Agenda setting and activation Self management- simple Self management- complex Primary care counseling Plan confirmation and care integration Proactive follow-up and stepped care Intensity: 5 =always; 4= often; 3 = periodic; 2 = support; 1 = reinforce and connect Larry Mauksch, M.Ed UW Family Medicine

Mastering a Skill Domain

Common Training Sequence Larry Mauksch, M.Ed University of Washington Department of Family Medicine

Observation Form Purpose and Training

PCOF Use Larry Mauksch, M.Ed University of Washington Department of Family Medicine

PCOF Categories

Relationship Communication and Efficiency: Creating a model from a literature review Mauksch, Dugdale, Dodson, Epstein 2008, Arch of Intern Med

UW Family Medicine Residency (Mauksch et al Families Systems, Health, 2001) Community RCT Brock, Mauksch et al JGIM, Nov Residents; 7 faculty 162 patients48 physicians, 1460 patients; two systems Brief reading, video, written learning confirmation, skill reinforcement 2 hr training w/demo & practice; handout, 2 hrs coaching/wk for 4 weeks, no reinforcement for 6 months Higher patient satisfaction More MD prioritization MDs charted more problems More f/u requests No difference in visit lengths EF MDs showed more upfront elicitations (“something else”*) EF patients more likely to say “that’s it” EF Patients & MDs had fewer “oh by the ways” in phase 3 Shorter visits 90 seconds (NS) No diff in pt / MD satisfaction

Agenda Creation

Agenda Refinement Then ask “What is going on in your life that causes stress and feeling down?”

Upfront Agenda Setting: Impressions Larry Mauksch, M.Ed University of Washington Department of Family Medicine

Self Management-Complex (Integration of Goal Setting and Action Plan, Patient Activation and Motivational Models)

Complexity Care Influences and Collaborators  Minnesota Complexity Assessment Model  Peek, Baird, Coleman  Bill Gunn, PhD and colleagues in Concord, NH  UW colleagues work on a Picker Foundation support pilot Study:  Kavitha Chunchu, MD., Carol Charles, MSW, Valerie Ross, MS., Judy Pauwels, MD  Family Care Network in Whatcom County, Wa  Berdi Safford, MD, Marcy Hipskind, MD. David Lynch, MD

Collaborative Complexity Care Assessment, Goals and Action Plans

Patient Centered Care Plan or Collaborative Care Plan

Patient Centered Goal Setting

Goal Setting Chart review PCCP 51 yrs;60%F Controls 55 yrs; 40% F Goal documented.96 %.43 % Ongoing activity Specific activity How often When Barriers Confidence What can help with confidence.53.00

Continued work