B RIDGING THE GAP Rachael Bowers, LICSW Nandini Sengupta, MD April 3, 2013

W HY I NTEGRATE ??? Barriers to Access Behavioral Health Services Financial Concerns July 2011: Launch Behavioral Health Pediatric Integrated Program (BHPIP) January 2012: Complete integration of all Pediatric BH Services into BHPIP

O UR M ODEL – W HO W E A RE 5 Primary Care Providers 1 Pediatric Social Worker 3 Licensed Behavioral Health Clinicians 1 Child Psychiatrist (1 day/week) 3,000 Patients BH served 221 Patients (7%) 3,784 Encounters

O UR M ODEL – W HAT W E D O Individual and Family Therapy Psychiatry (weekly) School-Based Behavioral Health Services Consultation to PCPs during medical appointments

O UR M ODEL – H OW W E D O I T Strong Clinic Leadership Commitment to Integrate Co-location Warm Hand Off Pediatric Social Worker Shared EMR Shared Administrative Staff Primary Care Behavioral Health Consultation Training Creative Access to Child Psychiatry Services

C O -L OCATION Fall 2013: Rate of referral = 16/month CONSTRUCTION BHPIP Moves across the hall at the end of November Rate of referral DROPS to 8.5/month Seasonal Variation? Not entirely: Winter 2012 ROR 13/month

W ARM H AND - OFF Tracking began July 1, 2013 Intakes Completed With Warm Hand-off 69% Without Warm Hand-off 25%

W ARM H AND - OFF CONSTRUCTION July - November 2013: WH rate 53% December 2013 – February 2014: WH rate 21%

B RIDGING THE GAP Pediatric Social Worker Liaison Referral Coordinator “Translator” Intake Clinician

O UTCOMES I - A CCESS Referrals to BH at Dimock increased from 18% to 63% Wait time for Services reduced to 1-2 weeks Why refer to other agencies? 1. Language Needs 2. Preference for School Based Services at a School Dimock does not serve 3. Preference for Home-Based Services 4. Distance

O UTCOMES II - Q UALITY OF C ARE COMPLIANCE WITH INTAKE: 67% Rough estimate of compliance pre-integration: ~30%

O UTCOMES III – F INANCIAL S USTAINABILITY Cost Neutral by the end of second Fiscal Year More streamlined/efficient use of Employee Time

O UTCOMES IV - M ORALE 1. Mutual Respect of Providers’ Disciplines 2. Frequency and Quality of Communication Leading to better understanding of patients (both MD and BH) and better compliance and tracking of patients within BH services 3. Improved Access to Services and Access to Information about Treatment (for MD) 4. Role of SW to facilitate the process from both MD and BH perspectives 5. Feeling of support and efficacy in role (BH)

E XPANSION OBHI (Ob/Gyn and Behavioral Health Integration) Launched November 1, 2013 Funded by Children’s Hospital 1. Introduction of BH services at New OB appointment 2. MH Screening at prenatal and post-partum appointments 3. Access to BHPIP for services when needed or requested

W HERE N EXT ? Behavioral Health Consultations 1. Increase: Could we reach more than 7% of Pedi patients? 2. Billing???

W HERE N EXT ? Could we integrate care of chronic conditions?

W HERE NEXT ? How do we redefine the “closed” BH case?