1. Session #Track 2, E2
Moving beyond integration to transformation: Practice-based innovations and strategies that transformed PCBH practice
Bridget Beachy, PsyD, Director of Behavioral Health at Community Health of Central Washington
David Bauman, PsyD, Behavioral Health Education at Central Washington Family Medicine Residency (CWFM)
Melissa Baker, PhD, Behavioral Health Consultant at HealthPoint Community Health Center
Ragina Lancaster, DO, 2nd year Family Medicine Resident at CWFM
Stephanie Ellwood, DO, 2nd year Family Medicine Resident at CWFM
Please insert the assigned session number (track letter, period number), i.e., A2a
Please insert the TITLE of your presentation.
List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation.
You may acknowledge other authors who are not attending the Conference in subsequent slides.
CFHA 18th Annual Conference
October 13-15, 2016  Charlotte, NC U.S.A.
Collaborative Family Healthcare Association 12th Annual Conference

2. Faculty Disclosure
The presenters of this session currently have or have had the following relevant financial relationships (in any amount) during the past 12 months. Mountainview Consulting Group
You must include ONE of the statements above for this session.
CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message.
The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community.
Collaborative Family Healthcare Association 12th Annual Conference

3. Learning Objectives At the conclusion of this session, the participant will be able to:
Define the basic philosophy and principles of the Primary Care Behavioral Health model of service delivery
Identify innovative strategies for maximizing BHC services in the primary care setting
Describe medical conditions, health behaviors, and aspects of a patient’s social health that warrant involvement of a BHC in the primary care setting
Include the behavioral learning objectives you identified for this session
Collaborative Family Healthcare Association 12th Annual Conference

4. Bibliography / Reference
Baird, M., Blount, A., Brungardt, S., Dickinson, P., Dietrich, A., Epperly, T., & Green, L.,… deGruy, F. (2014). Joint principles: Integrating behavioral health care into the patient-centered medical home. Annals of Family Medicine, 12(2), doi: /afm.1633 Reference
Baker, M., Beachy, B., Bauman, D., Wilson, A., & Tiernan, K. (2014, October). Stress, psychological flexibility, and behavioral health satisfaction: An assessment and intervention study with primary care providers. Accepted presentation at the 16th Collaborative Family Healthcare Association annual conference. Washington, D.C.
Beachy, B., Bauman, D., & Reiter, J. (2015). Cardiovascular disease in Patient Centered Medical Homes: The Trident Approach. In O'Donohue, W. T., Maragakis, A., & C. Snipes (Eds), Integrated primary and behavioral care: Role in medical homes and chronic disease management. New York, NY: Springer Science, Business Media, LLC.
Burt, J. D., Garbacz, S. A., Kupzyk, K. A., Frerichs, L., & Gathje, R. (2012). Examining the utility of behavioral health integration in well-child visits: Implications for rural settings. Families, Systems, & Health, 32(1), Reference
Levey, S. B., Miller, B. F., & deGruy III, F. V. (2012). Behavioral health integration: An essential element of population-based healthcare redesign. Translational Behavioral Medicine, 2(3), 364–371. doi: /s  
Meadows, T., Valleley, R., Haack, M. K., Thorson, R., & Evans, J. (2011). Physician “costs” in primary behavioral health in primary care. Clinical Pediatrics, 50(5), doi: /  
Ray-Sannerud, B. N., Dolan, D. C., Morrow, C. E., Corso, K. A., Kanzler, K. E., Corso, M. L., & Bryan, C. J. (2012). Longitudinal outcomes after brief behavioral health intervention in an integrated primary care clinic. Families, Systems, & Health, 30(1), doi: /a  
Robinson, P. J., & Reiter, J. T. (2016). Behavioral consultation and primary care: A guide to integrating services (2nd ed.). New York: Springer.
Continuing education approval now requires that each presentation include five references within the last 5 years.
Please list at least FIVE (5) references for this presentation that are no older than 5 years.
Without these references, your session may NOT be approved for CE credit.
Collaborative Family Healthcare Association 12th Annual Conference

5. Learning Assessment A learning assessment is required for CE credit.
A question and answer period will be conducted at the end of this presentation.
Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation.
This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.
Collaborative Family Healthcare Association 12th Annual Conference

6. Today’s agenda Introductions Brief overview of the PCBH model
Data regarding our PCBH model services
Innovative techniques to improve integration
HealthPoint CHC
Blocking schedules, co-visits, pairing with medical provider
CWFM
Scrubbing schedules, situating self in clinic, curbside consultation
Resident perspective
What helps?
How does these innovative strategies change your practice?
Conclusion and Q/A

7. Introductions Bridget Beachy, PsyD David Bauman, PsyD
Melissa Baker, PhD
Ragina Lancaster, DO
Stephanie Ellwood, DO

8. Our clinics Community Health of Central Washington (5 clinics)
Central Washington Family Medicine Clinic
Serves 18,000 patients in Central Washington
24 family medicine residents
2-4 BHCs
12-16 providers including
MD’s, DO’s, NPs and PAs
While BHCs… faculty, as well… Psychosocial Medicine Curriculum
HealthPoint Community Health Center
FQHC; Level III Patient Center Medical Home
Serves over 75,000 patients in Greater Seattle Area
12 clinics including 2 school-based clinics and a brand new residency clinic
1 lead BHC per clinic; 1-3 BHC students per clinic; 1 MSW per clinic
My Clinic (Bothell)- 9 providers (MDs, DO, NPs, PA, ND)

10. Trident Approach to PCBH (Beachy, Bauman & Reiter, 2015)
*PCBH research…

11. Our data CWFM Six month averages for B&D (March 2016 – September 2016)
1493 patient visits completed
Patients/clinic = 5.1
Patients/hour = 1.5
*Initial visits = 40%
*Same day visits (WH or paired medical) = 40%
*David’s August visit/patient:
Average – 2.5
Mode – 1
Median – 1
13% of visits greater than 6

12. Barriers for PCBH
PCBH sounds GREAT in theory!... Reality is sometimes different…
What have you found to be barriers?

13. HealthPoint Strategies
Pairings
BHC Schedule
Huddling pre-shift and mid-shift/Huddle Boards
Positioning of BHC
Face-to-Face consults “curbside”
Co-visits with PCMT
Hot-spotting
Scrubbing
Exam rooms vs. office

14. Pairings 2014 Project (Baker, Bauman, Beachy, Wilson & Tiernan, 2014)
Paired w/ 2 medical providers for 1 week
Expand scope of BH services
Decrease Stigma of BH
Increase collaboration
Evaluate a new strategy
What happened in this study?
BH saw more patients! (211 to be exact between 4 BHCs)
65% first time visits
What did PCPs say about their experience?
Streamlined workflow
New BHC utilization
Improved efficiency
So what real world applications did we take from this study?

15. Pairings Application New BHC students
1- 2 months into training
New PCPs/Staff (Nutritionist, MA)
Spend one full-day paired
Provider w/ low BHC utilization
Half-day/1 day pairing
Discussion about what went well? Challenges?
Provider w/ high BHC utilization
Target population on panel (diabetes, A1C > 8)
Yearly
Review workflows
BHC introduction

16. BHC Schedule
Most BHCs are seeing a combination of scheduled/follow-up visits and warm handoffs
Warm handoff versus Scheduled Visits
What should the ratio be?
How do we structure a BHC schedule to support penetration of the population? BH utilization?
2014 Study- Application
Discussion w/ my lead PCP and HCM
PCPs wanted more BHC access during peak hours

17. BHC Schedule Red = Warm Handoff Blue = Schedule/Follow Grey = Break?
Yellow = BHC Team Mtg

18. Co-Visits Joint BH visit with…. PCP Nutritionist Nurse Dentist
Pharmacist
Discussion- Benefits of Co-visits? Challenges?

19. Co-Visits Other types of co-visits Group Visits
Half-Days- Pair w/ a PCP for a half-day shift targeting a population such as:
Diabetics
Well Visits/Sports Physicals
Hypertension
Chronic Pain
Women’s Health
Group Visits
60 minute group co-led with PCP
Typically PCP comes in towards the end of the group for minutes with BH provider
Diabetes
Weight Management

20. CWFM strategies Scrubbing schedules Huddling in morning
Co-visits/Pairing with a PCP
Positioning of BHC
Where we see patients
Curbside consults/“getting it in the water”

21. Reviewing & scrubbing schedules
Why?
How does it work?
Resident perspectives

22. Reviewing & scrubbing schedules
Example:

23. Reviewing & scrubbing schedules (your turn)
Your turn, who would you want to check in w/ the PCP about?

24. Reviewing & scrubbing schedules (your turn)
Your turn, who would you want to check in w/ the PCP about?

25. Huddling w/ PCPs

26. Co-visits/Pairing with a PCP
Why?
How does it work?
Resident perspectives

27. Positioning of BHCs
Why?
How does it work?
Resident perspectives

28. Positioning of BHCs Increasing provider/clinic “buy-in”
Proximity to providers
Something always evolving…

29. Positioning of BHCs
Beyond where you are physically located…

30. Positioning of BHCs
Beyond where you are physically located…

31. Where we see patients
Why?
How does it work?
Resident perspectives

32. Curbside consults/“getting it in the water”
Why?
How does it work?
Resident perspectives

33. Curbside consults/“getting it in the water”

34. PCP suggestions for new BHCs

35. Trident approach & strategies for transformation
Scrubbing schedules
Huddling in morning
Co-visits/Pairing with a PCP
Positioning of BHC
Visits in exam rooms
Blocking of schedules
Curbside consults/“getting it in the water”

36. Summary & Q/A Principles of PCBH Model?
Strategies to transform PCBH practice?
What types of conditions can BHCs & PCPs work together on?

37. Session Evaluation
Please complete and return the evaluation form before leaving this session. Thank you!
This should be the last slide of your presentation
Collaborative Family Healthcare Association 12th Annual Conference