Workshop 6 - Sulik - Pal-Tech

stuckwarmersΚινητά – Ασύρματες Τεχνολογίες

14 Δεκ 2013 (πριν από 3 χρόνια και 7 μήνες)

199 εμφανίσεις

S



M
INNESOTA

C
OLLABORATIVE

P
SYCHIATRIC


C
ONSULTATION

S
ERVICE


L. Read Sulik, MD, FAACAP

Senior Vice President


Behavioral Health Services

Sanford Health

read.sulik@sanfordhealth.org


Clinical Associate Professor

Department of Psychiatry, University of Minnesota


Clinical Associate Professor

Department of Clinical Neuroscience, University of North Dakota

Background

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Minnesota background efforts

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Minnesota 2006 Legislation

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Minnesota 2010 Legislation to fund statewide psychiatric consultation service

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Drug threshold workgroup

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Minnesota Psychiatric Consultation Workgroup

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Children’s Psychiatric Consultation Protocols workgroup

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ADHD subgroup

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Bipolar subgroup

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Differential diagnosis, including trauma, anxiety disorders and disruptive behaviors
subgroup

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Eating disorder subgroup

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Substance abuse subgroup

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Triage subgroup


2

What is
M
h
INT
?

Mental Health Integration &
Transformation Program

S
A partnership w/ Minnesota healthcare organizations and
additional support partners:

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Healthcare Systems: Mayo Clinic, Sanford Health, Prairie Care,
Essentia

(5
th

partner TBD)

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Non
-
profits: Minnesota Psychiatric Information and Outreach
(MPIO), REACH Institute

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Project Management Consultant

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Videoconferencing Vendor

3

What is the Purpose/Intent of the Minnesota
Collaborative Psychiatric Consultation Service?

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To
increase quality and access to children’s mental health services
across the state of Minnesota by…

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Increasing primary care providers’ (PCPs’)
skills and willingness

to manage
children and adolescents with mild
-
moderate mental health problems

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Creating linkages and partnerships between primary care and specialty mental
health providers

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Increasing rapid access for selected face
-
to
-
face consultations

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Reducing problematic prescribing practices via case
-
specific support and
consultation

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Building partnerships among Medicaid, private insurers, healthcare
organizations, and providers to facilitate sustainability


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Why is the Service Needed?

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Traditional CMEs, written guidelines, and

hit
-
and
-
run


workshops and lectures are generally ineffective.

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Evidence
-
based prescriber
t
raining methods need to focus on
skills (not factual knowledge), and must address obstacles
encountered in practice.

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Effective training programs must use collaborative learning
partnerships, vs.

one
-
down


relationships, and use PCP role
models as co
-
teachers, similar to those being trained.

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How Will the Service

Achieve Its Purposes?

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Targeted outreach to providers;

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Systematic and regular communications to providers about available services and
training opportunities;

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Linkage assistance to available services;

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Hands
-
on coaching, skills training, and information support;

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Same
-
day phone consultation services (both voluntary and mandatory
consultations); and

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Rapid face
-
to
-
face evaluations for

emergent


cases.

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M
h
INT

Innovative Approaches

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Web
-
based tool that allows providers to identify and
link families to community resources;

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State
-
of
-
art video
-
teleconferencing
available at no cost to
internet
-
linked healthcare providers state
-
wide;

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Pathway


to sustainability
, with Medicaid codes
approved for use by healthcare providers;

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Creation of primary care

champions
” who can in effect
increase the state’s mental health manpower

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Mayo Clinic subcontracts

to
M
h
INT

Partner sites

and other subcontractors

Project Steering Group

L.
Vukelich

& Associates

REACH

Soltrite

MPIO

Executive Committee

SE Minnesota Region

Mayo Clinic

Western Region

Sanford Health

Northeastern Region

Essentia Health

Twin Cities
-

East

Prairie Care

Twin Cities
-

West

TBA (e.g., Allina
Health)

M
h
INT


Project Organization

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Regional
Teams


5
regional healthcare
system
teams
, located strategically
across the state


Each team consists of:


>
2 Child/adolescent Psychiatrists (CAPs)


>
1 Triage Mental Health Professional (
TMHPs
)


Other support staff as needed


Multiple team members enable cross
-
coverage within and
across sites



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Leadership/Planning and Timetables


Weekly EC Meetings


Co
-
Chairs: 1 Site Principal, Linda
Vukelich


Partnership with
b
y
-
laws guiding the collaboration


Subcommittees and Assigned Tasks:


Database, Website, REACH adaptations, Electronic Communications,
CAP/TMHP Training, PR/Outreach, Program Evaluation


Start
-
up phase June/July


August 1


December 31, 2012, 3
-
4 sites only


January 1, 2013, and beyond: 5 sites

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Web
-
Based Tools


M
h
INT
(via MPIO) will
support the creation of

a web
-
based tool that allows providers to identify
and link families to available community mental
health
resources


Regularly
updated by M
h
INT Team &
MPIO


Publicly
available

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REACH Training


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Hands
-
on, with role plays and extensive practice

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2 day
s of face
-
to
-
face training with 15
-
30 clinicians, with 2
-
3
trainers, followed by:

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6
-
12 months of twice
-
monthly phone call consultation and
support, 1
-
1.5 hours/call

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Individual case presentations, with learning and risk
-
taking shared
among peers

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6 years in development, used in NYS, Nebraska, North Carolina

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HD Video
C
onferencing over the Internet


Secure


HIPAA compliant


PC, Mac, iPad,
iPhone

& Android


Can interoperate with traditional
video conferencing technology

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Video conferencing Services


Will likely include:


Training


Collaboration between and within MhINT
partners and DHS


Communication between
primary care doctors
and specialty mental health providers


Potentially some patient consultations


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Consultation Services

M
h
INT will not
encourage PCP
management of the
following:


1.
Psychosis

2.
Suicidality

beyond minimal risk

3.
Aggression
involving serious

injury
to others or serious
destruction of property

4.
Clear
Bipolar I disorder

5.
Substance
abuse/dependence

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Work Flow for Phone Consultations

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Triage mental health professional (TMHP) takes the
initial phone call and responds to calls within their
scope of training and expertise.


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If a child and adolescent psychiatrist (CAP) is
needed/requested, the covering CAP returns the
phone call at scheduled time (same day).


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HIPAA I


Voluntary phone calls are
consultations to the primary care provider
(PCP), as well as
a clinical service to patients.



PCPs will maintain records of the consultation, and ensure
patient confidentiality and HIPAA
-
compliance. Protected health
information (PHI) NOT needed for voluntary consults.



De
-
identified demographic and clinical information can be used
to provide evaluation of the project.


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Face
-
to
-
Face Consultations

Face
-
to
-
Face
Consultations

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Selected cases
will be seen
for a
face
-
to
-
face

(or
possibly,
telepsychiatric

if the patient is
geographically distant) consultation with a
M
h
INT

child/adolescent psychiatrist.


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F
ace
-
to
-
face
(FTF) evaluations
will be scheduled
within
1
-
2 weeks with
the local child/adolescent
psychiatrist.

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Face to Face Evaluations are
Consultations Only

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Face to face evaluations are
consultations
only,
with follow
-
up as needed by PCPs.


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Patients cannot be followed by CAPs for
ongoing treatment and medication
management.


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PCPs will need to apprise patients and
families about this.

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Resources & Contact Info

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DHS Website
:
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET
_DYNAMIC_CONVERSION&RevisionSelectionMethod=
LatestReleased&dDocName=dhs16_158267


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L. Read Sulik, MD, FAACAP

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Senior Vice President


Behavioral Health Services, Sanford Health

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Email: read.sulik@sanfordhealth.org

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Telephone: 701 234 4124

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