VA Primary CareBehavioral Health Integration in Practice David Hunsinger MD MSHA Medical Director Binghamton VA Outpatient Clini c Objective Over the course of this presentation participants will begin to consider the broad range of clinical situations in which involvement of a Behavi ID: 556658
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Who Should I Refer?VA Primary Care/Behavioral Health Integration in Practice
David Hunsinger, MD, MSHAMedical DirectorBinghamton VA Outpatient ClinicSlide2
Objective
Over the course of this presentation, participants will begin to consider the broad range of clinical situations in which involvement of a Behavioral Health provider can prove helpful.Slide3
Key Characteristics
Co-locatedCollaborativeDedicated Behavioral Health (BH) Provider with schedule flexibilityWarm HandoffsSlide4
Benefits of the Model
Timely patient evaluation and assistanceSlide5
There’s no time like the present….Slide6
Benefits of the Model
Timely patient evaluation and assistanceA continuation of the Primary Care encounterEliminates the potential for ‘no show’Slide7
Benefits of the Model
Face to face introductionSlide8Slide9
Benefits of the Model
Face to face introductionLends legitimacy and credibilityReduces patient anxiety about the meetingMore personalSlide10
Benefits of the Model
Face to face introductionLends legitimacy and credibilityReduces patient anxiety about the meetingMore personalSlide11
Benefits of the Model
Reinforces ‘whole person’ focusSlide12
Mind body connection by John HerseySlide13
Tip #1
Referrals are not just for Urgent ProblemsSlide14
Urgent Problems
Major depressionAnxietyGrief reactionAdjustment reaction‘crying in the office’Slide15
Tip #2
Consider scripting your warm hand-offintroSlide16
Warm Hand-Off
“I work with someone whose job is to help patient’s in situations like this. If you have a few minutes, I’d like to introduce you.”“We have someone who is a great resource for these things. Let me introduce you and you can get his/her card if you want to talk to someone about it.”Slide17
Warm Hand-Off
“One of the members of your healthcare team is _________. If you have a few minutes, I’d like to introduce you so he/she can tell you a little bit about what kind of help he/she can provide you.”Slide18
Tip #3
Refer all positive Clinical Reminder screens…….better yet, revise clinic flow to have these patients seen automaticallySlide19
Clinical reminders
PHQ2/PHQ9 [depression]PTSD screenAUDIT-C [alcohol]?TBI screenSlide20
Tip #4
Think Patient needs not DiagnosesSlide21
Needs not Diagnoses
Establishing a healthy lifestyleBehavior changeTobacco and alcohol issues/concernsRelationship stressJob stressSlide22
Establishing a healthy lifestyle
ExerciseHealthy DietSleep hygieneSlide23Slide24Slide25
Exercise
Cardiovascular conditioning affects many health conditionsPromotes a sense of well-beingRelieves stress/tension/anxietySlide26
Healthy Diet
Weight lossDisease specific concernsPatients considering MOVEPatients unable to participate in MOVESlide27Slide28
Tobacco Use
Individual coaching as an alternative to QuitSmartSlide29
Relationship issues
Spouse/significant otherChildrenBossCo-workersSlide30Slide31
Tip #5
Healthcare is a team sport [especially in a PACT environment]Slide32Slide33
Team
Talk to your PCMHI providerAsk for suggestions about referralsInvite him/her to huddles and team meeting where patients are discussedSlide34
Tip #6
Most people’s lives are impacted far more by psychological, psychosocial, and behavioral issues than by physical issuesSlide35
Conclusion
So………… refer early refer often!Slide36
Conclusion
So………… warm hand-off early warm hand-off often!