www.rmhcare.org The Evolution of Behavioral Health Services at Rocky Mountain PACE:

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www.rmhcare.org The Evolution of Behavioral Health Services at Rocky Mountain PACE: Meeting the Growing Needs of Our Participants Sheri Gibson, Ph.D. Director of Behavioral Health Services NPA Boston Conference 2017

www.rmhcare.org Key Questions to Consider Is Behavioral Health a significant issue at PACE? What are the benefits of Behavioral Health to IDT? What are the potential benefits of Behavioral Health to the Intake and Enrollment Team? What are the potential benefits of Behavioral Health to participant care and reduction of hospitalization?

Is Behavioral Health a Significant Issue at PACE? Impact on the Team (6 days of IDT, 59 cases)

www.rmhcare.org Is Behavioral Health a Significant Issue at PACE? Prevalence at Rocky Mountain PACE as an Example: Diagnoses 2012 2013 2014 Dementia/Cognitive Impairment 29% 31% 35% Depr , Anx , Bipolar, Schizoaffec (4 most prevalent diagnoses)66%64%71%More than 1 MH DiagnosisNot measured39%42%Both Dementia & MH/BH Dx22%25%23% Percentage of Total Enrollees

www.rmhcare.org Benefits of Behavioral Health to the IDT GOAL: To increase enrollment, retention of & provide excellent care to BH Clients Who comprises the Behavioral Health Team? What is the role of Behavioral Health Team with the IDT?

www.rmhcare.org Benefits of Behavioral Health to the IDT Increase Enrollment, Retention & Care of BH Clients Meet eligibility requirements Understanding behavioral health needs PRIOR to enrollment Pre-Enrollment Staffing and Care Planning Education to the IDT Reduce Chaos, Control Costs, Provide Good Care Decrease use of Higher Levels of Care (Inpatient hospitalizations, SNF); Increase Independence Accurate Coding and Reimbursement

www.rmhcare.org Benefits of Behavioral Health to Participant Care and Reducing Hospitalizations Provide Direct Services to Participants: Assessments including Neuropsychological and Psychological. Behavioral Interventions with Dementia. Psychoeducational series for Participants. Individual and Group Counseling. Consistency in coaching participants to implement skills. Coordinate with contract psychiatrist—give info, relay info to medical, make recommendations.

www.rmhcare.org Behavioral Health Team at Rocky Mountain PACE Behavioral Health Evolution: Year 1-3: One full time licensed Counselor, plus doctoral interns Year 4: Added a second FTE licensed Counselor with CAC II, plus interns. Year 5: 3 rd Qtr : Added third FTE licensed Counselor and 4 th Qtr : PTE PhD, plus interns. Initiated on-site neuropsychological capacity evaluations. Year 6: Added PTE Ph.D. Post-doctoral fellow Year 7: Employed FTE Clinical Geropsychologist Year 8: Geropsychologist moved into Director position; providing direct care and capacity evaluationsYear 9: Added FTE Clinical Psychologist

Collaboration with University of Colorado, Colorado Springs Contract 2 PhD interns each year (total of 28 hours each per week) 1 Post-doctoral Fellow added in year 5 & 6 (10 hours per week) www.rmhcare.org

www.rmhcare.org Growth in RM PACE

www.rmhcare.org Current Structure

www.rmhcare.org Role of Behavioral Health with the IDT Assist with delineation of factors preventing participant engagement. Inform re: participants’ engagement in behavioral health treatment. Address behavioral health factors related to self-management of chronic conditions. Interprofessional training in working with psychiatrically complex participants.

www.rmhcare.org Role of Behavioral Health with the IDT Supporting Social Services department in determining how to involve participants with limited capacity and their families (e.g., cognitive assessments). Maintaining clear roles on the team to reduce confusion and burn out. Behavioral Consultation to the IDT, External Caregivers, and partnering facilities. Staff Trainings: clinical topics, boundaries, how to handle challenging behaviors, de-escalation, dementia-care, compassion fatigue.

www.rmhcare.org 2017Mental Health Prevalence Rates at RM PACE

www.rmhcare.org 2017 Referral Rates at RM PACE

www.rmhcare.org Types of Referrals 2017

www.rmhcare.org Behavioral Health Programming Chronic Pain Management Program Wellness ClassDBT (Dialectical Behavioral Therapy)Chaplaincy (Pastoral Care)Participants At-Risk Team (PART)Guided Meditation ClassesBariatric support groupReminiscence Group Therapy

Questions? www.rmhcare.org