Integration of Behavioral and Medical Care by Using Traditional Health Workers (THW) - PowerPoint Presentation

Slide1

Integration of Behavioral and Medical Care by Using Traditional Health Workers (THW)

MOMS and EDIT

Veronica Sheffield MS BSN RNSlide2

Meeting Members Where They Are One of the CCO mandates is the use of

Traditional

Health Workers.

(THW

)

THW

are called navigators, community health workers, and peer wellness specialists here in Oregon.

AT WVCH we also call them mentors.

When we think of health care – we often think of doctors, nurses and social workers, those “experts” who tell us what is “wrong” and they often decide what’s “happen next”.

THW

are not experts, they are

not

here to tell members what is wrong or what to do. Slide3

“Non”-Traditional Health Workers

Their primary goal is to

activate members

so that:

Members feel empowered to express their needs and desires.

Members learn skills to advocate for themselves.

Members and providers have shared control and shared responsibility for what happens next. Slide4

Role model

a success story

and

enhance a member’s belief in self

Encourages

members to develop and focus on reaching their personal health goals.Navigates the member through the maze of community/health resources.Advocate for the member .

THW-

Mentors:Slide5

MOMS PROGRAM

Empowering pregnant women who struggle with drugs/alcohol to stay clean and sober while developing the tools they need for themselves and their families. Slide6

MOMS In

2005

, the year before we started MOMS:

Methamphetamine abuse was a major problem.

The number of babies born with a positive drug screen was increasing.

The number of babies taken at birth for a positive drug screen in Marion county was 114.Slide7

Who is involved?

The program consists of:

Mentors

(THW

)

Plan Level Nurse Case Managers- Public Health Nurses (CaCoon, Babies First)Providers (OB, PCP, Behavioral Health)Other Agencies (DHS, parole/probation, drug court, Early Childhood programs) Members Slide8

HOW IT WORKS?

Screening/Assessment:

Alcohol/Drug

assessment , mental health

assessment,

random drug screenings, and depression screeningServices: Prenatal care, behavioral health, dental, and non-medical services (WIC, housing, vocational and educational services, parenting classes, and domestic violence interventions)Slide9

Results in Marion County

The number of babies taken at birth for a positive drug screen in Marion county has dropped from:

114 in 2005

11 in 2012

99.9% of MOMS participants test negative for illegal drugs and alcohol at the birth of their babies. Slide10

Emergency Department Intervention Team (EDIT)

Empowering individuals to build healthy lives Slide11

Emergency Department Intervention Team (EDIT) This team includes mentors,

plan level

nurse

case managers, a psychiatrist, the member’s providers, and most importantly the

MEMBER

.

This team’s goal is to identify the healthcare needs and care barriers for members who use the Emergency Department frequently - 3 times in a month, 6 times in 6 months or 10 or more times a year. The team develops a plan together to help meet the complex health needs of these members. This plan includes Metric screening (Depression, SBIRT) Slide12

A Case Study…

Clinical Picture

Diabetic type 2, Fibromyalgia, chronic lung disease (COPD), Bi-polar, Coronary Artery Disease, Hypertension and chronic nausea- gastro paresis. ..

Interventions

Member actively engaged in developing their own plan of care

PCP no longer prescribed psych meds- their newly engaged mental health provider doesTransportation, a major barrier to care, was addressedMember was scheduled with needed specialists Mentor supported member during a stressful court issue (non medical). Slide13

Outcomes to Date:

For this member:

ED visits

last year were

41

, there has been only two

visits since entering the EDIT program. Overall we have seen approximately a 70% reduction in ED use in our EDIT participants who also verbalize their experience of care as improved.