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APNA 29th Annual Conference Session 3032: October 30, 2015 McIntosh 1

I ntegrated Physical and Mental Health Care Role for Advanced Practice Psychiatric Nurses: Part of Our Evolving Healthcare System

American Psychiatric Nurses Association Annual Conference Session ID: 3032 October 30, 2015 Diana McIntosh Ph.D., APRN, PMHCNS‐BC

Disclosure

The speaker has no conflict of interests to disclose.

Objectives

As a result of participating in this session, the participant will be able to:

• 1. Describe models of integrated care of

physical and behavioral health.

• 2. Compare and contrast examples of the role
• f the integrated care advanced practice psychiatric

mental health nurse.

• 3. Propose the future role of an integrated

care advanced practice psychiatric mental health nurse.

APNA 29th Annual Conference Session 3032: October 30, 2015 McIntosh 2

Outline of Presentation

• I. Brief review of the literature and theories on

integrated care physical and mental health models.

• II. Analyze successes and challenges of integrated

care.

• III. Compare and contrast examples of the role of

the integrated advanced practice psychiatric (APP) nurse in real life practice settings.

• IV. Describe obstacles and factors contributing to

success of integrated role.

• V. Propose a future model of the integrated care

APP nurse

TOM Define Integrated Care

“...in essence integrated health care is the systematic coordination of physical and behavioral health care. The idea is that physical and behavioral health problems often occur at the same time. Integrating services to treat both will yield the best results and be the most acceptable and effective approach for those being served.”

Hogg.utexas.edu. Hogg Foundation: Integrated Health Care [Internet]. 2014 [cited 28 August 2015]. Available from: http://www.hogg.utexas.edu/initiatives/integrated_health_care.html

APNA 29th Annual Conference Session 3032: October 30, 2015 McIntosh 3

Integrated Care

The United States’ 2010 Patient Protection and Affordable Care Act included provisions encouraging increased collaboration of care for individuals with behavioral and physical health service needs in the public sector.

The Kaiser Foundation Affordable Care Act Summary; 2012[cited 28 August 2015] Available from: http://kff.org/health‐reform/fact‐sheet/summary‐of‐the‐affordable‐care‐act/

World Health Organization Report

• Reasons for integrating mental health into primary care:

– burden of mental illness is large; – mental and physical health problems are interwoven; – the treatment gap for mental disorders is great; – primary care settings improve access for mental health services; – integration may reduce stigma and discrimination; – integrated care is more cost‐effective; – most people with mental disorders treated in collaborative primary care have improved outcomes.

Funk M, Ivbijaro G. Integrating Mental Health into Primary Care—A Global Perspective [Internet]. 1st ed. Geneva, Switzerland: World Health Organization and London, UK: World Organization of Family Doctors; 2008 [cited 28 August 2015]. Available from: http://www.who.int/mental_health/policy/services/3_MHintoPHC_Infosheet.pdf?ua=1

Models of Integrated Care

Concepts Definitions Four Quadrant Clinical Integration Model that identifies populations to be served in primary care versus specialty behavioral health Primary Care Settings:

• Quadrant I: Low behavioral and physical health needs
• Quadrant III: Low behavioral health/High physical health

needs Primary Care and Specialty Mental Health Settings:

• Quadrant II: High behavioral health/Low physical health

needs

• Quadrant IV: High behavioral and physical health needs

Adapted from Collins et al. .http://www.milbank.org/uploads/documents/10430EvolvingCare/ EvolvingCare.pdf

APNA 29th Annual Conference Session 3032: October 30, 2015 McIntosh 4

Successes and Challenges of Integrated Care

Many studies demonstrating effective integrated care target specific conditions in behavioral or primary care settings ( Alexopoulos, 2009; Hay, 2012; Druss, 2012;

McGuire, 2009)

Studies Demonstrating Effective Models

• Alexopoulos (2009) and Hay’s (2012) studies

had adequate sample sizes and demonstrated collaborative care management interventions that were more likely to result in depression free days for primary care patients.

Intermountain Mental Health Integration Model

• Dr. Reiss‐Brennan’s model promotes three

essential primary care practice changes:

– improve the detection, monitoring, stratification, and management of depression and other mental health and medical conditions; – reinforce ongoing relational contact with patients and their families to promote adherence and self‐ management; – match and adjust treatment and management interventions if there is evidence of increasing complexity and/or inadequate patient response.

Intermountain Integration Model (cited 28 August, 2105) Available from: http://www.aannet.org/mental‐health‐integration‐at‐intermountain‐healthcare‐‐ut

APNA 29th Annual Conference Session 3032: October 30, 2015 McIntosh 5

Role of Integrated Nurse

• An argument can be made that for effective

integration to occur, the same APRN needs to address both medical and behavioral health needs of patients.

Role of Integrated Nurse

• APRNs need to further develop the integrated

care role and lead the way with innovations to increase access, advance retention and improve quality of integrated care. Nurses are already positioned as experts in integrated care.

Competencies of Integrated Nurse Role

• Core Competency Categories include:

– interpersonal communication – collaboration and teamwork – screening and assessment – care planning and care coordination – Intervention – cultural competence and adaptation – systems oriented practice – practice‐based learning and quality improvement – Informatics.

Hoge M.A., Morris J.A., Laraia M., Pomerantz A., & Farley, T. (2014). Core Competencies for Integrated Behavioral Health and Primary Care. Washington, DC: SAMHSA ‐ HRSA Center for Integrated Health Solutions.

APNA 29th Annual Conference Session 3032: October 30, 2015 McIntosh 6

Role of Integrated Nurse

• In 2013, the American Psychiatric Nurses Association (APNA) put

forth a primary care statement that addressed why psychiatric nursing is part of the primary care workforce.

• APNA in 2014 added to their Scope and Standards of Psychiatric

Nursing a section on integrated care

• APNA put out a call of interest for a position paper on “what would

integrated physical and mental health care look like”?

• The International Society for Psychiatric Nurses (ISPN) in 2015 is

expected to complete a white paper on integrated care.

What would the role of the integrated care Advanced Practice Psychiatric Mental Health Nurse look like in the future?

Obstacles

• Infrastructure
• Certification
• Training
• Access to does not guarantee participation
• Threat to Identity

Factors Contributing to Success of Integrated Role

• Skill Set Psychiatric Mental Health Advanced

Practice Nurses bring

– Leadership – Engagement Skills – Assessment and Diagnostic Skills – Collaborator – Advocacy

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Future Role of Integrated Nurse

Integration is the hallmark of the future of healthcare.

Advanced Practice Psychiatric Mental Healthy Nurses can be the hallmark providers of integrated care.

Discussion