Telligen Quality Innovation Network Quality Improvement Organization - - PowerPoint PPT Presentation

Telligen Quality Innovation Network – Quality Improvement Organization

Behavioral Health Recovery: Leveraging Outside Resources and Addressing Patient and Family Stigma Wednesday, May 1, 2019

This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. This material is for informational purposes only and does not constitute medical advice; it is not intended to be a substitute for professional medical advice, diagnosis or treatment. . 11SOW-QIN-C3-02/19/19-3244

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Telligen QIN-QIO

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The Telligen QIN-QIO network offers expertise and support at local, regional and national levels We believe the quality of healthcare can be transformed to better serve the people of all communities How we serve our participants:

• Assess and understand unique needs and opportunities
• Provide opportunities to connect with
• Align improvement efforts
• Leverage expertise and relationships
• Facilitate connections, sharing and learning
• Bring you access to tools, resource, metrics, evidence based, collaboration, best practice,

peer support, education

Join the Telligen QIN-QIO Network

Behavioral Health Recovery:

Leveraging Outside Resources and Addressing Patient and Family Stigma

Presenter: Megan Swenson, MA LPC LAC Manager of Integrated Care and Care Coordination

Our mission: To inspire hope, improve lives and strengthen our community by providing mental health and related solutions for individuals and families. Our values: People First • Empathy with excellence • Collaborate to make life better Community minded • Anticipate and evolve • Dignity for all Jefferson Center is a nonprofit, community-focused mental health care and substance use services provider. We offer hope and support to individuals and families who are struggling with mental health issues and substance use disorders. Serving our community is at the core of everything we do.

Jefferson Center

A Community Mental Health Center

Integrated Care and Care Coordination

Breaking the silos of behavioral health care and medical care to address the whole patient

Behavioral Health Recovery

HOPE

HEALTH HOME PURPOSE COMMUNITY

What it looks like in medical settings

Integrated Care and Care Coordination

Breaking the silos of behavioral health care and medical care to address the whole patient

Behavioral Health Recovery

HOPE

HEALTH HOME PURPOSE COMMUNITY

What it looks like in medical settings

Heath B, Wise Romero P, and Reynolds K. A Review and Proposed Standard Framework for Levels of Integrated Healthcare. Washington, D.C.SAMHSA-HRSA Center for Integrated Health Solutions. March 2013

SAMHSA Levels of Integrated Care

Hospitals Hospitals Specialty Clinics Specialty Clinics Primary Care Clinics Primary Care Clinics Social Service Agencies Dental Clinics Housing Providers

Graphic courtesy of Dale Jarvis & Associates

Union Square Health Home (USHH)

Space includes:

• 9 exam rooms and a procedure room
• Jefferson Center Outpatient/Intensive/ACT/Navigation/Wellness/

Supported Employment/POD

Jefferson Plaza Family Health Home

Jefferson Plaza is a family health home shared with MCPN that includes medical providers specializing in youth, families and adults and a pediatric NP, a midwife, and an adult PA. Space includes: 10 MCPN exam rooms, 10 Jefferson Center offices, and 2 consult rooms

Integrated Care and Care Coordination

Breaking the silos of behavioral health care and medical care to address the whole patient

Behavioral Health Recovery

HOPE

HEALTH HOME PURPOSE COMMUNITY

What it looks like in medical settings

Behavioral Health: Behavioral health looks at a persons emotions, behaviors and biology and associates these areas to an individuals mental well-being, their ability to function in every day life, and their concept of self. Behavioral health not only looks at mental health and wellness but also an individual’s possible substance use and abuse and overall recovery. Recovery: A process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential. Recovery is built on access to evidence-based clinical treatment and recovery support services for all populations (SAMHSA).

Terminology Review

Myths and Misconceptions

Patients with MH or SUD are “difficult” Relapse = ineffective tx and/or moral failing Personality weakness/ character flaws cause MH MAT replaces one addiction with another Abstinence is the only way to be in recovery People with mental health can’t hold down a job Behavioral Health prevention doesn't work Inpatient treatment is always necessary Addiction is a choice, not a disease; they can stop if they wanted to

“The focus groups revealed that the patient-provider relationship is the “single most important hallmark of quality care,” the report

• stated. Finding a provider

who meets individual patient needs is part of building a quality provider relationship.”

https://patientengagementhit.com/news/cons umers-say-patient-provider-relationship-key-to- quality-care

Relationship

Integrated Care and Care Coordination

Breaking the silos of behavioral health care and medical care to address the whole patient

Behavioral Health Recovery

HOPE

HEALTH HOME PURPOSE COMMUNITY

What it looks like in medical settings

Hope, the belief that these challenges and conditions (behavioral health) can be overcome, is the foundation

• f recovery. A person’s recovery is built on his or her

strengths, talents, coping abilities, resources, and inherent values. It is holistic, addresses the whole person and their community, and is supported by peers, friends, and family members.

• SAMHSA

Hold slide for Sonja’s story

SAMHSA: Recovery Support Strategic Initiative

(https://www.samhsa.gov/recovery) (2016)

Health –overcoming or managing one’s disease(s) or symptoms, healthy choices for physical and emotional well-being Home –having a stable and safe place to live Purpose –meaningful daily activities such as a job, volunteerism, family caretaking to participate in society Community –relationships and social networks that provide support, friendship, love, and hope

Integrated Care and Care Coordination

Breaking the silos of behavioral health care and medical care to address the whole patient

Behavioral Health Recovery

HOPE

HEALTH HOME PURPOSE COMMUNITY

What it looks like in medical settings

Universal Behavioral Health Screening in Medical Settings

Adverse Childhood Experiences (ACE) Survey Collected one time:

• Adult patients
• Adolescent patients 13 yrs+
• Parents of patients under 13 yrs

Use of original ACE questionnaire; expanded using Center for Youth Wellness ACEQ- includes foster care, bullying, intimate partner violence, deportation, etc. Psychoeducation about trauma, resiliency and community resources are reviewed after each interview.

Content source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention https://www.cdc.gov/violenceprevention/acestudy/ACE_graphics.html

ACE score of 4+ decreases life expectancy by 20 years.

ACE Score > 3

• 1.5x the rate of obesity
• 6.5x the rate of ever having a suicide attempt
• 5x the rate of self reported Alcohol Dependence
• 7x the risk of ever having injected drugs
• 1.5 x as likely to have Ischemic Heart Disease
• 1.3 x as likely to have a stroke
• 2 x as likely to have COPD
• 1.2 x as likely to have Diabetes
• 1.2 x as likely to have a fracture

Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults Felitti, Vincent J et al. American Journal of Preventive Medicine , Volume 14 , Issue 4 , 245 - 258

SBIRT screening

Follow up screening tools:

• 1. AUDIT (alcohol use)
• 2. DAST (drug use)
• 3. PHQ9 (depression)
• 4. GAD7 (anxiety)
• 5. Nicotine use/smoking cessation

Social Determinants of Health

(Heiman & Artiga, 2015)

Economic Stability –Employment, Income, Expenses, Debt, Medical bills Neighborhood and Physical Environment –Housing, Transportation, Safety, Parks, Playgrounds Walkability Education –Literacy, Language, ECE, Vocational training, Higher education Food –Hunger, Access to healthy options Community and Social Context –Social integration, Support systems, Community engagement, Discrimination Health Care System –Health coverage, Provider availability, Provider linguistic & cultural appropriateness, Quality

• nly addresses 20% of a persons health and well-being

Why is it important to address social determinants of health?

https://www.promedica.org/socialdeterminants/pages/default.aspx

Screening for Social Determinants

• f Health and Recovery Supports

Questions:

• 1. Are you already screening?
• 2. If not, why not?

The Denver Regional Accountable Health Community

Weekly Multidisciplinary Care Team Meeting

• Takes a “whole person” approach
• Includes Primary Care Provider, Medical Assistants,

Psychiatrists, Therapists, Care Coordinators (Nurse or Therapist), Health/Wellness Coach, Navigation

• Shared “Collaborative Care Plan”

Integrated Care and Care Coordination

Breaking the silos of behavioral health care and medical care to address the whole patient

Behavioral Health Recovery

HOPE

HEALTH HOME PURPOSE COMMUNITY

What it looks like in medical settings

Vocational Services Community Wellness Classes

Purpose

Volunteer Opportunities

Integrated Care and Care Coordination

Breaking the silos of behavioral health care and medical care to address the whole patient

Behavioral Health Recovery

HOPE

HEALTH HOME PURPOSE COMMUNITY

What it looks like in medical settings

https://www.serenityatsummit.com/news/overview-rat-park-addiction-study/#

Community Connection

Recovery International Adult Children of Alcoholics Al-Anon/Alateen Alcoholics Anonymous AlcoholScreening.org Alzheimer's Association American Association of Retired Persons Grief and Loss Information American Association of Suicidology: Support for family/friends that have lost a loved one to suicide Anxiety and Depression Association of America, Anxiety and Depression Association of America peer-to-peer support group Attention Deficit Disorder Association Autism Society of America The Balanced Mind Foundation Brain Injury Association of America Caregiver Action Network Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) In addition to support groups, CHADD has a section for parents which includes many helpful resources (look at list of options on right-hand side of the page) and a link that explains their Parent to Parent Family Training classes. For more information about these on-line training classes, review the information at the link we've provided or contact the CHADD national resource center at 1-800-233-4050. Co-Dependents Anonymous or sign up for their email list. You can also visit http://www.codependents.org/ The Compassionate Friends Grief Support: After the death of a child (Use this link to find groups in your area) CoSLAA Support groups for family and friends of people who have a sex addiction Crisis Text Line Debtors Anonymous Depression and Bipolar Support Alliance Dual Diagnosis of Oregon, Inc. (Although based in Oregon, offer support to those in other areas who wish to establish groups to help those who have both a mental health and alcohol/substance abuse condition) Dual Recovery Anonymous: Support for those who have both a mental health and alcohol/substance abuse condition Emotions Anonymous: Modeled after the Alcoholics Anonymous 12-step program, Emotions Anonymous is open to any individual dealing with emotional difficulties. Federation of Families for Children’s Mental Health, a parent support and advocacy network trauma, their family and friends, and professionals)

Community Connection

Freedom from Fear (In addition to finding support groups, you can use the Finding Help/Resources tab on left hand side to access on-line support, e-mail support, and blogs) Gamblers Anonymous Gift from Within: Article for partners (Support for both men and women with post-traumatic stress disorder. Use the Trauma Support tab at the top of the page to access a wide variety of support options.) Hospice Foundation of America (Grief and Loss section includes link to find a local hospice office using link from left-hand side of the page; many

• ffices offer grief support groups. National hospice office can be reached by calling 1-800-868-5171.)

International Obsessive Compulsive Disorder Foundation International Society for the Study of Trauma and Dissociation Male Survivor (Discussion board and chat room for men who have been sexually abused can be accessed from Survivors tab on left hand side of the page) Narcotics Anonymous The National Alliance on Mental Illness (NAMI): A family support and advocacy organization National Eating Disorders Association O.A.S.I.S.@MAAP (Autism and Asperger Syndrome support group information for both individuals and their family/friends; Support groups tab accessible from left-hand side of the page) Overeaters Anonymous Offer in-person, telephone, and on-line meetings Parents, Families and Friends of Lesbians and Gays (PFLAG) Postpartum Support International and link to support resources in your area (National 24-hour Postpartum Depression Helpline 1.800.944.4PPD) S-Anon International Family Groups Support groups for family and friends of people who have a sex addiction Self Mutilators Anonymous Sex Addicts Anonymous (description of organization) and find a meeting link http://www.sexaa.org/Meetings/UnitedStates/ Sidran Institute (Extensive information and resources on ptsd, dissociative disorder, trauma, and self injury; e-mail or call 1-888-825-8249 to request support group information) Survivors of Incest Anonymous (Use the SIA Groups and Intergroups options on the left-hand side of the home page to find meeting information) The Arc (Support and information for people with mental retardation and related developmental disabilities and their families) To find a chapter near click here. Tourette Syndrome Association, Inc. TARA Association for Personality Disorder: National Borderline Personality Disorder Resource and Referral Center The TLC Foundation for Body-Focused Repetitive Behaviors Well Spouse Association Support for spousal caregivers. Witness Justice (Information, resources, and on-line support for victims of violence or

• http://www.mentalhealthamerica.net/find-support-groups
• Local Public Health Initiatives and Resources
• Local Foundations
• Connection to your Community Mental Health Center

Community Connection

Questions/Discussion

Thank you Megan Swenson megans@jcmh.org 303-263-2252