to Improve Access to Mental Health Care: Student and Staff outcomes - - PowerPoint PPT Presentation

▶
to improve access to mental health care
SMART_READER_LITE
LIVE PREVIEW

to Improve Access to Mental Health Care: Student and Staff outcomes - - PowerPoint PPT Presentation

May 04, 2023 184 likes •429 views

Designing Primary Care Behavioral Health Services to Improve Access to Mental Health Care: Student and Staff outcomes Kevin Readdean, Jamie Seastrand, Keith Anderson Counseling Centers of NY Conference June 2019 Overview Primary Care

slide-1
SLIDE 1

Designing Primary Care Behavioral Health Services to Improve Access to Mental Health Care: Student and Staff outcomes

Kevin Readdean, Jamie Seastrand, Keith Anderson Counseling Centers of NY Conference – June 2019

slide-2
SLIDE 2

2

Overview

  • Primary Care Behavioral Health (PCBH) model – history,

literature, trends, college health survey

  • PCBH at Rensselaer
  • Services before and after PCBH implementation
  • Access and satisfaction outcomes
  • Clinical outcomes
  • Trajectory of care
  • benefits for access and staff, students,
  • f co-location, improvements in collaboration, data on improved access to

care, primary care provider satisfaction

  • Present data on student outcomes (improvements in reported

distress), review the trajectory of care from pcbh to long-term mental health services (aggregate data and case report)

slide-3
SLIDE 3

3

Primary Care Behavioral Health (PCBH) Model

  • Behavioral Health Clinician embedded in Primary Care
  • Goal – Improve Primary Care Services
  • GATHER

○ Generalist - full range of issues ○ Accessible - same day ○ Team-based - member of PCP team ○ High productivity - 10+ patients per day ○ Educator - behavioral interventions ○ Routine protocols - clinical

slide-4
SLIDE 4

4

Primary Care Behavioral Health (PCBH) Model Research: Current State of the Science and a Call to Action (Hunter, et al., 2018)

  • Patient Outcomes (satisfaction, symptoms, functioning)
  • Provider Outcomes (satisfaction, burn-out, training)
  • Implementation Outcomes (acceptability, adoption, cost, fidelity,

reach)

slide-5
SLIDE 5

5

College Health Integration Study – 2018

Readdean, K., Heuer, A., Hoban, M. & Parrott, J. S. (in press) Integrated Primary Care Behavioral Health Services in College Health: Results from a National Survey of Health Center Administrators

74% 58% 26% 42%

0% 10% 20% 30% 40% 50% 60% 70% 80%

2007 Survey 2018 Survey

Non-Integrated vs Integrated Organizational Models 2007 to 2018

Not Integrated Integrated

74% 58% 26% 42%

0% 10% 20% 30% 40% 50% 60% 70% 80%

2007 Survey 2018 Survey

Non-Integrated vs Integrated Organizational Models 2007 to 2018

Not Integrated Integrated

slide-6
SLIDE 6

46% 54%

Percent of Non-Integrated Centers Reporting BH Clinicians on Staff

6

College Health Integration Study – 2018

Readdean, K., Heuer, A., Hoban, M. & Parrott, J. S. (in press) Integrated Primary Care Behavioral Health Services in College Health: Results from a National Survey of Health Center Administrators

Interpretation: Almost half of non-integrated centers are employing a primary care behavioral health model (PCBH) in which a non-prescribing BH clinician is embedded within the primary care setting

BH Clinician No BH Clinician

slide-7
SLIDE 7

7

UNIVERSITY-BHCS-L

Listserv for Behavioral Health Clinicians (BHC) practicing in Primary Care Student Health Centers

  • Provide a forum where BHCs practicing within primary care

student health centers on college and university campuses can share ideas, post resources, seek support and guidance, and engage in other networking endeavors related to their roles as a student health center BHCs.

  • Elevate the emerging field of PCBH in college health through

the connection of BHCs who currently lack a formal disciplinary association focused solely on PCBH in college health.

  • Create opportunities to collaborate on PCBH quality

improvement, benchmarking, and research efforts.

slide-8
SLIDE 8

8

Primary Behavioral Health at Rensselaer

  • Primary Care/Health Center
  • Triage BHC embedded in Primary Care
  • 30 minute initial appointments
  • 30 or 50 minute follow-ups
  • Counseling Center
  • 30 minute initial appointments
  • 30 or 50 minute follow-ups
slide-9
SLIDE 9

Triage Unit Student Health and Wellness Health Care Counseling Health Promotion Sports Medicine Disability Administrative Operations Health Information Technology

9

Student Health Services – Org Chart

slide-10
SLIDE 10

10

Healthand Counseling TriageUnit

Triage Nurse Assessment

NursingCare Self-care Advice Medical Provider Appointment Hospital

Triage Counselor Assessment

Brief Interventions Counseling Center Classand Residential Deans Disability Services ALAC Graduate Dean Officeof Graduate Education

Reducewait-tim eandriskthroughtheprovisionofrapid multidisciplinaryassessment,briefintervention,andreferral

The Triage Process

slide-11
SLIDE 11

11

Primary Care Behavioral Health at Rensselaer

  • A new approach that complements the traditional psychotherapy

model (comprehensive intake visit with on-going 1-hr follow-up sessions)

  • 20-30 minute assessments focused on crisis assessment, internal and

external resource identification, brief interventions and referrals.

  • Co-location within the Primary Health Care Clinic
  • Counseling Center - mix of PCBH and traditional care
slide-12
SLIDE 12

12

Trends in Student Population and Counseling Encounters 2012-2017

Primary Behavioral Health Model

  • 5% increase in class size
  • 25% increase in demand for

counseling

  • Increasing percentage of

students entering college with a preexisting mental health diagnosis

slide-13
SLIDE 13

5/9/2019 13

Trends in Student Population & Counseling Encounters

slide-14
SLIDE 14

14

Student Health PCBH Services

Benefits of BHC Embed

Decreased Wait Time:

  • 1. Appointments reduced from

weeks to same day.

  • 2. Increased student and parent

satisfaction levels.

  • 3. Prevents symptom escalation

while awaiting care. Effective Use of Staff Resources:

  • 1. Greater number of students

seen.

  • 2. Limits the need for additional

staff.

  • 3. Improved collaboration among

division.

slide-15
SLIDE 15

15

BHC Scheduling Options

  • Scheduling via the Student Health Portal

○

Students have previously had access to schedule online medical appointments and new in Spring 2018 are able to schedule appointments with the Behavioral Health Clinician

  • Walk - Ins

○

Offices located within a building that also houses many other Student Life Offices

  • Call the Counseling Center

○

Appointments scheduled by the Receptionist

  • Warm Hand Off

○

Medical Providers

○

Other Student Life Offices

slide-16
SLIDE 16

16

PCBH/Triage Unit Outcomes

  • Access
  • Impact on no-shows
  • Levels of Distress
slide-17
SLIDE 17

17

Quotes:

“I’ve appreciated the access this new model has allowed as our student body grows. The counseling center moving to a triage model has improved timely student access to support. Our first- year students benefit from seamless referrals and I have found it easier to get consultation time with counseling staff” “With the new Primary Behavioral Health System (Triage) medical providers have been able to get their students of concern into counseling the same day which has left the providers and our students much happier.”

Janelle Fayette, Dean of the First-Year Experience

  • Dr. Leslie Lawrence, Executive Medical Director
slide-18
SLIDE 18

18

Access Data

  • Spring 2018 = 6 FTE (1 BHC/5 Traditional) = 340 students served
  • Fall 2018 = 4 FTE (1 BHC/3 Hybrid) = 430 students served

2 4 6 8 10 12 Spring 2018 (6 FTE) Fall 2018 (4 FTE)

Average wait time for appointments in days

Wait for New Wait for Return 6 4 57 108 20 40 60 80 100 120 Spring 2018 Fall 2018

PCBH allows more students to be seen with fewer staff

Number of Staff Number of Students/Staff

slide-19
SLIDE 19

19

Benefits of “Rapid Access” reduced no-shows?

  • Entered treatment – average 5 day wait – both semesters
  • No-shows/Cancellations - average 6 day wait – both semesters
  • More research needed to determine if this is a benefit of the

model

slide-20
SLIDE 20

20 6.00 2.98 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00 Initial Session Distress Score Final Session Distress Score

Change in SUDS scores (n=53)

  • 134 students attended at least one triage counseling session and completed the Subjective Units of Distress

Scale (SUDS)*. After this first visit their SUDS scores reduced, on average, by 1.78**

  • 53 students, of the 134, attend two or more triage counseling sessions. This group had an average SUDS

score reduction of 3.02** (see graph)

*Kaplan, D. M., Smith, T., & Coons, J. (1995). A validity study of the subjective unit of discomfort (SUD) score. Measurement and Evaluation in Counseling and Development, 27(4), 195-199. **statistically significant at p < 0.00001 with paired t-test

Outcomes of the PCBH: Initial findings Spring 2018

slide-21
SLIDE 21

21

Growth of the model

  • Based on the demand for service, the decision was made to involve more

staff in the PCBH model.

  • Replacement staff were designated to participate in the PCBH model

○ It was anticipated that by being fully staffed, and using shorter

triage sessions, we could increase the likelihood of having students wait less time before the initial visit.

  • Based on the improvements found in reduced SUDS scores and a

continuing demand for service, the decision was made to involve all of the counseling center staff in the PCBH model.

slide-22
SLIDE 22

22

Growth of the model

Currently:

  • All of the staff are using an initial 30 minute visit, followed by 30 minute

follow-ups.

  • As needed, students are transitioned to traditional hour long follow-ups.

Future:

  • Hybrid model - mix to be determined
  • Additional drop-in counseling locations (athletics, student union, gym)
slide-23
SLIDE 23

23

  • American College Health Association (2010). Considerations for integration of counseling and

health services on college and university campuses: An ACHA White paper. Journal of American College Health, 58(6):583-596.

  • Blount, A., Integrated Primary Care: Organizing the Evidence. Families, Systems & Health, 2003.

21(2): p. 121-133.

  • Funderburk, J. S., Fielder, R. L., DeMartini, K. S., & Flynn, C. A. (2012). Integrating behavioral

health services into a university health center: Patient and provider satisfaction. Families, Systems, & Health, 30(2), 130-140.

  • Hunter, C. L., Funderburk, J. S., Polaha, J., Bauman, D., Goodie, J. L., & Hunter, C. M. (2017).

Primary care behavioral health (PCBH) model research: Current state of the science and a call to

  • action. Journal of clinical psychology in medical settings, 1-30.
  • Pratt, K. M., DeBerard, M. S., Davis, J. W., & Wheeler, A. J. (2012). An evaluation of the

development and implementation of a university-based integrated behavioral healthcare program. Professional Psychology: Research and Practice, 43(4), 281-287.

  • Reiter, J. T., Dobmeyer, A. C., & Hunter, C. L. (2018). The primary care behavioral health (PCBH)

model: An overview and operational definition. Journal of clinical psychology in medical settings, 25(2), 109-126.

  • Spiegelhoff, S. F., & Luke, M. (2015). Integration of College Counseling and Health Services: A

Phenomenological Study. The Wisconsin Counseling Journal, 22-36.

References

slide-24
SLIDE 24