Who Should I Refer? VA Primary Care/Behavioral Health Integration in Practice

1. Who Should I Refer?VA Primary Care/Behavioral Health Integration in Practice David Hunsinger, MD, MSHA Medical Director Binghamton VA Outpatient Clinic

2. Objective Over the course of this presentation, participants will begin to consider the broad range of clinical situations in which involvement of a Behavioral Health provider can prove helpful.

3. Key Characteristics • Co-located • Collaborative • Dedicated Behavioral Health (BH) Provider with schedule flexibility • Warm Handoffs

4. Benefits of the Model Timely patient evaluation and assistance

5. There’s no time like the present….

6. Benefits of the Model Timely patient evaluation and assistance • A continuation of the Primary Care encounter • Eliminates the potential for ‘no show’

7. Benefits of the Model Face to face introduction

9. Benefits of the Model Face to face introduction • Lends legitimacy and credibility • Reduces patient anxiety about the meeting • More personal

10. Benefits of the Model Face to face introduction • Lends legitimacy and credibility • Reduces patient anxiety about the meeting • More personal

11. Benefits of the Model Reinforces ‘whole person’ focus

12. Mind body connection by John Hersey

13. Tip #1 Referrals are not just for Urgent Problems

14. Urgent Problems • Major depression • Anxiety • Grief reaction • Adjustment reaction • ‘crying in the office’

15. Tip #2 Consider scripting your warm hand-off intro

16. Warm Hand-Off • “I work with someone whose job is to help patient’s in situations like this. If you have a few minutes, I’d like to introduce you.” • “We have someone who is a great resource for these things. Let me introduce you and you can get his/her card if you want to talk to someone about it.”

17. Warm Hand-Off • “One of the members of your healthcare team is _________. If you have a few minutes, I’d like to introduce you so he/she can tell you a little bit about what kind of help he/she can provide you.”

18. Tip #3 Refer all positive Clinical Reminder screens …….better yet, revise clinic flow to have these patients seen automatically

19. Clinical reminders • PHQ2/PHQ9 [depression] • PTSD screen • AUDIT-C [alcohol] • ?TBI screen

20. Tip #4 Think Patient needs not Diagnoses

21. Needs not Diagnoses • Establishing a healthy lifestyle • Behavior change • Tobacco and alcohol issues/concerns • Relationship stress • Job stress

22. Establishing a healthy lifestyle • Exercise • Healthy Diet • Sleep hygiene

25. Exercise • Cardiovascular conditioning affects many health conditions • Promotes a sense of well-being • Relieves stress/tension/anxiety

26. Healthy Diet • Weight loss • Disease specific concerns • Patients considering MOVE • Patients unable to participate in MOVE

28. Tobacco Use • Individual coaching as an alternative to QuitSmart

29. Relationship issues • Spouse/significant other • Children • Boss • Co-workers

31. Tip #5 Healthcare is a team sport [especially in a PACT environment]

33. Team • Talk to your PCMHI provider • Ask for suggestions about referrals • Invite him/her to huddles and team meeting where patients are discussed

34. Tip #6 Most people’s lives are impacted far more by psychological, psychosocial, and behavioral issues than by physical issues

35. Conclusion So………… refer early refer often!

36. Conclusion So………… warm hand-off early warm hand-off often!