Delaware Guidance Services for Children & Youth, Inc. has five locations throughout the state, in all three counties. Founded in 1952, Delaware Guidance has grown into the single largest not-for-profit provider of comprehensive mental health services in Delaware for children and their families. The agency’s staff includes child psychiatrists, a psychiatric nurse practitioner, master’s level licensed clinicians, and a child psychologist.
Health Management Associates (HMA) practice coaches have engaged with the agency’s Behavioral Health Integration (BHI) leadership team, headed by CEO Jill Rogers, to identify and develop opportunities to improve access to primary care for their clients through enhancement of referral relationships with primary care, and development of primary care within their agency sites in the “reverse integration” model.
The HMA coaching process has focused on development of key elements of a strategic approach to achieving these goals, including: (1) a plan for communication with staff, the board of directors, and clients to facilitate education about and engagement in development of integration; (2) assessment and improvement of intake and referral and other patient flow processes for efficient and effective referrals; and (3) a business model and plan for development of reverse integration at Delaware Guidance.
Successes to date toward Goals 1 and 2 include the formation of a plan and staff workgroups to conduct formal improvement activities for intake and referral processes; engagement with two primary care practices for mutual development of an enhanced referral process; and a scheduled strategic planning presentation regarding integration opportunities at the quarterly board of directors meeting in June. For Goal 3, the agency has initiated steps to develop its business plan by creating and disseminating a survey to its client base, to evaluate current engagement in primary care and interest in receiving primary care at Delaware Guidance. This information will inform the market demand analysis portion of their integration business plan.
The HMA coaches have also supported Delaware Guidance in addressing challenges to attaining these goals by providing change management consultation to identify and address organizational needs to support integration, including personnel and management infrastructure, process improvement, and business planning capabilities. This change management consultation benefits the Delaware Guidance BHI team’s commitment to maximizing the support of the BHI transformation project to develop its ability to meet the needs of its clients for improved access to primary care.
Westside Family Healthcare is an FQHC that joined the first cohort of practices in the Delaware BHI pilot initiative. This group has behavioral health therapists within primary care, but wanted to implement full integration using the collaborative care model. The Westside team has recently hired a psychiatric nurse practitioner who is engaged and ready to be an active partner in the collaborative care team and assume the role of the consulting psychiatric provider. The HMA coaches have been working with Westside, developing collaborative care implementation, which they’ve begun by gathering patient data from all their sites and analyzing it for areas of need. The eligible population — focused on patients with depression and diabetes —has been identified.
Westside has selected a pilot site location, started to identify champions and build awareness within that site. They are creating drafts of new workflows and are determining the best fit for the role of the Behavioral Health Care Manager (BHCM). Screenings have been implemented with the PHQ-9 but will now add systematic measurement to monitor progress. Once the BHCM role is in place, they can start overall education for the pilot team and begin to implement warm hand-offs to the BHCM, and tracking and follow up within a registry.
Westside believes the biggest challenge is financial viability because there is no reimbursement for these particular roles and overall model. In addition, time is always a challenge to implement any new change, with many needs that include identifying champions to be engaged in spreading the word, training, and maintaining momentum for a new approach to care. A population health approach that utilized a registry tool for tracking and follow up was not part of the workflow, and they are looking forward to piloting the tool that is being developed through this Delaware initiative.
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