Janice Berry Edwards, PhD, LICSW, LCSW-C, BCD, ACSW

Enhancing Diagnostic Accuracy In Assessment, Intervention and Advocacy

New Directions in Clinical PracticeGuided by Integration and Clinical Sensibility

Janice Berry Edwards, PhD, LICSW, LCSW-C, BCD, ACSW

Integration of mental health services into the primary care setting, will lead to improved access to mental health services and communication with providers of health care.

Integration of care allows for the promotion of optimal social and emotional wellness, because the whole person is being treated and not just a part.

Safe and effective mental and physical health care requires collaboration and communication between all providers of health care.

Mental Health and Wellness

Health care visits often have underlying psychosocial influences.

70% of all health care visits are generated by psychosocial factors. (Fries et al., 1993; Shapiro et al., 1985).

Mental Health problems can arise from physical problems. The majority of visits in primary care are related to

behavioral needs but not to identified mental health disorders. Many patients respond to psychosocial stress by developing vaguely defined, distressing physical symptoms that have no organic cause. (Kroenke et al., 1989)

HERE’S WHAT WE KNOW

An estimated 75% of patients with depression present physical complaints as the reason they seek health care. (Unutzer et al., 2006).

Medical outcome studies reveal that depression results in more functional impairment than chronic diseases such as diabetes, arthritis and angina. (Wells et al., 1989).

Mental Health and Wellness

A national survey found that 32% of undiagnosed, asymptomatic adults would likely turn to their primary care physician to help with mental health issues; only 4% would approach a mental health professional. (National Mental Health Association, 2000).

HERE’S WHAT WE KNOW

Will allow for the early identification of mental health problems and interventions.

Improved care coordination among, all providers of health care and especially patients, families, among community mental health clinicians.

Collaborative Mental Health Care PartnershipsWhat this looks like

Increased knowledge, and enhanced abilities in diagnosing and responding to presenting and underlying mental health problems.

Enhanced abilities in diagnosing and responding to both physical and mental health problems.


Implementation and discussion of therapeutic and psychopharmacologic services.

Development of a means for the collaborative measurement of treatment outcomes.

Integration of culturally sensitive and evidence‐based mental health services.


https://www.youtube.com/watch?v=IFFYkB6n-_g&list=PL2737C2C6E81E9177

What Practitioners Are Saying




We are at a time where there is a critical public health need for evidence‐based mental health services. Improved and better working relationships between all providers of care can significantly enhance mental health services outcomes across populations.

Successful collaborations can lead to significantly influencing the psychiatric care of larger numbers of patients.

Collaborative care will also allow for advocacy, the promotion of prevention, early identification, timely intervention, and treatment of psychiatric illness.

COLLABORATIVE CARE

http://camhblog.com/2015/04/01/promoting-collaborative-mental-health-online/

“Real time” communication is important to collaborative mental health care partnerships this requires availability.

Answers to clinical questions ideally are provided to Primary Care Clinicians (PCCs) within a time frame that allows them to respond in a timely way to patients and their families.

PCCs see a higher volume of patients and as such, their workflow requires efficient use of their decision‐making and time. Timely access to consultation can provide practical and understandable advice.

Timely Access to Consultation

Timely access assures real time discussion of plans in collaboration with the PCCs. It helps PCCs to support therapeutic goals.

Particularly in collaborative consultation timely access can foster the development of a growing sense of trust and confidence develops that encourages PCCs to extend their involvement in mental health care beyond their usual scope of practice.

Consultation and Collaboration

The development of a communication protocol can be helpful to enhance the quality of the consultation and collaboration. Social Workers who are working closely with PCCs can identify their ability to handle psychiatric problems in their practices and when necessary, can help facilitate referrals to other mental health or community agencies.

Social Workers in consultation with PCCs can serve to triage primary care patients, based on acuity and complexity, to the appropriate level of service intensity (e.g., direct evaluation and treatment by the appropriate clinical provider of care, or emergency care and inpatient hospitalization when indicated).


Consultation or collaboration can involve scheduling

the evaluation in the offices of the PCC and/or mental health clinicians.

The use of telepsychiatry is an option, particularly in rural settings. When used in the context of a collaborative system of care in which both the mental health clinician and the PCC share responsibility for the success of the treatments, telepsychiatry can prove a valuable resource.


The psychiatric evaluation or consultation should include biopsychosocial formulation, diagnostic impressions, and treatment/referral recommendations.

It is important to have specific recommendations for the PCC that include in the consultation prompt communication of the findings and recommendations.

Initial communication regarding urgent findings requiring immediate response by the PCC can occur in real time.

Direct Psychiatric Service

Given the complexity of the nation’s health care system, care coordination (or case management) is essential to helping patients and their families navigate access the appropriate level of psychiatric services (e.g., outpatient, urgent, emergency, inpatient).

Care coordination is an important component of effective collaborative partnerships.

Care Coordination

Care coordination needs to be part of the collaborations. PCCs should consider in the their practices the inclusion of Social Workers who can be responsible for care coordination and case management.

Social Workers are well versed in utilizing the available community mental health resources.

Social Workers are well trained in both of these roles.

Care Coordination

Social Workers and other Mental Health clinicians have the opportunity to educate PCCs regarding mental health issues and treatments that allow PCCs to extend their involvement in mental health care beyond their usual scope of practice.

Care Coordination

They also have the opportunity to guide PCCs in the education of their patients and their families. Mental Health clinicians working with the PCC can “lunch and learn” in primary care practices about cases, diagnosis, treatment, best practices, therapies, and community resources.

Care Coordination

Opportunities to involve mental health providers of care in CME training events, case conferences, and collaborative office rounds can enhance the relationship as well as provide an opportunity to share opinions on the care of selected patients.

Care CoordinationThe Benefits

Advocating for collaborative mental health

partnerships ranges from simple networking with community PCCs, to implementing a local community program, or to building large‐scale partnerships.

Working with PCCs have proven to be a successful combination in building a strong foundation of awareness and concern among the widest array of stakeholders about the problems of access to mental health services.

Advocacy

“The walls between professions and institutions will crumble, so that your experiences will become seamless. You will never feel lost.’’

Institute of Medicine, Crossing the Quality Chasm. The New Health System for the 21st Century. Washington, DC: National Academy Press; 2001

CONCLUSION

Documents

Janice Berry Edwards, PhD, LICSW, LCSW-C, BCD, ACSW