San Francisco Primary Care Interface: Coordinating Behavioral Health

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San Francisco Primary Care InterfaceCoordinating
Behavioral Health Health Care ServicesRose
Jenkins Conference October 2007 Sacramento,
California

• Presenters
• Michael Baxter, MSW
• Sai-Ling Chan-Sew, LCSW
• Debi Hines, RN
• Hamilton Holt, M.D.
• Irene Sung, M.D.

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Presentation Overview

• Primary Care Interface (PCI) Levels
• PCI Case Studies
• PCI New Policies and Funding
• PCI Lessons Learned Replication
• Questions Answers

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Definition of PCI

• Primary care interface is a partnership among
  health care professionals, behavioral health
  providers, and families to meet the behavioral
  health and health care needs of children and
  youth through a collaborative care management
  approach, usually at the primary care setting.

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PCI Models
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PCI Communication

• No direct consultation between health care
  professionals and behavioral health providers
• Release of information

• Paper exchange e.g. medication form

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PCI Consultation Case Management

• Community Needs Assessment
• 11 clinics visited
• High priority needs identified 1) prompt,
  thorough psychiatric evaluations
  2) curbside questions for less acute cases and
  3) behavioral health education
• Staff resources designated medical doctor and
  social worker

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PCI Consultation Case Management

• Client Assessment Process
• Emergency room model
• Primary care physician (PCP) calls faxes
  referral form to PCI
• Social worker and PCP see child and family in
  primary care setting (within 1-3 weeks)

• Diagnosis and treatment plan discussed with PCP
  and copy placed in psychosocial section of chart

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PCI Consultation Case Management

• Client Follow Up Triage
• Short-term follow up by PCI team (2-4 visits)
• Intermittent, long-term follow up for behavioral
  health-resistant, complicated cases
• Medication management by PCP with backup from
  psychiatrist as needed

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PCI Consultation Case Management

• Follow Up Triage (cont.)
• Bridge to behavioral health clinic, parent
  resources, etc.
• Continuous communication between PCP and PCI as
  child grows older

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PCI Service Co-Location

• Co-location at satellite clinics

• Co-location at primary care clinics

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PCI Co-Location at Satellite Clinics

• Providers
• - Chinatown Park Health Center (Autism Clinic)
• - Mission Neighborhood Health Center
• - Ocean Park Health Center
• - Silver Avenue Family Health Clinic

• Health care providers work with behavioral health
  providers in service areas

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PCI Co-Location at Satellite Clinics

• Joint planning and implementation of satellite
  clinic services in high need neighborhoods
• Hawkins Village co-location of primary
  care and behavioral health with Head Start, legal
  aid and low income housing services

• Services provided include assessment, brief
  interventions, consultation, referrals and case
  management
• One-Stop Shop for access to care and other
  community-based resources

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PCI Co-Location at Primary Care Clinics

• MOU between community-based primary care clinic
  and behavioral health clinic
• Mutual referral and co-management of cases

• Linguistic and culturally competent assessment,
  engagement and referral
• Behavioral health outreach and engagement at
  pediatric clinics

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PCI Full Integration

• Three models
• School-Based Full Service Partnership
• High School Wellness Program
• Integrated Services at Primary Care Clinics

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PCI Full Integration

• Co-located health care and behavioral health
  services

• Providers
• - Balboa Teen Health Center
• - Cole Street Youth Clinic
• - High School Wellness Program
• - Supportive Programs for Youth/Youth Guidance
  Center

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PCI Full Integration/School-Based Full Service
Partnership

• Balboa Teen Health Center comprehensive health
  services on high school campuses

• Services include outreach, assessment, health
  education, behavioral health, clinical services
  and reproductive health counseling

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PCI High School Wellness Program

• Wellness Program multidisciplinary team located
  in a permanent site on a high school campus
• Multi-agency partnership
• Center coordinator reports directly to S.F.
  Unified School District
• Behavioral health services provided by CBO

• Initiative coordinator appointed by Department of
  Children, Youth and Their Families.
• Services include health education and
  assessment, counseling, mental health assessment
  and brief interventions, substance abuse
  counseling
• Coordinates services of other CBOs at site

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PCI Integrated Services at Primary Care
Clinics

• Cole Street Youth Clinic

• Special Programs for Youth/Youth Guidance Center

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PCI Outreach

• Behavioral Health An Adolescent Provider
  Toolkit
• (Adolescent Health Working Group)

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PCI Case Study 1

• 4-year old Filipino boy referred by PCP for
  severe hyperactivity and impulsivity speech and
  language problems impairment of social
  interactions

• Mom feeling overwhelmed caring for child and his
  sibling
• PCI worked with family to enroll child in
  supportive community daycare

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PCI Case Study 1 (continued)

• Progress in speech and languagebut impulsivity
  and distractibility persisted
• Further talks with mother and PCP plus school
  observation
• Conclusion behavioral health would affect school
  success as child entered kindergarten

• Placed on medication trial, evaluated for speech
  and therapy, provided additional educational
  interventions as needed
• Today child participating in classroom school
  engaged in monitoring childs progress mother
  more assured and hopeful

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PCI Case Study 2

• 12 year-old girl of mixed race/ethnicity (African
  American, German, Puerto Rican) admitted for ICM
  services at Family Mosaic Project (FMP) for
  treatment of severe anxiety.

• Prior to FMP enrollment, mother died of
  HIV-related illness. She and her 2 sisters were
  removed from fathers care due to his drug abuse.

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PCI Case Study 2 (continued)

• After drug treatment, father regained custody of
  three daughters, but circumstances still unstable
  in and out of shelters, father unfamiliar with
  parenting, isolated, lack of support.
• Family referred to FMP.

• Three months later, clients younger sister died
  of arteriovenous malformation/burst aneurysm at
  summer camp in front of client.
• Anxiety and fear increase, panic attacks, somatic
  complaints, fear of death.

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PCI Case Study 2 (continued)

• Treated with wraparound behavioral health
  services and support to father to gain Section 8
  housing, parenting skills, individual and family
  therapy.

• Family situation more stable, but clients fears
  persisted, needing concrete evidence that she
  would not die, like her sister.
•  

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PCI Case Study 2 (continued)

• PHN worked with client and family to access PCP
  to r/o AV malformation in client.
• Reqd persistence from PCP and communication with
  therapist who could support client - all
  facilitated by PHN.

• Today father better able to better parent
  daughters, client attending high school
  consistently and preparing for college.
•  

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PCI Lessons Learned Replication

• Need medical doctor
• Need social worker
• Need common language between healthcare
  professionals and behavioral health providers

• Must have understanding of pressures faced in
  primary care setting and within behavioral health
  system
• De-stigmatize access to behavioral health by
  providing services through primary care setting

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PCI New Policy and Funding

• CBHS Integration Policy mandates contractors and
  civil service clinics identify primary care
  clinics as partner agencies
• Healthy San Francisco (Universal Health Access
  Program) funded social worker positions at all
  primary care clinics
• Mental Health Services Act funded Autism Clinic
  in Chinatown Public Health Center and Chinatown
  Child Development Center

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PCI Lessons Learned Replication

• Identify funding MAA billing, MHSA, Medi-Cal,
  General Fund
• Understand difficulties in engaging families

• Ensure services are culturally competent and
  family-driven
• Provide education and training to healthcare
  professionals and behavioral health providers

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San Francisco PCI
Questions Answers
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Contact Information

• Sai-Ling Chan-Sew, LCSW, Director
• Child, Youth and Family System of
  Care/CBHS
• [phone], sai-ling.chan-sew_at_sfdph.org
  
• Irene Sung, M.D., Medical Director
• Child, Youth and Family System of
  Care/CBHS
• [phone], irene.sung_at_sfdph.org
• Hamilton Holt, Jr., M.D., Director
• Primary Care Interface Program
• Child, Youth and Family System of
  Care/CBHS
• [phone], albert.holt_at_sfdph.org
• Michael Baxter, LCSW, Director
• Balboa Teen Health Center
• [phone], michael.baxter_at_sfdph.org
• Debi Hines, RN, Public Health Nurse
• Family Mosaic Project
• [phone], debi.hines_at_sfdph.org

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