Theme 2. Optimizing capacity of interprofessional teams
Presentation Materials (Members only)
Optimizing Capacity of the Mental Health team. Triaging the patient: who is the right provider? Responding to the Needs of Patients with Anxiety-Developing a Comprehensive Group Program at a FHT
(I) Integrated Care for Better Outcomes: Supporting Primary Care Patients with Mental Health and Addictions Issues
Learning Objectives
At the end of this session, the learner will understand:
- Factors that influence the implementation of evidence-based integrated care in addressing mental health and addictions issues in the primary care settings.
- The role of a Mental Health Care Technician in supporting and enhancing the interprofessional collaboration between primary care and mental health providers.
- The experiences of primary care providers, at participating Family Health Teams working within the context of the integrated care model
- Challenges and strategies for successful implementation.
Summary
Depression, anxiety, and at-risk drinking are among the most common health problems for patients receiving general medical care. The majority of patients are seen exclusively in primary care, and never see a mental health or addictions provider. Undetected, untreated or under-treated these conditions create a significant public health burden. This interactive presentation will overview a three-year research project partnering with Ontario Family Health Teams (FHTs) evaluating an innovative integrated care model of telephone-based, computed aided care management to support the mental health care of primary care patients. The project will compare enhanced usual care (EUC) and a telephone-based intervention -- including psychoeducation, regular monitoring, and support from a Mental Health Technician (MHT) and team supervision from a psychiatrist. Demands in primary care make it difficult for physicians to obtain needed information, follow-up as frequently as needed, and use best practices effectively. The proposed model addresses these gaps by facilitating collaboration with PCP and new MHT role, to provide screening and symptom monitoring, follow-up calls, access to on-line psychotherapies, while enhancing patient self-management and supporting adherence to treatment and medication management. Clinical updates and specific recommendations are sent to PCP to facilitate initiation of evidence-based pharmacotherapy or psychotherapy, and referrals to specialty mental health services when indicated. Within the context of primary care and an integrated care model, partnering FHTs will speak to their experiences identifying and referring patients, utility of recommendations, and communication and collaborating with MHT role. The presentation will discuss challenges and strategies for successful implementation.
(II) Optimizing Capacity of the Mental Health Team. Triaging the Patient: Who is the right provider?
Learning Objectives
Primary care is often the first place a patient with mental health concerns present. These presentations are varied in complexity and urgency and require expert care. How does one decide the best way to support this patient? Understanding the skills mix of the Mental Health Team is essential. At McMaster FHT, a Mental Health Summit was organized and all staff who was interested in mental health services was invited to attend. This meeting revisited the priority and focus of the FHT; the skill set required to meet that focus and the direction of new programming, including a commitment to the interprofessional triage team comprised of the system navigators, occupational therapists, administrative support, leadership, psychology and psychiatry. Outcomes were predicted (and achieved) with regard to wait times, provider and service delivery times.
Summary
This presentation will describe the interprofessional team, the challenges and successes of the triage process and the successful outcome achievement of reduced wait times. The interprofessional mental health team is committed to supporting the various needs of the patient with mental health concerns. Role definition and clear understanding of that role are important in the triaging of referrals appropriately. Identifying the most appropriate provider/professional supports patient centered care by aligning that patient with the profession best suited to meet their needs. This has reduced wait times and resulted in timely and effective care planning that includes the patient. The one hour weekly triage meeting reviews all new referrals, closes files as appropriate, and manages patients who have missed appointments. Complex cases are reviewed as a team and recommendations for ongoing care (patient and provider) are shared. Community Resources are an essential part of the extended interprofessional team. Seeking out appropriate community resources and employment supports is an important strategy within the FHT. The importance of process measures and timely reporting of those measures has worked to keep the team focused on excellence in patient care and effective triaging to the most appropriate team member. Ongoing training was recommended and supported by the Mental Health and the Leadership teams and to that end, DBT training opportunities have been levered. Next (ongoing) steps include further reducing the wait times to within 2 weeks, gathering patient feedback and strengthening the relationships with community partners (i.e. Teen services).
Presenters:
McMaster FHT
- Kathy De Caire, Clinical Director, Stonechurch FHC; McMaster FHT
- Jill Berridge, Clinical Manager, McMaster Family Practice; McMaster FHT
(III) Responding to the Needs of Patients with Anxiety – Developing a Comprehensive Group Program at a FHT
Learning Objectives
In the last 12 years the McMaster Family Health Team has developed a three part group treatment program to address the ever increasing numbers of clients being referred for treatment of anxiety. This presentation will focus on the development of the core anxiety treatment group, a teen group and the aftercare group. It will follow the challenges and sucesses of our groups and help participants develop some practical ideas about how to develop interprofessional group leadership, how to publicize groups, how to structure group sessions and tips about when to move from offering the core anxiety group to offering more specialized programming.
Summary
Patients presenting with anxiety use a signficant amount of many primary care givers time. Skills for managing anxiety can be taught and practiced in a group setting. Learning the skills for managing anxiety in a group can be a normalizing experience and can provide a sense of peer support. Treatment groups provide the opportunity to utilize the skills of numerous health care providers including the pharmacist, dietitian, occupational therapist, psychologist, physicians and social workers. In this presentation, we will begin with a discussion of the structure of our group programs, group resources, treatment modalities, publicity, interprofessional networking, and common mistakes. We will then examine the outcomes of the client satisfaction sureys. Finally, we will provide time for participants to ask questions about their specific clinical experiences. We now have several hundred people referred to our anxiety groups each year. Groups are offered 5-6 times a year so the wait is much shorter for group programming than the wait for individual counselling. We are able, through an interdisciplinary collaborative appraoch, to provide quality care to many more patients than could be served in 1-1 sessions. Client feedback indicates that many clients prefer group sessions to individual counselling particularly in some age groups. Teens, a challenging population to network with, have routinely indicated that they prefer group to individual treatment. The aftercare group provides ongoing clinical support to patients who might otherwise be taking individual appointment spaces. Group programming is an effective response to a significant mental health need and may be part of the solution to the significant numbers of patients seeking mental health care through Family Health Teams.
Presenters:
- McMaster FHT
- K. Lynn Dykeman, Social Worker
- Colleen O'Neill, Occupational Therapist