During the CNY Care Collaborative Board of Directors meeting on June 23, 2016 Planned Parenthood Mohawk-Hudson (PPMH) presented a “Project Spotlight” highlighting the success they’ve experienced by co-locating Behavioral Health services in their practice.
For half a day, once a week, a therapist from Psychological Healthcare, LLC is on site at PPMH to work with patients who score on the PHQ-2/9, or who are referred based on clinical judgment of the PPMH provider. The complete “Project Spotlight” presentation is available for view, here.
What follows are excerpts of a conversation CNY Care Collaborative had with PPMH’s Utica Health Center Director, Cheryl Lincoln-Lovely following the presentation, discussing the challenges, accomplishments, and thoughts on how other organizations could replicate PPMH’s success.
How did this project start?
Actually, our CEO and our Medical Director called the lead clinician on this project and me, and asked if we thought this (incorporating behavioral health services into PPMH) was “do-able”; we both said “yes” and we thought it was needed. Our patients needed this service and they were really comfortable coming here. We believed our patients would be comfortable getting expanded services here at PPMH.
Before PPMH was offering this service, where do you think your patients were going for behavioral health services?
I think some patients were seeking services outside of here. I think some patients were seeking outside services, but many just didn’t know where to go -- and they didn’t realize before we started doing the screening that it was something they could get help for. Or, they simply didn’t recognize that behavioral health services were something they really needed.
Can you share an example?
I can give you a recent example of a young woman that came into PPMH. We did the screening and she moved into the PHQ-2/9. After talking to the Nurse Practitioner the patient said she didn’t realize it wasn’t normal to feel so bad on a regular basis” and to struggle through her days. She had become so used to feeling “not great” all the time that she didn’t realize something could be different.
As a result, we ended up prescribing medications and scheduling appointments with our behavioral therapist. And when she did come back in for a follow-up appointment -- from what I understand -- she felt like a completely different person.
How did you communicate this program to your patients?
Basically, when we started doing the screenings we explained that we were trying to expand services and we knew that our community had a great need for behavioral health services.
We let patients know that we were providing the screening to every person that came in. That also let them know that they were not being singled out for needing help. We shared with them our plan to expand these kinds of services, and many patients agreed that there is a high level of need in our community.
Did you experience any reluctance to participate?
Not very much if any. I haven’t heard any feedback about patients being upset about the questions or annoyed that were asking the questions at all. I think patients are receptive because anytime we’ve implemented new services, we’re sure to explain in laymen’s terms what we’re doing and why we’re doing it.
So how did the relationship with Psychological Healthcare, LLC develop?
Actually, it developed because our Health Center Director from the Rome-Oneida clinic went to event called “Speed Dating” at CNY Care Collaborative – and that’s how she connected with Leslie at Psychological Healthcare. So that worked really well.
How does the co-locating relationship work with Psychological Healthcare?
Well, I know from our end it’s going really, really well. They’ve been very easy to work with, they’re very organized, the therapist we’re working with (Leslie) is just wonderful and very focused on patient care. I’ve found every person in that organization to have the same mindset. So things are going really well.
Do you think this is something that can be replicated by others?
Why did this project work?
I think a key thing was “staff buy-in”
And I think that was because our initial approach was to present the idea to our staff, and explain how it was going to benefit our patient base. And as we started moving along the project we really incorporated staff input on how we were going to make this work.
What are the challenges to achieving “staff buy-in”?
I think most places probably feel so overwhelmed already, so it can probably seem (from a staff perspective) that things just keep getting thrown at them.
So rather than just say “we’re going to do this because DSRIP and CNY Care Collaborative say we have to” you should explain why we’re doing this. I think if the people implementing the programs go in saying “we’re doing this because it’s really important to our community, and it’s really important to our patients” then the staff works together to make it work.
Buying in also includes leadership; our CEO and our Medical Director really embraced this project and they embraced it because of the need of our patients. Their approach and support was wonderful because they asked right from the start:“Do you feel this is something we can accomplish?”
What other challenges did you face?
I think the most difficult part of the project was probably trying to figure out the coordination issues and how we were going to have someone co-located between two agencies.
I’ve found that we’ve been very creative and we have incorporated more people into the group since we started out as a MAX (Medicaid Accelerated eXchange) project. At this point, we have incorporated what we call stakeholders – like the people in our IT department who are experts in our EHR system -- and had them join in. Their expertise was instrumental because that was where some bumps in the road came up (e.g., How are we going to chart this? How are we going to communicate?). It’s really important to bring in a holistic approach to make it successful.
There’s still some fine tuning that we’re doing, but we were realistic about that too – we realized that the first time we tried something we may not be perfect -- and that was okay.
So what does the future hold?
Eventually, we are planning to expand the behavioral health program throughout the Planned Parenthood affiliate. Our plan is to finish up what we consider the MAX project in September. Then, we’re setting up telemedicine so that this behavioral health element can be expanded through tele-health and into our other sites. We’re in one (site) now, we want to expand to all ten. So we are looking at that moving out throughout the year.
Any final thoughts?
Kelly Lane (CNY Care Collaborative Project Manager) has been wonderful to talk with. She’s been supportive the whole time. And I think that ties in. I really think that projects of this magnitude cannot be successful unless you have everybody involved on board. So I think that’s been the key, honestly.
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