Video Demonstrations of Integrated Medicine Procedures
1. Warm Handoff - Motivational Interviewing: The Primary Care Physician (PCP) using a warm handoff to a Behavioral Health Consultant (BHC who is a Mental Health Worker) when there is a concern about the behavioral health of a patient. When the PCP meets with the patient the PCP uses Motivational Interviewing to engage the patient’s cooperation and willingness to participate in meeting the BHC, to put a plan into action. The steps of the Motivational Interview are:
- Use reflective listening: The PCP seeks to understand the patient’s idea about the issue for which a handoff from the PCP will be made to the BHC. The PCP in this step then offers a recap of the patient’s ideas so as to confirm an understanding of the ideas offered.
- Ask permission: The PCP asks the patient if he/she is open to talking with the Behavioral Health Consultant (BHC).
- Ask open-ended questions: When the BHC meets the patient, the BHC avoids asking questions with yes or no answers to engage the patient in conversation on the issues for which the handoff has been made.
- Enhance motivation: The BHC elicits talk from the patient about change and the patient’s desire, ability, reason and need to change.
- Determine patient’s readiness: The BHC determines the patient’s stage of readiness for change.
- Negotiate a plan: The BHC negotiates a plan with the patient based on what steps he/she is ready to take.
Video available at: https://www.youtube.com/watch?v=GpSU7zMZ6xA
2. Warm Handoff – Anxiety: The Primary Care Physician (PCP) using a warm handoff to a Behavioral Health Consultant (BHC who is a Mental Health Worker) when there is a concern about anxiety as the behavioral health issue of a patient. When the PCP meets with the patient the PCP uses Motivational Interviewing to engage the patient’s cooperation and willingness to participate in meeting the BHC, to put a plan into action to address the anxiety. The steps of the Motivational Interview are:
- Define Integrated Healthcare: The PCP explains to the patient how primary health and behavioral health work together
- Ask permission: The PCP asks the patient if he/she is open to talking with a BCH.
- Team communication: The Primary Care and BHC consult together about the patient
- Build rapport: The BCH forges a nonjudgmental connection with the patient
- Raise the subject: The BHC explains the role of BHC, introduces the process and asks permission to have a discussion about the anxiety issues which the patient is experiencing
- Reflect on change: The BHC summarizes what has been discussed with the patient about the anxiety related issues.
- Establish next steps: The BHC assists the patient with scheduling a follow-up appointment.
Video available at: https://www.youtube.com/watch?v=pkKZ4e0iUqg
3. Brief Intervention: SBIRT: Screening Brief Intervention Referral to Treatment is an evidence based intervention which can be used within Primary Care Setting to assist patients to address their problematic substance abuse issues.
SBIRT involves the following steps:
- Build rapport: The staff person (usually a Behavioral Health Consultant-BHC) forges a nonjudgmental connection with the patient.
- Raise the subject: The BHC explains the role, the process and asks for permission to have discussion about the substance/alcohol use.
- Provide feedback: The BHC share pertinent information and elicits patient feedback.
- Enhance motivation: The BHC uses reflections and other tools to increase a patient’s readiness to address and change health behaviors.
- Negotiate a plan: The BHC negotiates a goal with the patient based on what steps she/he is ready to take
Video available at: https://www.youtube.com/watch?v=T4EFmjw7Epc
4. Morning Huddle: The staff of an Integrated Primary Care Center have brief morning meetings to go over their list of patients and their specific needs which the team can address when the patients come in that day:
There is no set formula for Morning Huddles, so they can be adapted by each team for the steps that work for them.
The steps involved in such huddles are:
- Conducting check-in: This is a motivational building activity of checking in with the members of the team to build morale
- Reflect on the week: This gives the team a chance to discuss any successes or challenges their patients gave them over the past week
- Overview of patients: The staff reviews patients’ physical health, behavioral health and any high risk issues.
- Agree upon tasks and integrated activities: The team members decide on the day’s consultations and warm handoffs.
- Agree upon follow-up and communication: The team members make a plan of action items.
Video available at: https://www.youtube.com/watch?v=-8lDsdru0Hs
NOTE: You will see that each video has DSRIP labeled on it. To clarify what this means we looked at what is DSRIP. The Delivery System Reform Incentive Payment (DSRIP) Program is the main mechanism by which New York State will implement the Medicaid Redesign Team (MRT) Waiver Amendment. DSRIP´s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health.
It was for this program that the National Council for Behavioral Health developed the above set of training videos to explain various components of Integrated Medicine. Since these are excellent quick videos they are being presented here so that you can get a better idea of what integrated medicine teamwork and patient interventions look like.
