The intent of the CMHA-CEI Integrated Care Initiative is to enhance the availability of mental health treatment services to patients of the various county Health Department clinics as well as primary care clinics within the Tri-County Area. The goal is to provide brief, evidence based, effective, outcome focused, services which are coordinated with primary care services in a fully integrated manner.
The co-located project with the Ingham County Health Department (ICHD) has continued to operate to capacity with three Mental Health Therapists located at three ICHD sites and recently experienced the exciting addition of four hours of consultative psychiatry to the main ICHD Adult Services location on S. Cedar.
Co-located services at the Eaton County office of the Barry-Eaton Health Department were added in July 2011 with excellent success thus far. Additionally, with the assistance of a Michigan Department of Community Health (MDCH) Block grant, co-located mental health services will be available in Clinton County through a project with Gratiot County CMH and the Mid-Michigan District Health Department which serves both Clinton and Gratiot Counties.
Through the diligence of many partners, primary care services will soon be available to AMHS consumers at the main CMHA-CEI site at 812 E. Jolly Road. This clinic, operating at two half days per month, will be made possible by the partnership of the Sparrow Family Medicine Residency Program (SFMRP), Michigan State University, Ingham County Health Department and Community Mental Health, with physician services being provided by the SFMRP. For persons with serious mental illness, a population which has a life expectancy of 25 years less than those without mental illnesses, this project will be invaluable.
Patients requiring behavioral health services are identified using a variety of methods which vary by the particular clinic location. Requests for mental health services are made by medical staff: 1) in writing, 2) by using an established referral form, or 3) electronically by using any form of messaging or notification within the clinic’s electronic medical record system (if available).
In all cases however, staff will strive to accomplish a “warm hand off” of care in which the medical provider introduces the behavioral health clinician to the patient, explains the purpose for the clinician’s involvement, provides a statement of the anticipated benefit possible through behavioral health services, and/or explains any other details necessary for effective integration of care.
CMHA-CEI behavioral health clinicians provide prompt documentation of all services provided and communicate regularly with medical providers regarding patient progress and/or any significant changes in the patient’s status. Medical providers, likewise, provide routine information to behavioral health clinicians as well.
Behavioral health services are intended to be brief and outcome focused. Evidence based treatment techniques are utilized, including but are not limited to the following: Cognitive Behavioral Therapy, Dialectic Behavior Therapy, Eye Movement Desensitization and Reprecessing, supportive psychotherapy, solution focused approaches, motivational enhancing techniques such as Motivational Interviewing, Targeted Case Management (when applicable), trauma informed care, family therapy, etc. When indicated, and as reimbursement streams become established, behavioral health clinicians seek to utilize various “health coaching” protocols and techniques to enhance psychological adjustment to chronic health conditions, promote improved tolerance of pain or physical disability, improve management of cardiac disease, provide instruction regarding stress reduction, provide training in progressive relaxation, etc.
When an outcome measure is established as a recognized means of evaluating the status and/or progress in treatment for a given condition, CMHA-CEI behavioral health staff will use such a tool. Measures endorsed by peer reviewed literature, by the National Institutes of Mental Health, and/or by the Substance Abuse and Mental Health Service Administration are strongly favored. Notation of the specific results of such measures will be noted within the medical record. Outcome measurements will be taken over time as a means of demonstrating the effectiveness of behavioral health services.
Services are provided using a brief, focused, model and the patient’s case is opened and remains open as long as he/she is a patient of the particular health clinic. Patients need not been seen regularly to remain eligible for behavioral health services.
In the event that a patient is no longer eligible for services through the health clinic, behavioral health services will be concluded as well. In the event that a patient is determined by the behavioral health clinician as potentially exhibiting symptoms or needs of a more serious nature, and as such may be potentially eligible for more intensive mental health or developmentally disabled services through CMHA-CEI, he/she is referred to Central Access for further eligibility screening.