Santa Rosa, California (pop 168,000) is the largest urban center between San Francisco and Portland Santa Rosa Community Dental Center (SRCDC) is a

Transcription

1 Santa Rosa, California (pop 168,000) is the largest urban center between San Francisco and Portland Santa Rosa Community Dental Center (SRCDC) is a FQHC which is part of Santa Rosa Community Health Center System of Clinics Our 5 medical clinics served 52,876 patients last year and the Dental Center pulls most of its patients from this pool.

2 VISTA FAMILY MEDICINE CLINIC ROSELAND PEDIATRIC CLINIC SOUTHWEST FAMILY MEDICINE CLINIC ELSIE ALLEN SCHOOL BASED CLINIC BROOKWOOD HOMELESS CLINIC

3 14 Chair Stand Alone Clinic 5.4 Dentists 1 Pediatric Specialist 1 Hygienist 13 Assistants/6 Reception Open since Feb SRCDC Operations

4 What Caused Us to Look at BH Integration? Patient with a disassociate event after dental treatment and young child with a panic attack Prompted meetings with the CMO and Director BH to ask ourselves what can we do?

5 Closer Look at our Population of Dental Patients to Find Out BH Needs In 2014 SRCHC served 1,157 individuals experiencing homelessness 37% of these patients have psychiatric or emotional conditions In last 12 months: # of BH Patients - 7,591 # Anxiety Diagnosis 2, % of our total patients have a BH Diagnosis 5.3% have Anxiety Diagnosis Metrics for other specific BH Diagnosis to come but anxiety typically affects more

6 Anxiety Disorders: Panic Disorder, OCD, GAD, PTSD, Social Phobia, Other Phobias

7 Trauma Informed Care (TIC) Trauma is a near universal experience of individuals with behavioral health problems. 85% 95% of women in the public mental health system report a history of trauma U.S. Department of Health and Human Services Office on Women s Health About 6 of every 10 (or 60%) of men and 5 of every 10 (or 50%) of women experience at least one trauma in their lives. (child/sexual trauma more common in women) (accidents, assault, combat scenarios more common in men) 05/27/15

8 Almost Half the Population Has Experienced Childhood Trauma Adverse Childhood Experiences study, conducted by the CDC and Kaiser Permanente, is one of the largest studies (>17,000) ever conducted to assess associations between childhood maltreatment and later-life health and wellbeing. Adverse childhood experience - physical or sexual abuse, neglect, or family dysfunction

9 Trauma Informed Care (TIC) Trauma is often shrouded in secrecy and denial. But when a hx of trauma exists, the abuse may be unintentionally recreated TIC is an approach that aims to engage people with histories of trauma, recognize trauma symptoms, and acknowledge the role that trauma has played in their lives Dental Teams should understand the principles of TIC and should work collaboratively with BH personnel to deliver dental treatment appropriately.

10 Mental/Dental Integration

11 Simple Integration Patient Education and Information Materials are co-located One page flyer with all-site BH services are available in Dental Reception, Patient Bathroom and Dental Suites Drug and alcohol brochures available to pass out in dental Cards with the Mental Health Coordinator s Contact Information available to pass out in Dental Clinic Information on Dental Clinic Services given to BH Staff to distribute

12 Patient Referral From Dental to BH: Have BH Care Coordinator Contact Info to pass to Patient Have a Resource for Immediate Consults at point of care: (i.e. patient in room upset etc.) Ours is a direct line to a BH clinician Have an on site Dental Anxiety Coach

13 Dental Anxiety Coach Dental Anxiety Coach A licensed psychologist who can rotate through the Dental Center each week She can: - have a schedule to see designated BH patients before their dental treatment (with patient agreement) - be available for brief interventions with upset patients (including children) and warm hand-offs to BH Her role is kept very low key. Recommend shadow dental team first

14 Plan for Routing/Identifying BH Patients Example: BH to Dental Referral The BH referral note, which includes pertinent BH information and suggestions regarding dental care, is placed in Dental Chart when patient appointment is made Patient is identified as a BH patient in Dental Chart using a trackable designation - Serves as an alert for the Dental Team - Ensures Continuity of Care with the same DDS Follow Up Care Calls to check on patient (don t hand hold too much)

15 How Can We Identify Patients With Potential BH Needs? 1) Include a BH question in the Medical History form: Is there anything, in particular, that might cause you anxiety in coming to the dentist? YES NO Would like to discuss in private 2) Note Dx: anxiety, (including panic disorder), social anxiety disorder, PTSD, GAD, or phobia in Medical Chart, but remember these may be mild cases, so NO to above question means NO 3) Be alert to patient behavior - BH staff to train Dental Team on this

16 Equipping the Dental Team Ongoing Behavioral Health Trainings for the Dental Team held by BH Staff to build awareness, response techniques, and motivational interviewing skills Clear Guidelines on Clinical Management of patients on meds for their BH condition i.e. drug interactions with common dental meds, use of nitrous oxide etc. Continuity of Care with the same DDS

17 Training Plan Overview of BH Conditions and Rationale for Integration Train on Workflow and Resources Available to the Team Motivational Interviewing BH Conditions with screening, behavior guidance techniques, and clinical guidelines on dental management Anxiety Depression Substance Use/Abuse (including alcohol and tobacco) Eating Disorders Trauma Informed Care Childhood Mental Health Issues

18 Equipping the Dental Team: Goals Work to change the perception of the Dental Team to move away from seeing patients as Uncooperative or Difficult Raise awareness of the Dental Team to the prevalence of BH conditions Empower Team response by raising BH competency

19 THANK YOU! Alicia Montell DDS