Connection and Integration

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17th Annual VA Psychologist Leadership Conference Serving Veterans Through Inter-professional Care And Expanding Partnerships Connection and Integration

1 17th Annual VA Psychologist Leadership Conference Serving Veterans Through Inter-professional Care And Expanding Partnerships Connection and Integration Stephen C Hunt MD MPH National Director, Post-Deployment Integrated Care Initiative Clinical Associate Professor of Medicine UW Department of Medicine OEM Program

2 Objectives To describe the history of the integration of medical care and mental health care in VA To articulate the rationale for and evidence supporting integrated care platforms for returning combat Veterans To discuss care integration in the context of health care in general, with an emphasis on the relevance of this to psychologists 2

3 Dedications Philip H. Rhinelander

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5 Descartes Des Horse 5

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7 M G A N G A Healer Doctor M C H A W I Magician Sorcerer Witch Wizard

9 Rate the degree to which you believe Persian Gulf Illness is: P e r c e n t Internal Medicine (n = 77) Mental Health (n = 176) 0 Mostly a Physical Disorder Mostly a Mental Disorder Richardson RD, Engel CC, McFall, M, McKnight K, Hunt SC. Clinician Attributions for Symptoms and Treatment of Gulf War-Related Health Concerns. Archives of Internal Medicine 2001; 161:

Rate the degree to which you believe Persian Gulf Illness, in general, is most effectively treated by: P e r c e n t 30 25 20 15 10 5 Internal Medicine (n = 77) Mental Health (n = 176) 0 Mostly

10 Rate the degree to which you believe Persian Gulf Illness, in general, is most effectively treated by: P e r c e n t Internal Medicine (n = 77) Mental Health (n = 176) 0 Mostly Biological Interventions Mostly Psychological Interventions Richardson RD, Engel CC, McFall, M, McKnight K, Hunt SC. Clinician Attributions for Symptoms and Treatment of Gulf War-Related Health Concerns. Archives of Internal Medicine 2001; 161:

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13 Primary Care-Mental Health Integration (Primary Care Mental Health Integration Initiative 2007) PCP Veteran MH

15 Post-Deployment Integrated Care Post-Combat Health Concerns Non-combat injury Combat injury TBI Marital/family financial difficulties Environmental exposure illness Non-combat illness Spiritual / existential struggles Post-combat symptoms Hearing loss tinnitus Mental health Needs C&P 15

16 Post-Deployment Integrated Care Integrated Post-Combat Care Non-combat injury Combat injury TBI Marital/family financial difficulties 16 Environmental exposure illness Non-combat illness Hearing loss tinnitus Spiritual / existential struggles Mental health Post-combat symptoms Needs C&P

17 Integrated Post-Combat Care Physical Psychological Veteran Psychosocial

18 Integrated Post-Combat Care PDICI Post Deployment Integrated Care Initiative 2008 Medical Provider MH Provider Veteran Social Worker

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20 The Continuum of Mental Health Treatment within a Whole Health Collaborative Care Model Level 1 Level 2 Level 3 Level 4 Self-care Community Accessing internet or smart phone applications and print resources from the community Incorporating proactive self-care strategies Foundational care available to all (Prevention and Resilience) Guided selfcare, integrative health coaching or peer support Primary care, PCMHI or PACT Assess for current stressors, develop trust, and use PHI to identify goals Brief professional treatment General mental health specialty care or PCMHI Mild or subthreshold conditions addressed Continue to assess for current stressors Offer integrative approaches Professional treatment Condition- specific subspecialty care Address cooccurring conditions Continue to assess current stressors and offer adjunct integrative 20

21 PPPD Care in a Measurement-based System: Balancing Our Approaches Disease Management and Risk Reduction 21

22 Interprofessional Care and Expanded Partnerships Will Enhance Mental Health Care The plan for Personalized, Proactive, Patient-driven Care in a Measurementbased System contributes to enhanced mental health care through a number of mechanisms. The focus on health and wellness can enhance Veterans mental health Prevention of mental disorders will translate into enhanced quality of life Enhancing communication/trust will enhance quality of care Moving to the left will extend effective interventions to additional patients. The increased availability of self-help will make interventions available to those who are reluctant to engage in care Increasing care for pain and insomnia will target important risk factors Measurement based care will improve outcomes for mental health treatment 22

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24 Connection Integration

25 Serving Veterans Through Inter-professional Care And Expanding Partnerships Connection and Integration VA Psychologists Leading the Way

HOME BASE A PRIVATE SECTOR PROGRAM FOR VETERAN AND FAMILY CARE

HOME BASE A PRIVATE SECTOR PROGRAM FOR VETERAN AND FAMILY CARE Louis Chow, PhD Director of Education MISSION World Class Care: High quality, evidence based, patient centered, safe, technologically advanced,