Untreated Trauma and Chronic Disease Network - background information for April, 2012 meeting
The Interface between Mental Health and Medical Care
Background:
Vermont’s Blueprint for Health is “a state-led initiative that is transforming health care delivery in Vermont with a focus on seamless, effective and preventive health services.”
- Vermont Blueprint for Health 2011 Annual Report, January 2012, pg 3.
(All Blueprint annual reports can be found here: http://hcr.vermont.gov/blueprint_for_health )
A stated goal for the Blueprint for Health in 2012 (pg 32) is;
“to better integrate the identification and treatment of mental health and substance abuse with primary care and the holisitic approach to individuals and patients. In collaboration with other state agencies (Department of Vermont Health Access or DVHA, the Department of Mental Health and the Division of Alcohol and Drug Abuse programs, or ADAP [within Vermont Department of Health] ), service providers and a mental health consumer, Blueprint staff developed three priorities to address health disparities in mental health and substance abuse.
- Improve the capacity of patient-centered medical homes to provide mental health and substance abuse care to individuals who are primarily served in primary care and for individuals who are seeking medication assisted treatment for opiate dependence.
- Create a systemic framework for the coordination of specialty substance abuse and mental health care with patient-centered medical homes for individuals with significant health, mental health, and/or addictions conditions.
- To develop capacity within specialty substance abuse and mental health settings to provide coordinated health care for individuals served primarily in specialty programs.
Another important feature of the Blueprint for Health, for our purposes, is the Community Health Team concept. Each Blueprint practice creates a Community Health team as a core feature of the practice.
From the 2009 Blueprint Annual Report (pg 8):
“The Community Health Team (CHT) is a group of qualified multi-disciplinary professionals intended to help a general population engage with preventive health practices, and to improve health outcomes. The teams include personnel such as nurses, social workers, behavioral health counselors, nutrition specialists, and public health specialists. They are local, work closely with medical home clinicians, and provide direct support to patients and families. Teams can be designed, scaled, and staffed based upon the needs of the population they serve, and to operate in urban, suburban, and rural settings.
An important design principle is that the CHT is intended to be a nimble entity, whose members can adjust their schedule and spend time in a particular clinical setting based on the size and needs of the population. Team members meet regularly to review strategies and make plans for improved coordination of services. The CHT is a functional unit whose services are not limited to a particular setting, organization, or subpopulation.”
From the Vermont Blueprint for Health 2011 Annual Report, January 2012 (pg 8):
“Many patients and families need additional services (both medical and non-medical) that go well beyond those that are readily available in the traditional primary care setting….
Effective teams (defined as inclusive and transformative) are the basis for all of the quality improvements in the Blueprint, supported by payment reforms that provide patients and practices with unhindered access to CHTs [Community Health Teams], CHT extenders, and self management opportunities.”
[CHT extenders] “ are individuals or teams that work closely with the core CHT to support more targeted subpopulations. They work directly in communities providing more intensive services to individuals that need them while the core CHT members support the general population. The APCPs [Advanced Primary Care Practices], core CHT members, and CHT extenders establish a flexible continuum of preventive and wellness oriented services in a community that can respond to changing needs of individuals and families. Examples of CHT extenders include:[Medicaid care coordinators who act as case managers for hig-rsik patients with particular chronic conditions, and the Support and Services at Home Program (SASH) for Medicare beneficiaries, so that individuals can live and age safely at home.”
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