Who Should I Refer?VA Primary Care/Behavioral

Health Integration in Practice

David Hunsinger, MD, MSHAMedical Director

Binghamton VA Outpatient Clinic

OBJECTIVE

Over the course of this presentation, participants will begin to consider the

broad range of clinical situations in which involvement of a Behavioral Health

provider can prove helpful.

KEY CHARACTERISTICS

• Co-located• Collaborative• Dedicated Behavioral Health (BH)

Provider with schedule flexibility• Warm Handoffs

BENEFITS OF THE MODEL

Timely patient evaluation and assistance

THERE’S NO TIME LIKE THE PRESENT….

BENEFITS OF THE MODEL

Timely patient evaluation and assistance

• A continuation of the Primary Care encounter• Eliminates the potential for ‘no show’

BENEFITS OF THE MODEL

Face to face introduction

BENEFITS OF THE MODEL

Face to face introduction• Lends legitimacy and credibility• Reduces patient anxiety about the meeting• More personal

BENEFITS OF THE MODEL

Face to face introduction• Lends legitimacy and credibility• Reduces patient anxiety about the meeting• More personal

BENEFITS OF THE MODEL

Reinforces ‘whole person’ focus

Mind body connection by John Hersey

TIP #1

Referrals are not just for Urgent Problems

URGENT PROBLEMS

• Major depression• Anxiety• Grief reaction• Adjustment reaction• ‘crying in the office’

TIP #2

Consider scripting your warm hand-off

intro

WARM HAND-OFF

• “I work with someone whose job is to help

patient’s in situations like this. If you have a few minutes, I’d like to introduce you.”

• “We have someone who is a great resource for these things. Let me introduce you and you can get his/her card if you want to talk to someone about it.”

WARM HAND-OFF

• “One of the members of your healthcare team

is _________. If you have a few minutes, I’d like to introduce you so he/she can tell you a little bit about what kind of help he/she can provide you.”

TIP #3

Refer all positive Clinical Reminder

screens…….better yet, revise clinic flow to have

these patients seen automatically

CLINICAL REMINDERS

• PHQ2/PHQ9 [depression]• PTSD screen• AUDIT-C [alcohol]• ?TBI screen

TIP #4

Think PATIENT NEEDS not DIAGNOSES

NEEDS NOT DIAGNOSES

• Establishing a healthy lifestyle• Behavior change• Tobacco and alcohol issues/concerns• Relationship stress• Job stress

Establishing a healthy lifestyle

• Exercise• Healthy Diet• Sleep hygiene

Exercise

• Cardiovascular conditioning affects many

health conditions• Promotes a sense of well-being• Relieves stress/tension/anxiety

Healthy Diet

• Weight loss• Disease specific concerns• Patients considering MOVE• Patients unable to participate in MOVE

Tobacco Use

• Individual coaching as an alternative to

QuitSmart

Relationship issues

• Spouse/significant other• Children• Boss• Co-workers

TIP #5

Healthcare is a team sport [especially in a PACT

environment]

TEAM

• Talk to your PCMHI provider• Ask for suggestions about referrals• Invite him/her to huddles and team meeting

where patients are discussed

TIP #6

Most people’s lives are impacted far more by

psychological, psychosocial, and behavioral issues than by

physical issues

CONCLUSION

So………… refer early refer often!

CONCLUSION

So………… warm hand-off early

warm hand-off often!