Mental Muscle: Addressing Behavioral Health in a Medical Home Framework
By Richard Scott
Medical Home Today
July 19, 2012
sat down with Kimberly Roberts, MA, LLP, a developmental psychologist embedded in a pediatric physician’s office, to gather a firsthand perspective of the fluidity and functioning of a medical home team in action.
Roberts shares her experiences below.
Medical Home Today: Can you describe the benefits of working within a patient-centered medical home model?
Kimberly Roberts: As a developmental (child) psychologist, my philosophy of care has always been one of integrating intervention into all the spheres of a child’s life – by integrating myself into a primary care physician’s office, I am able to advocate for the child and collaborate with the doctor, call upon other services (e.g., school, community, faith-based organizations), and help the family all at the same time. Efficiency is the name of the game.
The time spent (and therefore the money spent) from initial referral question to healing process is significantly lower. Where a behavioral health referral may take months (three to 18 months) in a private practice or school setting, I can usually see a child within a couple of weeks. She won’t lose months to waiting.
I free up the doctors to do the things they do best – and when a behavioral question comes up, they can let me do the things I do best.
The stigma of behavioral services decreases dramatically – children, adolescents (especially) and families are not afraid to show up at a doctor’s office they’ve been going to for years to see a lady that looks like everyone else there.
MHT: What is the normal workflow between yourself and fellow team members? At what point do you (and team members) enter the patient’s world?
KR: Usually, the doctor will see the patient for any number of reasons and during the course of the visit will be made aware of behavioral issues. The doctor then asks if the patient would like a referral to me; if the response is positive, the doctor will then give me a written referral. I will then call the family, screen for a preliminary differential diagnosis, and possibly make an appointment. During the course of assessment, therapy and/or testing, the doctor is kept abreast of my progress on the chart and verbally, if they ask. If medication is indicated, the doctor and I work closely together to monitor adherence to a medical regimen. Many times, the family has other needs and then I go to the care managers who help with a myriad of other referrals and services.
MHT: What effect have you seen on transitions of care and patient follow through as a result of these coordinated efforts?
KR: I have had limited experience with transitions of care but in cases where a child lands in a psychiatric hospital, I have been able to track them and provide aftercare services. In addition, I have also been able to call upon the care managers to help. Patient follow through is always better if a family knows that there are several people at the doctor’s office who are thinking of them regularly and want them to get better.
MHT: Do you have any success stories you could share?
KR: I have numerous success stories. I have had mothers tell me that there child would never have gotten into college had it not been for our efforts. I have had children who were too scared and anxious to go to school be able to finish out their year with a smile and move on to the next grade. I have had abused children who were anxious and depressed feel empowered enough to jump back into life.
MHT: Where do you see the future of the medical home going – and is it here to stay?
KR: The primary care physician’s office is the natural place to begin a wrap-around service industry. At our practice, we already consider ourselves a complete ADHD clinic and are in the talking phases of eventually having an obesity clinic for children on the property. I see PCMH’s being the Meijer’s of healthcare – those that do it well will be able to serve whatever health need a person has – reducing sick time, anxiety and costs. Our care managers will be like healthcare concierges that will be available to everyone and because of their discretion, the very best services will be utilized again and again. The cream will rise to the top, so to speak. A good PCMH will develop organically to meet the needs of its population, benefiting the entire community.