Don R. Lipsitt Award Lecture: Integrated Care: Implementation Strategies at an Academic Medical Center

Background: The evidence for systematic integration of mental health into primary care is robust. ‎Integrated models, such as the collaborative care model (CoCM), improve access to care, reduce total cost ‎of care, and most importantly, they improve patient outcomes for the common psychiatric conditions. ‎However, implementation strategies vary across health care organizations. This interactive workgroup will ‎review implementation strategies when building integrated behavioral health (IBH) services at academic ‎medical centers, and how integrated programs add value across the departmental missions (i.e., clinical, ‎education, research, advocacy, community engagement). ACLP participants will engage with the ‎discussant and speakers about real-world challenges when implementing these models of care. ‎

In addition to brief presentations, 30 minutes will be allotted for audience participation and a facilitated ‎discussion.‎

‎Dr. Anna Ratzliff will serve as the moderator and will briefly review key principles of ‎implementation science and application to Collaborative Care.‎

‎Dr. Lorin Scher will describe how the UC Davis Department of Psychiatry partnered with the ‎ambulatory care leadership and the division of population health to implement IBH across 14 primary care ‎sites at UCDH. He will also review the evolution, development and sustainability of the following program ‎components: PCP and staff engagement, screening initiatives, case management services, collaborative ‎care model (CoCM) implementation, and embedded psychiatry consultation. ‎

‎Dr. Christina Lee will share her experience working as an adult integrated behavioral health ‎psychiatrist and e-consultant at UC Davis. She will provide an overview of the structure of the clinic, ‎including collaboration with integrated behavioral health therapists and strategies in building relationships ‎with primary care physicians. Dr. Lee will also review opportunities to teach trainees about collaborative ‎care through the integration of residents and fellows in the various clinic sites. ‎
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‎Dr. Michael Donath is a current fellow in consultation-liaison psychiatry at UC Davis and will ‎discuss his personal experience rotating through the integrated care program. Dr. Donath will review the ‎educational benefits of an integrated care curriculum. He will also highlight the importance of trainee ‎exposure to health systems science, population health models of care, and team-based care in the ‎ambulatory settings. Additionally, Dr. Donath will summarize key factors that lead to positive resident and ‎fellow experiences within integrated settings. ‎
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‎Dr. Melissa Hopkins will discuss approaches to designing and implementing a pediatric integrated ‎care program by adapting from the UC Davis adult clinic model. Challenges and successes encountered ‎during the program’s launch will be discussed and differences in implementing integrated care efforts with ‎pediatric populations will be highlighted. Dr. Hopkins will also describe how a population health framework ‎is being used to improve access to mental health care throughout the UC Davis health system and the role ‎of integrated care in laying the foundation for this approach.

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References: ‎
‎1. Matthew L Goldman, Ekaterina Smali, Talia Richkin, Harold A Pincus, Henry Chung, A novel continuum-based ‎framework for translating behavioral health integration to primary care settings, Translational Behavioral ‎Medicine, Volume 10, Issue 3, June 2020, Pages 580–589, https://doi.org/10.1093/tbm/ibz142‎
‎2. Adams TCE, Lim CT, Huang H. The Practice of Psychiatric E-Consultation: Current State and Future Directions. ‎Harv Rev Psychiatry. 2022 May-Jun 01;30(3):191-197. doi: 10.1097/HRP.0000000000000338. Epub 2022 Apr ‎‎23. PMID: 35452426.‎
‎3. American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Collaborative and Integrated ‎Care and AACAP Committee on Quality Issues. Clinical Update: Collaborative Mental Health Care for Children ‎and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry. 2023 Feb;62(2):91-119. doi: ‎‎10.1016/j.jaac.2022.06.007. Epub 2022 Jun 29. PMID: 35779696.‎
‎4. Zimbrean PC, Ernst CL, Forray A, Beach SR, Lavakumar M, Siegel AM, Soeprono T, Schwartz AC. The ‎Educational Value of Outpatient Consultation-Liaison Rotations: A White Paper From the Academy of ‎Consultation-Liaison Psychiatry Residency Education Subcommittee. Psychosomatics. 2020 Sep-Oct;61(5):436-‎‎449. doi: 10.1016/j.psym.2020.05.004. Epub 2020 May 19. PMID: 32650995; PMCID: PMC7235569.‎