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The Michigan Mental Health Counselors Association (MMHCA) held its 2015 Conference in East Lansing Michigan on the campus of Michigan State University. The conference was entitled: Integrative Care in the Mental Health Field-Applying Theory to Practice.

There was a Keynote address by Jim Messina, Moderator of the Integrated Medicine Community on AMHCA Connection entitled: Opportunities for Mental Health Counselors in the Next Decade under the ACA (which PowerPoint you can download from Coping.us at: http://coping.us/behavioralmedicine/affordablecareactimplications.html)

Jim’s presentation was then followed by a powerful program on Integrated Care: How Physician and Counselor Collaboration Improves Patient Care. The presenters were Robert LaBarge, the President and CEO and Jo Hagood, Vice President of Practice Management of Sturgis Hospital in St. Joseph County, Michigan which is a rural community with an underserved population.  Here is a summary of their talk:

Facts about Sturgis hospital

• $48 million in net revenue annually
• Average inpatient census about 15
• 350-400 births per year
• 2,000 surgical procedures per year
• 78,000 outpatient visits per year at the Hospital
• 15,000 ED visits per year
• 12,000 visits per year in am & PM care (urgent care)
• 75,000 visits per year in the Sturgis Hospital Physician Network
• 325 employees

Facts about St Joseph’s County

• Population of 60,000
• Ranked 54 of 82 in Michigan county health rankings
• Designated as health professional shortage area (HPSA)
• Community Health Needs Assessment identified need for primary care, dental and mental health services
• No full time psychiatrist in St. Joseph County
• Median household income below state and national averages
• 65+ population exceeds state and national averages as a percentage
• 58% of students qualify for free or reduced lunch
• 14.5% of residents have a bachelor’s degree compared to state average of 25.9%

Rationale for Sturgis Hospital’s venture into Integrated Medicine

• Estimated that at least 50% of our patients have some mental health                                    treatment/diagnosis being treated by PCP
• Mental health services are in limited supply in St. Joseph County
• Community Health Needs Assessment identified access to mental health services as primary need in the County
• Reduce the stigma associated with mental health services
• Allow for smoother collaboration between providers

Initial Trial of the concept:

• Began in 2012 with the addition of LSW to Sturgis Pediatrics at 8 hours per week in conjunction with Community Mental Health
• Well received by pediatrician and patients
• Provided crisis intervention, family counseling and ADHD evaluations

Second step in their progress:

• In early 2014 they added a LPC to Sturgis Primary Care (FP/IM) 10 hours per week in partnership with Sturgis Consultation Center (which will be talked about later in this summary.
• Provided immediate crisis management and one on one counseling services
• Sturgis Hospital paid Sturgis Consultation Center and then billed for the services provided

The Third step in their progress:

• Fall 2014 Sturgis Hospital contracted directly with LPC to provide services at Sturgis Primary Care
• Began at 10 hours per week and grew quickly to 16 hours per week based on demand from the practice
• Grew to 24 hours per week with the addition of the Colon Clinic in late 2014

The Fourth step in their progress:

• Summer 2015 transitioned contract from LPC to PsyD to staff Sturgis Primary Care
• Increased from 20 hours per week to 24 hours per week based on continued increasing demand
• Added additional services to include neurological testing and ADHD testing for adult and pediatric patients

The Fifth step in their progress:

• In April 2015 they started the Gesundheit Help and Healing Center (grant funded school linked clinic)
• LSW in the Gesundheit Center 12 hours per week
• Initially the clinic shared LSW with Sturgis Pediatrics
• Currently they have a contract with the Sturgis Consultation Center to provide LPC 12 hours per week
• Designed to address mental health issues for student age population
• This has proven to be a big need for the students

The Sixth step in their progress:

• Added LPC, CAADC to Sturgis Hospital Pain Management Center 8 hours per week
• Contract with Sturgis Consultation Center to provide the services of the LPC
• Many patients in the Pain Program have mental health co-morbidities that can be addressed by the LPC
• Feedback from partners very positive
• Being considered as a model for other pain centers

As a result of these initiatives the volume of patients continues to increase at Sturgis Primary Care, Sturgis Pediatrics and Colon Medical Clinic:

• February 2014 to August 2014 (7 months) 206 patients    353 annualized visits
• September 2014 to February 2015 (6 months) 296 patients   592 annualized visits
• March 2015 to September 2015 (7 months) 443 patients   759 annualized visits  

Early Results of their Integrated Medicine Collaboration:

• Program has reduced the barriers to patients seeking services by having the service in the primary care practices
• They believe it has contributed to reduced stigma of seeking mental health services
• Allowed for appropriate crisis intervention on an ad hoc and more timely basis
• Allowed for integration of notes in the medical record
• Provided opportunity for PCP to consult with mental health staff prior to seeing patients
• Volume increases prove need for the services

 What Sturgis Hospital has learned from their foray into Integrated Medicine with Mental Health Providers:

• Need time and discussion to allow for increased understanding between primary care and mental health staff – the two worlds don’t fully understand each other
• Proper credentialing with insurance companies is essential so they can get paid for services provided
• Financial issues will be key to the sustainability of the integration effort
• Appropriate organizational form of the integration still seems unclear and they need to clarify how to bring on Mental Health Professionals either by: Contract for services or Employment or as a Joint venture with Mental Health Professional Practices or Organizations

 Future Plans of Sturgis Hospital as it moves forward with its Integrated Medicine approach:

• They expect to see continued expansion of the integration effort
• The would like to see mental health and primary care located in same building and/or same campus
• The would like to work to build financial models that create a sustainable future for this effort.

 So how did these LPC’s who are Clinical Mental Health Counselors get engaged in this Integrated Medicine Project at Sturgis Hospital? The answer came in the next session entitled: Implementing Integrated Care in Your Practice presented by Sara Sue Schaeffer, Donald Amidon and Drew Colbert. It turns out they are the Sturgis Consultation Center’s Staff. They were able to assist the hospital to plan and implement their integration model. This group has grown to create a new entity which they announced at this conference called: Integrated Counseling Connections, LLC: Providing support for physicians and other healthcare professionals. (Their brochure is located on the Integrated Medicine Discussion Board).

 The services they provide are:

• Connecting medical and behavioral health providers
• Training for behavioral health and medical providers
• Ongoing consultation for program development
• Consultation for billing issues
• Consultation for program evaluations, including: Outcome Surveys; Patient Satisfaction and Provider Satisfaction Surveys

 Their effort recognizes that Clinical Mental Health Counselors in private practice can get involved in Integrated Medicine through regular scheduled hours in health care settings or by appointments. The General and specialty services they advocate CMHC’s be contracted to provide are: Primary Care; Substance Abuse; Women’s Health; Men’s Health; Pediatrics; Pain Management; Chronic Illness’ and Acute Illness. They emphasize with the medical community that such integration is financially feasible by: Paying Counselors only for the time they spend in the medical facilities. They help medical practitioners to learn how to contract counselors for a specific fee, which will be reimbursed after the practitioner’s bill for the behavioral medicine services provided and how the practitioners would retain a portion of the billed services to go back into their medical practices.

 It was clear that Integrated Counseling Connections is a ground breaking effort in the mental health field and they have been invited to work with AMHCA’s Integrated Medicine Community to provide more information on their efforts. They already are open to consulting with CMHC’s in other states and you can reach them through their email: IntegratedCC@aol.com or write them at: Integrated Counseling Connections, 1534 Woodland Drive, Portage, MI, 49024 or call: (269) 327-6030.

 There were two other breakout sessions from the Sturgis Integrated Medicine initiatives: Integrated Care: Model Pain Clinic Project by Sara Webb and Integrated Care in School-Linked and Pediatric Care Programs by BrieAnn Daugherty, Taggert Doll, Sara Sue Schaeffer and Jo Hagood. Finally, there was a highly informative program: Insights into Integrated and Integrative Holistic Medicine by James Boniface.

 Jim Blundo, the Executive Director of MMHCA and Sue Schaeffer worked together to put together this incredibly ground breaking and creative conference. The conference clearly puts them ahead of the curve in getting counselors more deeply involved in the Integrated Medicine initiatives in the State of Michigan. If you would like more information on MHHCA’s efforts you can email Jim Blundo at: jamesblundo@att.net

 One last note. This conference was also a problem solving and brainstorming session. As a result of their open discussions, you will see in another blog from me a plan of action for all state MH Counseling Associations to adopt. The proposal would engage Counselor Education Programs and practicing licensed Clinical Mental Health Counselors in direct collaborative efforts with Medical Schools in their respective states. The proposed programs would develop quality educational programming for physicians to prepare them to work in Primary Integrated Medical settings with special emphasis on servicing underserved and diverse patient populations. This collaborative effort could not only produce improved Behavioral Medical Training for physicians but also for mental health counselors in training. The proposed program would also provide currently licensed counselors in the state an opportunity to engage in collaborative integrative medical practice training and research. This clinical programming effort would be similar to that being implemented in the Sturgis Hospital System in Rural Michigan.

 Submitted,

Jim Messina

Moderator, AMHCA Connections: Integrated Medicine Community