MINNESOTA COLLABORATIVE
PSYCHIATRIC
CONSULTATION SERVICE
L. Read Sulik, MD, FAACAP
Senior Vice President – Behavioral Health Services
Sanford Health
read.sulik@sanfordhealth.org
Clinical Associate Professor
Department of Psychiatry, University of Minnesota
Clinical Associate Professor
Department of Clinical Neuroscience, University of North Dakota
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Background
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Minnesota background efforts
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Minnesota 2006 Legislation
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Minnesota 2010 Legislation to fund statewide psychiatric consultation service
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Drug threshold workgroup
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Minnesota Psychiatric Consultation Workgroup
S Children’s Psychiatric Consultation Protocols workgroup
S ADHD subgroup
S Bipolar subgroup
S Differential diagnosis, including trauma, anxiety disorders and disruptive behaviors
subgroup
S Eating disorder subgroup
S Substance abuse subgroup
S Triage subgroup
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What is
Mental Health Integration &
Transformation Program
S A partnership w/ Minnesota healthcare organizations and
additional support partners:
S Healthcare Systems: Mayo Clinic, Sanford Health, Prairie Care,
Essentia (5th partner TBD)
S Non-profits: Minnesota Psychiatric Information and Outreach
(MPIO), REACH Institute
S Project Management Consultant
S Videoconferencing Vendor
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What is the Purpose/Intent of the Minnesota
Collaborative Psychiatric Consultation Service?
S To increase quality and access to children’s mental health services
across the state of Minnesota by…
S Increasing primary care providers’ (PCPs’) skills and willingness to manage
children and adolescents with mild-moderate mental health problems
S Creating linkages and partnerships between primary care and specialty mental
health providers
S Increasing rapid access for selected face-to-face consultations
S Reducing problematic prescribing practices via case-specific support and
consultation
S Building partnerships among Medicaid, private insurers, healthcare
organizations, and providers to facilitate sustainability
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Why is the Service Needed?
S Traditional CMEs, written guidelines, and “hit-and-run”
workshops and lectures are generally ineffective.
S Evidence-based prescriber training methods need to focus on
skills (not factual knowledge), and must address obstacles
encountered in practice.
S Effective training programs must use collaborative learning
partnerships, vs. “one-down” relationships, and use PCP role
models as co-teachers, similar to those being trained.
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How Will the Service
Achieve Its Purposes?
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Targeted outreach to providers;
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Systematic and regular communications to providers about available services and
training opportunities;
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Linkage assistance to available services;
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Hands-on coaching, skills training, and information support;
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Same-day phone consultation services (both voluntary and mandatory
consultations); and
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Rapid face-to-face evaluations for “emergent” cases.
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Innovative Approaches
S Web-based tool that allows providers to identify and
link families to community resources;
S State-of-art video-teleconferencing available at no cost to
internet-linked healthcare providers state-wide;
S “Pathway” to sustainability, with Medicaid codes
approved for use by healthcare providers;
S Creation of primary care “champions” who can in effect
increase the state’s mental health manpower
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Project Organization
Project Steering Group
L. Vukelich & Associates
Executive Committee
SE Minnesota Region
Western Region
Northeastern Region
Twin Cities - East
Twin Cities - West
Mayo Clinic
Sanford Health
Essentia Health
Prairie Care
TBA (e.g., Allina
Health)
Mayo Clinic subcontracts
to MhINT Partner sites
and other subcontractors
REACH
Soltrite
MPIO
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Regional Teams
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5 regional healthcare system teams, located strategically
across the state
Each team consists of:
• >2 Child/adolescent Psychiatrists (CAPs)
• >1 Triage Mental Health Professional (TMHPs)
• Other support staff as needed
Multiple team members enable cross-coverage within and
across sites
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Leadership/Planning and Timetables
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Weekly EC Meetings
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Co-Chairs: 1 Site Principal, Linda Vukelich
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Partnership with by-laws guiding the collaboration
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Subcommittees and Assigned Tasks:
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Database, Website, REACH adaptations, Electronic Communications,
CAP/TMHP Training, PR/Outreach, Program Evaluation
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Start-up phase June/July
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August 1 – December 31, 2012, 3-4 sites only
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January 1, 2013, and beyond: 5 sites
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Web-Based Tools
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M INT
(via MPIO) will support the creation of
a web-based tool that allows providers to identify
and link families to available community mental
health resources
• Regularly updated by MhINT Team & MPIO
• Publicly available
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REACH Training
S Hands-on, with role plays and extensive practice
S 2 days of face-to-face training with 15-30 clinicians, with 2-3
trainers, followed by:
S 6-12 months of twice-monthly phone call consultation and
support, 1-1.5 hours/call
S Individual case presentations, with learning and risk-taking shared
among peers
S 6 years in development, used in NYS, Nebraska, North Carolina
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HD Video Conferencing over the Internet
• Secure – HIPAA compliant
• PC, Mac, iPad, iPhone & Android
• Can interoperate with traditional
video conferencing technology
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Video conferencing Services
• Will likely include:
• Training
• Collaboration between and within MhINT
partners and DHS
• Communication between primary care doctors
and specialty mental health providers
• Potentially some patient consultations
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Consultation Services
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will not encourage PCP
management of the following:
1. Psychosis
2. Suicidality beyond minimal risk
3. Aggression involving serious
injury to others or serious
destruction of property
4. Clear Bipolar I disorder
5. Substance abuse/dependence
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Work Flow for Phone Consultations
S Triage mental health professional (TMHP) takes the
initial phone call and responds to calls within their
scope of training and expertise.
S If a child and adolescent psychiatrist (CAP) is
needed/requested, the covering CAP returns the
phone call at scheduled time (same day).
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HIPAA I
•Voluntary phone calls are consultations to the primary care provider
(PCP), as well as a clinical service to patients.
•PCPs will maintain records of the consultation, and ensure
patient confidentiality and HIPAA-compliance. Protected health
information (PHI) NOT needed for voluntary consults.
•De-identified demographic and clinical information can be used
to provide evaluation of the project.
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Face-to-Face Consultations
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Face-to-Face Consultations
S Selected cases will be seen for a face-to-face (or
possibly, telepsychiatric if the patient is
geographically distant) consultation with a
MhINT child/adolescent psychiatrist.
S Face-to-face (FTF) evaluations will be scheduled
within 1-2 weeks with the local child/adolescent
psychiatrist.
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Face to Face Evaluations are
Consultations Only
S Face to face evaluations are consultations only,
with follow-up as needed by PCPs.
S Patients cannot be followed by CAPs for
ongoing treatment and medication
management.
S PCPs will need to apprise patients and
families about this.
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Resources & Contact Info
S DHS Website:
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET
_DYNAMIC_CONVERSION&RevisionSelectionMethod=
LatestReleased&dDocName=dhs16_158267
S L. Read Sulik, MD, FAACAP
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Senior Vice President – Behavioral Health Services, Sanford Health
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Email: read.sulik@sanfordhealth.org
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Telephone: 701 234 4124
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