CARE COORDINATION COLLABORATIVE: A QUALITY IMPROVEMENT COLLABORATIVE
FUNDED BY THE DEPARTMENT OF HEALTH CARE SERVICES
SPONSORED BY CALIFORNIA INSTITUTE FOR MENTAL HEALTH
Learning Session 1
CASE SIMULATION VIGNETTE #1 (HAN)
Name: Han Lin
DOB: 1-1-1950
Residence: Apple Street Shelter. She has been there for three months
Mental Health Clinician: Marcia Devers, first contact 1-1-2005
Psychiatrist: Ed Vasquez, MD
Primary Care Provider: Connie Nguyen, ARNP
Han is a 64-year-old, single, Chinese immigrant who came to California from Hong Kong in 1957. She has limited
English proficiency and is unemployed. She has two children (now in their 20’s) who were removed from her
home many years ago. She periodically expresses a desire to re-connect with them. No other known family or
community supports. She has lived in mental health residential facilities throughout the past 10 years and has
never really worked. Housekeeping and maintaining personal hygiene when she is depressed is a challenge.
She has diagnoses of major depression with psychosis and PTSD. Han has received extensive services from 5
different mental health centers over the last 10 years. In the last year, she made 51 phone calls to the mental
health crisis line. She makes frequent complaints that her psychiatric medications are not working while
practitioners note inconsistency of her taking her medications.
Han has significant physical health conditions including blood pressure, Type 2 diabetes, and obesity. Han has a
strong connection with her primary care nurse practitioner but still over-utilizes the Ed (She has had 9 ED visits in
the last two years, mostly regarding anxiety or her heart condition).
Encounter List for February, 2014:
Date
2/05/2014
2/12/2014
2/13/2014
2/14/2014
2/15/2014
2/15/2014
2/15/14
2/23/14
Type
Mental Health Home Visit
County Crisis Line – Telephone Call
No show Psychiatrist Visit
ER Visit
Outreach Worker
CMHC – Mental Health
Psychiatrist Visit
Calaveras Clinic – PCP Visit
(Encounter Details on back of this page).
1
Learning Session 1, Case Simulation Vignette
Clinician
Marcia Devers, LMFT
Ed Vasquez, MD
Mary Lee, MD
Fred Chu
Marcia Devers, LMFT
Ed Vasquez, MD
Connie Nguyen, ARNP
CARE COORDINATION COLLABORATIVE: A QUALITY IMPROVEMENT COLLABORATIVE
FUNDED BY THE DEPARTMENT OF HEALTH CARE SERVICES
SPONSORED BY CALIFORNIA INSTITUTE FOR MENTAL HEALTH
Encounter Details:
Type
2/05/2014
Location: Home visit
Clinician: Marcia Devers
Clinician Progress Notes
I spent time with Han and reviewed care plan elements along with her residential
care provider who also served as interpreter. She describes her mood as “good as
any – who cares?” Han mostly wants help with re-connecting with her (grown)
children, but otherwise seems un-interested in mental health care. Does not
appear to have any psychosis. No SI. PHQ-9 = 18. States she is taking her meds but
her caregiver reports it is a daily struggle to get her to take them.
Medications verified with residential care worker:
Risperidone 3mg PO QHS, Zoloft 100mg QAM, Ambien 5mg PO QHS, Amlodipine
10mg, Hydrochlorothiazide 25mg, Glyburide 5mg, Metformin 5mg
2/12/2014
County Crisis Line
Location: Telephone Call
2/13/2014
Psychiatrist Visit
Location: CMHC
Psychiatrist: Ed Vasquez,
MD
2/14/2014
ER Visit- Mary Lee, MD
2/15/2014
CMHC – Mental Health
Outreach Worker- Fred Chu
2/15/14
Psychiatrist Visit
Location: CMHC
Psychiatrist: Ed Vasquez,
MD
Interpreter Present: Yes
2/23/14
Primary Care Visit
Location: Calaveras Clinic
Primary Care Provider:
Connie Nguyen, ARNP
2
Plan: Psychiatrist visit next week.
Ms. Lin called saying ‘I’m having a panic attack – my medications are not
working.’ Calmed with reassurance and agreed to come in for her appointment
tomorrow.
No show for psychiatric visit
Chief Complaint: Shortness of breath / anxiety
BP 135 / 98, Blood Sugar 180 – improved with hydration and BP medication.
Discharged to outpatient follow up, next-day appointment with MH.
Picked up client for psychiatrist office visit. Talked with client about personal goals
and what steps might be helpful for her.
Plan: See updated care plan
BP 125/84, Weight 200, Height 5’6”, PHQ-9=20
No psychosis. No suicidal ideation. Appears at her usual state, but complains
medications are “not working.” Previous history of better response to Zoloft at
150mg dosage.
Plan: Zoloft increased to 150mg per day.
BP 124/82,
BS = 110 (non-fasting), HbA1c = 8.5, PHQ-9 = 18
Drop-In appointment, Care Coordinator present by telephone during appointment.
No acute complaints. Mild rash on left arm has come back, previously responded to
careful personal hygiene and HC cream. Care provider reports Zoloft just increased
last week by psychiatrist.
Plan: 1. Rash as above. 2. Diabetes, Stable. 3. Depression, treatment per CMHC. 4.
High blood pressure, stable.
Plan: Meds list reviewed and meds refilled. Advised to resume HC Cream. Hygiene
counseling completed. Plans reviewed with patient and care coordinator.
Learning Session 1, Case Simulation Vignette