NYAPRS Note: The following piece emphasizes the importance of the role of health home care managers and the training that is needed to help case managers make the transition. See below for details of an exciting new NYAPRS/NYS Council training program for OMH case mangers and OASAS MATS workers.
Health Care Delivery System Prompts New Workforce Role for Case Managers
Mental Health Weekly April 30, 2012
The implementation of health homes, considered a key part in the delivery setting of the future, is prompting a change in the role of the traditional mental health case managers whose skill sets are transferable to assisting consumers with chronic physical health conditions, according to field leaders.
“There’s a need for an expanded skill set in an era of health care reform,” Joan King, senior integration consultant at the National Council for Community Behavioral Healthcare, told attendees during the National Council’s annual Mental Health and Addictions Conference in Chicago earlier this month (see MHW, April 23).
“Primary care and behavioral health integration is no longer optional,” she said. “The system is changing.”
Mental health case managers can integrate face to face with primary care providers, King said.
“Case managers have played a critical role in the health care system up to this point,” King said during her session, “Supporting and Developing Health Navigation Skills in Case Managers and Other Community Based Staff.”
King advised the field to develop its workforce to create healthier communities. Components such as integrated primary care/behavioral health practices, Mental Health First Aid and integrated care management are essential to making that happen, she noted.
“Our understanding is that recovery is happening in the community,” said King. “Community health has a huge impact on the ability of people to recover.” King added, “The movement to care management is part of the future of case management. Transforming the role of case managers involves using their existing skills and developing new partners (e.g., primary care physicians, federally qualified health centers (FQHCs) and accessing community-based resources, she said.
“Case managers can be mobile,” King said. “It’s not an additional task but a redirection of their traditional work,” she said.
“We have to take the holistic approach and bring it up to another level. We need to work across cultures,” King said. “Primary care providers [PCPs] are very solution-focused.”
PCPs focus less on the process and more on plans and outcomes, she said.
Physical health care is essential to the core service of a CMHC’s package, she noted. Health navigation training offered by the National Council is a one-day session with three follow-up webinars, said King.
The content includes information on key health conditions for people with diabetes, heart disease and other behavioral health-related challenges, she noted. Trainees can identify current health trends that will affect their role, said King.
“We’re not trying to turn case managers into nurses,” said King.
“It’s about trying to help case managers get enough health literacy skills that they can navigate and use those nurses as consultants.”
What’s in a name?
While there are many disciplines and training levels, there currently is no consistency in how terms such as care, case, health, behavioral health managers, coordinator and navigator are used across settings, said Alexander Blount, Ed.D., director of the Center for Integrated Primary Care at the University of Massachusetts Medical School.
Mental health and medical cultures define the role differently because they define the needs of the patient/client differently, he said.
“There is a commonality in the role of [professionals] who keep the patient, consumer or client connected with the system,” said Blount.
The patient-centered medical home (PCMH) is an enhanced form of primary care delivered in primary care settings or in CMHCs, and requires care management that addresses all needs of “complex” patients with challenging medical and behavioral health needs, he noted.
“The patient-centered medical home is sweeping the nation,” said Blount. “The primary care medical doctor is getting back to what primary care is supposed to be. They’re now trying to make [services] attractive and flexible.”
Blount noted that functions for mental health case management generally included:
– Obtaining basic supports.
– Crisis prevention and intervention.
– Assessment to determine need for services.
– Outcome-/function-focused treatment planning.
– Referral and linkage with chosen services.
– Engaging in/developing helping, trusting relationships.
– Coordinating and adjusting service delivery.
Medicare care management for people with a serious mental illness makes a difference, said Blount. He pointed to a study published in the February 2010 issue of the American
Journal of Psychiatry, in which lead author Benjamin G. Druss, M.D., and colleagues tested a population-based medical care management intervention designed to improve primary medical care in community mental health settings.
In the study, “A Randomized Trial of Medical Care Management for Community Mental Health Settings: The Primary Care Access, Referral, and Evaluation (PCARE) Study,” care managers served as an advocate for the patient as well as a communication conduit between the patient and specialty medical and mental health provider. During the intervention, care managers/coordinators provided information to patients about their medical conditions, and about available medical providers in the community and upcoming appointments.
According to the study, subjects assigned to usual care were given a list with contact information for local primary care medical clinics that accept uninsured and Medicaid patients.
Subsequently, these subjects were permitted to obtain any type of medical care or other medical services.
At a 12-month follow-up evaluation, the intervention group received an average of 58.7 percent of recommended preventive services, compared with a rate of 21.8 percent in the usual care group. Medical care management was associated with significant improvements in the quality and outcomes of primary care.
These findings suggest that
care management is a promising approach for improving medical care for patients treated in community mental health settings.
Peers are also going to have many roles in the patient-centered care environment as wellness coaches and navigators, said Blount.
“Peers are going to be [essential] to connecting people to behavioral health care,” he said. Peers will become involved in transportation, making appointments and reminding consumers of those appointments, and providing some health teaching, Blount said.
Blount also said that PCMHs are even more important now because “the cost of health care is strangling our economy.” “Primary care can improve health and reduce costs, if people will use it,” he said. “Primary care needs to be made user-friendly, to attract rather than coerce people to use.” •
Thanks to generous support from the New York State Department of Health’s Workforce Re-Training Initiative (HWRI), the New York Association of Psychiatric Rehabilitation Services (NYAPRS) and the New York State Council for Community Behavioral Healthcare (NYS Council) are delighted to announce the launch of the New York State Care Management Training Initiative (NYSCMTI).
NYSCMTI is designed to make a meaningful contribution to the successful transformation of the health/behavioral health care delivery system here in New York. Our primary objective is to prepare SOMH Case Managers and OASAS MATS staff to deliver high quality, integrated care coordination services to New Yorkers who qualify for NYS Medicaid Health Home services. To achieve this goal, we have designed a dynamic package of face-to-face and web-based training opportunities to help staff succeed in their new roles as Health Home Care Coordinators.
We are very pleased to have engaged the New York Care Coordination Program (NYCCP), a nationally recognized leader in the delivery of evidence-based training and technical assistance services, to develop, coordinate and deliver all our web based and face to face trainings. Starting in May and continuing over the next two years, the NYSCMTI will offer the following resources/opportunities to eligible staff:
- Nine 90 minute webinars designed to introduce new skills and enhance existing competencies staff need to succeed in their new roles
- Two (2) day-long face-to-face trainings to be held in convenient locations across New York where participants can acquire new information and practice newly acquired skills including (but not limited to) outreach and engagement, health and behavioral health identification and coaching, and utilizing a person-centered approach to care.
- Full access to the NYSCMTI website stocked with articles, videos and other learning tools enabling participants to engage in self-directed learning between scheduled webinars and in-person training events
Please don’t miss out on this timely, free opportunity! Go to our link on survey monkey https://www.surveymonkey.com/s/NYSCMTI today and send us the name of your case management/MATS supervisor and assure your staff a place in this important training initiative. Remember this training is on a first come, first served basis.
Commencement of this project is set for May 16thfrom 2:30 – 4:00pm when we will be offering a webinar designed for SUPERVISORS of eligible staff. Please have your supervisors register for this event by sending us the supervisor’s name and e-mail address at email@example.com no later than May 14.
We look forward to working with each of you. If you have any questions, please contact Edye Schwartz or Lauri Cole at firstname.lastname@example.org.
Harvey Rosenthal Lauri Cole
Executive Director Executive Director
Who is Eligible to Take the Training?
NYSCMTI is funded to provide training opportunities to a total of 700 participants (students). Eligible participants are staff employed in OASAS and SOMH agencies that currently operate ICM, SCM, BCM, and MATS services for recipients.
A related training program for Long Island agencies will begin shortly under the direction of our partners at Clubhouses of Suffolk and the Mental Health Association of Nassau. Unfortunately, NYSCMTI did NOT receive funding to provide training to staff working in agencies within the 5 boroughs of New York.
Due to the importance of this training to our workforce and the limits of our grant to fund only 700 students, please ensure that all appropriate case managers and MATS workers are enrolled and make a serious commitment to complete all training sessions.
Please use this link, https://www.surveymonkey.com/s/NYSCMTI, to provide us with information regarding who will act as our contact with your agency throughout the project. Ideally this would be the person who supervises the Case Management/MATS staff you want enrolled in the Initiative.
Once you give us the supervisor’s name and contact information, we will contact them directly for the list of all the individual students you wish to enroll in the training. Upon completion of registration, we will let you know that your staff have been accepted into the Program.
Once accepted and before the first webinar in June, each student will need to complete a brief pre-training assessment designed to assure that our curriculum best meet the needs of all students.
Because we know demand will be high, registration will be conducted on a FIRST COME, FIRST SERVED BASIS within the prescribed limits under which we are operating. Our grant requires that we train a certain number of students in each area of the state for which we are funded.
With this in mind, we have decided to establish a waiting list to manage requests beyond the 700 slots.
Kick Off Event!
Commencement of this project is set for May 16th from 2:30 – 4:00pm when we will be offering a webinar designed for SUPERVISORS of eligible staff. During the webinar, we will share information regarding the curriculum we have planned and leave time for questions and answers regarding the specifics of this Initiative. Please don’t miss this session! Have your supervisors register for this event by sending us the supervisor’s name and e-mail address at email@example.com no later than May 14. Once your supervisor has registered for the webinar, we will forward the links. We look forward to working with all of you.