<p> Integrated Behavioral Health Meeting Minutes</p><p>Date: 6/8/17 Time: 7:30am to 9:00am Location: Washington Room RIQI, 50 Holden St, Providence, RI Call-in: 508.856.8222 code 4614 (host 7191)</p><p>Meeting Information: Attendees (marked with an *) Meeting Purpose/Objective: to establish a work group to lead the Matt Roman, Co-Chair* Robert Crossley Debra Hurwitz Peter Pogacar* transformation of primary care in RI in the context of an integrated Rena Sheehan, Co-Chair Vanessa Cumplido Brenda Jenkins Carla Porter* health care system Kathryn Amalfitano Kristin David Cynthia Kaplan* Putney Pyles* Donna Bagdasarian Betsy Dennigan Martin Kerzer Angela Reda* Christopher Baker Deidre Denning-Norton Steve Kozak Nicole Renzulli Handouts/Attachments: Tom Bledsoe Brenda Dowlatshahi Jill Lamberton Kelley Reilly Michele Brown* Susan Eagleson* Elizabeth Lange* Sarah Roderick  Meeting Agenda Joanna Brown Kristen Edward Rachel Legend Jan Romagnolo David Brumley Gina Eubank Carol Lewis* Renee Rulin Susan Bruce* Sarah Fessler Debra Lobato Andrew Saal Susan Boudreau Pat Flanagan* Millie Luckens Marilyn Saunders Chrystal Boza Sarah Fluery* Michael Jessica Savoca Maggie Bublitz Gregory Fritz Lichtenstein Donna Soares Nelly Burdette* Rick Ford Jason Lyon Kathy Schwab Susanne Campbell* Elizabeth Fortin Elizabeth Lynch Michael Spoerri Chris Campanile Sarah Gambell Joanna MacLean Andi Srabian* Chris Camillo Stan Galek Linda Mahoney Gregory Steinmetz Erin Campopiano Melissa Garbutt* Gail Martin Sue Storti Liz Cantor Deidre Gifford Thomas Martin Ann Sullivan* Sheila Capece Richard Goldberg Ramona Mello Lois Teitz Lauren Capizzo Lynda Greene Tammy Messier John Todaro Christine Carr* Jamie Handy Stephanie Iris Tong Jody Cloutier Emily Harrison McCaffrey Kimberley Townsend* Matthew Collins Suzanne Herzberg Suzanne Tilak Verma Emily Collier William Hollinshead* McLaughlin Judith Westrick* Kathy Congdon Margaret Howard* Deb Morales Cindy Wyman Emily Cooper Kristen Hull Mary Moore Pano Yeracaris* Allison Croke Linda Hughes* Laura Morton Sherri Zinno Charlotte Crist Bill Mueller Alice Zory Meg Murray* # Time Comments</p><p>1. Susanne Campbell  Introductions and Updates 10 minutes o CTC-RI and PCMH-Kids are excited to announce that they will be contracting with Margaret Howard, Ph.D, Founder and Director of the Day Hospital at Women and Infants Hospital; Professor of Psychiatry and Human Behavior (Clinical) at Alpert Medical School of Brown University; Division Director at Women’s Behavioral Health, Women and Infants Hospital; and serves as the vice chair of the Care New England Brain and Behavioral Health Council. Dr. Howard will be providing behavioral health subject matter expertise for the PCMH-Kids practices that are participating in this important role of screening and identifying mental health issues in their patient’s caregivers. Going forward, Dr. Howard will be attended the quarterly meetings in person. Page 1 of 4 Date: 6/8/17 Time: 7:30am to 9:00am Location: Washington Room RIQI, 50 Holden St, Providence, RI Call-in: 508.856.8222 code 4614 (host 7191) o Dr. Howard asked the practices to include the reasoning behind the screening frequency rational in their report outs. o The new 2017 NCQA OHIC Standards including Screening for Maternal Depression.</p><p>2. All  Postpartum Depression Learning Collaborative Work Plan, Aim Statement and Baseline Measure Point 70 minutes Each practice reported out on how they are doing on the project to date. o Anchor Pediatrics  Their aim statement is to begin administering Edinburgh screening tool to 50% of primary caregivers at the 1, 2, 4 & 6 month well baby visits on June 12, 2017.  They will be screening at 2 weeks in addition to the 1, 2, 4 and 6 month visits.  The practice is meeting today with staff to review the process with staff and they are going to start on Monday. o Coastal Narragansett Pediatrics  Their goal is to routinely screen at 1, 2 and 4 month visits and may adjust to the 2 week as well.  They are not currently formally screening, so they will be establishing a new process and their current plan is to hand a paper copy of the Edinburgh survey to the mom at these visits.  They have incorporated the medical release form into the screening form for the parent to sign should they need to be referred.  They are additionally hoping to use CHADIS for these screenings as well. o Coastal Waterman Pediatrics  Their aim statement is by February 2018, 60% of their primary caregivers will be additionally screened at both the 2 and 6 month postpartum visit using the 10 question Edinburgh tool.  This practice has been screening previously, but will now be screening at 2 weeks, 1, 2, 4, and 6 month.  Additionally, the forms will be laminated and entered into the EMR. They are trying to cut back on the documentation scanned. o EBCAP  Their aim statement is to increase their postnatal depression screening rate by 20 percentage points by the end of February 2018 using the Edinburgh assessment on all postpartum patients between 6-8 weeks after delivery. o E. Greenwich Pediatrics  Their aim statement is by February 2018, 50% of primary caregivers will be screened at the 1, 4, and 6 month postpartum visits using the Edinburgh tool.  When they have a positive screen, they refer the patient and follow up with the mom the next day.  They additionally provide a list of BH providers to the moms at the visits. o Hasbro Pediatric Primary Care  Their aim statement is: a random chart review indicated that currently we screen 55% of primary care givers for Post- Partum Depression twice in the first 6 months of life, using the Edinburgh PPD tool. By February 2018, our goal is to screen 65% of primary care givers by their child’s 6 month of life.  There are many other social factors for these families for getting them in for their appointments (i.e. child care, transportation, literacy issues, etc.) o Pediatric Associates  Their aim statement is to initiate postpartum screening at 4 and 6 months. They will improve overall postpartum depression screening rate at 1, 2, 4, and 6 months from their baseline of approximately 30% at the beginning of June 2017 to 60% by the end of February 2018. Page 2 of 4 Date: 6/8/17 Time: 7:30am to 9:00am Location: Washington Room RIQI, 50 Holden St, Providence, RI Call-in: 508.856.8222 code 4614 (host 7191)</p><p> A lot of the parents previously screened already had pre-existing issues and a BH provider. However, increasing the screening should hopefully find the women that might not have been identified previously.  Additional Discussion Items:  The group had questions about if the other practices had a referral letter to the mother/parent/guardian’s OB/GYN if there is a positive screen since the mother is not necessarily a patient of the office. .Dr. Howard has a referral letter template to use for Women and Infant’s Day Hospital (unless the parent already has a primary health provider). The template will be sent to the group with the meeting minutes. .The referral information for the Day Hospital is: fax number 401-276-7873 and direct phone 401-274- 1122 x 42870. .There were questions around the referral and follow up process for ‘no show’ appointments from Women and Infants Day Hospital as well.  Additionally, the group had questions and concerns around the necessity of the parent signing a medical release form to send information to their primary care or BH provider.  Practices should be tracking the number of screens, who the patients were referred to, what happens after the referral, what was the follow up, etc.  Practices also discussed the PHQ-2 (2 question screen) versus the Edinburgh (10 question screen), when to use which one and which practices are using what. .2 week (PHQ-2) .1 month (PHQ-2) .2 month (Edinburgh) .4 month (PHQ-2) .6 month (Edinburgh)  Dr. Howard’s recommendation would be to use the Edinburg at the 2, 4 and 6 month visits, and said would be cautious on screening at the 2 week visit as most parents are past the ‘baby blues’ after 3 weeks.  Other questions were related to who in the office is conducting the screen (i.e. MA, other office staff, etc.) and if they are getting push back from the parents for not being their patients. .Most practices reported little to no push back (minus when and if the parents received an additional bill for the referral) and that some even provide a new parent guidebook to the parents at their first visit.  Separate discussion items were related to Tricare. CTC will work on getting more information and perhaps a representative at a future pediatric focused meeting.  There was additional discussion on screening and referring new moms under the age of 18. The Day Program will be able to able to take referrals as soon as they have a Child and Adolescent Psychologists on staff. .Susan Eagleson, Child and Adolescent Clinical Nurse Specialist, joined EBCAP in the fall and welcomes new referrals of children and adolescents. She sees patients in E. Providence and Newport. The number to make an appointment is 401-246-1195.</p><p>10 All  Next Steps 10 minutes o Begin to think through to collect some early data and clarification with the billing codes would be helpful to review at the next meeting. o Tracking if referrals were actually made: Did you have a positive screen and was there a referral? Out of those moms referred how many of them made an appointment and consider a warm hand off process.</p><p>Page 3 of 4 Date: 6/8/17 Time: 7:30am to 9:00am Location: Washington Room RIQI, 50 Holden St, Providence, RI Call-in: 508.856.8222 code 4614 (host 7191)</p><p> Deliverable Reminders: o Please send your aim statement, work plan and baseline information to Michele if you have not done so already.  Upcoming Events/Meetings: o 2017 Meeting Frequency  September 14, 2017 - Quarterly Pediatric IBH Program  October 12, 2017- Quarterly Adult IBH Program  November 9, 2017- Regular Committee Meeting  December 14, 2017 - Quarterly Pediatric IBH Program </p><p>ACTION ITEM LOG Added Action # Action /Status D Closed</p><p>6/8/17 1 Send the draft referral form to Michele to distribute. 6 6/15/17 6/8/17 2 Follow up with Tri Care to see if anyone could come to one of our pediatric meetings. 7 6/8/17 3 Clarification with the billing codes would be helpful to review at the next meeting. 7</p><p>Page 4 of 4</p>