CU Nursing - Spring/Summer 2020 - 21

CLASS NOTES

After assessment, providers place patients into a tier, with monitoring of
outcome measures integral to the collaborative care model:

potential end-result of serious mental
issues left untreated. "So obviously, we
need new solutions in order to address
this crisis."

1. Mild cases with little safety risk stay with the primary care provider for
treatment, as long as the patients continue progressing toward remission
of symptoms.

Barton and some of her team members
shared highlights of their work during
the December Nursing Grand Rounds.

2. Moderate cases with slightly more safety risk see their PCP, who consults
regularly with a mental health care professional.

By combining a team of PCPs, care
coordinators, case managers, and
mental health experts in one location,
collaborative care allows for an array of
services aimed at boosting treatment
in an efficient setting.

3. Higher risk patients see both a PCP and a mental health expert concurrently. The providers work as a team.
4. Serious cases, generally with psychoses, are referred out for more intensive
treatment than the clinic can provide.
Having both physical and mental
health care providers working together in one setting helps reduce
patient dropout from therapy and
psychiatric services.

The already nurse-led, inter-professional environment at Sheridan Health
Services clinics provides an ideal setting for the model, a partnership with
primary care providers that moves
beyond other integrated care models.

COLLABORATIVE CARE: TREATING
'ONE PERSON WITH ONE TEAM'

More than 80 randomized controlled
trials worldwide support collaborative
care in primary care settings, Stalder
said. The Sheridan project, funded
by the Health Resources and Services
Administration (HRSA), is now in its
fourth year.

PROJECT IMPROVES CARE,
TACKLES HURDLES TO ACCESS
Studies repeatedly show that the model,
which largely addresses hurdles to
care, boosts access and improves
outcomes, Stalder said. The Sheridan
project's results mirror those findings.
Baseline scores in participants with
depression improved 41% within two
years of the program's launch. For
patients with bipolar disorder, scores
rose by 50%.
A four-tiered system unique to the
model helps address a national
shortage of trained mental health care
providers by treating all patients more
efficiently and achieving remission
of symptoms sooner. In the United
States, 60 percent of counties have
no practicing psychiatrist.

A population-based registry and tracker
system also plays a chief role with
compliance, said Carlo Caballero, LPC,
the team's case manager. Caballero
monitors the computerized registry and
serves as a patient advocate.
"I really focus on assessing patients'
needs, connecting them with internal
and external resources, scheduling appointments for patients, and bridging
the gap between patient and provider," Caballero said. "Basically, it's being a
CU Nursing guide for patients throughout their treatments so they don't get lost."

Professor Amy
Barton, PhD,
leads a pilot
project to boost
mental health
care at local
clinics.

Many issues can lead to healthcare access problems, including homelessness and
lack of transportation, which burden the clinics' largely underserved population.
Taxi vouchers, food banks and low-income housing are types of resource referrals
he makes to prevent treatment dropout, Caballero said.
PCPs and mental health experts working in tandem also helps with patient
screening and accurate diagnoses, Stalder said. Some physical symptoms
can mimic mental health disorders and vice-versa, she said. Moreover, many
physical ailments come with mental health symptoms, such as heart disease
and depression.
"We've thought of physical and mental health care as separate for a long time,"
Stalder said. "This combines them. We are treating them as one person with one
team, and that's the way it should be," she said.
"The biggest thing is reaching the right people with the right treatment at the
right time," Stalder said. "And I think that's what collaborative care helps us do."

CU Nursing - Spring/Summer 2020

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