NYAPRS Note: Get Well/Stay Well, a cutting-edge program of the Niagara Falls Memorial Medical Center, serves adults 55 and older. Based on the IMPACT model (Improving Mood – Providing Access to Collaborative Treatment), it integrates depression treatment into primary care and other medical settings.
Since the program commenced in May 2014, the center has conducted more than 3,100 screenings and provided 950 counseling appointments. It has shown to be successful in many regards, including combatting the stigma that many older people feel about mental healthcare.
The program has been recognized by the National Council on Behavioral Health for its Inspiring Hope Awards which Niagara Falls Memorial Medical Center will receive next month at the National Council’s annual conference in Las Vegas.
Integrated Care Program For Seniors Reveals Promising Results
Mental Health Weekly February 2, 2016
When it comes to addressing mental health concerns with older adults, many may shy away from such discussions or are often in denial of having any issues in the first place. That’s the premise program leaders of a Niagara Falls, N.Y.– based medical center used when establishing an integrated care program expressly for seniors.
Get Well/Stay Well, a program of the Niagara Falls Memorial Medical Center, a not-for-profit community- owned hospital, serves adults ages 55 and older.
The program is based on IMPACT (Improving Mood — Providing Access to Collaborative Treatment) and integrates depression treatment into primary care and other medical settings. The evidence-based depression care model was developed by Jürgen Unützer, M.D., M.P.H., and a team of researchers at the University of Washington AIMS Center.
“Most patients are in denial if you tell them they need to see a psychiatrist,” Sanjay Chadha, vice president of service line operations at the Niagara Falls Memorial Medical Center, told MHW. “They say, ‘I’m fine.’ Through this program a primary care physician (PCP) can introduce a therapist as part of the team. We call this a ‘warm handoff.’”
The Get Well/Stay Well program offers seniors behavioral health services and senior support services in an integrated primary care setting at Memorial’s Summit Family Health Center. “Our program commenced about 20 months ago out of a need for what we saw in the community,” Chadha said.
Elderly patients are also concerned about stigma, said Chadha. “It’s hard for them to get away from that stigma of being referred to a mental health clinic or a psychiatrist,” he said. The behavioral health services conveniently offered onsite help alleviate those fears and concerns, Chadha said.
The location is ideal, says Chadha, because the family center also has a teaching residential program, which provides “a great opportunity to train residents” as part of their three-year residency program. “They practice in the community. They’re assured how to discuss these issues with seniors and how to treat them,” he said. “It’s a great skill set.”
At the center, patients are screened via three tools — the Patient Health Questionnaire, a depression module; Generalized Anxiety Disorder Assessment; and Alcohol Use Disorders Identification Test — to determine if a patient may be at risk for an alcohol abuse problem.
“These screenings are done in the waiting room or during the exam,” David Spagnolo, project manager, told MHW. “If the scores are positive, we discuss the patient’s options. The whole program is based on the patient’s trust of the PCP. That trust is what we use to help connect patients to behavioral health specialists.”
The program includes a licensed clinical social worker and a psychiatrist, and depending on their schedules as well as the patient’s, can begin a session following their physical treatment. “Primary care still takes the lead; it’s the base on the spine,” Chadha said.
Patients’ behavioral health and physical health are contained within one system, Chadha said. When the therapists document the session outcomes and treatment plan, the physician can view those recommendations with the patient to ensure he or she understands what’s going on, and determine short-term and long-term goals, he noted.
Conversely, therapists when in session can see what the primary care recommendations are for the patient, Chadha noted. Physicians and therapists can view one another’s notes without playing phone tags or faxing information. “We can communicate through one common system,” said Chadha.
“This is a seamless one-stop shop,” said Chadha. “Our focus is on seniors and being able to provide them a comfortable environment, and [one that’s] more amicable to discuss not only their physical care needs, but their mental health needs also.” Memorial’s local affiliate, Dale Association Inc. in Lockport, N.Y., is a senior services organization. “We contracted with a senior advocate as part of the team when they’re in need of certain services, such as Meals on Wheels, or legal services,” Spagnolo said. The advocate is available for any type of community outreach need, he added. “The senior advocate connects those patients to those types of resources,” he said.
An 80-year-old male or female may have issues with depression and diabetes along with a need to find a place to live, for example, said Chadha. “All of these issues can be addressed in a primary care setting,” he said.
Chadha added, “This is what makes the program unique. Seniors do not have to make three different trips to address [these issues].”
Since the program commenced in May 2014, the center has conducted more than 3,100 screenings and provided 950 counseling appointments, said Spagnolo.
These impressive outcomes have no doubt contributed to their recognition by the National Council on Behavioral Health for its Inspiring Hope Awards. Niagara Falls Memorial Medical Center will receive its award during the National Council’s annual conference March 7–9 in Las Vegas.
The integrated care program for seniors can be easily replicated, noted Chadha. In fact, the program leaders plan to expand Get Well/Stay Well to another one of its primary care locations. “We have the recipe for success now,” Chadha said.
Added Spagnolo, “If you’re taking an existing practice and making the conversion to collaborative care, you want all staff to be involved the whole way through. We kept them involved. They gave input and we made alterations to help with the flow of the program.”
It’s important to have that buy-in from the top administration to the receptionist, said Spagnolo. “Everyone has a stake in the program,”