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Audience Q&A
Audience Q&A
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So, I wanted to go to the questions and begin by, could you talk just for a minute about some recommendations about how to develop a good communication pattern with primary care? Okay. Yeah. Yeah. That's, I think, I think that's a great question because, you know, actually the, you know, the use of this is an attempt to sort of speak the, speak the primary care language. And so, you know, there's a, there's a real difference in, in culture, of course, between what it's like in a mental health facility or a mental health center and, and what happens in primary care. What happens in primary care is much faster. There's a, there's a whole array of kind of procedures and workflows that have to do with the care of different conditions and it's all kind of routinized and rapid and it's not our, it's not our business, it's not our usual content. And furthermore, there's a particular way of communicating that is used in primary care that you have to get used to, you have to, you're going to communicate with them, you have to, you have to speak their language. It's not that you have to be a master of jargon, but it is that you have to be prepared to tell your story brief. And so if you're, for example, if you're, you know, this is one of the things that's in the, it's, that's in the job aid, that you want to think ahead of time about exactly what the questions you're going to ask, in fact, I recommend that you write them down. For example, in Jeff's case, it was, what are, how is he doing with regard to his diabetes? And, and, you know, are there any questions, for example, about what he's eating? And you have to be prepared to, to give a brief pithy presentation of what you're interested in. Similarly, when you call and you have a question, you want to, what time is the appointment? Is it, the medication was supposed to have been called in the pharmacy and we're not getting it. You have, you have to be, you have to be prepared and more or less have it written down and give it very succinctly in a couple of sentences, because what happens is if you don't give it in a couple of sentences, the busy, overwhelmed primary care front desk staff start losing attention. And it would be nice, it would be ideal, it would be ideal if it wasn't like that, but it is. And so I'm speaking as somebody, I ran a primary care organization and we did our best to be welcoming and receptive and culturally competent, but, but you have to, you have to be, you have to be clear and organized and brief. That's one thing. I like to speak, if you can't speak the language, it's very difficult to develop a relationship. The other thing is that when you're, when you're developing a relationship with a primary care partner, the best thing is you actually have something to, you actually have something to offer. So it's good to think of, you bring something, you give something and you get something. So very commonly, for example, a good, a good primary care provider is taking care of a patient. Jeff is concerned, he wants him to do well. And often with one of their concerns about folks with SMI is that they feel like they're failing, the process of their medical care is failing and that upsets them. You'd be surprised how upset this gets. For example, if folks are not compliant or not adherent, which is, which is a challenge, the primary care provider would be very concerned. So if you're, if you come in and you're bringing with you the resource of assisting with that, assisting with that process of improving the medical outcome, that stands for a lot. And they will, they will often view that as help with a difficult situation. And you want to have that in your head. You want to remind them as you're going about the way that you're helping, which you are. And that counts for a lot. The other thing that often is helpful in terms of bringing something, getting something and giving something is, you know, often the primary care provider can be a little uneasy with the clientele and sort of being present to sort of smooth the process of the social interaction during an appointment or during an encounter in the waiting room or whatever. It counts for a lot. A lot of primary care organizations are worried that there'll be a ruckus, there'll be something unsightly will happen in the waiting room and that will create a problem. But if it's possible to smooth out the encounter, that counts for a lot. And that makes it, and that makes the primary care organization feel like they're dealing with people who know what they're doing and make their life during that time when your patient, your client's with them better. Great. The questions are rolling in. While it may be ideal for a behavioral health provider or case manager to attend primary care appointments with their clients with SMI, it may not be feasible most of the time. Have peer mentors, family members or other in a person's support network been able to learn and carry that role effectively using tools you shared? Absolutely. You know, I used the example of a case manager accompanying a client to an appointment as sort of a framework for that kind of assistance. Anybody who works as a case manager knows that the decision to actually take somebody to the primary care provider is a big decision, it's a big time suck. It's slow and meanwhile you have all the other things, you're all the other people, everything else you have to do. It's a considered decision and of course it doesn't happen. Mostly it doesn't. Peers, in our hands, peers did this kind of thing all the time and certainly family members, if you have, depending on where you are and who you're working with, if there are family members that are involved and willing to do this, of course those things are appropriate and suitable and helpful for folks to be doing those things. So this is an intended, say only a case manager can do this. You remember in the very early part of the slides we talked about all the different kinds of people who do this kind of work. So it's meant to be, you know, I use the term case manager, it's a generic term, but certainly other folks could do this. So imagine you're somebody's aunt, you're somebody's cousin, somebody's brother, and you're taking, you're going with them, you know, all the things we talked about, all the kind of planning ahead, all the being ready at all times. I love this next question because I myself wish I could do this. So here's the question. As a case manager, I find it difficult to identify doctors in private practice who are knowledgeable of and are SMI friendly. What would you recommend case managers to look out for? What are some things we can do prior to arranging the initial appointment for our SMI clients? Okay. I have a couple of thoughts about that. One is that, again, different centers in different places have different scenarios. In some of them, there's kind of your go, you'll have your go-to people. And a lot of centers have created these, you know, a defined program where they're in partnership, you know, they're a community mental health center, they're in partnership, for example, with a local federally qualified health center. And the intention is that as many of those clients will attend treatment at the federally qualified health center as possible because it's sort of, you know, the likelihood of successful coordination of care will be higher. In places, I did this, and in places where you do that, what you find is that you never get 100%, or even close, that people have their own ideas about where they wanted to be seen. And often, you'll find people who, you know, want to see, in my old place, there are people who wanted to be seen by the doctor and 200 of them, you can see them their whole life. And then you'd have to make a relationship. But I am hedging a little bit. So the real question is, if you're in a situation where you're choosing, where you have to choose, able to choose, how do you detect somebody who is going to be appropriate and helpful in a good park? And so let's see, how would I do that? I think that, you know, if there's any scuttlebutt from the neighborhood or from other patients, if you have other clients who have had an encounter with a given provider who does well, that's good. I think that it's hard. I think that short of that, it's difficult. You can't like, you can't go on, you can't go online and get this information, you know, you go online, and there's like health grades, I can't remember what they call them all. But that's not, that information is not. And I think that, you know, at an organization, keeping kind of a, you know, a running list of who's who does a good job, who does a poor job, is a good idea. Yeah, I mean, and failing that, I think if you're calling, you'd say, hey, I'm calling on behalf of so-and-so, and we're talking about the appointment, and this is the situation, and you know, see what kind of feedback you get, perhaps. One thing that someone wrote in, and I love the crowdsourcing when it happens on these kinds of webinars, but although we don't, we can't really predict who might be good or bad. One person wrote in and said, sometimes I found it helpful to have a one-page profile of my client ready to share with the new healthcare provider to make it beneficial, to sort of prep them for what are these person's issues, how is it easier to communicate with them, what are the things that I use as their supports, how do I motivate them, might be really helpful for the new provider. And I thought that was a great idea. I mean, that sounds to me like case management at an extremely high level. So whoever you are, I salute you. I want to say it's over and above, but I mean, that's awesome. You know, the other thing that's, of course, very helpful, but I can tell you that if you're the primary care provider, the information you want about our client, they want to know diagnosis, they want to know medication list, they want to know any relevant labs. And then the kind of thing, especially if it's someone with a lot of needs or who needs a lot of kind of behavioral support, that kind of, you know, those kind of pearls about how someone does best is super helpful. It just reminds me of another issue, the other issue being, you know, the question of information going back and forth. And that gets a lot of press, but it turns out it's just like, I should write another I should write another of these with just that, like, here are the five things they want to know. And if they knew, if you came in and you had these five things on a piece of paper, they would, they would be, and this would be another way of speaking the language and building a relationship with them as someone who knows what they're doing and can help them function well. So how do you effectively communicate around the issues we've talked about today, physical health, with clients who are resistant to change? Do you have the magic for that? I have two words for you, motivational interviewing. This is the sphere of motivational interviewing, so I am a huge fan. I think that it's an absolutely fabulous and respectful and collaborative way of helping people to find their way to taking care of themselves in a way that feels like it comes from them, that they can own and belong, that it belongs to them. And so if, if you have not had prior exposure to or training in motivational interviewing, I cannot, I cannot recommend it enough. And I think that it's a, you know, it's a real, it's a real skill. You can't learn it from a webinar. It takes practice. And in my old, years ago, I had a, what was called a primary behavioral health care initiative program. And it was a team doing this kind of work. And we, we had weekly staffing to get together and talk about all the clients and what they were doing and what our plans were and what was going to happen. And we spent half the meeting doing that. We spent half the meeting practicing motivational interviewing. We did that for four years. And the most skillful purveyor of motivational interviewing in our team, far none, far away, no question, was one of our peers who just took to it like a duck to water and was so skillful and so helpful to its clientele. Most of them, of course, are mostly not interested at first, anyway, in health care. So, so I, so it's a long-winded two words, but motivational interviewing. It makes me though, think that you just gave the answer to the next question, which may be, which may be leveraging peers. But here's the question. I have a client that refuses to use any form of medications. Even with motivational interviewing with him, he still actively refuses to even see a primary care doctor. Ideas? Is the answer peers? I know, I think the, well, I mean, if you have a, if you have a peer who's, who's, you know, skillful at that, then fine. If you, you know, it's the same, it's the same thing. It's really the same question. I think that it's, this sounds like a boring one note, but I think that the motivational interviewing approach is far and away the most useful means ever designed of addressing this kind of problem. And I would say that when you're doing this kind of work, there's, you know, there's like the bell-shaped curve of engagement, like so that the case that I described, Jeff, you know, he's, he's just cooperative to a fault. He's almost too cooperative, gets in trouble. And then there, and then there's like the usual folks who, you know, you got your, you got something to sink your teeth into in terms of engagement. And then there's like this end of the bell-shaped curve where people are like not having it and are never going to have it. And that's just part of the landscape. And some of, you know, some of your folks, if you do this work, some of you're going to have some successes and you're going to have some folks like that. And you, you do your best, you get up in the morning and you go see them and you strategize and you do your best. And then, you know, you, you, you, you know, you save the rest for another day. It's a long, it's like I was saying at the very beginning, behavior change is a long-term investment. And I've, I've frequently had the experience. I worked, I worked in, for 27 years in the Community Mental Health Center where I work. And we had people who weren't having it for a long decades. And then at some point they'd say, you know, you told me this, and that other case manager told me this, and that my mom told me this, and that doctor told me this, and so maybe, maybe you're all not idiots. And so, and so there's, so you have to, I always found it helpful to keep that in mind when I was giving somebody my educated recommendation, which they thought was nonsense. You know, sometimes, sometimes you get in line of the people who are idiots until, until some magical day something happens differently. But you do your best, you do your best, and you don't, and you can't, if you're doing good work, like, you know, the case it was described, you can't hold yourself responsible if it doesn't go perfectly, because sometimes that's going to happen. You can only do your job well, you can't ensure, you can't be guaranteed a good outcome. It reminds me of two things that you brought up in your talk today. One is choose one small thing that you're going to try to move, and make sure that everybody on the team is on board that that's the one small thing we're trying to move right now. And then the message comes from a lot of different folks that all congeals on the same issue you're trying to change. So I thought that was... Yeah, I think it's great when the team can be, but I would make it even tinier. I would make it even tinier. When you're, when you're helping somebody kind of learn the, the procedure, if you will, for behavior change, you want to make it tiny. So that the tiniest, smallest amount of behavior change that makes any sense at all. So the classic example is, can you stand up from the couch? And it sounds crazy. It sounds crazy. But that, it turns out, it means a lot. But if you can do that, and you say, that's a good start, and tomorrow, you know, maybe we'll walk over to the kitchen. It doesn't matter what it is. You reinforce, you reinforce the process of setting a goal, meeting the goal, and then being reinforced. And then you take that procedure, you take that skill, and then you slowly expand it. But you start, start super tiny. And, you know, even, even before you've discussed, you know, the tiniest thing you can think of that seems even remotely meaningful. Well, we're going to have to wrap up the questions. But I would say that, although you haven't been able to see the chat board, there have been a lot of positive comments. They've really enjoyed interacting with you today. And the pocket tool, people are going to put it on their clients' fridges. And so they're very excited about that. So they appreciate that you added that to your handouts. You know, it's really, it's nice to come away from a webinar with an actual tool. So that's appreciated. I think that's great. I'm a huge fan of things like this. I have lots of them on mine. Just a word to the wise, laminate. You can laminate it. I don't know if I'm always saying this, lamination confers truth. So if it's laminated, it's even more authoritative.
Video Summary
In this video, the speaker discusses recommendations for developing a good communication pattern with primary care providers. They emphasize the importance of understanding the cultural differences and fast-paced nature of primary care. It is essential to speak their language and be prepared to communicate your story in a brief and organized manner. The speaker recommends writing down questions and providing a succinct presentation of your interests. They also highlight the value of bringing something to the table when building a relationship with primary care partners. This could include assisting with improving medical outcomes or helping with social interactions during appointments. The speaker mentions the effectiveness of leveraging peers, family members, or other support network individuals when attending primary care appointments with clients. They suggest using motivational interviewing techniques when communicating with clients who are resistant to change. The speaker also addresses the difficulty of finding doctors in private practice who are knowledgeable about serious mental illness and offers some tips for case managers to identify suitable providers. They suggest asking for recommendations, sharing a one-page profile of the client, and considering scuttlebutt from other patients. The speaker emphasizes that behavior change is a long-term investment and that even small changes can make a significant impact. The webinar ends with participants expressing their appreciation for the speaker's insights. Overall, the video provides valuable recommendations for improving communication and collaboration between the mental health and primary care sectors.
Keywords
communication pattern
primary care providers
cultural differences
fast-paced nature
building a relationship
behavior change
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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