[AVAPL Members] Re: Clinical Teams--how are you set up?

  • From: "Long, Stephen [Northport]" <Stephen.Long@xxxxxx>
  • To: "'members1@xxxxxxxxx'" <members1@xxxxxxxxx>
  • Date: Thu, 18 Nov 2010 13:50:35 -0500

I am very happy that Edgardo and Michael put the descriptions of redesign 
models on this string.

Systemic and programmatic changes are being discussed around the country.

Some of what is proposed is guided by a focus on discrete diagnoses being the 
basis for program development rather than a more holistic approach.  While 
there is certainly a place for some specialization when a particular diagnosis 
may be most central in  particular cases, too strict a focus on specific 
diagnoses will not provide the integrated care that the vast majority of 
patients - who typically present with what we've come to call                   
    "co-morbidity" - would benefit most from.



From: avaplmembers-bounce@xxxxxxxxxxxxx 
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Padin, Edgardo (VHACLE)
Sent: Thursday, November 18, 2010 9:27 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Clinical Teams--how are you set up?

Michael:  Here is the MH Redesign Model we recently developed here in Cleveland.

From: avaplmembers-bounce@xxxxxxxxxxxxx 
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Stewart, Michael O 
ASHVAMC
Sent: Thursday, November 18, 2010 9:19 AM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Clinical Teams--how are you set up?

I was wondering if anyone would be willing to give some feedback backchannel on 
the way clinical teams are set-up within their Mental Health Clinic.

We are considering a couple of formats, with "teams" including psychologists, 
social workers, psychiatrists, mid-levels, and nurses:
1) Teams organized around disorders (with permeability for co-occuring issues) 
such as a PTSD (combat) Team, PTSD (MST) and some combat et al. Team, Mood 
Disorders and non PTSD anxiety Team, and SMI and High Risk Team.

2) Teams organized (similar to primary care) in a Team A, B, C, D format where 
each team is about equal size and has clinicians and med-providers with skills 
covering a range of clinical presentations, and access to a "specialty team" 
such as PCT as needed.

3) Smaller "specialty Teams" (i.e., a sample of clinicians with specialized 
niches) embedded within a general Mental Health Clinic (closer approximation to 
our current set-up).

Also, considering how patients interact with the teams (following an initial 
intake evaluation):
1) Patient meets with the team as a whole to develop a collaborative treatment 
plan
2) A clinician is assigned a patient, who meets with the patient to develop a 
collaborative plan and presents recommendations to the team (i.e., patient not 
present) and coordinates care (e.g., a Principal Mental Health Provider)
3) An orientation and treatment planning session whereby patient collaborates 
with a provider who then triages patient based on this plan-this clinician may 
or may not be further involved with patient once triaged (closer approximation 
to our current set-up).


Any feedback and considerations would be appreciated-what has worked/ not 
worked for your clinic, barriers, etc.

Thanks!
~Michael

Michael O. Stewart, Ph.D.
Psychologist
Local Evidence-Based Psychotherapy Coordinator
Systems Redesign Committee
Asheville, NC VAMC
828-298-7911 x5735

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