[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 16:37:27 -0500

And a nice shiny 2 cents it is.

From: avaplmembers-bounce@xxxxxxxxxxxxx 
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Sandeen, Evelyn
Sent: Thursday, November 18, 2010 4:25 PM
To: members1@xxxxxxxxx
Subject: [AVAPL Members] Re: Clinical Teams--how are you set up?

In Albuquerque, I think that a major problem was initiated several years ago 
when the clinics became diagnosis-based.  As Stephen says, most of our 
clientele have multiple issues and do not cleanly fit into one or another 
diagnostic category.  Having patients divided by diagnosis has caused many 
problems regarding "turf wars" and, in my opinion, retards creative thinking to 
some degree.  I think a team-based model for the majority of mental health 
care, with episode-of-care specialty experiences which can be referred to, 
would be the ideal.  Just my 2 cents.

Evelyn Sandeen, Ph.D., ABPP

Director of Psychology Practicum, Internship and Post-Doctoral Training
Southwest Consortium Predoctoral Psychology Internship
www.psychologytraining.va.gov/albuquerque/
Psychologist
STARR (Substance abuse, Trauma, and Rehabilitation Residence)
Raymond G. Murphy VA Medical Center
BHCL (116)
1501 San Pedro Dr., S.E.
Albuquerque, NM 87108
505.265.1711x3283

From: avaplmembers-bounce@xxxxxxxxxxxxx 
[mailto:avaplmembers-bounce@xxxxxxxxxxxxx] On Behalf Of Long, Stephen 
[Northport]
Sent: Thursday, November 18, 2010 11:51 AM
To: 'members1@xxxxxxxxx'
Subject: [AVAPL Members] Re: Clinical Teams--how are you set up?

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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