Behavioral Health Toolkit for Primary Care Physicians

Introduction:

Highmark Health is dedicated to its Mission statement “To create a remarkable health experience, freeing people to be their best”, supporting the Highmark vision of “A world where everyone embraces health”. This vision embraces both the physical health and mental well-being of our members. Behavioral Health concerns have reached an all-time high in the United States, and present challenges to our members and health care providers. To complicate this, is the fact that there has been an increasing shortage of Behavioral Health Care Professionals across the United States. It is estimated that there may be a deficit upwards of 250,000 of Behavioral Health Practitioners, including Psychiatrists, as well as non-MD specialists/therapists, by the year 2025.¹

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2018, 57.8 million Americans were diagnosed with a mental and/or substance use disorder. Among the Highmark population, this health care challenge exists as well. In January through December 2019, among the 2,410,601 members residing in Pennsylvania, Delaware, and West Virginia and actively enrolled in December 2019, Cotiviti chronic conditions for behavioral health were attributed to the following number of members:

• Depression – 157,558 members (6.54%)
• Other Behavioral Health Diagnoses – 128,475 members (5.33%)
• Substance Abuse Disorders – 116,157 members (4.82%)

To address this growing problem, Highmark has developed this Behavioral Health Toolkit to assist Primary Care Physicians in the care delivery to this vulnerable population. The Toolkit contains links to valuable and timely Information Sheets with Best Practice recommendations, Screening tools, Clinical Practice Guidelines, as well as additional tools and resources that can be incorporated into your practice.

Reference:

_{¹ U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce, National Center for Health Workforce Analysis: National Projections of Supply and demand for Selected Behavioral Health Practitioners: 2013 – 2025 , November 2016, retrieved 12/22/2019 @ https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/behavioral-health2013-2025.pdf} 

Information Sheets for Behavioral Health Challenges facing the Provider:

• Antidepressant Medication Management
• Follow-Up Care for Children Prescribed ADHD Medication
• Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse and Dependence
• Follow-Up After Emergency Department Visit for a Mental Illness
• Follow-Up After Hospitalization for Mental Illness
• Initiation and Engagement in Alcohol and Other Drug Dependence Treatment
• Metabolic Monitoring of Children and Adolescents on Antipsychotics
• Risk of Continued Opioid Use
• Use of First-Line Psychosocial Care for Children and Adolescents on Antipsychotics
• Use of Opioids at High Dosage
• Use of Opioids From Multiple Providers

Screening Tools:

• Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide @
  https://www.niaaa.nih.gov/publications/clinical-guides-and-manuals/alcohol-screening-and-brief-intervention-youth
• AUDIT (Alcohol Use Disorders Identification Test) @
  https://www.drugabuse.gov/sites/default/files/audit.pdf 
• CAGE – AID (commonly used 5 question tool used to screen for drug and alcohol use) @
  https://www.hrsa.gov/behavioral-health/cage-aid-substance-abuse-screening-tool 
• Primary Care PTSD Screen (PC-PTSD) @
  https://www.ptsd.va.gov/professional/assessment/documents/pc-ptsd5-screen.pdf 
• Patient Health Depression Questionnaire (PHQ – 2) @
  https://www.aafp.org/afp/2012/0115/hi-res/afp20120115p139-t3.gif 
• Patient Health Depression Questionnaire (PHQ – 9) @
  https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjQn-nRyvDqAhU6g3IEHRB3CNcQFjADegQIBRAB&url=https%3A%2F%2Fwww.uspreventiveservicestaskforce.org%2FHome%2FGetFileByID%2F218&usg=AOvVaw2yZ9TqORR-INR_A1Fdw8-M 
• Geriatric Depression Scale (Long form) @
  https://integrationacademy.ahrq.gov/sites/default/files/2020-07/Update%20Geriatric%20Depression%20Scale-30.pdf 
• Geriatric Depression Scale (Short form) @
  https://integrationacademy.ahrq.gov/sites/default/files/2020-07/Update_Geriatric_Depression_Scale-15.pdf
• SAFE-T: Suicide Assessment Five-step Evaluation and Triage @
  https://store.samhsa.gov/product/SAFE-T-Pocket-Card-Suicide-Assessment-Five-Step-Evaluation-and-Triage-for-Clinicians/sma09-4432 
• Columbia Suicide Severity Rating Scale @
  https://suicidepreventionlifeline.org/wp-content/uploads/2016/09/Suicide-Risk-Assessment-C-SSRS-Lifeline-Version-2014.pdf 
• NICHQ Vanderbilt Assessment Scales (Used for diagnosing ADHD)@
  https://www.nichq.org/sites/default/files/resource-file/NICHQ_Vanderbilt_Assessment_Scales.pdf 

Clinical Practice Guidelines:

• The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder January, 2018 https://doi.org/10.1176/appi.books.9781615371969
• The American Psychiatric Association Practice Guideline on the Use of Antipsychotics to Treat Agitation of Psychosis in Patients with Dementia May, 2016 https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890426807
• APA Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts: Guideline development Panel for the Treatment of Depressive Disorders (Adopted as APA Policy 2/16/2019)
  https://www.apa.org/depression-guideline/guideline.pdf 
• The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia, Third Edition @ https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9780890424841
• American Academy of Child and Adolescent Psychiatry: Practice Parameters for the Use of Atypical Antipsychotic Medications in Children and Adolescents (approved by the AACAP Council on August 2, 2011) https://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/Atypical_Antipsychotic_Medications_Web.pdf
• APA Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents @ https://pediatrics.aappublications.org/content/144/4/e20192528 
• CDC Guideline for Prescribing Opioids for Chronic Pain – United States 2016 @ https://www.cdc.gov/drugoverdose/prescribing/guideline.html 

Additional Tools/Resources:

• Medication for the Treatment of Alcohol Use Disorder (Pocket Guide) – National Institute on Alcohol Abuse and Alcoholism (NIH); Substance Abuse and Mental Health Services Administration (SAMHSA) @ https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4907pocketguid.pdf
• Six Myths and Facts About Mental Illness – National Alliance on Mental Illness (NAMI) https://www.nami.org/Blogs/NAMI-Blog/October-2019/Six-Myths-and-Facts-about-Mental-Illness
• Agreement on Controlled Substances Therapy for Chronic Pain Treatment (American Academy of Pain Medicine) https://painmed.org/uploads/education/agreement-on-controlled-substances-therapy.pdf
• Medication – Assisted Treatment (MAT) U.S. Department of Health and Human Services. Substance Abuse and Mental Health Services Administration (SAMHSA) https://www.samhsa.gov/medication-assisted-treatment
• Family Guide 2010: What Families Need to Know about Adolescent Depression – National Alliance on Mental Illness (NAMI) http://www.shared-care.ca/files/FamilyGuidePRINT_NAMI_Depression.pdf
• Guidance on Strategies to Promote Best Practice in Antipsychotic Prescribing for Children and Adolescents (SAMHSA) 2019 @ https://store.samhsa.gov/product/Guidance-on-Strategies-to-Promote-Best-Practice-in-Antipsychotic-Prescribing-For-Children/PEP19-ANTIPSYCHOTIC-BP 
• Treatment of Young Peoples with Antipsychotic Medications in the United States 2015 JAMA http://jama.jamanetwork.com/article.aspx?doi=10.1001/jamapsychiatry.2015.0500&utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jamapsychiatry.2015.0500
• Perinatal Depression: U.S. Department of Health and Human Services, National Institutes of Health, NIH Publication No. 20-MH-8116 @ https://www.nimh.nih.gov/health/publications/postpartum-depression-facts/index.shtml
• SAMHSA.2019. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health”@ https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf
• Annual Surveillance Report of Drug-Related Risks and Outcomes, United States, 2019. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, @ https://www.cdc.gov/drugoverdose/pdf/pubs/2019-cdc-drug-surveillance-report.pdf
• Calculating Total Daily Dose of Opioids for Safer Dosage @ https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf 

This Behavioral Health Toolkit is provided for general information. Highmark does not recommend particular treatments or health care services.  This information is not intended to be a substitute for professional advice, diagnosis, or treatment.  You should determine the appropriate treatment and follow-up with your patient. Coverage of services is subject to the terms of each member’s benefit plan.  Additionally, state laws and regulations governing health insurance, health plans and coverage may apply and will vary from state to state.