Ho-Chunk Nation Integrative Team Approach

CDR Ted Hall, PharmD, BCPP
Ho-Chunk Nation Director of Pharmacy/Chief Pharmacist
 Mental health is a state of “successful performance of
mental function, resulting in productive activities,
fulfilling relationships with other people, and the
ability to adapt to change and to cope with adversity”
Mental health: a report of the Surgeon General — executive summary. Rockville (MD):
US Department of Health and Human Services, Substance Abuse and Mental Health
Services Administration, Center for Mental Services, National Institutes of Health,
National Institute of Mental Health; 1999.
 People with more serious mental illness die
prematurely from chronic disease
 Higher rates of smoking, obesity, and poor
compliance with medical care
 Also due to physiology: endothelial
inflammation, platelet stickiness, and changes
in the epinephrine-norepinephrine axis and in
cortisol metabolism
 Long-term elevations in cortisol levels can alter the
developing brain
 High, sustained levels of cortisol result in damage to a
part of the brain called the hippocampus. This can
lead to impairments in learning, memory, and the
ability to regulate certain stress responses
 The mission of the Ho-Chunk Nation
Health Facilities is to optimize wellness in
our patients. In doing so, we are committed
to the Ho-Chunk cultural philosophy of the
state of complete physical, mental, social,
and spiritual well-being
 Mechanism for organizing and blending
interrelated health issues, activities, and
prevention strategies to facilitate comprehensive
delivery of services
 Encourages service providers to offer various
interrelated services to persons whenever they
access services
 Important to understand the local epidemiology,
as well as the needs of the community
 Provide high quality and culturally appropriate
services delivered in timely manner
 Maintain patient confidentiality- Legal compliance:
 CFR 45 HIPPA, CFR 42 (2) Substance Abuse Protection,
American Recovery and Reinvestment Act of 2009
(HITECH Act)
 Written explicit consent- ROI and Integrated Consent forms
 Streamline patient care services for cost reduction,
improved efficiency, and improved patient care
 Medical Home Model- AAAHC
 Vivitrol for alcohol and/or opiate dependence
 Safe chronic pain symptom management
 Monthly case management with entire team:
(Behavioral health (AODA/LPC), MDs, PA-C, RDs,
PharmDs, community health RNs and clinic RNs)
 (Core Team)
 David Nelson, PhD, LPC, SAC
 CDR Ted Hall, PharmD, BCPP
 Amy DeLong, MD, MPH
 Indian Health Service (IHS) Improving Patient Care
(IPC) Team Model
 Based on the Chronic Care Model by the MaColl
Insitute for Health Care Innovation
 Integrated Multi-disciplinary Patient Care Model
 Ultimate goal is individualized patient centered care
 IPC Team Green- Safe Pain Symptom
Management/Addiction Prevention and Treatment
 Core team members: 2 BH Providers, 2 Pharmacists,
3 Medical Providers, 1 RN, 1 Nutritionist
 Manages daily cases on as needed basis
 Initiates controlled substance agreements
 Pain syndromes can be of either biological or psycho-social
origin; often mixed
 Intake conducted by behavioral health counselor for ALL
clients with a pain diagnosis
 Assess type of pain, psychiatric contributions, and underlying
addiction disorders
 Opioid Pain Medications
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Controlled Substance Agreements
Opiate Induced Hyperalgesia (paradoxical effects)
Iatrogenic Addiction Disorders
Potentially Lethal Treatment
Recent literature suggests ineffective treatment for chronic
pain syndromes
 Evidence based addiction withdrawal supportive care
treatment protocol
 Medication ‘cocktails’ for withdrawal syndromes
 Opiate, Alcohol, Benzodiazepines
 Assists primary care providers with outpatient detox
management and AODA counselor effectiveness
 Decreased need for inpatient detox
 Vivitrol Protocol
 Depo-naltrexone treatment for alcohol and opioid
dependence
 Traditional
 Linear, immediate, and
easily observed
 reduced opiate prescribing
 less opiate pills dispensed
 Realistic:
 Not all patients will be
completely opiate free
 Reduced doses considered
successful
 Non-Traditional
 Abstract and long-term
 Reduced ER visits
 Reduced incarcerations
 Improved patient follow-up
with medical care
 Behavioral health
appointment adherence
 Attitude/behavior changes
 Reduced calls to
nurse/pharmacy for refills
 Overall improved quality of
life
 Team : medical providers, pharmacists, clinic nurses,
nutritionists, community health nurses, mental health
counselors, AODA counselors, social services, exercise
physiologists
 Co-located services under umbrella of Health
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Department
Monthly meetings x 2 hours
Consent forms
Any provider may bring a case to the meeting
Improved patient safety and outcomes
 House of Wellness
 S2845 WhiteEagle Road
 Baraboo WI 53913
 608.355.1240
 David.nelson@ho-
chunk.com
 Ted.hall@ho-chunk.com
 Amy.delong@hochunk.com