The Collaborative Care Model (CoCM): An Evidence- and Team-Based Care Approach to Integrating Behavioral Health into Primary Care

Collaborative Care, originally developed by the University of Washington, is a cost-effective, evidence-based integrated behavioral health care model. The primary care provider, behavioral health care manager, and psychiatric consultant function as a team, using a shared care plan, to meet the needs of patients with mild to moderate behavioral health concerns.

The Michigan Center for Clinical Systems Improvement (MiCCSI), Michigan Institute for Care Management and Transformation (MICMT), and Michigan Collaborative Care Implementation Support Team (MCCIST) have been contracted by Blue Cross Blue Shield of Michigan for this project.

Continuing Education

This live series activity, Preparing to Implement Collaborative Care, from 06/10/2020 - 07/31/2020, has been reviewed and is acceptable for credit by the American Academy of Family Physicians. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Approved for (1 credit per session ) AAFP (Prescribed) credits.

AMA/AAFP Equivalency: AAFP Prescribed credit is accepted by the American Medical Association as equivalent to AMA PRA Category 1 credit(s)™ toward the AMA Physician’s Recognition Award. When applying for the AMA PRA, Prescribed credit earned must be reported as Prescribed, not as Category 1.

Nurses can use the CME for their state requirements. Information on this can be found on LARA and through the Michigan Nurse Association (MNA) at https://www.minurses.org/education-resources/resources-for-practicingnurses/state-of-michigan-ce-requirements/
This course is approved by the Michigan Social Work Continuing Education Collaborative-Approval # 051420-00 The Collaborative is the approving body for the Michigan Board of Social Work


Presenters

Mark Williams, MD

Laura Saunders, MSSW

Susan Vos, BSN, RN, CCM

Robin Schreur, BS, RN, CCM

Disclosures

The presenters and all planners have indicated that they have no commercial interests related to the content of this educational activity.


Continued Learning Webinar Series

We are offering continued learning opportunities to expand your knowledge and skills to support the Collaborative Care Management care model. Nursing and Social Worker continuing education applications are pending. You may register for one or all of the sessions.

Motivational Interviewing

These sessions are presented by Laura Saunders and will continue to build on Motivational Interviewing knowledge and skills for working with patients experiencing depression and/or anxiety. These sessions will be highly interactive allowing participants to practice and hone their skills.

  • October 26th | Spirit of MI
  • November 17th | OARS
  • December 2nd | OARS Part 2
  • January 6, 2021 | SBIRT & Putting it All Together
Presenter

Laura Saunders, MSSW - Wisconsin State Project Manager for the Great Lakes Addiction, Mental Health and Prevention Technology Transfer Centers, Madison, WI

Continuing Education

Nursing
This nursing continuing professional development activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91). Approval ONA#: 2020-0000000815
Approved for 1 Contact Hour per webinar attended.

Social Work
This course, Motivational Interviewing core concepts and approaches for the patient with depression, anxiety and or substance use risks is approved by the Michigan Social Work Continuing Education Collaborative-Approval #: -101620-00. The Collaborative is the approving body for the Michigan Board of Social Work. This course is approved for up to 4 CE hours.
In order to receive credit for this activity, the learner must register for each webinar, attend the full webinar, complete the evaluation and submit the evaluation. Upon receipt of the evaluation, the certificate of completion will be awarded.

Click to Register


Behavioral Activation & Problem Solving

These sessions presented by Eric Lake will provide a hands-on learning opportunities to further the depth of your knowledge and skills with treating patients with depression using behavioral activation and problem solving treatment techniques.

  • November 20th | Problem Solving Treatment
  • December 4th | Behavioral Activation
Presenter

Eric Lake, MA, LLP, CADC - Mary Free Bed Rehabilitation Services: Psychologist, Pain Rehabilitation Program, Grand Rapids, MI

Continuing Education

Nursing
This nursing continuing professional development activity was approved by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation (OBN-001-91). Approval ONA#: 2020-0000000815
Approved for 1 Contact Hour per webinar attended.

Social Work
This course, Review and application of problem solving treatment and behavioral activation for the patient diagnosed with depression and/or anxiety is approved by the Michigan Social Work Continuing Education Collaborative-Approval #: 102220-01. The Collaborative is the approving body for the Michigan Board of Social Work. This course is approved for up to 2 CE hours.
In order to receive credit for this activity, the learner must register for each webinar, attend the full webinar, complete the evaluation and submit the evaluation. Upon receipt of the evaluation, the certificate of completion will be awarded.

Click to Register


Operations

These sessions will provide best practices for establishing CoCM operational processes in the practice.

  • November 24th | Patient Identification Processes
  • December 21st | Building an Effective Systematic Case Review Process
  • January 19th | Data & Billing Strategies
Presenters

Phil Baty, MD - Mercy Health Physician Partners & Mi-CCSI Medical Director, Grand Rapids, MI
Robin Schreur, BS, RN, CCM - Mi-CCSI Trainer, Grand Rapids, MI
Susan Vos, BSN, RN, CCM - Mi-CCSI Program Manager, Grand Rapids, MI
Mark Williams, MD - Mayo Clinic, Rochester, MN

Click to Register



AIMS Team Member Self-Assessment

AIMS Team Member Self Assessment


Day 1

This session provides an overview of the Collaborative Care model, patient identification strategies, the roles of the care team, billing codes, and implementation strategies.

Intended audience

This training is intended for primary care physician/provider champion, psychiatric consultant, behavioral health care manager, care coordinator, clinical surpervisor, practice manager, and other practice team members who are charged with implementing the collaborative care model.


Objectives

Day 1 Objectives


Content

Agenda

Day 1 Training CoCare Agenda AW-092520

Presentations

Part One-Collaborative Care Model The Why?

Part One: Collaborative Care Management

Part Two: The Process of CoCM

Part Two: The Process of CoCM

Part Two: SBAR Care Review Tool

Part Two: SCR Demo - Care Manager Initial Note

Part Two: SCR Demo - Initial Psychiatry note

Part Two: SCR Demo - Care Manager monthly note

Part Two: SCR Demo - Psychiatry monthly note

Part Three: Team Roles & Responsibilities

Part Three: Team Roles & Responsibilities

Part Three: CoCM Shared Vision Worksheet

Part Four: Patient Identification & Tracking

Part Four: Patient Identification & Tracking

Part Five: Billing & Sustainability

Part Five: Billing Collaborative Care Services

Part Five: AIMS Code Review CMS_FinalRule_BHI_CheatSheet

Part Five: CMS FAQ Billing

Part Five: Billing Coding CMS

Part Five: CoCM Medicaid Service Bulletin Guide

Part Six: Preparing for Implementation

Part Six: Preparing for Implementation

Part Six: CoCM Practice Fidelity Assessment

Part Six: Clinical Workflow Plan

Additional Handouts

PHQ-9_English

GAD-7_English

PHQ & GAD-7 Screening Tools in other Languages

AIMS Center Shared Vision Worksheet

Collaborative Care Implementation Guide

SBAR Care Review Tool

CM Followup Guide

AIMS CMS Code Review CheatSheet

CMS FAQ Billing

Billing Coding CMS

CoCM Medicaid Service Bulletin Guide

Care coordination intake template for EPIC


Day 2

This session provides an overview of key responsibilities of the behavioral health care maager in the CoCM treatment team; tracking patients, problem solving and behavioral activiation, motivational interviewing, psychotropic medications and diagnoses, maintenance and implementation strategies.

Intended audience

This training is intended for behavioral health care manager, care coordinator, clinical surpervisor, practice manager, and other practice team members who are charged with implementing the collaborative care model.


Objectives

Day 2 Objectives


Content

Agenda

Day 2 CoCM Agenda

Presentations

Part One: The Role of the BHCM and the COCM Process & Maintenance

Part One: The Role of the BHCM and the COCM Process & Maintenance

Part One: PHQ-9_English

Part One: GAD-7_English

Part One: PHQ & GAD-7 Screening Tools in other Languages

Part One: Audit-C

Part One: Self Management Goals

Part One: Patient Safety PlanTemplate

Part One: Self-Management Action Plan Template</a

Part Two: Identifying & Tracking Patients

Part Two: The Role of the BHCM continued & Patient Identification & Tracking

Part Three: Psychotropic Medications and Diagnosis Criteria

Part Three: Psychotropics Overview

Part Three: Pharmacology Support Resources

Part Four: Let's Get Ready & Moving Forward

Part Four: Getting Ready & Moving Forward

Part Five: Problem Solving & Behavioral Activation

Part Five: Problem Solving & Behavioral Activation

Part Five: Problem Solving Therapy Tool

Part Five: Activity Log

Part Six: Motivational Interview, Problem Solving & Behavioral Activation Continued

Part Six: Motivational Interviewing, A Patient-Centered Approach

Additional Handouts

CM Follow Up Guide

Problem Solving Therapy Tool

The Cycle of Depression

Understanding Depression

SBAR Care Review Tool

Self Management Goals

Self-Management Action Plan Template

Activity Log

Managing Medication Side Effects black text

Relapse Prevention Plan

COMPASS_Toolkit_2015

MHTTC- SBIRT Short Screens & Brief Assessments

Audit-C Tool

Audit Tool

Activity Log

Pharmacology Support Documents_

Resource: Mental Health Apps


Patient Tools

The Cycle of Depression

Understanding Depression

Managing Medication Side Effects

Relapse prevention plan

AIMS Relapse Prevention Plan

Care Manager Introduction to CoCM Scripting

Patient brochure MICCSI