As case management grows more robust, case plans need to account for all the SDOHs occurring at any given moment. This is especially true for children, adults, and the elderly who fall under the IDD (intellectual and developmental disabilities) umbrella. According to the NCI-IDD (National Core Indicators – Intellectual and Developmental Disabilities) In-Person Survey, 60% of individuals living with IDD who are 65 and older also struggle with anxiety and depression.
Government-funded Home- and Community-Based Services (HCBS) programs have already started to blend mental and behavioral health and crisis services. In fiscal year 2021, states spent $968.9 million for nearly 200,000 IDD individuals in this area.
By connecting IDD case management with behavioral health and human services, case managers can work with their clients to create better service plans. Rather than separate case plans for different diagnoses, agencies can integrate IDD and behavioral health through shared case management workflows, care plans, and data.
Here's how to change the approach for public health and behavioral service integration teams through the use of case management software in five steps.
Step 1. Use One Integrated Care Plan
Integrated case management starts with treating IDD and behavioral health as multiple primary conditions within a single care plan. This reduces the strain on families trying to communicate across different providers. When Texas integrated its state disability and mental health agencies, family members found it much easier to access services with a centralized location for the administrative processes required to do so.
Person-centered plans should be built in collaboration with IDD professionals, behavioral health providers, and the person and their family (much like how it is in wraparound services). The plan should cover:
- IDD services (skill building, habitation, employment, etc.)
- Behavioral health treatment (therapy, psychiatry, crisis plans, etc.)
- Social determinants support (housing, income, transportation, etc.)
How PlanStreet Helps
PlanStreet's behavioral health and IDD case management software creates a single source of truth. All of the information needed to communicate across providers, such as intake, needs assessments, service plans, case notes, scheduling, surveys, and documents, is stored in one platform.
Customizable forms and workflows let you build one person-centered plan that includes IDD supports, mental health treatment, and social services tasks. Role-based access ensures each provider has the details they need while keeping sensitive information protected.
Step 2. Standardize Assessments and Coordination Workflows
When working with a dual diagnosis of IDD and behavioral health, treatment providers benefit from utilizing assessments built with comprehensive needs in mind. For example, 37% of adults with ASD (autism spectrum disorder) also have depression. By using standardized assessments, providers can screen simultaneously for developmental disability, mental health, trauma, and functional needs, speeding up the care planning process.
Additionally, workflows need to be shared and defined to ensure accurate handoff between IDD and BH teams. Task templates in SaaS software ensure that necessary steps are carried through as required. Teams can flag anything from routine check-ins or major life transitions (such as hospitalization or school-to-adult transitions), and easily spot bottlenecks in service provision, and intervene as needed.
How PlanStreet Helps
PlanStreet's case management software was built to ease coordination, with tools such as:
- An advanced form builder to create tailored assessments, using validation rules and conditional logic to reduce errors and keep documentation consistent across programs.
- Built-in secure messaging, shared notes, and file sharing allow case managers and care providers to coordinate quickly.
- Client portals allow patients and their families to schedule appointments, contact professionals, and view case plans at their convenience.
- Pre-built forms, such as DSM-5 and ICD-10 ready therapy notes, and secure access to the EHR (electronic health record) from any device.
Step 3. Build Multi-Disciplinary Case Management Teams
When integrating IDD and behavioral health, team-based models are crucial. For any case, a single care coordinator or case manager may spearhead case planning and service scheduling, but all service providers must have a say. A team usually includes:
- IDD case managers
- Behavioral health providers
- Peer and family partners
- Primary care doctor
- Home health coordinator (if applicable)
Cross-training IDD and behavioral health staff can be a great way to better serve intersecting conditions. IDD staff need to be able to recognize and intervene when spotting mental health symptoms. Likewise, behavioral staff must understand the communication, sensory, and behavioral-support needs of people with IDD. Organizations such as the Mental Health and Developmental Disabilities National Training Center offer training modules to close the gaps in care often seen for people with IDD.
How PlanStreet Helps
PlanStreet offers task tracking features to help facilitate the training process. Modules can be given due dates in the software to ensure professionals stay up-to-date with the latest best practices. These same features can be used to divide care plan tasks to the appropriate team members, allowing everyone to understand their role in caring for clients.
Step 4. Implement a Shared Case Management Platform
From a SaaS perspective, integration happens when everyone works on the same platform and has access to the information they need to make the best decision at any given moment. A cloud-based case management software like PlanStreet offers all of the tools IDD and behavioral health teams need to work together, including:
- Role-based access for IDD and behavioral health teams
- Shared care plans
- Task lists
- Progress notes
- Outcomes dashboards
Ideally, these can be connected to EHRs, Medicaid waivers and billing, and other critical software features so that case managers can see an entire record in one place.
How PlanStreet Helps
With PlanStreet, your organization can customize the platform to meet your exact specifications. For each client, we can build out a solution based on the features needed for workflows, including the ones listed above and more.
Step 5. Embed Crisis and Follow-up Into Case Management
Integration tends to collapse in crises unless it is designed into case management. When building a shared workflow, incorporate a crisis plan (such as this one from Vanderbilt Health). This should include:
- Baseline behaviors
- Usual triggers
- Crisis signs
- Strategies for helping the patient at every stage
Case management software can automate alerts and schedule follow-up tasks based on actions taken when utilizing a crisis plan. Professionals must always track post-crisis follow-up, medication changes, and environment or support adjustments in the same system so both IDD and behavioral health sides can see what changed and adjust supports together.
How PlanStreet Helps
PlanStreet's dynamic Power BI dashboards and reporting help care teams track critical pieces in case plans. They can spot trends and intervene with care before a trigger turns into a crisis. Additionally, leaders can track outcomes across entire programs, ensuring that IDD and behavioral health services continually improve to better serve their patients.
PlanStreet: Increasing Collaboration for IDD and Behavioral Health Teams
PlanStreet's case management software creates a single ecosystem for IDD and behavioral health teams to communicate, address concerns, and better serve each patient's distinct needs. When utilizing PlanStreet, our current client Equal Hope found:
- A significant reduction in missed follow-ups and uncompleted referrals
- Enhanced coordination between case managers, clinics, and outreach teams
- Greater accessibility of services to uninsured and underinsured individuals
Learn more about how PlanStreet can help improve outcomes and schedule a free live demo with our case management experts today.