What does MIH do?
Mobile Integrated Health is a multidisciplinary team of paramedics, nurses, and social workers who support patients and families by offering post EMS intervention, assessment, disease management planning, care coordination, disease education, resource provision, emotional support, and advocacy to ensure patients have access to the right level of care and can strive for the highest life quality they envision for themselves.
What professionals are part of MIH?
PBCFR believes that patients and families are best served by a multidisciplinary team of professionals who work in partnership with the patient/family to address all of the unique aspects of that patient/family's needs. To achieve this, PBCFR created an innovative model that includes paramedics, nurses, medical social workers, and other healthcare professionals. By approaching MIH with the understanding that every situation is unique we ensure that every patient gets the care, attention, and outcomes that they believe are right for them.
What are Medical Social Workers?
Medical Social Workers have a Master's degree in social work, and at Palm Beach County Fire Rescue, are also licensed in the state of Florida as Clinical Social Workers. Medical Social Workers have experience helping individuals and families navigate issues related to their physical and emotional health. Medical Social Workers can assess needs, problem solve, provide crisis and trauma care, identify resources, create plans of care, provide counseling and emotional support, educate, and also advocate. Medical Social Workers have compassion and expertise in issues related to adjusting and living with chronic medical issues and have advanced skills and knowledge on connecting identified needs of individuals with solutions and resources to enhance their quality of life.
What are Community Paramedics?
Community Paramedics are licensed paramedics in the state of Florida and have specialized training to offer medical evaluation, medical intervention, advocacy, and disease specific education to ensure the health needs of individuals are met as part of a Mobile Integrated Health contact. Community Paramedics go beyond their advanced lifesaving skills to evaluate and assist in creating care plans to help individuals and families navigate chronic disease management challenges that may be impacting life quality and an individual's ability to function.
How are MIH patients selected?
Patients who may benefit from MIH are identified by data indicating they meet criteria for one of the MIH programs and through referrals from our PBCFR crews who identify a need during a 911 call.
Are patients automatically enrolled in MIH?
PBCFR believes in the patient's right to make their own health decisions. When a patient is identified as being a candidate for MIH, our team reaches out to explain our programs and how we may be able to help. If the patient is in agreement, we complete an enrollment package to ensure the patient is involved every step of the way.
How is MIH different from a home care agency?
Mobile Integrated Health does not provide the services of a home care agency, but rather, MIH identifies the need for and connects patients to home care services to ensure their nursing and therapy needs are met. MIH is a partner to home health by advocating for home care involvement with physician and discharge planners. MIH is in a unique position to see the home environment and how the patient functions within it. This allows MIH to effectively assess home care needs and request orders that will enhance the patient experience and improve patient outcomes. By remaining in the patient's home for up to 30 days, MIH can ensure the home care agency receives orders to start care, and that any challenges that arise with referral to home care are navigated in a way that supports the needs of the patient. When the entire health care continuum works together we improve the patient experience and set patients on a path to successfully managing their health and wellness needs.
What types of programs does MIH offer?
Diabetic Intervention Program: This specially designed chronic disease management program is intended to empower patients living with diabetes to reduce their reliance on EMS and ensure patients are receiving the care and resources they need to successfully manage their health and wellness needs. Patients who participate in this program will receive in home visits and telehealth support for 30 days while they partner with the MIH Team to determine what their needs are and how to best meet those needs based on their unique strengths and challenges. Patients receive health education, disease management strategies, assistance with adjustment to their chronic disease, advocacy, and assistance creating a community based care team to ensure they receive the right level of care to meet their health and life quality goals.
Addiction Program: This telehealth program is aimed at reaching out to individuals who have recently experienced an addiction related 911 call and may benefit from emotional support and connection to addiction intervention resources. Patients receive a telephone call after their 911 encounter from a specially trained paramedic who offers compassion, understanding, addiction education, and an entry point to medically supervised addiction care.
Crew Referral Program: This program allows PBCFR paramedics the opportunity to refer patients and families for post EMS follow-up care when they determine a need exists beyond the emergency medical care they provide on scene. The MIH social worker contacts the patient/family and works with them via telehealth or in-person to assess needs, connect them to resources, provide support, or assist with problem solving.
Fall Intervention Program: This innovative program was designed to help reduce the risk of traumatic injury and death from falls. MIH paramedics may co-respond to 911 fall calls in an effort to provide immediate fall intervention support to patients and their caregivers, facilitate home visits 24-48 hours after a fall call, and/or make telehealth contacts 24 hours after a fall. The MIH Team completes a fall risk assessment, home safety assessment, provides fall prevention education and tools, assists with safety modifications in the home environment, and also connects patients to data driven home health fall intervention programs.
Pregnancy and Pediatric Outreach Program: This program is intended to help connect pregnant teens and women to prenatal care and pregnancy/childbirth resources to support the health of both mom and baby, and reduce the risk of complications and/or fetal demise. Patients receive a telephone call after their 911 encounter for a specially trained paramedic or medical social worker who offers non-judgmental support, prenatal care and safe sleep education, and an entry point to the Healthy Mothers, Healthy Babies system of care to be screened for programs that may support them. Patients who are identified as having experienced a pregnancy loss are connected to postnatal grief care in partnership with VITAS Bereavement Services. This program also responds to the needs of pediatric patients or crew referrals that involve a minor on scene by assessing needs, connecting families to resources, providing support, and assisting with problem solving.
Pediatric Outreach Program: This program has a goal of supporting patients 17 and under who have a chronic disease, disability, or health condition that has increased their risk of requiring emergency medical care. Partnering with the patient, their family, and their healthcare team, our MIH social workers and paramedics can assist by providing resources, health education, connection to health care professionals, and emotional support so that our youngest patients can thrive.
Cardiac Arrest Survivor and LVAD Support Program: This program ensures cardiac arrest survivors, newly discharged LVAD patients, and their families are connected to community and home based resources to ensure they have a connection to mental health and peer support related to their cardiac conditions.
Grief Support Program: This program ensures families receive a contact from a social worker after a loss to ensure they have a pathway to seeking grief support and related resources in the community.
For more information about MIH at PBCFR please contact Captain Todd Lessard at TLessard@pbcgov.org or Lauren Young Work, LCSW at LDYoung@pbcgov.org