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From the Field funding and a financial commitment from Lucile Packard Children’s Hospital to provide pediatric social worker support allowed RFHC to hire 2.3 fulltime-equivalent behavioralists. Our behavioral health team provides services in three therapeutic settings. Team members support our clinic’s 12 FTE primary care providers and provide wraparound services to our local school district counseling program. They also support the local parolee reentry and recovery programs. Our behavioral health services, offered on site, are unique in that our full-time program assistant, who has a bachelor’s degree in social work, is key to making this team of part-time, bilingual, multicultural behavioralists — a psychologist, a social worker with a master’s in social work, consulting pediatric and adult psychiatrists, and a Marriage and Family Therapist intern — work as a unit. We were told that the primary pitfall to avoid when designing an integrated behavioral health practice is hiring part-time behavioralists. However, because of funding limitations and our need for a rich mix of behavioralist providers, we o employ part-time staff. We have found that a well-trained, engaging, and empathetic program assistant conducting the warm handoff can be effective. Our first 6 months of data showed an 80% rate of follow-through to a first appointment when the program assistant conducted the warm hand-off, versus a 20% follow-through rate when the patient was given an appointment by phone. Our second setting is half a block away, at a neighboring substance abuse recovery nonprofit. Our full-time MFT intern dedicates half of her time off site working with parolees with complicated mental health histories and the other half of her time pro- viding goal-directed mental health services to the RFHC clients in the residential treatment program. In our third setting, our consulting pediatric psychiatrist devotes one day a week to seeing referred patients from the clinic and consulting to and providing training to our primary care practitioners, community youth workers, and school district interns. Our next goal is to provide care in the school setting to people whose children receive support from the school district but who are unable to access mental health services for themselves. Currently, RFHC is sponsoring a 6-week parent education program for families of these students. Our IBH program, delivered in three clinical settings, is a vibrant and effective practice. South Central Foundation Finds Colocation and Flexibility Critical to Integrated Care Wendy D. Bradley, LPC, Lead Behavioral Health Consultant Family Medicine, South Central Foundation, Anchorage, AK wdbradley@SouthcentralFoundation.com n keeping with its vision of wellness for the whole person, the South Central Foundation formed a team of behavioral health consultants in its primary care center 5 years ago. Customers can receive comprehensive and immediate treatment in the exam room while visiting their primary care provider. The team’s goals are to meet customers “where they are” and to provide immediate services for a wide range of physical, mental, and emotional needs. Behavioral Health Consultants share offices with the providers and case managers, which creates seamless communication and collaboration for patient care. BHCs are part of primary care and are located in family medicine, women’s health, and pediatrics departments. Currently, 11 BHCs serve about 40 provider teams. BHCs are licensed professional counselors and licensed clinical social workers. SCF is funded by a mix of private insurance, Indian Health Service funds, and grants. BHCs from SCF have acquired information from several programs, including Cherokee Health Systems and the Air Force Integration Model. We use a variety 38 / NATIONAL COUNCIL MAGAZINE • WINTER 2009 I of resources, such as the Primary Care Evaluation of Mental Disorders for depression, the Pain Patient Profile and Symptom Checklist−90 for chronic pain, the Cognistat Neurobehavioral Cognitive Status Examination for dementia, the Ages and Stages Questionnaires for child development, and the Alcohol Use Disorders Identification Test for substance abuse. We have also developed clinical guidelines for mood disorders, grief, anxiety, chronic pain, attention deficit–hyperactivity disorder, oppositional defiant disorder, and sleep disorders. In addition, we use a combination of handouts and workbooks. Our BHCs had 7,659 visits in 2008. After BHC visits, we found reductions in emergency room visits by approximately 18%, urgent care visits by 20%, family medicine clinic visits by 11%, and pediatrics visits by 40%. At the same time, visits for behavioral health, complementary medicine, and traditional healing services increased. Provider surveys indicated 92% improved access to behavioral healthcare, a 64% increase in provider job satisfaction, and a 61% increase in appointment efficiency. Providers have observed that “BHCs have been a wonderful addition; not only has access to behavioral health services been improved, patients are screened for appropriateness of the referral. A definite asset is the ability to have immediate intervention, which not only promotes patient care but also prevents crisis situations. A great asset and much appreciated.” Patients agree and comment, “By seeing my doctor, my dietician, and BHC, I was able to get my diabetes under control, lose weight, and find meaning in my life again.” At SCF, we’ve learned that for integration to be successful, shared offices are a must. Such an arrangement allows information to be shared easily, and it reminds providers to use BHCs. Also, when customers are seen in the exam room and introduced by their providers, it makes for a seamless transition. Stick to short, solution-focused visits. Too many scheduled visits can make the BHC unavailable for consults. Trying to be too rigid in therapeutic approaches will not work. Flexibility is key. Newly hired clinicians who have a lot of experience may find it difficult to change how they work.

National Council Magazine - Winter 2009

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