Integrating Behavioral Health with Primary Care

John Muir/Mt. Diablo Community Health Fund

Building Bridges to Better Health  

Integrating Behavioral Health with Primary Care

Research has shown nearly 70 percent of primary care visits have a mental health component. Yet during a typical primary care visit, few providers have the time, training, or resources to diagnose, much less address, mental health concerns. Even if primary care providers do identify a need, it's usually difficult to convince patients to follow up with an unfamiliar mental health provider.

For many years, this problem was exacerbated in La Clínica de La Raza’s patients, because studies show they are particularly reluctant to acknowledge their mental health needs and, like many low-income patients, cannot readily access mental health providers.

That changed in 2007 when La Clínica began using CHF funding totaling more than $1 million to plan, pilot, evaluate, and strengthen the integration of behavioral health services into primary care visits at La Clínica's Pittsburg and Monument clinics. Research has shown this approach to be both clinically and economically effective.

During the program's first three years, CHF funds supported one year of planning, a two-year pilot implementation, and three years of evaluation. For that initial period, the U.S. Department of Health and Human Services’ Federal Partners Senior Workgroup on Mental Health recognized La Clínica as a “Best Practice Setting.”

Two middle aged women

At the end of the pilot, the CHF-funded evaluation by The AVISA Group found considerable success and offered guidance for ongoing improvement during a Phase Two implementation, which a Contra Costa Mental Health Services Act (MHSA) grant supported. During Phase Two, La Clínica evolved its behavioral health integration by expanding behavioral health screening, which initially only targeted adults, to patients in five age categories. La Clínica also added new elements to its screening process and implemented new prevention strategies.

In 2011 and 2012, the CHF provided additional funding to:

  • Support development of a training program to help La Clínica expand age-specific, integrated behavioral health services to seniors.
  • Create a training process for medical social workers that would assure quality integrated behavioral health screening and intervention services for pediatric patients (ages 0–5) and their families.
  • Extend the ongoing evaluation by The AVISA Group.

The five-year evaluation found that its Integrated Behavioral Health program enabled La Clínica to steadily expand the number of people being screened across all age groups. This resulted in:

  • Improved access to mental health services for La Clínica’s patients
  • The easing of symptoms for many patients with mild to moderate mental health conditions
  • The identification of new areas to improve the care and case management of these patients
  • Solid levels of staff satisfaction