|
|||
   |
|||
Left to Right: La Clínica de la Raza Behavioral Medicine Specialists Heather Barnett, LCSW, Leslie Lessenger, PhD, and Michael McGlathery, MFT
Integrating Behavioral Health with Primary Care
"From our work in this community, we know there is a lot of pent-up demand for mental health services." - Jane Garcia, Chief Executive Officer, La Clínica de la Raza
In Brief: To better meet the full spectrum of patients' physical and mental health needs at its Contra Costa clinics, La Clínica de La Raza is integrating behavioral health services into primary care visits. Research has shown this approach to be clinically and economically effective. Our grant supports a planning process, staff training, implementation, and evaluation.
The Health Issue: For a variety of reasons, many La Clínica patients are reluctant to acknowledge their own mental health needs and have no easy way to access mental health providers. They are particularly prone, therefore, to do something that all populations do to some degree: express mental health distress through physical symptoms. Research has shown nearly 70 percent of primary care visits have a psychosocial 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 providers do identify a need, it's usually difficult to convince patients to follow up with an unfamiliar mental health provider.
The Health Improvement Strategy: By "nesting" behavioral health providers at their primary care clinics in Contra Costa County, La Clínica expects to dramatically improve the way it meets the mental health needs of its patient population.
The behavioral health expert provides direct patient services, and acts as a consultant to the primary care providers. If during an appointment, the primary care provider identifies a mental health need - either through a specially designed intake form or during the actual exam - he or she introduces the patient to the behavioral health specialist who is trained to rapidly assess mental health concerns and, in simpler cases, treat the concern. (For example, a patient suffering from sleep deprivation might be reminded not to drink caffeine at night.) Some studies indicate that as many as three-quarters of mental health problems can be addressed this way in one to three visits, thereby addressing many mental health concerns before they become more serious.
For more severe problems - such as depression, substance abuse, or domestic violence - the behavioral health specialist can establish a relationship, increasing the chances that the patient will arrive for a follow-up visit.
"This is not a therapy model or a long-term solution to more severe problems," says Leslie Preston, La Clínica's director of mental health. "If a patient has those needs we refer them on to the county or to community organizations that deal with specific problems... but we can help provide leadership in integrating behavioral health in primary care, which enables us to treat our patients as whole people."
"From our vantage point, the Community Health Fund gave us an incredible gift in that we could be deliberate about designing a program that would have the greatest impact on our population." - Jane Garcia