Behavioral Health Integration in Nurse-Managed FQHC
Rationale/Background: The delivery of primary behavioral health (BH) care is, by necessity, different than the delivery of BH services in traditional, specialty behavioral health clinics or private practices. Literature cites up to 70% of primary care patient appointments include psychosocial concerns covering both the full spectrum of psychiatric disorders—from subclinical distress to serious mental health concerns—and a range of behavioral concerns. The BH Provider (BHP) in this context is tasked with providing brief assessments, targeted treatment, triage, and management of primary care patients with medical and/or BH problems. Integrated primary BH care interventions focus on helping individuals replace maladaptive behaviors with adaptive ones, provide skill training through psycho-education and patient education strategies, and focus on developing specific behavior change plans. SHS has achieved various levels of integration that can be described with the 2013 SAMSHA-HRSA six-level integration framework. They propose three main categories — coordinated, co-located, and integrated care — there are two levels of degree within each category.
Outcomes achieved/documented: Our integration model includes universal screening for BH issues done by all providers, self-management support and brief interventions by a BHP, treatment of BH conditions by the care team, group interventions, and appropriate referral to a higher level of BH care when warranted. The SHS BH Program has served a larger numbers of clients and provided more comprehensive behavioral health care. In 2012 the BH Program provided 1253 encounters to 226 individuals, in 2013 it provided 1832 encounters to 376 individuals, and it is on track to provide an increase in encounters to a larger client base in 2014. Twice a month multidisciplinary integrated care meetings have provided a forum for discussions that informed the development of over 10 standard operating procedures that increase congruity of care, efficiency, quality of care, and decrease overall stress to all members of the multidisciplinary team. Increase in client encounters is connected to the implementation of a menu of group visits that utilize evidenced-based curriculum including StressLess, Chronic Pain Management, and Youth Life-Skills Building.
Conclusion:
Nurse-managed health centers have long recognized the value of integrating with BH care and have actively been practicing integrated care before it even had its name. A purposeful focus on aligning care provided by the Behavioral Health Program with the principles of primary behavioral health care has resulted in significant organizational benefits and overall quality of client care. The enhancement and expansion of integrated BH and primary care has been a key factor in our organization’s successful pursuit of and receipt of FQHC designation.