Build an Effective Integrated Behavioral Health Model
Many community Health Centers (CHCs), Federally Qualified Health Centers (FQHCs) and private practices offer behavioral health (BH) services. They have psychologists, therapists, case managers and maybe a psychiatrist on staff if they are lucky. However, few organizations actually have Integrated Behavioral Health services…. where they integrate their medical care with their mental health services. Integrating Behavioral health into Primary Care ensures the most comprehensive care experience for patients and reduces the possibility that they could fall through the cracks.
The big differences between offering behavioral health services and integrating them is co-location and connection: facilitation of warm handoffs or brief interventions throughout the clinic session. Similar to any strong Patient Care Team (PCT), behavioral health staff should be co-located within the PCT workspace in order to integrate care. Co-location facilitates integration; however, co-location is not in and of itself integration.
Another vital step is having behavioral health staff join daily PCT huddles to discuss patients scheduled to come in that day. Many organizations find it helpful to start their integration by having BH staff join daily PCT huddles. More advanced integration follows up huddles with frequent interaction throughout the day between BH staff and the medical team. This provides real-time behavioral health care for scheduled patients. For example, hallway consults alone between BH staff and a PCP are a good start, but they aren’t integration. Advanced Integration includes a medical provider messaging or speaking to the BH provider on the Patient Care Team after seeing a patient, and saying something like, “You know, you were right this morning in the huddle. I just saw Sally Jones and she is struggling to take her diabetes medication and daily blood sugar. She was telling me about some significant issues at home. Can you pop in and talk to her for a little bit and if you’re tied up, at least meet her briefly and set up a time to see her next week?” Co-location makes this kind of workflow easier, and frankly—makes it even possible. However, there are some workarounds if co-location is not a possibility yet.
Some organizations cannot fit behavioral staff in their medical workspaces. This is a chance to get creative when integrating mental health services until workspace adjustments can be made to allow for co-location. If BH staff aren’t sitting within the PCT pod or workspace, they should still join daily PCT huddles in order to collaborate with the medical team, discuss shared patients, and strategize to address each patient’s mental health or chronic care needs as a team. There is an excellent example of a Patient Care Team huddle located here on our website. (Look for Brizzia–in a white coat with blonde hair—who is playing the social worker in this portrayal.) Some organizations that aren’t co-located yet have arranged for a direct phone or walkie-talkie connection so they can be called as needed for brief interventions or pre-scheduled co-visits throughout the clinic session. This isn’t the preferred method to integrate but is a great way to start until workspace changes can be made within the Patient Care Team areas to accommodate the Behavioral Health Team.