November 3, 2014 | Tags: Blog | Tags: FQHC , Behavioral Health Integration , PCBH , Central Oregon
Through feedback collected in stakeholder interviews, the Patient-Centered Primary Care Institute identified a significant and growing community interest in training and technical assistance related to behavioral health integration (BHI) as part of the development of robust patient-centered primary care homes. In the fall of 2013, the Institute partnered with Patricia Robinson, PhD, of Mountainview Consulting Group to deliver trainings and offer on-site coaching to clinics working on BHI in Oregon and to build a library of resources, including a 200+ page Primary Care Behavioral Health Implementation Toolkit, accessible to clinics on the Institute website.
Behavioral health integration can take many forms, but the Primary Care Behavioral Health, or PCBH model, includes a Behavioral Health Consultant (BHC) as part of the primary care team whose function is to deliver brief interventions and other behavioral health services in consultation with the clinician leading the care team. Read more about the PCBH model in this sample chapter from Behavioral Health Consultation in Primary Care: A Guide to Integrating Services, Robinson & Reiter, 2007.
Mosaic Medical clinics in Central Oregon participated in the BHI training, and two clinics and four BHC's received on-site practice coaching. Mosaic Medical in Bend was selected as a BHI Best Practice Site for their efforts in adopting the Patient-Centered Behavioral Health (PCBH) model of care.
As a Best Practice Site, Mosaic Medical serves as a resource to other practices interested in adopting the PCBH model. We spoke with Lacey Sheppard, a BHC at Mosaic Medical, about their PCBH implementation experience.
Q: What makes the PCBH Model a good fit for Mosaic Medical?
The PCBH model offers primary care practices a patient-centered approach to overall health. The model provides opportunity for patients to partner with their primary care treatment team, therefore increasing the likelihood of the patient improving their overall health and quality of life. The model also offers primary care providers consultation with BHCs, which allows for an ongoing conversation about patient care. Consultation with primary care providers (PCPs) decreases likelihood of burnout and it increases team-oriented treatment. This model is a perfect fit for Mosaic Medical, as we are embracing integrated team-based primary care.
Q: What were your most significant barriers to optimal initiation of the PCBH program?
Barriers seem to vary across the number of clinics at which Mosaic Medical has implemented the model. At some of our clinics, we have found that provider time to cultivate buy-in for the model has been somewhat of a barrier, which has resulted in limited warm handoffs and most patients being scheduled out. We are working on partnering with primary care providers and clinic teams to educate on benefits of warm hand-offs and same-day appointments, as well as efficacy of behavioral health interventions, which will likely increase provider buy-in. In another high volume clinic, the patient needs outweigh the job capacities of the BHCs, resulting in appointments with the BHC being booked out several weeks, and some warm hand-off needs not being addressed in the moment. In the future we will likely need to address adequate staffing needs for behavioral health support across multiple clinics at Mosaic Medical.
Another barrier is not having synchronized and efficient workflows for behavioral health needs. This would likely ensure quality and accountability for services to patients, so we will continue to look at improving organizing workflows. We also have had some difficulty implementing groups due to the barrier of having limited patient group spaces. Several other growth areas are around staffing BHC positions, and implementing quality measures and productivity standards.
Q: What were some of the most notable improvements to your practice that resulted from the coaching received from Dr. Robinson and what is your plan for continuing to make improvements?
Thanks to Dr. Robinson’s support in teaching the PCBH model to our consultants and clinic staff, including PCPs, we have improved our implementation of the model at Mosaic Medical. We also have a better understanding of the tools available and how to utilize them. Additionally, our communication among clinic staff has improved thanks to Dr. Robinson’s modeling and sharing of an effective communication process. Finally, Dr. Robinson reinforced the importance of having a useful policy manual, and as a result we are working on ratifying ours so it will be a better resource than before.
As for continuing to improve, we have made a commitment to continue to meet regularly to discuss behavioral health integration and complete a behavioral health referral barriers questionnaire every six months. We also meet with administrative staff regularly to discuss PCBH model needs and come up with a plan for addressing them. Furthermore, we have met with the new Chief Medical Officer to discuss the BHC policy manual ratification in order to ensure all parties are in agreement and are supportive of the manual.
Q: What advice would you share with other clinics looking to adopt the PCBH model?
In primary care, this model works very effectively. I would recommend against trying to integrate behavioral health into primary care without a model to guide the integration. The PCBH model has been proven effective for Mosaic Medical across our clinics, as it has guided behavioral health care, consultation with teams, and has provided our patients an integrated approach to their health.
Lacey Sheppard, LCSW, is a BHC at Mosaic Medical in Bend, OR. She works with a wide variety of patient populations in primary care, including people dealing with diabetes, hypertension, alcohol abuse, anxiety, depression, grief issues, weight management, ADHD, relational difficulties, suicidality and domestic violence. Lacey has experience working with children, adolescents, families and older adults in a variety of settings. She has practiced in a crisis clinic implementing brief strategic therapy and crisis counseling for victims of violence. She has served children and their families in both a day treatment school setting and in the community. She has worked on an army base assisting military families with prevention of child abuse. Also, she has worked in several health care settings, as a part of an integrated behavioral health primary care team. These experiences offer her to be well versed in behavior modification techniques.
If you have questions or would like to discuss PCBH implementation further with Mosaic Medical staff, you can contact Lacey at:
541-383-3005 ext. 7306