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What Works: Behavioral health integrated into primary care practices

July 20, 2016
by Tom Valentino, Senior Editor
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For Christiana Care Health System, making behavioral healthcare more accessible was a matter of meeting patients where they’re at: the offices of primary care physicians.

Recognizing the success of having psychologists embedded within its neurology, cardiology and cancer services for the past 10 years, the Wilmington, Del.-based not-for-profit system chose to integrate behavioral healthcare specialists into its primary care practices as well.

“We decided to expand toward primary care integration because that is really the first place where many folks are seen,” says Linda Lang, MD, chair of the Department of Psychiatry at Christiana Care. “It’s a place where people bring their families for checkups, and so if there’s something going on in the behavioral health realm, that’s where it will be picked up early.”

Under the integrated model at Christiana Care, a primary care physician can invite an on-site therapist to join in for a consultation during a visit with the patient’s permission. Patients can schedule follow-up visits with the therapist, who can then bring in a psychiatrist for medication issues as needed.

The timeline for accessing behavioral healthcare—meeting with a specialist on the same day as a visit to a primary care physician—is a dramatic shift from the traditional model, in which wait times to meet with a specialist otherwise could have been up to six weeks, Lang says. Among the integrated model’s other benefits is more efficient and seamless care delivery as a result of having the primary care physician serving as a central hub for managing treatment. Plus, it is delivered in a familiar setting for patients.

Patients that prefer to meet with behavioral providers separately still have that option, Lang says.

The system began the process of integrating behavioral health specialists into 11 primary care practices in November 2014; the program later expanded with four additional therapists. Recognizing that the clinicians would be working in a very different environment from which they had been accustomed, Christiana Care implemented training from the University of Washington.

“They were the pioneers in behavioral health integration, and developed the IMPACT model for behavioral health integration into primary care,” Lang says. “We brought them in to train our specialists, our social workers and psychologists on how this model works.”

After a pilot at one of the system’s most active facilities, the program fully launched. Since integrating into primary care practices, Christiana Care behavioral health specialists now treat 600 patients per month, compared to an average of about 170 patients per month, according to Lang.

Integration best practices

For fellow health systems considering whether to integrate behavioral healthcare into their primary practices, Lang offers the following advice:

Be flexible. For behavioral health specialists who are used to sitting in an office, working in a primary care setting can be a jolt.

“It’s a much more fast-paced, ‘anything can happen throughout the day’ kind of thing,” Lang says.

Define expectations. Primary care and behavioral health specialists who will be collaborating need to clearly define their respective roles in their working relationship.

“Helping primary care doctors understand what they can expect from the behavioral health provider is important,” she says. “Some primary care doctors really want to manage their patients fully. Others prefer to have a collaborative approach.”

Understand the value of staff buy-in. When presented with the integrated model, caregivers at Christiana Care were receptive, which helped with implementation.

“We were able to get our psychologists and social workers to sign on for something new and exciting, knowing we were meeting the needs of folks in a much different way,” Lang says. “Training and buy-in are very important for this to be successful. There are some of us who have been doing a certain model for a long time. We have a group of people here interested in learning new models of care. Medicine changes all the time. We practice an evidence-based way of delivering all care, and there’s lots of evidence to show this works better. We all are of similar mindset that we want to do what’s best for the patient. We want to grow and learn new techniques.”

Tom Valentino is Senior Editor for Behavioral Healthcare.