The full-text version of this article can be accessed through the EBSCOhost database in the Ashford University Library. This article explores communication and collaboration among key stakeholders, including complementary and alternative medicine (CAM) and biomedical practitioners, at an integrative health clinicTop of Form
Establishing an integrated care practice in a community health center.
Authors:
Auxier, Andrea. Salud Family Health Centers, Frederick, CO, US Farley, Tillman. Salud Family Health Centers, Frederick, CO, US Seifert, Katrin. Salud Family Health Centers, Frederick, CO, US, kseifert@saludclinic.org
Address:
Seifert, Katrin, Salud Family Health Centers, P.O. Box 189, Frederick, CO, US, 80530, kseifert@saludclinic.org
Source:
Professional Psychology: Research and Practice, Vol 42(5), Oct, 2011. pp. 391-397.
NLM Title Abbreviation:
Prof Psychol Res Pr
Publisher:
US : American Psychological Association
Other Journal Titles:
Professional Psychology
ISSN:
0735-7028 (Print) 1939-1323 (Electronic)
Language:
English
Keywords:
collaborative care, health psychology, integrated care, integrative medicine, primary care, community health center
Abstract:
In a progressively complex and fragmented health care system and in response to the need to provide whole-person, quality care to greater numbers of patients than ever before, primary care practices throughout the United States have turned their attention and efforts to integrating behavioral health into their standard service-delivery models. With few resources and little guidance, systems struggle to gather the support required to establish effective integrated programs. Based on first-hand experience, we describe a working integrated primary care model, currently utilized in a large community health center system in Colorado, that encompasses universal screening, consultation, psychotherapy, and psychological testing. With appreciation for the way an organization’s unique circumstances inform the best approach for that particular organization, we highlight the clinical-level and system-level variables that we consider necessary for successful practice development and address how our behavioral health program operates despite funding limitations. We conclude that organizations that aim for integrated primary care must mobilize leadership to implement systemic changes while making difficult decisions about program development, financing, staffing, and interagency relationships. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Document Type:
Journal Article
Subjects:
*Community Mental Health Centers; *Health Care Psychology; *Integrated Services; Primary Health Care; Community Health
PsycINFO Classification:
Health & Mental Health Services (3370)
Population:
Human
Format Covered:
Electronic
Publication Type:
Journal; Peer Reviewed Journal
Publication History:
First Posted: Aug 29, 2011; Accepted: Jun 15, 2011; Revised: Jun 9, 2011; First Submitted: Mar 21, 2011
Release Date:
20110829
Correction Date:
20151207
Copyright:
American Psychological Association. 2011
Digital Object Identifier:
http://dx.doi.org.proxy-library.ashford.edu/10.1037/a0024982
PsycARTICLES Identifier:
pro-42-5-391
Accession Number:
2011-19049-001
Number of Citations in Source:
84
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Establishing an Integrated Care Practice in a Community Health Center
Contents
1. Integrated Primary Care at Salud Family Health Centers
2. Components of Integrated Care
3. Clinical Variables
4. System Variables
5. Putting It All Together: Salud’s Integrated Care Model
6. Services Offered
7. Patient Contacts
8. Financing
9. Conclusion
10. References
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By: Andrea Auxier Salud Family Health Centers, Fort Lupton, Colorado; University of Colorado, Denver Tillman Farley Salud Family Health Centers, Fort Lupton, Colorado; University of Colorado, Denver Katrin Seifert Salud Family Health Centers, Fort Lupton, Colorado;
Biographical Information for Authors: Andrea Auxier received her PhD in clinical psychology from the University of Massachusetts, Boston. She is Director of Integrated Services and Clinical Training at Salud Family Health Centers and a senior clinical instructor at the University of Colorado, Denver, Department of Family Medicine. Her areas of professional interest include integrated primary care research and practice, especially as they apply to immigrant populations with trauma histories.
Tillman Farley received his MD from the University of Colorado, School of Medicine, and completed his residency at the University of Rochester. He is board certified in Family Medicine. He is the Medical Services Director at Salud Family Health Centers and an associate professor at the University of Colorado, Denver, Department of Family Medicine. His areas of professional interest include integrated primary care and health disparities, particularly as they apply to immigrant populations.
Katrin Seifert received her PsyD in clinical psychology from the University of Denver. She is the Associate Psychology Training Director at Salud Family Health Centers. Her areas of professional interest include practice and clinical training in integrated primary care as well as complex trauma.
Acknowledgement:
The health care system in the United States is facing a paradox of declining outcomes and rapidly increasing costs (Rabin et al., 2009). In 2008, mental health conditions accounted for $72 billion in expenditures, making them the third most costly group of conditions (along with cancer), exceeded only by heart conditions and trauma-related disorders or conditions (Agency for Healthcare Research & Quality, 2008). In an effort to improve the provision of health care, many experts and key organizations are lending support to the movement for integration of behavioral health into primary care settings (Blount, 2003; Institute of Medicine, 2001, 2006; Pincus, 2003; U.S. Department of Health and Human Services, 2006; World Health Organization & World Organization of Family Doctors, 2008). Numerous studies have demonstrated that integrated services can improve access to mental health care, enhance quality of care, decrease health care costs, improve overall health, decrease the burden on primary care providers (PCPs), and improve PCPs’ ability to address patients’ mental health needs (Butler et al., 2008; Chiles, Lambert, & Hatch, 1999; O’Donohue, Cummings, & Ferguson, 2003; World Health Organization & World Organization of Family Doctors, 2008).
The decision to organize integration efforts at our community health center was, in part, based on well-known data regarding primary care patients. For example, psychiatric conditions are common in patients who are seen in primary care practices (Cwikel, Zilber, Feinson, & Lerner, 2008) and many patients who have mental health needs seek treatment for these concerns through their PCP (Goldman, Rye, & Sirovatka, 2000; Petterson et al., 2008; Wang et al., 2006). Additionally, the majority of medical problems seen in primary care practices are undeniably linked with behaviors, and it has been estimated that 40% of premature deaths in the United States are attributable to health behavior factors (McGinnis & Foege, 1993; Mokdad, Marks, Stoup, & Gerberding, 2004). Behavioral health integration is an integral part of a solution to the complex health care needs of these patients.
Although the terms mental health and behavioral health are sometimes used interchangeably, we conceptualize them as different constructs. The term behavioral health applies to patients whose primary diagnosis is somatic and whose psychological symptoms, if present, are subclinical and related to the primary diagnosis. The term mental health applies when the focus of treatment is psychiatric; there may or may not be an accompanying medical condition. In this article, however, the term behavioral health will subsume both categories.
Integrated Primary Care at Salud Family Health Centers
Founded in 1970, Salud Family Health Centers (Salud) is a federally qualified community health center consisting of nine health care clinics covering eight counties in North Central Colorado. Salud is an important part of the health care safety net, providing population-based, fully integrated medical, dental, and behavioral health services regardless of finances, insurance coverage, or ability to pay–Salud focuses on the needs of the medically indigent, uninsured, and underinsured populations. The national distribution of payer sources for federally qualified health centers is 35% Medicaid and 25% Medicare or private insurance, with 40% of patients falling into the uninsured category (Adashi, Geiger, & Fine, 2010). By comparison, 30% of Salud’s patients have Medicaid, 14% have Medicare or private insurance, and 56% are uninsured, leaving Salud to support the health care of a greater proportion of patients with no funding source.
Salud employs 540 individuals, including 60 medical providers, 14 dentists, 9 dental hygienists, and 15 behavioral health providers (BHPs). In 2010, Salud served more than 80,000 patients with approximately 300,000 visits, making it the second largest health care provider in a six-state region. The most common visit types include well-child checks, prenatal visits, diabetes, and hypertension. About 3,000 of Salud’s patients are migrant and seasonal farmworkers, and 65% of patients are Latino, many of whom speak Spanish as their primary or only language.
In response to the extraordinary number of patients with behavioral health needs, immigration-related stressors, and limited financial means, Salud’s move toward integration began in 1997 under the leadership of its medical director, who had received training in an integrated model. The need for integration was apparent, but it soon became clear that incorporating a team of behavioral health providers into an established medical setting was a more complex proposition than it initially seemed. The program started with one BHP in one clinic. PCPs who found value in the service vocalized their desire for an expanded behavioral health presence. As Salud hired more BHPs, it became necessary to build an infrastructure designed to support integration at an organizational level. We set out to create a service-delivery model and develop job descriptions, billing and coding practices, policies, protocols, standard operating procedures, and data tracking mechanisms. In order to accomplish these tasks, the focus shifted toward securing administrative support from key members of the organization. Over time, with the collective mission to provide quality health care—and with the implicit acceptance that behavioral health needs must be addressed as part of its delivery—efforts materialized into an integrated care program. In an effort to measure the effectiveness of our program, we recently have begun to work toward an information-technology-driven, outcome-based approach, whereby we collaborate with university partners to measure and benchmark our data through regional and national comparative effectiveness research networks.
In 2010, we developed a mission statement that reads: “To deliver stratified, integrated, patient-centered, population-based services utilizing a diversified team of behavioral health professionals who function as PCPs, not ancillary staff, and who work shoulder-to-shoulder with the rest of the medical team in the same place, at the same time, with the same patients.” The implications of this mission include that BHPs have the ability to see a patient at any time, for any reason, without requiring a consult request from a PCP. This approach requires a paradigm shift from a superior/subordinate mentality to one of implicit understanding of the unique skills that all persons involved in the patient’s care contribute to the patient’s overall well-being. It gives BHPs the latitude to determine which patients they need to assess on a given day, and providers see each patient as “our patient” not “my patient.”
Components of Integrated Care
