CareNet understands the importance of integrating our behavioral health care providers into medical offices, such as primary care physicians, family doctors, internal medicine, etc., and working with these doctors who are on the front line of interaction with patients.
Partly driven by the Affordable Care Act, there is a calling for primary care services, which includes behavioral and mental health, to be located together in the same offices, buildings, or suites of offices. We believe that if patients can go to just one parking lot and access their primary care doctor, their therapist, their nutritionist, etc., then they are more likely to use the resources available to them. For those patients who use primary care as the frontline for services, this integration will decrease their need to go to the hospital.
Research shows that 60% of all medical issues that show up in a primary care doctor’s office have a behavioral health care issue to them. Many of them are stress induced, anxiety induced, or associated with depression. Many of our both acute and chronic medical issues can be managed through life-style change. Diabetes is an example – if we can help patients know, not just what to eat, but also integrate a new way of eating, we will be more successful. Even a theology of food can lead to a change in behavior. Putting our counselors in these places where the conversations happen gives the patient more access to more resources.
CareNet is already doing integrated behavioral health care in five locations across the state of North Carolina. The settings are all somewhat different: two are basic family doctors’ offices, one is a pediatric office, one is a medical practice strategically placed in an underserved area of Winston-Salem where most of the patients are on Medicaid or uninsured with difficult transportation issues, and one is in a Weight Management Clinic at Wake Forest Baptist Medical Center.
The counselors are working both within and without the Wake Forest Baptist Health Medical system. The Medical Center owns two of the clinics, one has a connection to Wake Forest Baptist Health through the Maya Angelou Center, which looks at injustices of the health care system, and the other two are connections through the CareNet counselors who had already created relationships themselves with primary care doctors in their community.
The newest co-location is the brand new Weight Management Clinic. Surprisingly, a lot more people have been signing up for the program than they imagined and more of those people are 15-20 lbs overweight rather than those who are morbidly obese. The clinic is already reporting that the two CareNet clinicians in the office have made a huge difference for these patients, and their help is already working. Because the patients are in a pretty good place when they enter the clinic, if they can make a change now, they won’t need more sophisticated services down the line.
In other locations, substance abuse is a big issue, which does not just mean alcohol or street drugs. The therapists are onsite to talk about those kinds of issues, and to catch people who may be on the front end of addiction. If it is caught early, and they can help people reflect on their practices, the patient can make small shifts now that will not become bigger issues down the road. There are also medical conditions related to depression – somatic complaints. We can help the patient see that it is not a stomachache that is the health issue, but, rather, the stress they are living under. Because of integrated behavioral health, the therapists are in place to help patients with mental health.
CareNet does have these five co-locations now; however, there is a need that in the next two years, everywhere there is a CareNet clinic, we will also be integrating behavioral health with a physician in some way. While there are already groups around the country doing this, it is really small scale. No one has developed the skill set to do this really well, and the information is not consolidated in one useful place (textbook, website, etc). As a way to begin doing the work and preparing ourselves to be a real leader for this kind of service in the near future, CareNet has internally developed a learning group with about 15 people from our network.
The structure of the learning group is virtual with the members meeting about every three weeks by web cam. They introduce resources to Bryan Hatcher; he vets and creates a short list. They all read the same articles, and then they review and discuss together. The learning group is defining the skill sets and characteristics necessary for a mental health counselor to do this kind of work. Integrated behavioral health is not for all counselors. It is a different kind of work; they are part of a medical team. They may have only one or two scheduled meetings a day, but they are constantly doing consultations with doctors, joining in medical evaluations. They get to hear the initial conversations from the clients and listen for mental health issues. Then they consult with the doctor and patient to help them get to a better place. These counselors will do brief interventions, not long-term counseling in the doctor’s office. If what the patient needs is long-term counseling, they will refer them to an appropriate provider. The point is to provide good, immediate care in the heat of the moment.
Already, counselors have intervened in about half a dozen cases with patients who were actively suicidal. They connected them to the resources they needed immediately to avert suicide and get help. In a few cases, the therapist helped in the reverse way. The doctor was ready to send the patient to the emergency room for suicidal tendencies, but instead, the therapist helped the doctor and patient communicate more clearly that suicide was not imminent. Integrated behavioral health provides people the help they need to get better quicker and averts the use of system resources when they are not necessary, thus improving the quality of care that our health system uses.
At some point, the learning group will send out teams from this group to locations around the country to other health care systems that are integrating behavioral health and have a good track record. They will not only theoretically but also existentially know what this business is like and how other folks are doing it. CareNet hopes to create a certificate program or integrate into a degree program for formal training around integrated behavioral health. And perhaps most important, CareNet brings something different to this process than most mental health providers – the spiritual-integrated health component.
We want to be experts in integrated behavioral health. The goal would be to become a thought and practice leader in this area with the plans to take what we learn and give it back to the world through formal academic programs, seminars, personal connections, etc. We are actively learning with each other, and we want to tell others around the world that they should be doing this, best practices, and the reasons why.