Maintaining overall good health involves more than just addressing physical symptoms. It also requires looking at behavioral health and evaluating the mind-body-behavior connection. An integration of physical and behavioral health services continues to develop at Harney District Hospital (HDH) Family Care clinic, where primary care providers have been joined by Behavioral Health Consultant (BHC) Richard Friday. As part of a year-long fellowship, Physician Assistant Lisa Howe is working to create work flow and communication processes between the providers and Friday to unite two areas of health care that have been historically kept separate.

Clinical Innovation Fellowship

Howe was selected in June to be a participant in the 2015-16 Clinical Innovation Fellows program. The program’s stated aim is “to build the capacity of health system transformation leadership within Oregon, support the success of coordinated care organizations, and spread the coordinated care model.” Fellows are selected by the Oregon Council of Clinical Innovators, a steering committee of Oregon health care leaders convened by the Oregon Health Authority Transformation Center.

Howe and 14 other Oregon health care professionals are participating in this year-long learning experience by developing innovation projects in their communities, through which they will “develop and refine skills in leadership, quality improvement, implementation and dissemination science” to create a “network of expertise.”

Howe heard about the fellowship opportunity through the Central Oregon Independent Practice Association. This is the second year of the program, and she noticed there had been no representative from Eastern Oregon in the program yet – so she decided to apply.

Part of the application process was to have a project planned or already in place. Howe said that former HDH Family Care Clinic Manager Stacie Rothwell had been working on behavioral health integration at the clinic for a year already, and that the topic is a major one in health care right now. This made it a natural choice for her fellowship project.

Howe explained that the fellowship provides the manpower and financial help (a $15,000 grant) to launch behavioral health integration at HDH.

Behavioral Health Consultation

One of the aims of the project was the recruitment of a BHC for the clinic. But even before Howe’s fellowship began in July, Friday, a licensed master’s social worker, was coming on board at HDH Family Care.

Friday moved to Harney County from Portland, where he was educated at Lewis and Clark College and Portland State University. He is in the process of becoming a licensed clinical social worker.

Friday’s primary role involves being available for patients following a visit with their primary care provider, to address habits, behaviors, stress, worries, or emotional concerns about physical or other life problems that are interfering with the patient’s daily life and overall health. These behavioral health concerns may come up during patient-provider conversation, and the provider may suggest a meeting with Friday to discuss them further. Most often, that meeting is able to happen immediately after the patient speaks with the provider. Ultimately, the patient may have between one and five brief (approximately 40-minute), solution-focused sessions with Friday. Along with the patient’s provider, Friday will work to develop and implement an integrated care plan that fits the individual. Behavioral change plans might address smoking cessation, weight loss, alcohol use, exercise, or other lifestyle modifications.

A BHC can help manage symptoms associated with various psychological conditions such as anger, anxiety, chronic pain, depression, grief, insomnia, panic attacks, stress, and more. However, a BHC does not provide traditional psychotherapy. If the patient or the BHC thinks that there may be benefit from specialty mental health services, a referral is made to other resources in the community.

Moving forward

Howe said the main focus of her project is on work flow and communication between Friday and the providers. This means identifying patients that may benefit from behavioral health consultation, determining how and when they will be referred to Friday, and maintaining the conversation between all involved.

Howe noted that, historically, physical and mental health services have been “siloed,” and that integrating these services involves changing the health care culture, which takes time.

“It’s important for patients to realize that their providers are working as a team with their behaviorist,” said Howe, “and it’s important to create an environment of total care.”

Howe said the fellowship gives her the structure and resources to give behavioral health consultation the boost it needs to take off at HDH.

“This fellowship is a bridge between the providers and the behavioral consultant, providing resources and project management,” Howe said.

As the year-long project continues, Howe noted that one upcoming challenge is to develop metrics to evaluate the success of behavioral health integration, and to make sure it’s sustainable. She and Friday are working on creating a system to document statistics and patient satisfaction.

Although the fellowship program has an end date, behavioral health integration, and the move toward a team-based approach to health care, is a long-term cultural transformation toward patient-centered, coordinated care.

For more information about behavioral health consultation, contact your primary care provider or HDH Family Care at 541-573-2074.