Blog

Overview of Program:
In September 2013, the Bread for the City primary care clinic launched an integrated-care behavioral health program in order to fill gaps in access to mental health services for our patients.

The full-time behavioral health specialist collaborates with the primary care clinic’s four medical providers to recognize, manage, and treat patients’ chronic behavioral health conditions, including depression, anxiety, PTSD, substance abuse, and chronic pain.

Through short, solution-focused interventions, offered in conjunction with the primary care visit, the behavioral health specialist helps patients gain insight about their mental health and socio-emotional well-being; provides psycho education, delivers Cognitive Behavioral Therapy, Motivational Interviewing, and Mindfulness-based coping strategies to help patients manage their symptoms and become full participants in their own treatment and recovery.

Quality of the Health Model:
Among other tactics, the clinic initiated an assessment tool based upon Scott D. Miller’s Outcome Rating Scale (ORS) to test whether patients who received three or more behavioral health visits reported an improvement in their ability to manage stress. The assessment tool was offered in English and in Spanish.

Results:
From September, 2013 to June, 2014, the behavioral health specialist treated 464 unique patients through 1,073 total patient visits, which means that 17.6% of all patients seen in the primary care clinic had a visit with the behavioral health specialist. Among the 464 patients seen by the behavioral health specialist:

51.7% had one visit

20.5% had two visits

10.0% had three visits

5.6% has four visits

2.8% had five visits

7.7% had more than 6 visits

Patients presented with a broad range of behavioral health issues. Nearly one in five patients (19%) presented with a complex mental health diagnoses, such as personality disorder, complex trauma, Bipolar Disorder, Schizophrenia and TBI.)

Nearly one in five (18.2%) of patients presented with depression, 12.5% of patients presented with Anxiety; and 17.4% of patients presented with primarily a need for social services. A smaller, but significant percentage of patients presented with concerns about weight management, insomnia, Diabetes, chronic pain, PTSD, and substance abuse.

BFC’s Behavioral Health Specialist Ali Jost

Conclusion:
After nine months of behavioral health integration data, the Bread for the City primary care clinic surpassed its goal of helping the estimated 14% of patients in need of behavioral health treatment.

In the future, Bread for the City hopes to gather more specific data on the 19% of patients seen who presented with complex mental health diagnoses, including personality disorders, complex trauma, Bipolar Disorder, Schizophrenia and TBI.

Finally, an initial review of the assessment measurement tool suggests that tweaks must be made in the future to collect assessment data among a larger percentage of patients seen within the primary care clinic. Likewise, we plan to track specific interventions used within the behavioral health visit and assess utility of specific interventions.

For a more comprehensive look at Bread for the City’s Behavioral Health Program: FINAL BH Poster Present