Integrating behavioral health into two primary care clinics serving vulnerable populations

Abstract

Behavioral health (BH) problems and chronic disease often co-occur. Patients with both physical and behavioral conditions use more medical services, require more hospitalizations and readmissions, and experience poorer quality of life. The purpose of this article is to describe an innovative model in which BH services are integrated into nurse-led primary care clinics for uninsured and underinsured patients. BH providers, including a psychiatric mental health nurse practitioner, psychiatrist, clinical social worker, and care coordinator, were integrated into the ongoing Providing Access to Healthcare (PATH) and Heart FailuRe Transitional Care Services for Adults (HRTSA) clinics. In addition, other providers received training in BH screening and motivational interviewing. All patients were screened for depression, anxiety, tobacco and substance use at every visit. Examination of appointments revealed information about patient engagement with BH. A total of 520 unique patients at both clinics qualified for BH services and 250 remained engaged in treatment for approximately five visits. Improvement on measures of depression and anxiety was observed for both engaged and non-engaged patients. Integrated BH and primary care within the same clinic space, along with training for all clinicians, allows for early diagnosis and intervention which are crucial to patients with few resources and high needs.