Successful Behavioral Health Integration into Primary Care at the Yakima Valley Farm Workers Clinic

Brian Sandoval:                 The Yakima Valley Farm Workers Clinic is a large federally qualified health center in the Pacific Northwest. We're up to 18 clinics now. We've got WIC, dental, behavioral health. We've got multiple programs that are in the school, so it's a really, really integrated full-service wrap around community health center. We decided that as an organization if we were really going to treat the whole person that we really need to have integrated behavioral health as a part of that process. We know that stigma is one of the single most barriers to receiving care, so the model that we've chosen to go with really helps us alleviate stigma and put it as a general part of care.

Nicholas W.:                       What we've started to develop is a program, not just a thing we do that we call integrated. We figure you better big or go home if you're going to do this right.

Kai Nevala:                          A patient will check in at the front desk and often have no knowledge of the fact that they might be meeting with a behavioral health consultant, or a dietitian, or somebody else with in our clinics. They see the medical provider and after that, the medical provider makes a determination as to whether the patient would benefit from seeing a behavioral health consultant or not.

Nathan Lilya:                      If I feel that it's a complaint that has a behavioral component to it, whether that complaint is psychological, anxiety, depression, that kind of thing. Medication noncompliance. Needing to exercise. I'll go ahead and notify our behavioral health consultant.

Nicholas W.:                       The provider or the medical assistant will put a flag up in the door to let me know where to go. Then they'll come find me and we'll have a quick verbal consult and talk to the patient about how at our clinic we treat the whole person mind and body.

John Hurley:                       I typically have them come in on just about every new patient because I think it's important that they know that service is available.

Kai Nevala:                          The primary care provider and the BHC talk about their patients I think in a couple different ways. One might be in a huddle type of a format at the beginning of each day.

Kirsten H. :                          I scrub the schedule every morning to see who's coming in the clinic day, and I'll let the provider know the very beginning of the day during our huddle, "Hey, this person's coming in. We're going to check in about how this, this, and this were going."

Kai Nevala:                          Warm handoffs are key. There's only so much, I think, that we can communicate via written types of communication, and there's a lot more benefit to these verbal communications.

Nathan Lilya:                      BHCs often times will set people up on their own schedules if they feel like they need to be followed with them closer. Then they usually are sending us all their chart notes to review.

Kai Nevala:                          They're pulling data from EHR in terms of which patients they're seeing, what types of issues they might be running up against, and then really looking at different types of industry accepted ways of tracking outcomes based on their intervention.

Nicholas W.:                       A lot of times people come here first for mental health concerns, and we know from the research if we refer them out 75% of the people won't go, so our goal is really to address them right here, right now when they're ready in the room.

Kirsten H. :                          If a patient were just going through a really stressful time and they knew that I was someone that they could come talk to, they could call or just walk in the door and ask if I had any appointments today or tomorrow. More likely than not, I will, so absolutely. If someone has a same day issue they can come in and talk.

Kai Nevala:                          Integration has impacted our practice, I think, in a couple different ways. Patient satisfaction in terms of the services that they might receive from our clinics and satisfaction from our provider group as well because they're able to take care of their patients a little bit better than if they didn't have some these other supporting services within our four walls.

Nicholas W.:                       The thing I love about this model is I get to be a true generalist. It stretches my skillset as a psychologist.

Kirsten H. :                          Patients not following treatment recommendations and that kind of stuff, having a behavioral health consultant there to help that process actually integrate for the patient and have those changes actually happen, not only does that improve the patient's life, but that improves the provider's life.

Nathan Lilya:                      The unfortunate reality of the medical world is that we are often times limited to a 15-minute office visit. Our BHCs allow us to extend that office visit time.

Kirsten H. :                          The thing I love most about integrated care is getting patients access to mental health care that they would've never gotten otherwise. I've seen so many different things. I'm learning every day. It's never going to get boring. I don't think I could do anything else now.