Going with what works
Special Report - Behaviorial health: Fixing a system in crisis
Editor's note: This article is part of Modern Healthcare's special report on behavioral health. Read the remainder of this special report.
It's a late Thursday morning in April. Angie waits patiently inside a small examination room to finish up a routine visit with her doctor. It's been a routine of hers since 2001, traveling roughly an hour each way from her south suburban home to the University of Illinois Hospital & Health Sciences System's Family Medicine Center just near downtown Chicago.
Angie said it's been the care and rapport that she has developed over the years with her family physician, Dr. Samuel Grief, as well as with rest of her care team of specialists and support staff that has kept her coming back despite the long drive.
"They always ask if you feel worthless, depressed or angry to get a better understanding," Angie said when asked to describe what happens during a typical visit to the clinic. "So when the doctor comes in, he can go over it with you so you can work out a plan."
Angie admitted it can be a bit tedious being asked the same questions during every visit, but it's all part of trying to identify a potential problem early. Each time she visits the clinic a nurse will ask her first a two-question screening tool called a Patient Health Questionnaire, or PHQ-2. If Angie answers "yes" to a question, then she is given a nine-question survey called a PHQ-9.
"You might get up one day and it's not your day," Angie said. "So the doctor needs to know that."
That day came for Angie in June 5, 1998, when she lost her son to asthma. Since then, she has relived that day many times. "You never get over that, and I think about him every day," Angie said. "You can be having a good time and all of a sudden it will just hit you, and then there it is. The emotions come out and try it to do everything I can to not think about it, but sometimes you just have to let it run its course."
It is in those moments she said she can turn to her doctor to quickly schedule a session to speak with a psychiatrist. Patients who show signs of having a behavioral health disorder are either seen by an embedded behavioral health specialist or referred to a specialist within UI Heath's Neuropsychiatric Institute. Ultimately, if falls on the family practitioner to be the point of access for patients in need of behavioral health services. Grief estimated there was a behavioral health component to roughly half of the cases that come into the clinic.
"It behooves the practitioner or physician to identify that behavioral healthcare need," Grief said. "Part of our practice as family is to talk about behavioral health to almost every single patient," Grief said. "It's kind of weaved into the conversation."
Angie credits Dr. Grief's console along with that of her behavioral healthcare specialist for helping her to manage the toll the death of her son has taken on her emotionally over the years.
Other providers have seen some success in incorporating a behavioral health component toward addressing specific medical issues.
In 2013, Signature Medical Group, an independent, multi-specialty physician group based in St. Louis, began a pilot maternity-care program funded through a grant awarded by the CMS that looked to improve child health outcomes by providing behavioral health services to women with high-risk pregnancies. The program uses social workers along with primary-care physicians, dentists and psychiatrists to create a comprehensive care plan that helps to address both a patient's chronic conditions, as well as mental health issues.
Social workers also identify non-medical factors that could pose a risk to the health of the mother or the child, such as the effects of poverty, food insecurity or housing instability, and help patients connect with community supports. As part of the scope of their work, social workers address issues involving depression, anxiety and substance abuse through trauma counseling.
The program has been credited for helping to reduce the number of the medical group's pre-term births by 16% since the addition of social workers in 2013, as well as decreases in patient stress and stays within their neonatal intensive-care unit.
"A lot of times this was the first time these women were really interacting in the healthcare system," said Jennie Oberkrom, clinical program coordinator at Signature. "So we're uncovering a lot of untreated, undiagnosed mental health issues as well as unaddressed trauma."
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