December 15, 2014 | Tags: Blog | Tags: FQHC , Behavioral Health Integration , PCBH , Interview
In the fall of 2013, Salud Medical Center in Woodburn, OR, took part in a Behavioral Health Integration (BHI) training offered by the Institute and delivered by Patricia Robinson, PhD of Mountainview Consulting Group. In addition to their participation in the training, the clinic received on-site practice coaching, and was selected as a BHI Best Practice Site for their efforts in adopting the Patient-Centered Behavioral Health (PCBH) model of care.
As a Best Practice Site, Salud Medical Center, a Yakima Valley Farm Workers Clinic (YVFWC), serves as an example and resource to other clinical staff and practices interested in adopting the PCBH model.
We reached out to Brian Sandoval, Psy.D., Primary Care Behavioral Health Manager, and Juliette Cutts, Psy.D., Primary Care Behavioral Health Consultant at Salud Medical Center to learn a bit more about their decision and efforts to adopt the PCBH model of care.
Q: What makes the PCBH Model a good fit for Salud Medical Center?
For the last year, Salud, along with the other YVFWC clinics, has been working towards certification as an integrated health home based on the National Committee for Quality Assurance (NCQA) standards. As we have pursued our goal of becoming certified by the NCQA, we have found that the PCBH model has been an integral part of meeting the behavioral health needs of our patients.
This model has been well received by clinical staff who have expressed appreciation for being able to treat psychosocial issues that are difficult for them to address during their medical visits. The model has provided a framework for our participation in the primary care team and provided helpful tools for demonstrating how we can contribute to our patients’ health.
In June of this year we were rewarded for our efforts when we received level three recognition as a Patient-Centered Medical Home from the NCQA (which complements our Oregon PCPCH recognition).
Q: What were your most significant barriers to optimal initiation of the PCBH program?
The main barrier that we have experienced is how to implement the various elements with our current staffing.
We have been pleased with the way our providers are utilizing the BHC service; however, we are also aware that there are still many needs and opportunities that we are not able to address with one BHC for 11 providers.
One strategy we have used to minimize this barrier is to develop strong partnerships with both internal resources and community agencies who can help address practical needs such as food, housing or legal assistance, and with specialty mental health providers who can address needs of those who would benefit from more intensive services. It would be very difficult to achieve the benefits of using the PCBH model without these important partnerships.
Q: What were some of the most notable improvements to your practice that resulted from the coaching received from Dr. Robinson and what is your plan for continuing to make improvements?
We have become more consistent in documenting patients’ contextual factors by utilizing the Love, Work, Play and 3 T’s framework, which is part of the Tools for Behavioral Health Interventions Library from the BHI training.
With practice, we have been able to collect this information in just a few minutes and find that in the process we are able to quickly identify more information about the patient’s chief complaint. We also learn important information about what is triggering their symptoms, which they frequently do not even realize is related to their symptoms.
Once we have identified a plan to address their concerns, patients have responded well to getting a summary of the plan on the BHC Prescription Pad. We will write out instructions, sometimes we even draw pictures for our patients who are not literate, so they can still have reminders of what we worked on.
Lastly, the Pediatric Symptom Checklist (PSC-17) has been a great addition to our service because it has helped us to more effectively identify what is contributing to the concerning or problematic behaviors that both the parent and the patient have observed.
Many times we have parents who are complaining about an attention problem but their responses to the PSC-17 actually indicate concerns for anxiety/depression or conduct. We can then discuss the outcome, provide education regarding options, and address the root behaviors right away which results in better outcomes in less time.
Q: What advice would you share with other clinics looking to adopt the PCBH model?
First, keep it simple. Identify what is most important for your patient population and what will be most helpful for your providers and do that really well.
Find people at all levels who will champion the model and help you to demonstrate what is possible, from administration, providers, nursing, and front office staff.
Take one step at a time making sure that patient care is always first.
Develop good partnerships with other agencies and providers both within and outside of your organization.
We have really benefited from networking with other clinics that are also using the PCBH model so we can leverage their best practices. As we have progressed in our implementation of the PCBH model, we have been very fortunate to have support from others who have been very generous with their knowledge and expertise!
Q: Who can clinics contact for more information about your experience implementing the PCBH model of care?
Anyone with questions or who would like to discuss PCBH implementation further with Salud Medical Center can contact either Brian Sandoval at: BrianSa@yvfwc.org or myself, Juliette Cutts, at: JulietteC@yvfwc.org.
Are you a behavioral health consultant looking to connect with other BHCs? If so, please comment below to tell us about your BH program and Institute staff would be happy to connect you to one of the Institute PCBH or other practices working on this model in your community.
Juliette Cutts, Psy.D. is a Licensed Psychologist and a Primary Care Behavioral Health Consultant at Salud Medical Center.
Originally established in 1978 as a provider of health care for migrant and seasonal farm workers, the Yakima Valley Farm Workers Clinic (to which the Salud Medical Center belongs), is a non-profit organization and has locations throughout Oregon and Washington. Their clinics serve significant populations of farm workers and low-income families. Services include medical and dental care, behavioral health care and counseling, pharmacy services, community health services and nutritional services, as well as educational and employment training programs. Services are provided without regard to an individual’s ability to pay, and two-thirds of staff members are bilingual/bicultural.
A library of resources from the BHI training, including a 200+ page Primary Care Behavioral Health Implementation Toolkit, is accessible to clinics via the Institute website.