Behavioral Health Integration in OB/gyn Settings

November 28, 2016   |  Tags: Blog   |  Tags: Behavioral Health Integration , Women's Care
Katie Snow, LCSW

The concept of behavioral health integration is not new in primary care clinics. There are, however, new efforts to integrate behavioral health into OB/GYN clinics. Obstetric and gynecologic settings often see patients at key transition times in their lives such as onset of sexual activity, decisions about when and how to become a parent, transitions to parenthood, menopause and more. These transitions present opportunities to provide accessible, low-stigma support and care benefiting individual's and families’ everyday functioning and quality of life.

Behavioral health providers can play many roles in an OB/GYN setting, including:

  • Outreach to patients who screen positive for mental health, substance abuse and domestic violence issues on new patient questionnaires for both OB and GYN patients
  • Immediate assessment, support, referrals and safety planning for patients experiencing a crisis or suicidal ideation while in clinic or calling into clinic
  • Consultation for providers on giving the best care to patients with mental health and substance abuse issues - particularly those who present as more challenging to engage in care or struggle to follow treatment plans
  • Quick, accessible, low-stigma care for perinatal mood disorders, pre-menstrual dysphoric disorder, menopausal symptoms, chronic pain, substance abuse, tobacco cessation, pregnancy loss, infertility, gestational diabetes and more
  • Help patients access mental health care and/or “warm them up” to the idea of mental health therapy
  • Address systems issues such as over-prescribing of opiates, implementing SBIRT etc.

As helpful as this sounds, implementation can be difficult. Here are a few challenges and potential solutions to consider:

Challenge: Significant startup costs due to inconsistent or low insurance reimbursement or credentialing issues that can be difficult for private clinics (vs Federally Qualified Health Center settings that may receive funding for these positions).

Solution:

  • If you serve patients who have health insurance through Medicaid (Oregon Health Plan) contact your local Coordinated Care Organization (CCO) to find out if they have grant funding available to help with startup costs. CCO’s tend to support behavioral health because having easily accessible treatment for things like tobacco use, obesity, depression etc. is going to decrease the long term costs of insuring a patient
  • Credentialing with health plans takes 90 days on average. Build in a cushion of time between date of hire and start date for behaviorists to insure that they will be eligible to bill most insurance plans when they start work
  • Start small. Hire one person, even if it means they will serve a large number of patients. Build the program slowly to allow kinks to be worked out as you go without huge expenditures

Challenge: Identifying a trained workforce with correct licensure (usually PhD, Psy.D and LCSW), educational background and interest/experience in caring specifically for women’s health needs.

Solution:

  • Consider partnering with a community mental health agency in your area. Some agencies hire, train and supervise teams of behaviorists that are fully integrated into medical clinics. Even if this isn’t an option in your area, consider asking for consultation from an agency that does this type of work (one example from the Portland, OR area is Lifeworks Northwest)
  • Again, start small. If you can find one person who is really interested in and invested in the work, you can grow your own program through additional training and nurturing leadership skills in your employee
  • There is a growing sub-specialty in the field of mental health that is generally referred to as “Infant Mental Health” but encompasses all aspects of the transition to parenthood and tends to attract those who are interested in caring for women’s mental health. Reach out to a training program or professional organization to get ideas about promoting your job posting to their graduates or providing training to your staff. Here are a few to look into:
  • Recognize that a job as a behaviorist is going to be a fairly big change for most mental health professionals: sessions are shorter, they will see patients for a much shorter duration (normally 1-6 times), the clinic environment is busier and full of interruptions. They have the skill set to do the job but it takes time to adapt to this environment and will need support and mentoring for this.

Challenge: Setting up behaviorist schedules, documentation and workflows to mirror clinic environment but accommodate differences between behavioral health care and medical care.

Solution:

  • Be willing to have your processes evolve over time and solicit feedback from the behaviorist on how to improve your system
  • Help the behaviorist understand the way your clinic works—invite them to participate in your typical “new employee orientation” even if you hire them as a contractor. The behaviorist may touch multiple processes and workflows including patient care, scheduling, phone calls etc. so it is important for them to have some cross-disciplinary training
  • Present the behaviorist as a part of the care team in the clinic. In order to achieve integration, patients, clinicians and staff need to see the behaviorist as a normal part of the health care you provide, not something special that is reserved for only the most difficult patients. The more you normalize behavioral healthcare the more normal it will be. Have informational brochures about the service, add the behaviorist to your website, invite them to your clinician meetings.

Bottom line: don’t give up when roadblocks arise — the positive impact on patient care is worth the hurdles!

This blog was based on a presentation done at the 2016 Oregon Perinatal Collaborative Summit. View the slides here.

For more information and resources on behavioral health integration into women's care, visit the Institute's Behavioral Health Integration Resource Library.

Katie Snow, LCSW is the Clinical Supervisor for Integrated Behavioral Health at Lifeworks Northwest/Women’s Healthcare Associates  in Portland. She graduated from the University of Wisconsin-Madison School of Social Work and completed a post-graduate certificate in Infant, Child and Family Mental Health, also at UW Madison. Prior to working as a Behaviorist, Katie worked for many years in community-based settings providing home visiting services for low-income pregnant women and families with young children. Prior to that, Katie worked as a home-based therapist for children with severe emotional disturbances and as a community educator for Planned Parenthood of Southwest Michigan.