1. The Primary Care Behavioral Health Model
Creating Access, Impacting Populations
Elizabeth Zeidler Schreiter, PsyD
Behavioral Health Consultant
Consulting Psychiatry Lead
Access Community Health Centers
Madison, WI

2. Access Community Health Centers
Federally Qualified Health Center (FQHC)
3 clinic locations in Madison, WI
William T. Evue Clinic and Wingra Family Medical Clinics have Patient Centered Medical Home Certification
Medical, Dental, Pharmacy and Behavioral Health Services
Over 26,000 residents seen in 2013 (over 80,000 office visits)
Over 10,000 behavioral health visits

3. 10-50% Chronic Disease Obesity Smokers Referral Completion Rate
When asked,
patients say they
prefer their care here
Surgeon Generals Report
80% visit PCP in a given year
Chronic Disease
Obesity
Smokers
10-50%
Referral Completion Rate
Primary Care “De Facto” Mental Health System

4. Severe Depression, Multiple somatic complaints
Provider Area
Exam Rooms
Hallway
Severe Depression, Multiple somatic complaints
= PCP
= BHC

5. Time Activity 9-9:20 9:20-9:35 9:45-10:10 10:10-10:30 10:30-10:50
Consult: Depression
9:20-9:35
Consult: Weight loss
9:45-10:10
Downtime
10:10-10:30
Consult: Panic attacks
10:30-10:50
Consult: Diabetes management
10:50-11:10
11:10-11:30
Consult: ADHD
11:30-11:45
Consult: Parenting Issues
11:45-12:15
Notes
What a consultant does:
brief consultations focused on quality of life and daily functioning
increase skills of providers via curbside consults
provide assistance for medication management & adherence
Phone-based consultation for patients & Assistance with behaviorally related calls to triage/ call center
manages other related services such as care management and consulting psychiatry
exerts leadership in areas such as patient-doctor communication, crisis management, staff response to difficult patients
Curbside Consult
Scheduled f/u
Warm hand-off

6. PCBH: The Benefits of Integration
Aims to meet the primary care needs and support PCPs
De-fragments and De-stigmatizes care
Allows collaboration in the moment
Reduces psychological and social barriers
Promotes cross-education and reciprocal learning
Supports use of evidence based treatment
Provides population based care
Increases access to care

7. Consulting Psychiatry
Population based approach which maximizes the skills of the psychiatrist to enhance the skills of the PCP
BHC & some PCPs present patients to the psychiatrist at weekly meetings, receiving verbal and written recommendations
Psychiatrist then works with BHC to select patients on a weekly basis to see for ‘one-time’ evaluations
PCP retains prescribing role & is cross-trained in primary care psychiatry through this process (as are the BHCs)

8. Steps Toward Implementation-Consulting Psychiatry
Behavioral Health Consultation and Consulting Psychiatry started at Access in 2007
Administrative backing
Population care focus thus emphasis on verbal and written consultations in addition to face-to-face encounters
Psychoeducation for medical providers
Space for psychiatry consultant to work (e.g. exam room)
Finding a psychiatrist ready, willing, and able to thrive in this environment
Utilization of Behavioral health consultant to assist with triaging need and appropriate allocation of resources
Increased access by written consults, if unable to be seen within 2 weeks written recs are requested. PCP always retains prescriptive authority
Collaborative Family Healthcare Association 12th Annual Conference

9. Care Management
Quarterly reviews of patients in 4 categories (depression, ADHD, pediatrics, consulting psychiatry)
Registry is populated with over 3,000 patients
Results in thousands of phone calls annually to engage patients along with cues to the medical team

10. PCBH In Action at Access
1 in 5 medical patients annually sees a BHC
Over 400 consulting psychiatry chart reviews and 208 face-to- face consults in 2013
Over 3000 care management chart reviews
5.5 FTE Psychologists/Social Workers; .25 FTE Consulting Psychiatrist
Train 5-10 psychology and social work trainees annually & 8 psychiatry residents annually
BHC are Generalists-Not focused on one disease category, but more support across all health and behavior conditions

11. Research Supports PCBH
Ray-Sannerud et al. (2012) Patients significantly improved using global measure of mental health functioning two years post contact with BHC
Corso et al. (2012) Patient self-report of therapeutic alliance with BHC exceeded outpatient specialty mental health alliance
Reiss-Brennan et al. (2010) Intermountain Health System shows high patient satisfaction, improved utilization and quality outcomes

12. Recommended Resources
Robinson, P., & Reiter, J. (2006). Behavioral Consultation and Primary Care: A Guide to Integrating Services. Springer.
Serrano, N. (Ed.) (2014). The Implementer's Guide To Primary Care Behavioral Health. iTunes Store. Access Community Health Centers.
Access Community Health Centers (Access) Integrated Primary Care Consulting Psychiatry Toolkit Available from:
Collaborative Family Healthcare Association (
Contact: