Establishing an Integrated Behavioral Health Program and Practicum Site in a Community-Based Primary Care Center Christina S. Lee, Ph.D. Dept. of Applied Psychology Northeastern University, Boston, MA IBH Program Director South End Community Health Center, Boston, MA

2 “Co-located”

Integration Primary Care Dan Simpson, M.D. Tom Sterne, M.D. Deb Clifford, R.N. Behavioral Health Laurie Goldman, Psy.D., R.N. Ray Walden, L.I.C.S.W. Alexander Young, Psy.D. Rick Silva, Pharm.D. Interns: –Heather Bennett –Atsushi Matsumoto

March, 2013 Integrated Behavioral Health (IBH) Program planning begins. April 20, 2013 Proposal for the IBH Program and Psych Intern training submitted by Dr. Lee to the SECHC. IBH Intern training objective is to pilot IBH training curricula for SECHC psychology interns. May, 2013 The curriculum for the IBH Program and the IBH Seminar series is developed. July 1, 2013 Focus group moderated by Dr. Lee with providers (n=15; 4 Adult medicine, 2 Family medicine, 2 Pediatrics, 6 Ob/Gyn, 1 Hass Center) on perceptions of behavioral health before IBH. Suggestions used to improve awareness, training needs, and communication regarding the IBH Program and intern training. July 15, 2013 IBH Program meeting with interdisciplinary providers and IBH interns Discussed IBH referral process between provider and consultant, triage process of linking out to care Sept 6, 2013 First IBH intern class orientation at SECHC. Sept 10, 2013 Introduction of IBH program to SECHC clinicians. The “Roll-Out” presentation. The purpose of IBH and referral process is presented. Survey and focus group findings presented. Sept 19, 2013 IBH Seminar Series begins and IBH interns begin shadowing providers Oct 1, 2013 IBH begins seeing patients Nov 17, 2013 Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns Dec 12, 2013Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns IBH Planning IBH intern seminars Timeline Year 1

Timeline Year 1, cont. Jan 25, 2014 Breakfast: IBH Program meeting with interdisciplinary providers and IBH interns. Providers give positive feedback on IBH. Discussion on how to improve referral system, and advantage of in- person referral March 3, 2014 IBH referral process reviewed by Admin team. Preliminary IBH data reviewed. New patient screening tools discussed June 3, 2014 IBH manual drafted August 4, 2014Procedures to gather IBH patient satisfaction survey reviewed. Focus group with providers planned. IBH coordination and Intern seminars

Integrated Health Seminars Functional Assessments and the 5As 2.Integrated behavioral health: Anxiety and depression 3.Medical literacy 4.Writing case notes for integrated care 5.Substance use assessments 6.Crisis management 7.Adult psychopharmacology in mental health, Part I 8.Negotiating behavior change in health behaviors 9.Adult psychopharmacology in mental health Part II

Date: ________________ Patient Name: ­­­­­­­­­­­­­­­­­­­­­­­_________________________DOB: ­­­­­­­­­­­­­­­­­­­­­­­­­_________________________ Preferred Language: [ ] English[ ] Spanish [ ] Other: _______________ Referring Provider: ____________________________ Referral Type:[ ] Routine [ ] Urgent-seen in 2-3 days [ ] Emergent Reason for referral: [ ] Anxiety[ ] Grief [ ] Depression[ ] Recent Psych Hospitalization [ ] Smoking Cessation[ ] ADHD/ADD Evaluation [ ] Diagnostic Evaluation, e.g. Bipolar, ADD, other[ ] Substance Abuse [ ] Other: ­­­­­­­­­­­­­­­­­­­­­­­­­­­_____________________________________________________________ Referral to: [ ] Pharm D: For comprehensive medication management for anxiety, depression, other psychiatric conditions, access to Specialty BH 3 rd floor [ ] CAMI Study: Alcohol use disorders, substance use [ ] Integrated BH Consultant: For evaluation and short term counseling; e.g. anxiety, depression, relaxation training, grief, sleep hygiene, smoking cessation, substance use [ ] Specialty Behavioral Health Service 3 rd floor [ ] PLEASE CALL PATIENT: Patient could not see clinician today, but wished to be called Telephone number (confirmed with patient): ­­­­­­­­­­­­________________________________ NOTE: IBH will usually see patient up to 3 visits and will refer to Specialty Behavioral Health, 3 rd floor, if patient needs long term management. IBH Referral Form

Importance of in-person referral Referral Type Pts seenRemaining to be seen Total Paper52 (36%)93145 Verbal33 (89%)437 Flag213 Paper & Verbal404 Total

Patient Satisfaction Survey* *Based on the Client Satisfaction Survey (citation)

Student education and training IBH Manual drafted Seminars planned Supervision issues and coverage Smaller cohort

Counseling PhD Student participation and development IBH Internship Track at SECHC – 6 Phd Level trainees IBH researchers: Welcome to our new Northeastern Counseling Ph.D students. Check them out on our website! – Janelle Alabiso, M.A. – Daniel Gittens Stone, M.A.

Thank You to the South End Community Health Center, and to the Psychology Interns for making this work possible!

Christina S. Lee, Ph.D. Dept. of Applied Psychology Northeastern University, Boston, MA