The Future is Now at IOL: Behavioral Health Integration

For the past year, the Institute of Living has been involved in an initiative across Hartford HealthCare to integrate behavioral health and primary care.

There are two goals behind this effort. The first is to provide resources to help primary care offices deal with the large number of patients who exhibit symptoms of mental health issues. The second goal is to help primary care physicians and their patients address the behavioral issues that interfere with other medical issues patients might be having. In 2015, the IOL supported two Hartford HealthCare primary care practices in West Hartford as a pilot project. IOL psychologists Jennifer Ferrand, PsyD., and Ila Sabino, PhD. each spent 20 hours a week at the practices providing assessments and short-term interventions, consultations and collaborating with other providers. These psychologists addressed many issues that arose, with depression, anxiety, adjustment problems, and chronic disease management being the most significant reasons for referrals. The pilot program was viewed as a great success, as the IOL has seen increased utilization and referrals while the project has been running. The program will continue in 2016, and the IOL has had numerous requests to integrate clinicians into other practices. A third site is expected to open at the beginning of the year.

Behavioral health integration, widely viewed as the wave of the future in providing comprehensive and efficient care, stems from the recognition that medicine must do more than simply treat illness. Rather, providers and caregivers must do better at preventing illness and enabling individuals to more effectively manage chronic disease.

Jennifer L. Ferrand, Psy.D, left, and Ila Sabino, Ph.D., of the Division of Health Psychology at the IOL, have played a key role in implementing the integration of behavioral health and primary care clinical services within Hartford HealthCare

Massive changes in the healthcare system have been underway since the implementation of the Affordable Care Act of 2010 that are meant to defragment care and achieve the “Triple Aim” of better population health, enhanced patient experience, and reduced cost of care. An important element of these emerging healthcare models involves strengthening the relationship between behavioral health and primary care physicians and practices. The effective and comprehensive delivery of primary care services is seen as a critical way to improve population health and reduce costs.

In addition to their role in treating illness, injuries, and chronic disease, primary care physicians are tasked with the management of a wide variety of mental health concerns. Nearly 60 percent of the total number of patients being treated for depression in the United States receive their treatment from a primary care physician, and there is evidence to support the efficacy of using antidepressant medications in primary care. The effective treatment of depression in the primary care setting, however, requires complex clinical decision making in order to make a correct diagnosis, choose the proper medication at the correct dose and for the appropriate duration, provide additional services such as psychotherapy, and/or refer to specialty care when appropriate. A collaborative approach to the treatment of depression has been shown to be more effective than standard care in improving depression outcomes in the short and longer terms, and likely also improves both patient and provider satisfaction. The fundamental components of collaborative programs include use of a validated screening tool for identification of behavioral health issues as well as ongoing management of depression symptoms. Other key components are the use of a registry and real-time measures to track patients’ progress over time, the use of evidence based guidelines and a stepped-care approach for treatment modi cation and intensification. Finally, it is important to provide relapse prevention planning to prevent depression from recurring, and a care manager who supports and coordinates care.

The Division of Health Psychology at the Institute of Living has been supporting specialty care at Hartford Hospital for many years. Psychologists from the division have worked closely with a number of medical specialties to provide psychological evaluations and evidence-based interventions to address mental health issues, in addition to the behavioral, physical and nonphysical issues that can interfere with successful patient outcomes. Some ways in which health psychologists or behavioral health clinicians provide service and value include improving the effectiveness of medical treatments, helping patients change health behaviors and better manage chronic diseases, and reducing the need for medical interventions (teaching behavioral pain management strategies).