Behavioral Health Integration
An Interview with Angie Schindler-Berg, Practice Facilitator at HealthTeamWorks:
May was mental health awareness month, and we wanted to dedicate that month to being intentional in thinking about how we, as a team and a society, might be able to make an impact on the significant and sometimes life-threatening gaps in access to needed care that exist in our communities.
And, while fraught with its own challenges, the integration of primary care and behavioral health is a one of those critical steps we should be taking to address these gaps and the behavioral health crisis we’ve come to understand. It can improve outcomes and quality but, importantly, it has the potential to provide a gateway to care that otherwise would have been out of reach for some.
In light of this, HealthTeamWorks Practice Facilitator, Angie Schindler-Berg, has been supporting the efforts of the Mid-America Mental Health Technology Transfer Center (MHTTC) providing technical training and assistance in integrated care, school mental health, serious mental illness, and behavioral health workforce development across HHS Region 7.
We spoke with Angie to learn more about her experiences in behavioral health integration and how practices may overcome barriers that exist to success.
Tell us about the work you are doing with MHTTC.
Angie: The work I do with MHTTC involves disseminating and implementing evidence-based practices for mental health disorders into the behavioral health field of practice, to accelerate the adoption and implementation of mental health-related evidence-based practices into medical and behavioral health practices and agencies. Currently, I’m working with practices across the state of Kansas implementing Assertive Community Treatment (ACT) Teams for Certified Community Behavioral Health Clinics (CCBHCs). These teams are designed to provide a comprehensive range of mental health and substance use disorder services, particularly to vulnerable individuals with the most complex needs. I also get to provide trainings on Trauma-Informed Care, Motivational Interviewing, Recovery Oriented Care, Shared Decision Making, Treatment Planning, and De-Escalation or Crisis Intervention across all Region 7 service areas.
What do you see as the biggest barriers to BH integration?
Angie: One of the biggest barriers I see is the reimbursement levels for behavioral health intervention codes. These reimbursement levels often don’t provide adequate financial support to allow practices to succeed. Recruitment and retention of qualified staff is also a big barrier, and there is a real need to enhance care team approaches that include behavioral health staff seamlessly into the clinic workflow. I think we need to acknowledge the culture and differences between medical and behavioral approaches but also optimize interprofessional scopes of practice and strengths to build a strong team-based approach.
What about bright spots you’ve seen in BH integration?
Angie: I have seen many examples of successful behavioral health integration, but there is one clinic that comes to mind that was a great display of truly integrating it into their team. When this clinic hired a behavioral health clinician, there was a dedicated team meeting lead by a provider champion, in which all clinic staff were provided with the background, experience, and role of this new clinician. When this behavioral health clinician came into the clinic, they spent the first week just shadowing providers and clinic RNs and MAs. This provided time for providers and care managers to introduce the clinician to patients, families, and caregivers. The clinician was able to spend time with patients during this period for deeper conversations and to provide education and obtain patient feedback and thoughts. They incorporated team huddles to enhance current workflows in a way that included warm hand offs, a clear referral process, and strong communication lines and to develop meaningful huddle templates.
The clinic made sure everyone was able to speak to the role, services, and supports of the behavioral health clinician if asked by patients or caregivers. Importantly, all team members understood the WHY behind the WHAT they would be doing. And integration was really supported by the clinician’s ability to identify supplemental training that would benefit staff, such as motivational interviewing and Mental Health First Aid that enhanced patient engagement.
What do you think practices need to achieve successful BH integration?
Angie: There are so many things practices can do to support integration, but ultimately buy in from the top down, a solid clinical champion, and team leads that can engage all team members are critical to success. Practices also need to ensure the right people are in the right positions and that they are building on team strengths for mentoring and on-going training.
Also, something we sometimes forget as being critical to success is enhancing community engagement to build strong community partnerships that support and best meet identified patient needs. Having a strong patient, family, caregiver committee that incorporates patient voice and perspective enables integration to truly work for the people being served. And in line with community and patient engagement, communications and workflows need to be adjusted to best meet challenges people face outside of the clinic walls.
Through her work, Angie hopes to support successful integration by heightening the awareness, knowledge, and skills of the workforce that addresses the needs of individuals living with mental illness and fostering regional and national alliances among culturally diverse practitioners, researchers, policy makers, family members, and consumers of mental health services.
Learn more about MHTTC here.
And to learn how our team is helping practices in their efforts to integrate behavioral health, reach out at firstname.lastname@example.org