Integrating Primary Care into the Behavioral Health Clinic

Innovative, forward-thinking behavioral health leaders are quickly moving forward to bring primary care services into their clinics. They are committed to improving the health outcomes of the individuals who receive their services. This blog post focuses on practical how-tos for optimizing service delivery.

PREPARING FOR INTEGRATED SERVICE DELIVERY

When co-locating primary care in a community behavioral health center, take care in planning the physical location of the primary care staff offices and exam rooms. Most behavioral health centers find space to be a premium. Bringing primary care services into the behavioral health clinic begins a flurry of activity of planning. An empty office or an office that is the obvious choice for doubling up employees is the typical starting point in planning. The easy solution is not the ideal solution. In order to prevent problems once the services are established, it is worth the effort to consider the following points:

Start with a Customer Service Perspective

Initial planning must be based on providing the best service for individuals who will be accessing services. This includes consideration of the ideal customer experience will be. Through starting with the end-goal in sight, you can effectively work backward to create the ideal. Providing a pleasant environment with a customer-centric flow that effectively integrates service delivery results in satisfied customers and providers.

Strategic Planning 

Integration of services will not occur unless primary care and behavioral health staff are located so that they can interact regularly. Passing each other in the hall promotes a sense of teamwork and allows for brief hallway consults. Physical distance prevents interaction and reduces the likelihood of true integration. When primary care services are segregated into a separate hallway, wing, or even a different floor, integration of services is hindered to the point of being essentially impossible. This model promotes a siloed model that discourages interaction between providers. A little disruption on the front end will prevent problems in the long run. Take the time to carefully plan the workflow. By relocating a few offices, chances for successful integration of services is maximized. Perhaps you may want to be really daring and have behavioral health and primary care professionals’ desks located in a central office near the exam rooms. Togetherness breeds camaraderie.

Encourage Warm Handoffs

This vote of confidence from one professional to another greatly increases the likelihood of follow through by the client. When the behavioral health and primary care professionals are in close proximity, even the busiest providers are able to take a moment to make this brief but invaluable introduction.

The Value of Flexibility 

Flexibility can be a challenge for behavioral health clinics. As a result, many rely on a rigid method of scheduling that is based on convenience of the clinic rather than the customer. This method has historically been a challenge for clinics and the people who seek services there. No show rates soar while unyielding (or is it naive?) administrators continue to expect people with cognitive impairment to somehow be trained to adhere to rigid methods of receiving services. This is costly for the clinic and frustrating for the client. It is NOT customer-centric.

It behooves community behavioral health clinics to follow the lead of their primary care cousins and opt for more flexible scheduling to meet the demands of the individuals served. This is even more important in an integrated setting that requires greater coordination for meeting the whole health needs of individuals. Open access and same-day scheduling are options.

Engage the Primary Care Staff in Planning the Workflow

Engaging primary care staff in planning workflow not only allows buy-in from everyone, it prevents having to make modifications later on. Workflow in primary care is very different than in the behavioral health setting. Negotiating the flow for integration ensures smooth service delivery and maximizes staff productivity.

Shared Reception is Ideal

One front desk for check in promotes the sense of seamless service delivery. It greatly simplifies the process for clients as well as staff. Having separate locations for checking in is an extra step in the workflow and is not customer-centric.

Plan for Frequent, Regular Case Consultation 

Weekly treatment team meetings that include all behavioral health and primary care providers offers a forum for integrated case discussion to supplement (rather than take the place of) ongoing, daily consultation. This allows providers to discuss difficult cases, building on the expertise of all. It also further promotes the sense of teamwork that is important for integration.

Check back for more practical how-tos for integrated service delivery.

This is by no means an exhaustive list. I encourage readers to send in their ideas of other logistical considerations for successful integration to behavioralhealthintegration@gmail.com to be included in a future post of Behavioral Health Integration. 

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