BizWest published an extensive article on our embedded mental health counselors:
“Boulder Community Health’s integrated behavioral health team
is working to make it easier for clinic patients to get the help they
need. The two-fold focus aims to improve physical health by improving
Embedded mental health counselors in physician offices are just another
way BCH is committed to our community's mental health. Learn more
about our mental health campaign at bch.org/mentalhealth.
BizWest article here and pasted below:
(Photo credit: Jonathan Castner for BizWest)
BCH integrates behavioral, physical health
Elizabeth Gold — March 7, 2018
BOULDER — Treatment for mental health care continues to lag in the
U.S. The Affordable Care Act has increased access to insurance for more
people, however, getting treatment for issues like depression and anxiety
can still be a challenge.
Programs at the federal and state level are focusing on filling in the
gaps. Locally, Boulder Community Health’s integrated behavioral
health team is working to make it easier for clinic patients to get the
help they need. The two-fold focus aims to improve physical health by
improving mental health.
Boulder Community Health runs 11 primary care clinics in the areas of Boulder,
Lafayette, Superior, Longmont, and Broomfield. Each has some level of
integrated behavioral care available onsite, according to Julie Jungman,
integrated behavioral health supervisor. A group of seven clinical social
workers is spread over the 11 clinics.
“Sometimes a doctor will bring me into the exam room for a quick
conversation,” Jungman said. “It could be that the patient
wants to talk about insomnia, and I can tell them a few things to try.”
In addition to these warm hand-off interventions, a patient can come into
the clinic and see Jungman or one of the other social workers for up to
three sessions of solution-focused therapy.
“It’s based on things a person can do to make their life less
stressful — common strategies like exercising by setting up goals
and action steps,” she said. “People can be referred for any
behavior that can be strategized to improve their quality of life.”
The integrated behavioral team can be called in by a primary care provider
to help patients work with issues like diabetes, weight loss and smoking
cessation through behavioral goals and support. Depression and anxiety
tend to be common struggles patients present.
“For any chronic illness, it’s not unusual for depression to
go hand-in-hand,” said Betsy Duckett, director of integrated clinical
services at BCH. “You can’t take care of your diabetes unless
you treat your depression. We want to meet mental health needs to be able
to better address physical health needs.”
To get to the heart of what a patient needs to be able to work with challenges
like diabetes, for example, the integrated behavioral social worker could
ask questions to get a bigger picture. Inquiring about the kind of social
activities a person is involved in or what they do to manage their stress
can help collect information that the primary care provider can follow-up
on and vice versa.
“It’s great when a doctor tells you to lose 20 pounds,”
Duckett said, but the directive can be overwhelming to a patient. When
the integrated behavioral health professional asks the patient to outline
steps they can take to lose five or 10 pounds and then have them check
back in a month, the directive becomes an attainable goal.
The integrated behavioral health initiative started in BCH clinics four
years ago and spread to all of its 11 clinics by 2017. The integrated
behavioral team also provides assistance beyond meeting with patients
when their primary care provider asks them to step in during a visit and
short term follow-ups.
“People who have depression and anxiety can be daunted by the idea
of finding a psychiatrist or provider,” Jungman said. “We
help them navigate by helping them figure out who’s in their network
and recommending three to four people in the community we think are a
Monica Bartoli, D.O., is a family medicine physician in BCHs Northwest
Family medicine clinic in Superior. One of Jungman’s tasks sometimes
includes reaching out to patients Bartoli has seen about two weeks after
the appointment to find out how a medication change is affecting them.
“For me, it’s helpful knowing how my patients are doing two
weeks after care in case we need to change medications or make adjustments
early on rather than waiting for their next appointment in six weeks,”
Bartoli said. “It used to be that we would give referrals to patients
for mental health care and then let them loose. This bridges the gap for
patients who don’t know how to navigate the system.”
The integrated behavioral health program in BCH clinics is rooted in a
few national concepts and programs. One, the Advanced Primary Care model,
focuses on building closer connections between primary care and other
clinical care as well as community-based services.
Patient-Centered Medical Home is a care delivery model where a person’s
primary care physician coordinates treatment to ensure that necessary
care is arranged when and where the patient needs it and in a manner they
The State Innovation Models (SIM) initiative provides federal grants to
states and focuses on lowering healthcare costs, providing better care
and improving population health.
SIM is “devoting resources to demonstrate the link between addressing
mental health issues and improved physical health, which is difficult
to do at the practice level,” said Jamie Jensen, chief population
health officer and vice president of strategy at BCH.
BCH received $5,000 for a two-year involvement and about $40,000 for each
clinic site. The dollars have helped cover a group visit room, a behavioral
health specialist position, IT enhancements to better understand its patients
needs and more.