G08 – Are We Just Paying “Lip Service” to the “Behavioral” in Primary Care Behavioral Health? Assessing Referral Reasons in a PCBH Service

Summary

The Primary Care Behavioral Health (PCBH) model emphasizes that behavioral health consultants (BHCs) are to be generalists and address any behaviorally influenced concern (Reiter et al., 2018). Beehler et al. (2017) found in the literature that many organizations lacked this fidelity, and rather, largely addressed mental health concerns. These findings call into question the feasibility of the PCBH model and, in laymen’s terms, “do what it says it does.” Additionally, with the strong influence of stigma, especially for minority populations, many patients may present with somatic concerns. Thus, if referrals are only addressing traditional mental health conditions such as depression and anxiety, this might once again contribute to the lack of access for groups who are affected by social inequity. Research has found that the PCBH model is helpful in addressing access for indigenous populations in New Zealand (Maude, 2018) as well as low income individuals (Ogbeide et al., 2018). The BHCs at Community Health of Central Washington (CHCW) embarked on a project to establish a data tracking system that provided the framework for assessing fidelity regarding BHC involvement in the full range of concerns found in primary care. Simply using diagnoses assigned is not sufficient considering the referral problems and the diagnoses assigned are not always congruent. Initial results (2018-2019) demonstrated about 56% of visits included a referral problem related to traditional mental health concerns (e.g., depression, anxiety, trauma, etc.); whereas, 44% of concerns were related to physical health conditions, substance use, interpersonal problems, etc. Updated results (2020-2021) will be presented during the session. In this presentation, the presenters will provide an overview of this data tracking system (structured review of EHR data from BHC templates at CHCW), including the initial steps taken to develop the tracking system, the iterations of the project, and a review of the initial and subsequent findings. A discussion will ensue regarding the implications of this data as it relates to assessing fidelity in PCBH services. The target audience includes behavioral health and medical clinicians, researchers, and staff, as well as the full range of healthcare administrators. The intent is for audience members to gain an understanding of the rationale, the processes involved, and the implications of tracking referral problems data in a PCBH service. It should be noted that the basic tenets of the referral problems and warm hand-off process at CHCW were simply expanded to include telehealth visits as prompted by the COVID-19 pandemic. In other words, instead of traditionally there only being in-person warm hand-off encounters offered, once the pandemic started, telehealth visits were an additional option. In-person and telehealth warm hand-off encounters were available (and continue to be available) through the entirety of the pandemic.