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The Connecticut Legislature is considering a recommendation by the Connecticut chapter of the National Association of Social Workers for a pilot program of integrated health care within pediatric practices.
As a state we are continuously faced with the challenge of getting behavioral health services and access to a population we hold dear – our children. Whether it’s the inability to get into treatment in a timely manner or the missed opportunity to provide a lifesaving intervention, we are failing.
There are systemic issues that go far beyond our great state, but there are innovative strategies we haven’t fully put our mind, and support, behind.
Behavioral Health Integration, also known as Integrated Care, looks at the intersection between medical and behavioral health conditions and provides resources where many of our children visit — the primary care medical office.
The Substance Abuse and Mental Health Services Administration discusses a six-level continuum of Integrated Care that aligns with Institute of Medicine’s research on the Quadruple Aim: a framework to provide quality healthcare with improved outcomes.
The research shows that patient experiences, improved health outcomes, cost-effective care and provider experience have a direct correlation with a quality healthcare system.
The continuum of Integrated Care fits this paradigm, because it offers a team-based approach to
- overall primary care with more individuals on the team providing the best level of care immediately to the patient
- patient improved health outcomes because our physical wellbeing impacts us emotionally and vice versa — we must treat the mind and body
- cost-effective care because if we are getting more of our overall healthcare needs met then there is less use of the emergency room and other costly endeavors for health over the long term.
- provider experience because we retain and recruit medical providers who have a team that supports them, lightening the stress and burden.
Picture the child who goes to the primary care office with a problem sleeping, unknown stomach complaints, unexplained physical pain, parents or guardians missing multiple days of work providing care. Many of these physical symptoms are signs of possible emotional distress which could include bullying, low self-esteem, anxiety, depression, etc.
Integrated Care has years of research supporting two evidenced based models: Primary Care Behavioral Health and Collaborative Care Model.
PCBH embeds a social-work-licensed clinician in the medical office to provide interventions during the medical office visit and identifying additional needs or concerns.
CoCM allows for a consulting psychiatrist to provide guidance on effective behavioral health prescribing by a psychiatrist, while also providing intense follow-up by a social worker between primary care office visits.
In a clinic providing Integrated Care not only are there brief interventions and support provided to the primary care physician and the patient, but also to the parents or guardians. There is an impact on the entire family system. Integrated Care is an opportunity for preventative care and to catch conditions when they are still mild or moderate rather than severe or when a child is in crisis. We’ve heard and seen the research on how important early intervention is at all stages of life.
So, how do we get Integrated Care going?
We start by providing startup money for primary care practices to invest in salaries of skilled licensed social workers, space and medical records needs — lessons learned from Hartford Healthcare’s innovation on Integrated Care would be helpful.
We need state procedures that support the growth of integrated programs. Some states allow abbreviated guidelines for licensed social workers billing psychotherapy CPT codes in an Integrated Care setting and CoCM billing codes to cover the type of unique services we are talking about providing.
We need workforce development money for our universities to train social workers, primary care providers, nurses and psychiatrists on approach to service delivery – like Fairfield University’s Collaborates for a Healthier Connecticut Scholars Program.
A pilot could assist pediatric practices with start-up costs and demonstrate the effectiveness of this model. Investing in services for our children is always the right decision.
What are we waiting on Connecticut?
Monica Williams Harrison, MSW, LCSW — NASW National Board Director, Region II
Stephen Wanczyk-Karp, LMSW — NASW Connecticut Executive Director