Integrated-care models improve access to treatment when they include three elements: brief psychological interventions, strong communications with local health-
care providers and “one-stop” health care, said speakers at an
APA 2011 Annual Convention session on integrated care.
“Having everything happen in one place is really critical, and
can increase patient satisfaction and coordination of care,” said
Patricia Arean, PhD, a professor at University of California, San
The models of care highlighted at the session were:
• Chase Brexton Health Services, Baltimore. When this
federally qualified health center opened its first clinic in 1978, it
helped mostly gay patients cope with HIV/AIDS and make end-
of-life decisions, said staff psychologist Robin Mullican, PsyD.
Now, its four clinics provide “one-stop” health care, including
primary care, HIV specialty care, dental care, behavioral health
services, case management and pharmacy services to nearly
20,000 patients annually.
In a program launched last year, psychologists team with
providers in the medical clinic, offering behavioral health services
to patients as an integral part of the primary-care visit. Primary-care providers “handoff” patients to psychologists to be seen in
the exam rooms immediately after their medical appointments.
Psychologists assess for co-occurring mental health and
addictions issues, and work with patients to help motivate
healthy behaviors and address obstacles to adherence and self-
care, she said.
• University of Alabama’s Interdisciplinary Behavioral
Healthcare Team. Once a week between 2008 and 2010, as
many as 10 University of Alabama doctoral clinical psychology
students, nurses, social workers, social work students and rural
medical scholars climbed in an R.V. and drove to provide care
to rural residents and seniors in western Alabama’s “Black Belt.”
Often the seniors there have multiple chronic health conditions,
such as diabetes, hypertension and depression and lack access
to mental health professionals, said geriatric psychology student
Latrice Vinson. “Depression goes unrecognized, and when it is
recognized, it may go untreated, due to a lack of psychological
services,” she said.
The R.V. parked at grocery stores, churches and senior
centers to provide free checkups, including blood-pressure
screening, as well as tests for HIV and glucose and cholesterol
levels. In 2008–09, the team performed 2,056 health
screenings; 88 percent of the tests screened positive for
hypertension or its precursor, she said. A nurse gave patients
their results, educated them about the dangers of untreated
hypertension and recommended a local physician for follow-up treatment.
• Molokai Community Health Center, Hawaii. This
federally qualified health center provides sliding-fee scale, low-cost health care to the island’s 7,400 residents, almost a quarter
of whom live in poverty. Almost half of patients seen at the
center have co-morbid chronic physical diseases, said Darryl
Salvador, PsyD, who served as the center’s behavioral health
director from 2006 to earlier this year.
Salvador said psychology can be successfully integrated into
primary-care settings when practitioners help run the center
as members of its executive management team. Success also
requires consulting with physicians, being accessible, readily
available and figuring out how you can help your fellow health-care providers and patients, Salvador said.
“Talk with the primary-care providers about how you can
help with their patients, be a team player and remember that
we’re there for the patients,” he said.
• UCSF HEARTS (Healthy Environments and Response
to Trauma in Schools). Located in three San Francisco
public schools, this program helps traumatized children by
encouraging teachers to guide them away from behavioral
blowups using empathy and skill-building instead of harsh
punishment, said Joyce Dorado, PhD, project director and
associate clinical psychology professor at University of
California, San Francisco.
Children traumatized by family and community violence often
get in trouble with their teachers when a non-threatening event
— such as a schoolmate accidentally jostling them when they’re
already agitated — causes a “fight, flight or freeze” reaction in the
classroom. To prevent blowups, for example, teachers can notice
when children are becoming stressed and pre-emptively have
them do a soothing activity to calm down, she said.
Preliminary results indicate school staff are using more
trauma-sensitive skills, and reporting a decrease in discipline
referrals to school principals, Dorado said. “You need to
understand and adjust to school culture and language, and
build collaborative relationships that respect the expertise and
strength of educators,” she said.
• Indian Health Service/Office of Clinical and Preventive
Services. The Indian Health Service started introducing
an intervention called the Alcohol Screening and Brief
Intervention at its 45 hospitals and 480 clinics nationwide in
2007. The intervention intercepts young adults and teens who
have come to an emergency room or primary-care clinic with
an alcohol-related injury stemming from incidents such as
motor vehicle accidents, said Rose Weahkee, PhD, who directs
the IHS Division of Behavioral Health.
The intervention follows the “brief negotiated interview”
developed at Yale University. It consists of an alcohol screening,
brief feedback and motivational interviewing, during which the
provider helps the patient make the connection between their
alcohol use and the injury that’s brought them in for treatment.
If a patient expresses a willingness to change his or her behavior,
the provider helps work out a plan for change, with the goal of
According to David Boyd, MD, national trauma systems
coordinator for IHS Emergency Services, the intervention has
reduced injury-related emergency room readmissions up to 50
percent for several years, Weahkee said. n