The Connecticut Legislature is considering a recommendation from the Connecticut Chapter of the National Association of Social Workers for a pilot program of integrated health care in pediatric practices.
As a state, we continually face the challenge of obtaining behavioral health services and accessing a population we hold dear – our children. Whether it’s the inability to get timely treatment or the missed opportunity to provide life-saving intervention, we fail.
There are systemic issues that go far beyond our great state, but there are innovative strategies that we have not fully thought about and supported.
Behavioral health integration, also known as integrated care, examines the intersection between medical and behavioral health issues and provides resources where many of our children go – the primary care doctor’s office.
The Addiction and Mental Health Services Administration discusses a six-level integrated continuum of care that aligns with Institute of Medicine research on the Quadruple Aim: A Framework for Delivering Quality Health Care with better results.
Research shows that patient experiences, improved health outcomes, cost-effectiveness of care, and provider experience have a direct correlation to a quality healthcare system.
The integrated continuum of care fits this paradigm because it provides a team approach to
- comprehensive primary care with more people on the team providing the best level of care immediately to the patient
- the patient has improved health outcomes because our physical well-being affects us emotionally and vice versa – we need to treat mind and body
- cost-effective care, because if we get a greater share of our overall health care needs, we will use less of the ER and other costly long-term health efforts.
- the provider experience because we retain and recruit medical providers who have a team that supports them, easing stress and burden.
Imagine the child who comes to the primary care office with a sleep problem, unknown stomach aches, unexplained physical pain, parents or guardians missing several days of work to provide care. Many of these physical symptoms are signs of possible emotional distress which can include bullying, low self-esteem, anxiety, depression, etc.
Integrated Care has years of research supporting two evidence-based models: the behavioral health of primary care and the collaborative care model.
PCBH embeds a licensed social work clinician in the medical office to provide interventions during the medical office visit and identify additional needs or concerns.
The CoCM allows a consultant psychiatrist to provide guidance on effective behavioral health prescribing by a psychiatrist, while providing intensive follow-up by a social worker between visits to the primary care practice.
In a clinic offering integrated care, not only brief interventions and support are provided to the primary care physician and patient, but also to parents or guardians. There is an impact on the whole family system. Integrated care is an opportunity for preventive care and to catch conditions when they are still mild or moderate rather than severe or when a child is in crisis. We have heard and seen the research on the importance of early intervention at all stages of life.
So how do we kick off integrated care?
We’re starting by providing seed money to primary care practices to invest in skilled licensed social worker salaries, space requirements, and medical records—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 who bill psychotherapy CPT codes in an integrated care setting and billing codes to cover the type of unique services we are talking about providing.
We need money for workforce development for our universities to train social workers, primary care providers, nurses and psychiatrists on the service delivery approach – like the curriculum Collaborates for a Healthier Connecticut Scholars at Fairfield University.
A pilot project could help pediatric practices cover 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 for in Connecticut?
Monica Williams Harrison, MSW, LCSW – NASW National Council Director, Region II
Stephen Wanczyk-Karp, LMSW – Executive Director of NASW Connecticut