Behavioral Health

Three ladies talkingFinger Lakes Community Health (FLCH) has long recognized the need to integrate mental health and substance abuse services into the primary care setting. With our services originally geared only to farmworkers, it was clear that depression was a major issue for many of our patients due to the isolation and distance from home and family. Also evident was the use of alcohol by a largely young male population as a means to temporarily overcome these issues.

As our patient population grew, we saw the need for more intensive services at our Centers. Substance abuse is a prevalent issue for many of our patients. The following explain how we have integrated each provider or specialty into our practice to give us the opportunity to offer expanded services to our patients in their primary care home.

Licensed Clinical Social Workers (LCSW)

We use LCSWs to see our patients for mental health services in our health center sites. This is an extension of our primary care services, with referrals for patient services coming directly from our providers or community health workers. The benefit of integration of these services into the primary care setting is that the LCSW can communicate directly with the providers. The LCSW has access to the electronic medical chart and documents all mental health services in the patient chart. Feedback is immediate. There is no need to wait for correspondence. Medical changes or prescription changes are quick and easily corroborated. The patient is comfortable in his or her own Health Center. The patient is a member of a team and knows that both the counselor and the primary care provider work in partnership to improve the patient’s health status.

Telecounseling

In the event that we encounter a non-English-speaking patient who needs a referral to counseling services, we use telehealth equipment as a tool to link them to bilingual/bicultural mental health counselors at a partner Federally Qualified Health Center (FQHC) with which we have established a contractual agreement. This agreement allows patients of FLCH to become mental health patients of the partner FQHC for counseling services. FLCH currently reimburses the partner FQHC for each visit, with the patient paying a nominal fee. This program was developed because we haven’t had success in recruiting a bilingual/bicultural LCSW for our patients, and the use of an interpreter is unacceptable except in an emergency situation. Both FLCH and the partner FQHC use the same electronic medical record (EMR) system, so records are shared between agency providers for continuity. FLCH has a Community Health Worker telepresenter there while the patient is being counseled in the event that an emergency situation arises or for any follow-up tasks requested by the patient and/or counselor. The partner FQHC mental health staff also takes part in our monthly mental health teleprogram staff meetings to maintain good communication among all parties.

Telepsychiatry

As we implemented our counseling services, it became apparent that our patients needed referral to a psychiatrist every 6 to 8 months for medication checks and/or changes in treatment for depression or other mental health diagnoses. We set up a referral process to a psychiatrist at our local hospital, but patients had issues going to the offices where the psychiatrist worked. We also noted that referrals were incomplete. We went back to the psychiatrist and requested that he see our patients using video-conferencing equipment. This way, the patient comes to the Health Center where they already receive their primary care and counseling services, and in a counseling room using video equipment, an LCSW connects them to the psychiatrist and gets the appointment started, then leaves the patient to their session. Referral completion data as well as patient satisfaction forms showed that completion rates were very high. Patients were extremely satisfied using video equipment to attend their appointment with the psychiatrist. The FLCH LCSW was able to talk to both the patient and the psychiatrist at the end of the session to review and make any recommended changes. The telepsychiatry program has really proven how telehealth can provide better, more efficient access to care for our patients.

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