By Joshua C. Eyer, PhD
The promise of integrated care is great, but how do you convince an established health system to start a new service and hire new behavioral health providers?
Peggy Howland, PhD , faced just this challenge recently and turned to the Society’s Health Psych Connections (HPC) program to get some help. A clinical health psychologist working in private practice in Auburn, Alabama, she also consults with the local cancer center, where she conducts wellness groups, advises the administrators on mental health, and takes referrals. Recent conversations have highlighted the growing need for integrated care services in this setting, but she wanted some help with what she should propose and how to propose it. She reached out to the Society to ask for guidance and resources on the effective and ethical use of PHQ-9 in screening and expanding services within the new cancer center with existing staff.
When I spoke with Dr. Howland to discuss her request, I learned that she was dealing with general challenges associated with starting a new integrated care service as well as specific challenges arising from the setting in a cancer center. We both thought it would be useful for her to be connected with a mentor actively involved in behavioral health at a cancer center. In addition, given my own experience running an integrated care project in the same state, I was able to direct her to several good resources for information (listed below) and discuss challenges of behavioral health integration in medical settings specific to Alabama.
The HPC Advisory Committee recommended that we connect Dr. Howland with Dr. Dwain Fehon, who agreed to serve as an HPC mentor. Dr. Fehon is an Assistant Professor, Director of the Behavioral Medicine Service and Chief Psychologist over Psychiatric Services at Yale-New Haven Hospital. His primary work is within the Smilow Cancer Hospital and the Yale-New Haven Transplantation Center. Dr. Howland found their discussion very helpful. He advised her on best practices to develop and manage a new behavioral health service, implement universal screening for depression, develop a stepped-care treatment algorithm, administer brief behavioral interventions, and determine the appropriate level of care for patient severity given the resources available.
Dr. Howland reported, “Being able to talk with Dr. Fehon at Yale about working within a cancer center was very reassuring when I discovered that some of the challenges that I was experiencing were typical and not necessarily problematic. He was able to give me concrete suggestions that I am incorporating into my work at the local cancer center.”
Over several follow-up interactions, Dr. Howland and I have also continued to share our experiences with behavioral health integration in Alabama and to discuss techniques for increasing behavioral health services at the hospital despite the many challenges it presents. One significant challenge has been educating the administrators about the need for behavioral health services, the options available, and the benefits of behavioral health to patients and providers, particularly in the area of prevention. Another challenge has been strategizing about how to handle the increased burden for the existing providers through training and progression to brief interventions. A related challenge is how to demonstrate the value of the service and gradually build out the provider base for behavioral health. To aid in communicating solutions to these challenges, a meeting is being planned for the cancer center, Dr. Howland, and me during one of my regular trips to her city.
“One fun part of the connection is that Dr. Eyer actually lives in my home state, so we are planning some joint meetings at my hospital, which will hopefully help facilitate the changes that I want to accomplish,” said Dr. Howland. “I had no idea that when I sent an email reaching out for help, that it would have been the beginning of ongoing relationships. I am delighted!”
Although this collaboration does not represent the standard mentoring relationship, it remains a valuable potential outcome of the connections that HCP forms. Since our initial contact, Dr. Howland continues to work with the cancer center to begin to implement a stepped-care protocol following depression screening that includes direct referral for evaluation and behavioral and pharmacological treatment. The need for these services is clear as they have already started to strain the existing behavioral health resources.
“Reaching out to the Health Psychologist Connections program was a really positive experience for me. I not only received consults with two sharp and helpful health psychologists who had solid experience in two different types of integrated care (primary care setting and a cancer center), but I also gained a new network of psychologists who can advise me on the changes that I am attempting to initiate at our local cancer center. I’d advise any psychologist who is looking for some mentoring in Health Psychology to reach out to the Connections program. It is a difference maker.”
Integrated Care Resources:
The Society for Health Psychology listserv
Health Psychology journal
SAMHSA-HRSA Center for Integrated Health Solutions
APA’s Center for Psychology and Health
The Collaborative Family Healthcare Association
The AIMS Center
Integrated Behavioral Health Partners
AHRQ’s Integration Academy