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Evaluation

Primary Care / Integrated Care
Symposia

Symposium 74 - Improving Behavioral Health Care Access and Outcomes through Primary Care

Saturday, November 16, 2024
10:30 AM – 12:00 PM EST
Location: Franklin 1, Level 4, Downtown Marriott
CE: 1.5

Keywords: Primary Care, Integrated Care, Implementation
Recommended Readings: Youn, S. J., Jaso, B., Eyllon, M., Sah, P., Hoyler, G., Barnes, J. B., Jarama, K., Murillo, L., O'Dea, H., Orth, L., Pennine, M., Rogers, E., Welch, G., & Nordberg, S. S. (2023). Leveraging Implementation Science to Integrate Digital Mental Health Interventions as part of Routine Care in a Practice Research Network. Administration and Policy in Mental Health, 10.1007/s10488-023-01292-9. Advance online publication. https://doi.org/10.1007/s10488-023-01292-9,   Khazanov, G. K., Jager-Hyman, S., Harrison, J., Candon, M., Buttenheim, A., Pieri, M. F., Oslin, D. W., & Wolk, C. B. (2022). Leveraging behavioral economics and implementation science to engage patients at risk for suicide in mental health treatment: a pilot study protocol. Pilot and Feasibility Studies, 8(1), 181. https://doi.org/10.1186/s40814-022-01131-y,  

Spottswood, M., Lim, C. T., Davydow, D., & Huang, H. (2022). Improving suicide prevention in primary care for differing levels of behavioral health integration: A review. Frontiers in Medicine, 9, 892205. https://doi.org/10.3389/fmed.2022.892205


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Despite the availability of evidence based practices (EBPs) for behavioral health concerns, many people in need do not access treatment. Increasingly, primary care is touted as an ideal setting to address this problem. Most people visit primary care each year (Blackwell, Lucas, Clarke, 2014). Behavioral health concerns, including depression, anxiety, and suicide risk, are discussed in nearly 70% of these visits (Hunter, Goodie, Oordt, & Dobmeyer, 2017). However, only half of the patients referred from primary care attend an initial mental health visit (e.g., Solberg et al., 2023). The proposed symposium brings together three projects focused on leveraging primary care settings to improve access to care for patients experiencing behavioral health problems, including elevated suicide risk, clinically significant anxiety, and depressive symptoms. Together, the presentations will focus on a range of approaches to increase access to mental health care through primary care, such as provider-initiated referral to digital interventions, the Collaborative Care Model (CoCM), and implementation strategies to increase behavioral health engagement following a primary care referral.

Our first presenter will discuss the scale out and effectiveness of Precision Behavioral Health (PBH), a pilot program that leverages primary care providers to connect patients with behavioral health concerns to a suite of digital interventions. Findings include high provider adoption following a brief training, with providers offering the program to most eligible patients and all providers referring at least one patient. Clinical improvement at 6 weeks was on par with clinician-delivered interventions, demonstrating that PBH is a promising low-burden, scalable approach to reducing mental health concerns through primary care. Next, our second presenter will present an evaluation of an adapted CoCM program in which primary care patients are referred to behavioral health care within the same practice, with a particular focus on patients at risk for suicide. Results provide evidence for CoCM as an effective approach to increase access to effective mental health care for at-risk patients. Key findings include pre- to post- treatment improvement in suicidal ideation, as well as reductions in anxiety and depression across patients with and without suicidal ideation. Our third presenter will then present a menu of strategies to increase mental health treatment engagement for primary care patients at risk for suicide. She will present the strategy development process, including semi-structured interviews with primary care and behavioral health clinicians, leaders, and patients, behavioral mapping with primary care partners, and results from rapid prototyping pilot trials. Finally, our discussant will synthesize and contextualize these presentations, drawing from her expertise in the implementation of EBPs in primary care to improve access and quality of care for a range of behavioral health concerns.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Describe reasons primary care is a promising setting for connecting patients to behavioral health care.
  2. Describe barriers and facilitators to initiating behavioral health care following a primary care referral.
  3. Describe strategies to promote behavioral health care initiation among individuals at risk for suicide.
  4. Describe strategies to promote the scale out of behavioral health interventions, including digital interventions.
  5. Describe pre-post treatment changes associated with the Collaborative Care Model for patients at risk for suicide.

Presentations:

  • 10:30 AM – 12:00 PM EST
    (SYM 74) Scaling a Digital Behavioral Health Interventions Ecosystem Through Primary Care Providers to Enhance Patient Reach

    Speaker: Soo Jeong Youn, PhD – Reliant Medical Group

    Co-author: Keke Schuler, Ph.D. – Reliant Medical Group

    Co-author: Pratha Sah, PhD – Reliant Medical Group

    Co-author: Brittany Jaso, PhD – Reliant Medical Group

    Co-author: Mariesa Pennine, BA – Reliant Medical Group

    Co-author: Mara Eyllon, PhD (she/her/hers) – Reliant Medical Group

    Co-author: Kankana Sengupta, PhD – Reliant Medical Group

    Co-author: J. Ben Barnes, PhD – Reliant Medical Group

    Co-author: Georgia Hoyler, BS – United Health Group

    Co-author: Samuel Nordberg, PhD (she/her/hers) – Reliant Medical Group

  • 10:30 AM – 12:00 PM EST
    (SYM 74) Change in Suicidal Ideation, Depression, and Anxiety Following Collaborative Care in the Community

    Speaker: Gabriela K. Khazanov, Ph.D. – Corporal Michael J Crescenz VA Medical Center

    Co-author: Courtney Benjamin Wolk, PhD – University of Pennsylvania

    Co-author: Emily Lorenc, BA – Perelman School of Medicine, University of Pennsylvania

    Co-author: Molly Candon, PhD – University of Pennsylvania

    Co-author: Matteo Pieri, BA – Perelman School of Medicine, University of Pennsylvania

    Co-author: David Oslin, MD (he/him/his) – Corporal Michael J. Crescenz VA Medical Center

    Co-author: Matthew Press, MD – Hospital of the University of Pennsylvania

    Co-author: Eleanor Anderson, MD (she/her/hers) – Hospital of the University of Pennsylvania

    Co-author: Emilie Famiglio, B.S. – University of Pennsylvania School of Medicine

    Co-author: Shari Jager-Hyman, Ph.D. (she/her/hers) – Perelman School of Medicine at the University of Pennsylvania

  • 10:30 AM – 12:00 PM EST
    (SYM 74) Developing and Pilot Testing Strategies to Increase Mental Health Treatment Engagement Among Primary Care Patients at Risk for Suicide

    Speaker: Shari Jager-Hyman, Ph.D. (she/her/hers) – Perelman School of Medicine at the University of Pennsylvania

    Co-author: Emilie Famiglio, B.S. – University of Pennsylvania School of Medicine

    Co-author: Gabriela K. Khazanov, Ph.D. – Corporal Michael J Crescenz VA Medical Center

    Co-author: Biiftu Duresso, B.A. – University of Pennsylvania School of Medicine

    Co-author: Eleanor Anderson, MD (she/her/hers) – Hospital of the University of Pennsylvania

    Co-author: David Oslin, MD (he/him/his) – Corporal Michael J. Crescenz VA Medical Center

    Co-author: Courtney Benjamin Wolk, PhD – University of Pennsylvania