In an effort to increase access to mental health care in Seattle and King County, the AIMS Center at the University of Washington partnered with UW Medicine to launch the Behavioral Health Integration Program (BHIP). BHIP uses collaborative care to bring mental health treatment into all of the UW Neighborhood Clinics, a system of twelve primary care clinics located throughout greater Seattle, as well as clinics at Harborview Medical Center and the General Internal Medicine clinic at UWMC Roosevelt. Like elsewhere, mental health is a big part of primary care in Seattle and King County; in 2009, 19% of all clinic patients had a mental health diagnosis. Although Collaborative Care has been implemented around the world, the AIMS Center and UW Medicine are very proud to be able to provide it in our own community.
BHIP utilizes a web-based Care Management Tracking System that supports population-based care, provides patient outcome measures, and assists in quality improvement efforts. In October 2012, several goals were established for the BHIP program: to increase patient access by care managers and across all BHIP clinics, to improve patient outcomes on measures of depression and anxiety, to increase provider satisfaction with care management, and to improve provider satisfaction with psychiatric consultation. When measured in August 2013, the BHIP program had exceeded initial targets for each of the seven indicators.
BHIP won a Psychiatric Services Achievement Award from the American Psychiatric Association in 2014, and a Washington Award of Excellence in Healthcare Quality from Qualis Health in 2016.
Untreated mental health illnesses have serious consequences for families, but fewer than one in four depressed people who identify as mothers receive effective treatment. This project examined depression care and clinical outcomes for pregnant people and people who identify as either mothers or primary caregivers, treated in 14 clinics serving racially and ethnically diverse communities with lower incomes as part of the Mental Health Integration Program (MHIP). The outcome of this project was published in Family Practice. Huang H. et al (2012) found that although there was substantial depression improvement in all four of the ethnic groups studied (Asian, Black, Latinx, White), outcomes of Latinx patients were higher than those of Black patients regardless of other demographic or clinical factors. Notably, this study shows that more intensive care management in the first month of treatment for primary care can lead to better outcomes for pregnant people, and mothers or primary caregivers with lower incomes experiencing depression. Another study describes the experiences of care managers working in this program and found that motivational interviewing skills were a valuable asset in engaging patients in care, which generally leads to better outcomes.
References
- Huang, H., Chan, Y.-F., Katon, W., Tabb, K., Sieu, N., Bauer, A. M., Wasse, J. K., & Unützer, J. (2012). Variations in depression care and outcomes among high-risk mothers from different racial/ethnic groupsV. Family Practice, 29(4), 394–400. https://doi.org/10.1093/fampra/cmr108
- Huang, H., Bauer, A. M., Wasse, J. K., Ratzliff, A., Chan, Y.-F., Harrison, D., & Unützer, J. (2013). Care managers’ experiences in a collaborative care program for high risk mothers with depression. Psychosomatics, 54(3), 272–276. https://doi.org/10.1016/j.psym.2012.07.011
This NIMH funded project is a collaboration between the University of Washington, Emory University and three sites in India (Chennai, Delhi, and Vishakapatnam). This grant will adapt the multicondition TEAMcare model to treat patients with poorly controlled diabetes and comorbid depression at these three sites and build on an National Heart, Lung and Blood Institute Center for Excellence grant established in India by Emory University. An initial one year qualitative study will help our research team adapt TEAMcare to the unique aspects of Indian culture and medical systems.
Link for TEAMcare: http://www.teamcarehealth.org/
The number of older adults is rising sharply and is expected to increase from 40.3 million to 72.1 million between 2010 and 2030. According to the Pew Research Center, 92% of adults aged 65 and older use text messaging. Despite misconceptions to the contrary, text messaging as part of primary care for older adults is growing. Text messaging holds promise as a strategy for engaging older adults in Collaborative Care depression treatment through frequent contact with a behavioral health care manager. The purpose of this research project is to develop and pilot test a text messaging intervention delivered in California primary care settings serving a patient population that is at least 25% older adults. Published research (Bao et. al. 2015) demonstrated that early follow-up contact predicts better clinical outcomes for patients. A recent analysis published by the AIMS Center (Renn et. al. 2021) showed that Collaborative Care was equally effective in older and younger adults but that older adults needed more contact with the behavioral health care manager to achieve these equivalent outcomes. Text messaging may be an effective strategy for both early and more frequent contact with patients. The AIMS Center is partnering with the Archstone Foundation on this project.