WITHDRAWN: Behavioral Health Integration in Native American Primary Care Clinics

Introduction: Integrating behavioral health into primary care can increase patient access to needed mental health and substance abuse care and improve patient health outcomes. Despite this, the integration of behavioral health in primary care is not widespread, especially in rural and underserved areas. American Indians and Alaskan Natives (AI/ANs) have endured both limited and differential access to resources, creating disparities compared with other racial/ethnic groups, and have increased risks for many health conditions including mental health and substance use disorders. Using evidence-based models, this ongoing project integrates behavioral health services into a Native American primary care clinic. This project will evaluate the process, patient and clinic staff satisfaction and patient health outcomes during behavioral health integration.

Methods: The project team partnered with a Native American health system in New York and built an inter-professional collaborative practice within their primary care setting. Trainings were provided on two evidence-based models, Screening Brief Intervention and Referral to Treatment (SBIRT) and Improving-Mood, Providing Access to Collaborative Treatment (IMPACT). The Primary Care Provider screens all adult patients for behavioral health disorders using evidence-based screening tools, including the PHQ-9, GAD-7, AUDIT and DAST. EMR integration with digital screening via tablets will be provided in order to optimize the clinic workflow. Primary Care staff provides a warm hand-off of the patients who test positive to the Care Manager who provides counseling, coordinates treatment and facilitates communication between providers. The Care Manager tracks patient progress and outcomes using a patient registry.

Results: This project is currently underway. In the first two months of the project, 9 out of 73 (12%) patients screened positive for Depression, 8 out of 69 (12%) patients screened positive for Generalized Anxiety Disorder, 10 out of 74 (14%) patients screened positive for an Alcohol Use Disorder and 15 out of 71 (21%) patients screened positive for drug abuse. Of the patients screening positive, 4 patients were actively engaged in integrated behavioral health services with the Care Manager.

Conclusion: Screening provides a public health approach to the delivery of early intervention and treatment services for patients with underrecognized and undertreated substance use disorder or mental health problems. This project responds to the critical need for increasing access to mental health and substance abuse treatment in underserved and rural areas.