NYAPRS Note: This type of service model may lead to a reduction in hospitalizations; BH providers seeking to integrate care and work toward whole-health management could consider integrating some of the elements of this approach in a proposal for NYS’ 1115 DSRIP proposal. If approved by CMS, performance-based projects will be allocated over seven billion in the next five years to reduce avoidable hospitalizations.
Asian Multiservice Agency Excels in Promoting MH Client Wellness
Mental Health Weekly; Vol 24, Num 3; 1/20/14
Behavioral health providers often struggle to have an appreciable impact on the physical health status of their patients. In the case of the patient population served by Asian Counseling and Referral Service in Seattle, the potential barriers to success loom even larger.
Most of the human services organization’s clients do not speak English, and many lack health insurance. Some carry a distrust of Western medicine, and most likely would find the typically harried medical office environment unwelcoming or downright intimidating.
As a result, Asian Counseling and Referral Service has capitalized on the personal relationships that its case managers have built with clients and has made its behavioral health program the nexus for integrated primary care and behavioral health services. It has used four-year Substance Abuse and Mental Health Services Administration (SAMHSA) grant funding to locate primary care physician support within the agency and to help redefine the overall organization as one that promotes individuals’ wellness.
“We outsourced our staff at primary care sites at first. We were nominally successful, but not fully,” Janet St. Clair, deputy director of Asian Counseling and Referral Service, told MHW.
What has largely made its more recent Wellness for Asian Pacific American (WAPA) project work is the effort of 40 case managers who speak around 20 languages among them, as they serve the King County region’s diverse Asian populations that include Vietnamese, Chinese, Filipino, Laotian and Cambodian, among others.
“For a lot of our clients, this is their second home,” Yoon Joo Han, M.S.W., the agency’s behavioral health program director, told MHW. Behavioral health is one of 13 programs overall in the human services agency.
Partnering with FQHC
The two generalist physicians who each spend one day a week at Asian Counseling and Referral Service are from International Community Health Services, a local healthcare organization with federally qualified health center (FQHC) status. Han said that to succeed in the behavioral health environment, physicians have to be open-minded and patient when working with the client population, and must be able to excel in a team environment. Many of Asian Counseling and Referral Service’s clients have serious mental illness, post-traumatic stress disorder (PTSD) or adjustment disorders.
Han added that the on-site doctors have had to be resourceful to a degree. “We converted two counseling rooms to pretty fully equipped examination rooms, but they do not always have everything that they might need,” she said. “Sometimes they might have to bring something from the main clinic.”
The physicians’ presence makes it easy for the case managers who work closest with the agency’s clients to walk a client down the hall for a visit with the doctor. Yet while physical health screenings and prescriptions for needed medications constitute an important component of the integrated care effort, the agency also has built an extensive list of ongoing wellness activities to support client well-being.
More than 500 clients are enrolled in the nearly two dozen wellness groups that meet at various intervals, mostly weekly. Some of the groups are tailored to specific ethnic groups served by the agency, while others focus on activities and skills such as yoga, t’ai chi, cooking, gardening and the arts.
In addition, St. Clair said that every therapeutic group in the agency now includes an exercise component as part of expected activities. “Also, case managers are encouraged to walk with their clients, rather than sit in an office,” she said.
Encouraging outcomes
As part of the SAMHSA grant project, Asian Counseling and Referral Service is evaluating WAPA’s effect on a number of client health indicators. Comparing baseline readings to those at clients’ second or most recent assessment, the agency has found that while 54 percent of clients had at-risk blood pressure readings at baseline, 47 percent had at-risk readings at reassessment.
The percentage of at-risk readings dropped from 53 percent to 45 percent for waist circumference, and from 50 percent to 45 percent for HDL cholesterol. While those types of numbers might not seem staggering, Han pointed out that many clients are seeing improvements in their readings even if these remain at risky levels. For example, 60 percent of clients have shown improvement in waist circumference, and 48 percent have shown improvement in HDL cholesterol.
Han added that every six months, the agency also asks clients about their perceptions of change in broader quality-of-life areas, from emotional well-being to housing and educational status. She said that in the most recent evaluation, 50 percent of clients reported an improvement in functioning, and 36 percent said they presently feel more socially connected.
Continuing the momentum
WAPA will reach a critical juncture this September, when the four-year SAMHSA funding cycle for the project ends. There remains some uncertainty about how the on-site primary care services might be structured after that point. While the local health center has stated it is committed to continuing in the partnership, it also will have to be able to justify its continued participation from a cost perspective.
Also, the potential effect of more Asian Counseling and Referral Service clients being insured as a result of the Affordable Care Act (ACA) has not been fully evaluated.
“We were giving the doctors more time with our clients than what they would usually receive at the health clinic,” Han said. “We may not be able to afford to continue that.”
But the organization believes that the wellness component of WAPA can be maintained with fewer challenges, now that the organization has been transformed into a wellness-focused operation. “By managing our own utilization, wellness will be sustained without much problem,” St. Clair said. “Wellness will become part of the overall treatment plan.”
She added, “We’ve begun thinking of ourselves as a whole health organization.”