Behavioral Healthcare Prominent in Georgia Centers that Destroy Silos
Mental Health Weekly March 13, 2012
Receiving the poorest possible score on health disparities analysis served as the fuel for Fulton County, Ga., officials to break down barriers that traditionally separate behavioral health services from the rest of healthcare. The manifestation of this change in the county’s service delivery system can be seen at two health centers that have come to be known as “one-stop” sites for all health services, with plans for several more sites in the works.
“We have a three-legged stool here. Most people look at integrating primary care and behavioral health, but we’ve added public health as well,” county director of health services Patrice Harris, M.D., told MHW. “It just makes sense to have as many services under one roof as possible.”
At one-stop sites that opened in 2009 and 2010 in the county that includes Atlanta and surrounding areas, it is common for patients to have a discussion with both their family physician and their psychiatrist present. At one of the sites, this might occur while their children are occupied in activities at an on-site public library branch. And on the way home from one of the sites, the family might stop briefly to buy produce at the farmer’s market stationed just outside the center’s doors.
“In planning these sites, the county looked at, ‘What neighborhood are we in, and what do people need in this neighborhood?’” Seattle based behavioral health consultant Dale Jarvis told MHW.
Jarvis, who focuses in his work on the needs of at-risk individuals in evolving behavioral health systems, will join with Harris to present a workshop session on Fulton County’s efforts at the April 15-17 annual conference of the National Council for Community Behavioral Healthcare in Chicago.
Unacceptable circumstances
Harris said that when the state Department of Community Health gave Fulton County an “F” grade on a health disparities survey, reaction in the metropolitan community that is home to millionaires and the homeless was that the result was understandable but not acceptable.
County administrators would proceed to work toward devising a new service delivery strategy, an approach that would come to be known as “Common Ground.” Harris explained, “This is where we decided to get out of our silos and make a concerted effort to integrate care within the county and in partnership with the community.”
While the one-stop sites that are in operation or are in the planning stages serve as the cornerstone of this strategy, Harris insists that integration
is more about a philosophy than the activity in a particular building.
“We emphasize that the attitude [among professionals] should not be, ‘I only give integrated care if I go to one of the centers,’” Harris said.
Yet Jarvis considers the onestop sites noteworthy in that while the concept behind them “isn’t rocket science,” few communities around the country have succeeding in shattering silos and integrating as many health and human services program elements as Fulton County has. “It became really clear to me that this was one of the first places in the country that was moving forward on blowing up the silos,” Jarvis said.
He added, “The future for me isn’t medical homes – it’s health and wellness centers that really think about whole health, in order to help everyone in the neighborhood.” And he believes that impression will become apparent to any visitor to the county’s two existing one-stop sites. At one of the sites, a dental clinic sits right at the center of activity.
“Dental services are usually forgotten about, let alone showcased,” Jarvis said. At the other site, visitors see a day care center to their immediate
right as they enter the facility.
Harris says the centers don’t simply provide traditional health services, but also attempt to link clients to housing, employment services and other supports.
Fulton County did not set aside new money for establishment of the one-stop sites, in most cases using reoccurring capital funding to equip existing county-owned buildings to house the centers. One site that is scheduled to open by this June does involve new construction, Harris said.
Similarly, the establishment of the centers has not altered the public payment mechanisms for the services housed together at the sites.
“The first question that always comes up with these arrangements is, ‘How are we going to get paid?’” Jarvis said. “But it’s generally the same people billing, just in a different building.”
Ultimately, though, the proximity of various health functions to one another will result in better care for the patient, he said. “The holy grail here is that all of us should have one care plan that addresses all of what we need,” Jarvis said.
Besides the two existing centers and the center that is expected to open by June, plans are also in the works for a child- and adolescent focused one-stop site by November and a fifth site by early next year, Harris said.
Harris explained that the county has realized some efficiencies by consolidating staff support functions such as human resources and information technology, now that previously separated care providers are being housed together.
Evaluating programs
Harris explained that in the early stages of these programs, county officials are evaluating success through the use of access parameters. Officials want to determine whether the service needs information that patients complete on questionnaires is translating to proper referrals for services, she said.
“In the past, when service A was delivered, no one was asking if the patient also needed B, C, or D service,” Harris said.
The programs also will track the rates at which patients follow up for referred services. Ultimately, Harris and her colleagues believe that access to more comprehensive and coordinated services will lead to better patient outcomes.
Harris considers the incorporation of public health along with behavioral health and primary care to be critical to the pursuit of better outcomes. These will be the care sites where an individual might learn of his HIV status, or where a teen might first find out she is pregnant. Harris believes these sites will serve as ongoing learning laboratories for their operators. “We hope there’ll always be opportunities to improve,” she said. “We’re not going to turn around health disparities in a day.”