Integrated Behavioral Health at Element Care

(Sponsored)   Element Care, a nonprofit serving the Merrimack Valley and the North Shore, provides complete health care to adults 55 and over through the Program of All-inclusive Care for the Elderly (PACE) and is a national leader in integrating behavioral health into coordinated care. “As our population ages, there is a growing number of people who have complex medical problems combined with mental health conditions and/or problems related to substances, and this presents a serious challenge for traditional primary care providers,” said Jenny Chiang, MD, primary care physician at Element Care’s Lowell PACE. “These individuals and their caregivers often find it hard to find any viable care options that meet all of their needs.”

Ten years ago, Element Care began addressing this need by integrating behavioral health into its PACE interdisciplinary care team and has developed one of the most promising models for treating these individuals and achieving superior clinical outcomes. This approach is validated by clinical studies which are beginning to show that patients get better results when behavioral health professionals partner with medical providers to provide integrated care.

In the past year, approximately 80 percent of Element Care’s new PACE enrollees entered the program with behavioral health needs and the percentage of program participants actively struggling with addictions has increased steadily. People who suffer from active mental health symptoms, or active substance use, generally find it difficult to fully participate in medical treatment or social support programs. Behavioral health problems, such as depression, also have a negative effect on both physical health and medical outcomes.

“We have found that the heart and soul of primary care and behavioral health integration is daily communication, seamless coordination and ongoing collaboration. These pillars of integration allow us to achieve early identification of emerging symptoms, and, most importantly, carry out early intervention before problems get worse,” said Gloria Burdett, director of behavioral health at Element Care. “Early intervention is a key to getting symptoms under control and preventing unnecessary emergency department visits and hospitalizations while reducing suffering.”

Daily Meetings Enable Rapid Interventions 

At Element Care, behavioral health clinicians attend daily interdisciplinary team meetings and have offices next to the primary care offices. They accompany social workers and nurses on home visits and are available daily to any colleague for behavioral health “curbside consults,” quick moments in the hall when medical and behavioral health thinking come together and results in optimal planning. “We do crisis evaluations, fit in urgent appointments, do rapid intakes on new referrals, practice state of the art medication management and conduct individual and group psychotherapy tailored to the needs of older adults,” added Johann Hepner, psychiatric nurse practitioner at Element Care’s Lowell PACE. “Equally important, we also provide ongoing support and education for our colleagues in other disciplines about behavioral health aspects of care and we partner with our medical colleagues for after-hours on-call services for our participants.”

Building an Advanced Behavioral Health PACE Program

Element Care hired its first behavioral health provider 10 years ago and then launched a full behavioral health team five years later. The team now includes seven psychiatric nurse practitioners and six psychotherapists, supported by two consulting psychiatrists and the Behavioral Health Director. Element Care offers on-site behavioral health services in Lowell, as well as in each of its other PACE centers. “At Element Care, we have been pleased to be able to help other PACE programs develop their own behavioral health teams without having to reinvent this wheel,” stated Burdett.

“We have many examples of people who entered our program with complex behavioral health conditions such as PTSD, severe depression and substance use disorders whose lives were transformed after receiving comprehensive behavioral health care,” added Burdett.

Burdett tells the story of a woman with advanced lung disease who was having panic attacks. This woman panicked when she had to ride in her car. “The more details I had about her distress, the more I thought that it wasn’t a mental health problem at all,” said Burdett. “During her appointment,
I said to her, ‘wait right here’ and I went down the hall and brought back one of our physical therapists.” After listening to the woman, the physical therapist went to her car where she put a foam wedge in the passenger seat to change her position. When the woman sat down in the car seat, her eyes filled with tears and she looked up at the Element Care staff and said, “Thank you, I can breathe!” This is a touching example of an outcome that illustrates the value of integrating behavioral health into Element Care’s PACE interdisciplinary team model.

To speak with an Information and Referral Specialist or to book a tour of our Element Care Lowell Center, call us toll-free at (877) 803-5564 (TTY users call (877) 752-2388 or 711) or email us at: info@elementcare.org. For more information on Element Care, please visit elementcare.org.

Top photo: Element Care’s integrated care team ( left to right ): Vanessa Salas-Wright, clinical social worker; Gloria Burdett, director of behavioral health; Jenny Chiang, MD, primary care physician; Johann Hepner, psychiatric nurse practitioner. Photo by Kevin Harkins.