Integrated Behavioral Health Services for Des Moines Health & Housing Campus

Grantee: Sea Mar Community Health Centers
Timeframe: July 2016 – June 2019 | Total Amount: $557,486

Year 1: July 2016 – June 2017. Amount: $180,830
Year 2: July 2017 – June 2018. Amount: $184,710
Year 3: July 2018 – June 2019. Amount: $191,946

Sea Mar has built a mixed-use health and housing campus in Des Moines, Washington, in South King County. The new development offers health care alongside affordable housing, with 43 units for low-income families, and a current total of 150 residents. The housing opened in September 2015 and medical and dental services are now in place. Sea Mar will utilize this funding to establish an integrated behavioral health team to serve patients coming to them through direct integration with the medical clinic or through referrals from other Sea Mar or community services. The behavioral health team will support King County community members experiencing barriers to accessing behavioral health services for a variety of reasons, including high health care costs, transportation issues, social stigma, lack of insurance, language barriers and more.

The behavioral health team will consist of an Integration Specialist (IS) and two Mental Health Therapists (MHT), all based in the medical clinic. Funding will support the first 12 months of salaries for these positions, after which time Sea Mar anticipates the team to be operating self-sufficiently. This team will ensure that patients have immediate access to behavioral health care and that they are transitioned between services seamlessly. When patients come to the medical clinic for an appointment, they will be given a brief screening using the Patient Health Questionnaire 2 (PHQ-2), which will be administered by the medical assistant (MA). This screening is designed to detect some level of depression in a patient. If the patient answers yes to one of the two questions, the MA will administer a second screening, the PHQ-9. This secondary screening tool helps to screen for and determine the severity of depression, including the presence of suicidal ideation. If the patient’s responses to the PHQ-9 indicate depression, the MA will call in the IS to work with the patient, in addition to addressing the issues for which the patient originally made the appointment. The IS will provide brief interventions for patients needing additional support. Some patients may need this kind of short-term support when their symptoms are not severe enough to warrant a more long-term treatment plan with a MHT, or when they are resistant to being referred for such services. In those cases, the IS will use motivational interviewing toward readiness for change and acceptance of referrals of any sort, whether for behavioral health or other services. The IS will work with patients for up to six sessions, after which time they will be referred to one of the two MHTs on staff should they need additional, ongoing support. During these sessions, the IS will continue to use the PHQ-9 to assess the patient’s level of depression. Scores will be recorded in Sea Mar’s EHR system. The MHTs will accommodate patients referred from the IS into their schedules as needed, and will work directly with the IS to get up to speed on patient history, needs, barriers to accessing care, and anything else relevant to provide treatment. The MHTs are responsible for conducting mental health assessments, individual therapy, family therapy, and group therapy as appropriate. They will use the EHR system for behavioral health, but will have access to the information in the EHR system for medical as needed to ensure proper coordination with a patient’s primary care provider and the IS. The MHTs will also be responsible for issuing referrals as needed for patients needed psychiatric services. In these cases, patients can be referred to a psychiatrist at Sea Mar’s Kent clinic for medication prescription and monitoring.