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April 30, 2020

An Interview with David Bauman, PsyD on IBH during the COVID-19 pandemic

Type: Announcements Tags: Covid 19, Interview, Levels Of Integration, Mental Health

This month's featured interview focuses on integrated behavioral health education and training during the COVID-19 pandemic. The NCIBH team spoke with David Bauman, PsyD. from Community Health of Central Washington

David Bauman, PsyD. is the Behavioral Health Education Director at Community Health of Central Washington, where he oversees a variety of behavioral health training programs. He also serves as the Region Training Director of the National Psychology Training Consortium (NPTC)-Cascades Region psychology internship.

How has integrated behavioral health (IBH) responded to COVID-19 in primary care settings?

Integrated behavioral health (IBH) has such variability to begin with and COVID-19 only furthers that variability. At the macro level, I think everyone in healthcare is aware of the emotional impact on healthcare professionals, as well as patients. Due to this, there appears to be a greater appreciation for IBH and a broadening of behavioral health consultants (BHC) roles to include medical colleague support. The importance of having IBH is being acknowledged throughout the United States healthcare system. And, as we know with past crises (e.g., natural disasters, mass shootings, etc.), the true toll and impact of COVID-19 on our communities’ mental health, as well as chronic medical conditions, will not be seen for some time to come. My hope is that IBH continues to be implemented and fortifies the primary care system to meet the growing demand.

At the micro level, at my organization,  Community Health of Central Washington, we have a saying “Do what primary care does.” Thus, our IBH program has followed the lead of our primary care team. When leadership moved clinical services to phone and virtual visits, the BHCs did. If primary care providers were still in the building, so were our BHCs. One of the many sobering truths of this crisis is that the health conditions we were treating previously within primary care (e.g., diabetes, hypertension, depression, etc.) are still present (or possibly worsened) in our patients. 

From day one, the Central West Behavioral Health Director, Bridget Beachy, told our BHCs that we need to reach out to our patients in any way we can. With the stay at home orders, the traffic in our clinics which typically prompts handoffs is lower; thus, we needed to adapt. Our patient visit volumes have not dropped during this time, which makes sense when you think of the current context. 

While it now looks different with our organization doing about 50% of all visits via phone or virtually. We are still completing warm handoffs, still working side by side with our medical providers, still striving to meet our community, and still striving to be about primary care. Our patients regularly comment about the health center being their lifeline and a source of comfort. There have been many tears during these phone calls, both from the patients and the providers. The importance and gratitude from both sides is palpable. 

What are some challenges IBH providers have faced/anticipate facing during COVID-19?

The obvious challenge has been adapting to the changing workflows. Workflows that would normally take months to be rolled out have been implemented within days. It is truly inspiring to see the teamwork within the primary care system. Our behavioral health visits appear to be more transferable to phone/video visits than medical visits. HIPAA considerations and workarounds have been challenging as we are striving to see our community, while still protecting confidential health information. Additionally, insurance reimbursement has continued to be an added challenge. Our state’s Medicaid program is currently reimbursing phone visits at our FQHCs encounter rate, whereas Medicare has not yet provided that support for phone visits.

Another challenge is figuring out how to stay connected as a team during this time. The IBH provider will have to figure out how to maintain their connection with the primary care team. This is especially the case if the BHC is working off-site (i.e., at home) and must be available for handoffs from the primary care team.

How can we better prepare IBH trainers, providers, and learners for the next healthcare crisis? What strategies do we need to consider strengthening the IBH workforce?

This healthcare crisis has highlighted areas we already knew were lacking and needed more training. I would recommend focusing on the importance of making behavioral health primary and necessary, which can be done by recognizing the vast majority of health concerns BHCs can help with (and understanding the behavioral influence on these health concerns). Second, ensuring that IBH providers truly understand population-based health and primary care goals must be part of our training as future IBH providers. And, lastly, making sure that we are training providers to understand patients’ contexts is of the utmost importance; and, while evidence-based interventions are important and need to be taught, interventions and strategies that promote compassion and engagement need to be given the same amount of attention.

What are some key recommendations for primary care providers in terms of recognizing and responding to integrated behavioral health needs during this time?

While BHCs are taught to focus on providing direct patient care, we often forget the “E” in the Primary Care Behavioral Health GATHER acronym and the role of being an educator to our teams. This is a different world for many of us and, most likely, it is a different universe for medical providers. Sharing your stories and strategies are vital during this time, as we know our patients are hurting and need to be seen.

Additionally, and as always, I think our medical colleagues can continue to be mindful of the obvious impact this crisis is having on our patient’s mental health. We have encouraged our medical providers to assume that the patients are having difficulties and phrase incorporating a behavioral health consult as the expectation, rather than the exception. Meaning, when completing visits, either in person or via telehealth, saying to the patient, “I am sure this is a difficult time and we have a team member, one of our BHCs, that would love to chat with you to work on skills to get you through this time. They should be available right now and I am going to reach out to them so they can visit with you, sound okay?”. This directional approach normalizes the process and allows BHCs to uptake effortlessly. Finally, medical providers should recommend as much as possible for patients to keep routine, stay connected (even through social distancing, such as Facetime/Zoom, etc.), limit and be mindful of substance use during this time, and keep healthy habits with sleep, diet, and exercise. 

Do you know of any resources you can share around IBH training and education during COVID-19?

There have been a ton of resources developed by a variety of organizations during COVID-19. The American Psychological Association (APA), Centers for Disease Control (CDC), and the World Health Organization (WHO), have a ton of behavioral health resources that medical providers will find useful. Furthermore, the Collaborative Family Healthcare Association (CFHA) and Society of Teachers of Family Medicine (STFM) listservs are great resources for up to date information. A recent YouTube video we have found particularly helpful is here. My suggestion, as it always is, is to always share helpful resources with your BHCs, your medical providers, and your colleagues!

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