A look at Sí Texas Project's Integrated Behavioral Health models: NuCare and Salud y Vida 2.0
By Anne Connor, director of community grants
In 2014, Methodist Healthcare Ministries of South Texas, Inc. launched the Sí Texas Project: Social Innovation for a Healthy South Texas (Sí Texas Project) with support from an unprecedented federal investment of $10 million by the Social Innovation Fund, a program of the Corporation for National and Community Service. Through the Sí Texas Project, Methodist Healthcare Ministries is evaluating nine evidence-based models of Integrated Behavioral Health (IBH) care, with some innovative aspects targeted at 12 counties within Methodist Healthcare Ministries' service area.
This week I'd like to take a closer look at two IBH models as part of the Sí Texas Project:
1. NuCare: Nuestra Clinica del Valle (NCDV) is implementing NuCare based on the collaborative care model at four of their primary care clinics in the Rio Grande Valley. A hallmark of the model is that patients are not referred to services, but the services come to them. NuCare includes a warm hand-off from the primary care provider to a mental health provider for an immediate, brief mental health intervention and warm hand-offs for health education and nutrition services. One of the innovative features of this model is the use of "promotores," or community health workers. In this project, the community health workers will meet patients in the reception area and accompany them through the visit, assist with depression screening, and meet the patient after the physical examination for an invitation to a wellness program. It is quite innovative to give promotores behavioral health responsibilities since they have been traditionally utilized for community outreach and health education. The focus in selecting promotores will be on hiring those who are controlled diabetics (true peers of the diabetic patients), Hispanic, suited to positions of leadership and program facilitation, and eager to accept training. Their involvement in administering the depression-screening tool (PHQ-9) is key because the clinic population is likely to need assistance because of challenges in reading and fear of behavioral healthcare. The physician and care team in further behavioral health assessments will use this information. The NuCare theory of change is that IBH, combined with health education, nutrition, and community-based support services, can improve diabetes control and reduce depressive symptoms. Improvement in physical and mental health will be achieved over several years in measurable impact for depressive symptoms and HbA1c levels among program participants. The warm hand-off from the primary care provider to the mental health provider, plus the presence of the promotor, breaks through the cultural barrier of stigma against behavioral health services and allows the counselor to develop rapport, encouraging patient confidence in the services offered.
2. Salud y Vida 2.0: The UT School of Public Health–Brownsville Campus will implement the Salud y Vida 2.0 model. The model incorporates enhanced primary and behavioral care, medication therapy management, community-based lifestyle programs, and teams of promotores or community health workers to conduct home follow-up visits. Medication Therapy Management will be provided for participants with low levels of medication adherence, and behavioral health services will be provided for participants who do not qualify for services with the local mental health authority, but who need behavioral health support. Community-based lifestyle programs will be provided across the Rio Grande Valley for the participants and their loved ones through peer-led support groups, cooking classes to build hands-on skills for patients wishing to prepare healthier foods, a healthy food choice customized smartphone application, and an obesity treatment program. The key to integration is on-going, systematic communication between hospital, clinic, mental health case managers, and the team of promotores who are following up with participants in their homes and at community-based educational sessions. Semimonthly case review meetings and a shared, secured web-based system called Chronicle Diabetes allow for coordination of participant services, advocacy, education and care. This model builds upon their existing Salud y Vida 1.0 program, a comprehensive chronic care management program that includes diabetes self-management education, integrated care planning and case review and outreach by community health workers.
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