A look at the Sí Texas Project Integrated Behavioral Health models: Sí Three, PCBH, and Reverse Co-location and Wagner

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 three IBH models as part of the Sí Texas Project:

1. Sí Three: Mercy Ministries of Laredo, a relatively small, faith-based clinic located in Laredo is implementing a model called, Sí Three: Integration of 3-D Health Services. The model's name comes from its three aspects of wellness: mind, body, and spirit. The model moves the clinic from its existing co-located model, in which behavioral and physical health services were offered in the same building, to an integrated model, in which these services are fully coordinated. Core components include:

• Navigators: Nurse practitioners who provide primary care services and develop patients' care plans;
• Referrals to internal and external resources, including telepsychiatry and faith-based counseling;
• Care coordinators to follow up on patient referrals; and
• Warm handoffs to behavioral health coordinators (licensed professional counselors) who patients see at every visit.

Mercy Ministries aims for its staff and providers to have a greater understanding of the roles and culture associated with IBH care. Patients' physical health is addressed through Mercy Ministries' primary care clinic. Mental health is addressed through internal and external referrals for counseling and through the use of telepsychiatry since psychiatrists are scarce in Webb County. Spiritual health is addressed through faith-based counseling. This is the only model in the Sí Texas Project that is evaluating a spiritual component, using a validated instrument that assesses spiritual well-being, and correlating the use of spiritual services with other key health outcomes related to diabetes, blood pressure, and depression.

2. Primary Care Behavioral Health (PCBH): The University of Texas, Rio Grande Valley (UTRGV) is implementing the Mountainview Primary Care Behavioral Health (PCBH) model in McAllen and Edinburg. This model integrates care through a consultant model, in which behavioral health professionals function as consultants to primary care providers and to their patients. At UTRGV, this model is implemented at family practice clinics where UTRGV medical students are placed for their residencies. In addition to the innovative use of medical residents, a key feature of this model is the use of a behavioral health consultant. Trained to function as a generalist consultant for the primary care physician, the behavioral health consultant addresses lifestyle-based somatic complaints, subthreshold syndromes, preventive care, and chronic disease. The behavioral health consultant also develops a clear patient care plan for both the patient and the primary care physician to follow.

3. Reverse Co-location and Wagner: Tropical Texas Behavioral Health is implementing Reverse Co-location in Brownsville, and aims to accomplish the key elements of the Wagner model for effective chronic illness care. Tropical Texas Behavioral Health is a Local Mental Health Authority, an agency that serves patients with Severe & Persistent Mental Illness (SPMI). The approach is called "reverse" co-location, because it is more common to integrate mental health providers into a primary care setting than to integrate primary care providers into a mental health setting. Following the reverse co-location model, Tropical Texas Behavioral Health will embed primary care and preventive services within their behavioral health setting. The Wagner model features an organized delivery system linked with complementary community resources, sustained by productive interactions between multidisciplinary care teams and educated patients and families.

An important aspect of this model is the use of a collaborative, interdisciplinary provider team, which functions with the help of a care coordinator. The clinical team will deliver coordinated, preventive primary care to Tropical Texas Behavioral Health clients with SPMI and chronic disease (i.e., obesity, diabetes, hypertension, or hypercholesterolemia). At its core, the proposed intervention features a team of medical professionals consisting of a primary care physician, physician assistant or nurse practitioner; a licensed vocational nurse; a registered dietician; a care coordinator; and other medical support staff. Together, this team will deliver coordinated, preventive primary care to Tropical Texas Behavioral Health clients with co-morbid SPMI and chronic disease (specifically obesity, diabetes, hypertension, or asthma) within a community-based outpatient behavioral health setting. SPMI includes individuals with major depressive disorder, bipolar disorder, schizophrenia, and other related disorders. Additionally, this model will actively link patients with various community resources beyond the clinic setting. Because of barriers created by SPMI, it is difficult for this target population to seek (on their own) services they need to help their lives be more stable and healthy.

A series of blog articles will be added to the Methodist Healthcare Ministries Blog over the next few weeks to introduce additional Sí Texas Project IBH models. To stay in the loop, please subscribe to the Blog at www.mhm.org/blog.