Partners in Integrated Care – Hamilton Health Center
The patient arrived at Hamilton Health Center, a Federally Qualified Health Center (FQHC) in Harrisburg, for a routine physical. A native New Yorker, she moved to central Pennsylvania to be closer to her family. But she felt isolated in her new environment. She couldn’t find work, and she stopped crafting the custom pieces of art that once proudly decorated her home.
The woman suffered from depression, which remains undiagnosed in about half of primary care patients with the condition. Through the Pittsburgh Regional Health Initiative’s Partners in Integrated Care (PIC) program, a collaborative care team at Hamilton Health Center was able to treat the patient’s physical and behavioral health needs right in the doctor’s office.
The evidence-based PIC model screens primary care patients for depression and/or unhealthy substance or alcohol use and supports them with a care team that includes behavioral health specialists. Behavioral health concerns are rarely addressed in primary care settings, despite one in five patients screening positive for depression or risky substance use when physicians use such assessments.
After screening positive for depression, the patient agreed to meet with Joyce McCadney, a licensed social worker at Hamilton Health Center. They discussed the patient’s troubles since leaving New York, and her ongoing struggles with depression that she rarely sought treatment for in years past. She beamed, however, when the topic turned to art.
“She loved to work with her hands,” McCadney says. I asked her to bring in some of her work the next week and she came in with all kinds of things. I was amazed at her skill and passion. We tapped into that creativity as a means of motivating her to take action to improve her situation.”
McCadney used Motivational Interviewing (MI) techniques, eliciting the patient’s own reasons for making positive changes and working with her to set goals. One major goal: rekindling the patient’s love of art. Each week, she showcased her latest creation while meeting with McCadney and the care team at Hamilton Health Center, which serves 20,000-plus patients.
“She never missed an appointment,” McCadney says. “She took the anti-depression medication prescribed by her doctor, and it worked really well. Recently, she called me to say that she found a job. Identifying her depression was the first step, then the relationship we established through PIC helped her to make huge changes.”
Many of Hamilton Health Center’s patients – 87 percent of whom live below 200 percent of the poverty line – struggled to access mental health services prior to PIC, says President and CEO Jeannine Peterson.
“Traditionally, medical providers want to refer out anyone who has a mental health problem,” Peterson says. “A lot of times, our patients weren’t getting to those appointments or they had to wait up to six months. Participating in PIC allowed us to train our staff for mental health services and create an integrated mental and physical health model in a way we’ve never done before. This truly works in our environment.”