Integrated Behavioral Health Adaptations During the COVID-19 Pandemic

Melissa K. Filippi; Andrea Nederveld; Mark D. Williams; Elise Robertson; Chyke Doubeni; Jeanette A. Waxmonsky; Christina M. Hester

doi:10.3122/jabfm.2023.230125R2

Article Figures & Data

Tables

View popup

Table 1.

Practice Demographics

Practice #	IPAT Score	Clinicians¹		Interviewee Roles
Practice #	IPAT Score	Physicians	BHPs	Residency Faculty	Behavioral Health	Practice Leadership
1	5	<5	1	2	1	0
2	4	≥15	2	1	1	1
3	5	≥15	6	2	1	0
4	4	≥15	2	0	2	0
5	5	≥15	3	1	1	1
6	4	≥15	2	1	1	1
7	6	≥15	2	1	1	1
8	5	≥15	2	2	1	0
9	4	≥15	4	0	2	1
10	5	5 to 9	1	1	1	1
11	5	≥15	9	0	1	2
12	4	≥15	5	1	2	0
13	5	≥15	5	1	1	1
14	5	≥15	5	1	1	1

Note. ¹Responses were based on participant perception, and numerical estimates may be inflated by inclusion of those outside the clinic who are part of the larger health system.
Abbreviations: BHP, Behavioral Health Provider; IPAT, Integrated Practice Assessment Tool.

View popup

Table 2.

Exemplary Quotations

COVID-19 related impacts to IBH: The need for and adaptation to virtual care	Every day our clinic, we have a morning huddle, and both our clinical psychologist and our social worker are on that phone call. It used to be done in person, but now with COVID it’s all done virtually via Zoom. They’re on that, and they daily report their availability and schedule. In terms of in-the-moment communication, if nothing gets brought up as part of that huddle that they need to be aware of, we have either means through our electronic medical record for communication. Our psychologist always has Skype open, so that’s our business communication platform for instant messaging. They’re available via phone call. There’s an on-call phone number during office hours for our social worker to be obtained for those acute needs that need to be addressed in the moment. Otherwise, for things that may not need to be done at that time and can be delayed by a day or two, they are very responsive to in-basket messages and Epic or to referrals for follow-up with certain patients.
Measurement harder with virtual patients	We can kind of make it up as we go along without really having a sense of “here’s the best practice for how to do telemedicine for behavioral health services”. How do you do co-visits? How do you do handoffs? What are some of the best practices for brief interventions by phone? How do you do PHQ screening and GAD screening? You don’t really have a model in place for that.
Increased demand and other services missing	[The need for BH services since COVID has increased] significantly. It's been kind of overwhelming honestly for our team to keep up with our referrals. We initially started falling really behind. That's part of why we changed our system and we had to go to the whole work flow process, is because we had pretty long wait list for people who needed more of that long term therapy and just weren't getting in when you're new patients. We've seen a pretty significant increase in referrals. I feel like this is anecdotal, but I know I've talked with some of my other psychology colleagues in my own clinic, but then also in other clinics. I feel like the intensity and the severity has been higher too.
Tele-behavioral health	Some of our patients really have limited access. They may have a pay-by-the-minute phone, and, so, to use their phone to do this, may not be possible. They may not have a computer or a tablet or some other means of technology to do it, so that can be a limiting factor, just simply the cost and the technology. It’s some of our patients are just less comfortable with the medium itself. I’ve had people say, “It just doesn’t feel as personal over the—on video, and I don’t like that. I don’t really know who I’m talking to,” those kinds of things. I’ve had some of that response.
Opportunities to stay connected with patient and teams	[Tele-health has] been a really amazing thing and it’s not worth losing more than half a million people’s lives, but I’d been pushing for this for a decade and suddenly, it’s not innovative anymore. It’s just normal and I do a bunch of my follow up visits with patients using the patient portal, which has also been super useful, just being able to have people message me about how they’re doing. I have as part of my routine to have people send me a message in a week, whether they’ve started their medicine, started their exercise plan, eating better, contacting their social network, all that stuff. In addition, I do a tele-med visit with them, 15-minute visit in a couple of weeks to a month, within a month of starting them on care, and that works super well. It’s equally good to being in person for sure.