La Comunidad Hispana (LCH) is a well-known and trusted provider of primary care and social assistance services in Southern Chester County, primarily serving low-income migrant Latinos and their families. The effects of social isolation, low literacy, long work hours, historical trauma, and genetic pre-disposition for chronic disease such as diabetes has led to depression, anxiety, and self-medication with alcohol and substance use, which when left untreated negatively impacts not only the patient, but the family as well. In order to address these community behavioral health needs, we established integrated primary care behavioral health in 2013. In 2014, we were awarded $250,000 from the Health Resources and Services Administration (HRSA) to expand these services. Today, our innovation seeks to empower our members through engagement in and self-direcion of illness prevention and treatment by establishing integrated self-service kiosks with Spanish language capability and audio-visual interface prompts to promote patient engagement, build confidence in health and disease management capabilities, and increase shared decision-making with providers. The use of this technology will allow our members to recover more quickly from their behavioral health challenges, because the obstacles to wellness that are most important to them will be addressed first and foremost.
Interactive, self-directed patient tools are not yet widely employed in the primary care setting, particularly in languages other than English. Increasing access to behavioral health-focused support services (including enabling services such as case management, financial counseling/eligibility assistance, and connection to resources that address the social determinants of health such as safety, housing, education and literacy levels, employment, and legal needs) in the primary care waiting room will increase the visibility and availability of these services at LCH. This capability will result in destigmatization and increased self-referrals to the behavioral health consultant and caseworkers, thereby increasing the population-level impact of the solution-focused brief interventions, grounded in the Transtheoretical Model, being provided by LCH staff.
The design, implementation, and workflow for this innovation project will be well documented and readily disseminated to the behavioral health community by the project leader. LCH has demonstrated leadership capacity by initiating a quarterly integrated behavioral health round table for Southern Chester County, coordinating the Southern Chester County Cross Systems Partnership, focusing on strengthening the relationship between mental health and housing/homelessness providers, is part of the Community Care Behavioral Health FQHC Collaborative, and is a member of the Health Federation of Philadelphia. LCH has advocated for the use of technology in strengthening diverse systems of care and is a leader in forward thinking in the community, making us well-poised to expand our reach as a model of care delivery for the larger primary care/patient centered medical home community to emulate.
LCH's commitment to providing integrated primary care and behavioral health services is clear, and with the support of funding from HRSA, private donors, and other foundations, we have the capacity and intent to incorporate our innovation into our service delivery model after the funding period is over. Additionally, as this money would go primarily toward technology purchase, configuration, and setup costs, the ongoing costs to use and maintain the technology would be absorbed into our IT budget.
We plan to engage volunteers and peers as the main liaisons between the technology this project would employ and our members. One example of the type of application we plan to use, CommonGround (a previous Scattergood grantee), already has a strong relationship with Community Care Behavioral Health (CCBH), LCH's behavioral health managed care organization. We are currently piloting one pillar of the CommonGround approach for our behavioral health consultants in collaboration with CCBH.
Lessons learned from implementation of innovative interactive technology will be shared with other FQHCs or primary care settings looking to incorporate technology into wellness, particularly for the Limited English Proficient or English Language Learner population. LCH is part of several cooperatives and coalitions such as National Council of La Raza, and regularly attends conferences where it would be possible to present on our use of the technology and how it furthers our Integrated Person-Centered Services (IPCS) model of care. We have a full-time volunteer coordinator to recruit and retain our peer and volunteer technology liaisons, who will keep detailed records of outreach efforts for replication at other institutions/organizations as well.
-Baseline penetration of behavioral health (BH) services delivered (# of unduplicated patients with BH consultation in 24 months prior to implementation / total # of unduplicated patients seen in 24 months prior)
-Post-innovation penetration of BH services delivered (# of unduplicated patients with BH consultation in 24 months after implementation / total # of unduplicated patients seen in 24 months after)
-Baseline # of LCH-designed "readiness to change" assessments performed prior to grant period (approximately three to six months)
-# of "readiness to change" assessments performed during first year after implementation
-Two sample t test comparing average scores on the 3-item CollaboRATE scale of patients utilizing kiosks prior to visit compared to those patients not utilizing kiosks prior to visit.
-To be determined behavior change assessment administered via telephone call to patients who completed CollaboRATE scale at 3 months and 6 months post-visit after innovation is implemented.