Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Primarycareshrink.com

Name of Innovative Program: 
Building Capacity for Integrated Practice
Sponsoring Organization
Primarycareshrink.com
Name of Innovative Program Lead: 
Neftali Serrano, PsyD
E-mail Address of Innovative Program Lead: 
nefserrano@me.com
Project Description: 
In addition to starting two successful primary care behavioral health programs in large health centers in Chicago and Madison, Dr. Serrano also established a clinical training program for psychology interns and post-docs and psychiatry residents to foster a workforce trained in integrated practice. He has also established a consulting practice and website, which features original podcasts available to anyone interested in building integrated care programs. He designed a distance learning certificate program in collaboration with Fairleigh Dickinson University for integrated care professionals. Through periodic visits and innovative web-based tools, he has been key to the implementation and spread of integrated care in health centers in Pennsylvania, providing program development, workforce training, clinical supervision and advocacy tailored to the needs of primary care and underserved communities. In summary, Dr. Serrano uses innovative and efficient techniques to inspire and support the spread of integrated primary care behavioral health nationally.
Creativity and Innovation: 
Dr. Serrano has developed unique and creative strategies to promote behavioral health integration in primary care. He has used technology to make resources and training highly accessible. In addition to being an inspirational communicator and passionate advocate, his consultations, podcasts, web-based training and use of Google communication tools are both effective and low cost. As one example, using Google docs, Dr. Serrano has developed a strategy for rapid training of Behavioral Health Consultants (BHC) in how to document in medical records in a format that is both comprehensive and concise so that medical providers will read and use BH notes for collaborative care management. By having web access for authorized users to de-identified notes posted by each BHC and comments and edits posted by Dr. Serrano in a rapid response cycle, each participant receives training while the entire group has the opportunity for shared learning using real time clinical cases.
Leadership: 
Dr. Serrano’s leadership has supported our integrated care network in its growth from 5 sites to 20 sites in Philadelphia with 5 more in surrounding counties. In addition, his podcasts and distance learning certification course have touched many others around the country (psychology students at PCOM use his podcasts, for example). His public speaking influenced me to bring him to Philadelphia 5 years ago, a decision that has helped leverage visibility, credibility and support for Primary Care Behavioral Health. His teaching program in Wisconsin has influenced professional education and introduced BHC skills to tens of behavioral health professionals -- his former students and colleagues have gone on to establish integrated practices. His fidelity to the principles of population based behavioral health care and integrity of practice have had a compelling and profound impact on those who benefit from his teaching and consultation.
Sustainability: 
Dr. Serrano has generously made many of his training tools available at no cost through his website www.primarycareshrink.com. Likewise, his public speaking and informal technical assistance are accessible to a wide audience. He has influenced his large, multi-site health center in Madison to fully embrace and institutionalize integrated Primary Care Behavioral Health as the necessary standard for primary care. And, with his assistance, we in Philadelphia have established an efficient, effective model of practice at the community level, with the full endorsement and reimbursement support of the County Medicaid Plan (CBH), which has not only been sustained but has grown and spread.    
Replicability: 
The principles and skills of integrated practice that form the focus of Dr. Serrano’s training are fully replicable, as demonstrated by the spread of this model within the Philadelphia region.  Furthermore, as the BHCs in our network have matured in their practice, he has challenged them to assume greater leadership within their own settings and at the network level. Therefore, a number of experienced BHCs have now undertaken training for their peers on specific professional development topics. A selected group of advanced BHCs are participating in leadership training with Dr. Serrano so they can begin to conduct on-site observations, supervision and coaching activities, especially with BHCs who are newer to this practice, thus reducing reliance on Dr. Serrano. This expands our capacity to support replication and ongoing program development and leverages the experience of local clinicians to support the network of Primary Care Behavioral Health providers within this region.
Results/Outcomes: 
The impact of Dr. Serrano’s innovative strategies have resulted in successful replication of integrated healthcare in 29 local sites, deployment of 38 BHCs, adoption of credentialing and payment reform by two BH/MCOs, and expansion of access to behavioral primary care to more than 22000 individuals who suffer from co-occurring medical and behavioral disorders. Through team-based approaches and patient engagement, screening, prevention, psycho-education and empirically supported interventions are delivered to a traditionally underserved population. Services are consistent with core principles of healthcare reform and are patient-centered, population based and recovery oriented. In a quest for continuous quality improvement, Dr. Serrano has been instrumental in implementing another novel strategy, which will help to define core competencies of BHCs, document mastery of those competencies within our network, and create the roadmap for targeted professional development. The strategy involves developing cases and new rating tools applied during observation of simulated encounters with standardized actor-patients. 
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