A System for Success: The Dimock Center Shares Its Expertise in Integrating Behavioral Health with Primary Care
The 2-year-old daughter of a 17-year-old patient comes into a community health center for a regular check-up with her grandfather, who is her primary caretaker. The doctor notices with concern that the toddler is essentially nonverbal.
An 18-year-old returns home after two months at college and shuts himself in his room for weeks. His mother contacts his pediatrician, alarmed over signs of mental illness.
Where can these patients turn for timely, holistic behavioral health treatment? At The Dimock Center in the heart of Boston’s Roxbury neighborhood, the answer is, “Right here.”
Many serious pediatric health issues are intertwined with emotional and behavioral problems. Yet only 15 to 25 percent of children receive behavioral health care from trained professionals. In communities with high rates of poverty, homelessness, family instability, and violence, children are especially vulnerable. These stressors can contribute to anxiety, depression, post-traumatic stress disorder, learning problems, and more. Urban community health centers should be on the frontline in addressing the emotional and behavioral health in the children and families they serve. But limited resources don’t always allow for on-site mental health specialists. A patient’s family can face barriers to accessing treatment when finding help is critical.
The playroom in the pediatric reception room at Dimock is a bright, colorful, and lively place where children play and wait for their appointments. Children who are there for a primary care check-up are not segregated from those scheduled for behavioral health appointments. “That’s intentional,” says Nandini Sengupta, MD, MPH, medical director of Health Services. “There’s no separate space for behavioral healthcare — it’s integrated within our pediatric clinic. Whether a child comes to see a pediatrician or nurse practitioner, or needs a social worker, or child psychiatrist, it all happens seamlessly in the same place and at the same visit. This not only improves access and increases the efficiency of the process, but just as important, it removes some of the stigma kids and families with emotional disorders may feel.”
Dimock has perfected the “warm hand-off.” During a medical visit, a child who seems in need of behavioral health evaluation or help will be introduced to a behavioral health provider and given an immediate appointment. Patients can get lost in a system when they have to wait for separate appointments in various locations. At Dimock, that possibility is greatly reduced. There’s no lag time between visiting a referring physician and getting a screening by a behavioral health clinician. There’s no trek to another location, or waiting list. The comfort of familiar faces and spaces helps ease the anxiety of assessment and treatment.
Dimock spent several decades developing its successful model of behavioral health integration (BHI) in primary care. “As mental and behavioral needs became increasingly urgent in our neighborhoods, our practices had to evolve,” says Dr. Sengupta. “We’re focused on family-centered care, and we know how behavioral health issues affect a whole family.”
Dimock has developed ways to merge medical with behavioral care, using management and operational tools. It increased behavioral health staff and expanded multidisciplinary care, bridging differences between primary care and mental health providers. It improved facilities to keep integrated care in one setting. It created more efficient administrative systems and reduced paperwork. It streamlined patient records and billing processing for private insurers and Medicaid, which helped keep Dimock’s BHI program revenue neutral. The results went beyond financial viability. Patient and staff satisfaction increased while the quality of care improved.
Now The Dimock Center is ready to share its successful BHI model. Over the next 18 months, with support from Boston Children’s Collaboration for Community Health, it’s creating a series of unique learning collaboratives. Ten community health centers in Massachusetts, serving approximately 30,000 children, will participate over two cohorts. All health centers across Massachusetts can also be introduced to behavioral health integration concepts by attending a conference. “Leading these cohorts gives health centers the benefits of sharing experiences, systems, and strategies — we don’t have to reinvent them,” says Michael Tang, MD, MBA, clinical director of Behavioral Health Integration. “We can pass on our proven best practices and help each other. There is evidence in the literature that children receiving integrated care have a 66 percent chance of better outcomes than usual care. Helping community health centers offer better behavioral healthcare can improve the lives of thousands of vulnerable families.”