Harris County Hospital District - Community Behavioral Health Program

Overview

In an effort to serve more patients, drastically shorten waiting times for appointments, and reduce transfers for expensive and limited hospital-based behavioral health services for a growing population of uninsured patients, Community Behavioral Health Program (CBHP) integrated behavioral health services into all 12 Harris County community primary care centers, two school-based clinics and its Homeless Program. Services include evaluation/treatment of scheduled patients, walk-in services for patients in crisis and “curbside” consultations to primary care physicians (PCPs) to support their psychiatric interventions. Thus, patients can receive psychiatric services at their neighborhood primary care medical homes and no longer have to travel to a designated psychiatric clinic and contend with the issue of “psychiatric stigma,” which deters many patients from receiving care. CBHP also developed and presented lectures and DVDs on symptoms and medications of major psychiatric disorders to PCPs and center staff, and implemented training rotations for medical students, nursing students, psychology interns, primary care residents and psychiatry residents.

Impact

CBHP successfully expanded capacity to address severe psychiatric shortages. This was determined by surveying Harris County Hospital District psychiatrists and PCP providers. Results showed mean scores of 4.58 and 4.18, respectively, on a 5-point Likert scale. Results of the BASIS-24, a patient self-report symptom and problem measurement for global functioning taken by CBHP patients showed significant improvement in overall scores and in domain scores for depression/functioning, self-harm and emotional liability. Waiting periods for new appointments decreased from an average of seven months to approximately three to four weeks, and more urgent patients are seen on the same day or within the week. With CBHP, admissions to the hospital-based psychiatric emergency center declined by 18 percent. Since patients received psychiatric services at their medical homes, the appointment no-show rate decreased to around 25 percent, whereas the no-show rate at the District’s hospital-based psychiatric clinic remained at 40 percent. Patients are less concerned about “stigma” when receiving psychiatric care at primary care centers and can get more easily to appointments at their neighborhood centers.

Challenges/success factors

CBHP acquired start-up funds from the Hogg Foundation, the Hospital District, and Abbott Laboratories. CBHP also obtained buy-in from PCPs to manage stabilized psychiatric patients on maintenance medications, after providing them with education on psychiatric medications and on-site curbside consultations.

Future direction/sustainability

Services will continue at all 16 locations.

Advice to others

Integrating behavioral health services significantly benefits both patients and providers. This model promotes collaboration across service lines and ensures holistic patient care management.

Contact: Britta Ostermeyer, MD
Chief of Psychiatry
Telephone: 713-873-4901
E-mail: brittao@bcm.edu