A community health worker at La Familia Medical Center in New Mexico

Community Health Workers: A Key Link in Integrated Behavioral Health Care

By Heidi Berthoud, MPH, staff writer and project manager at the MacColl Center for Health Care Innovation at Group Health Research Institute Community Health Workers (CHWs) play an important role in delivering medical services to hard-to-reach populations. Routinely used in many developing countries to connect patients with resources, the benefit of employing CHWs is now being recognized in many U.S. practices across the country. Tapping into deep knowledge and understanding of their communities, CHWs have a unique connection to patients who may otherwise fall through the cracks. This connection is put to good use in La Familia Medical Center’s integrated behavioral health program. La Familia is a federally qualified health center located in Santa Fe, NM. According to Dr. Wendy Johnson, La Familia’s medical director, New Mexico is ahead of the curve in using CHWs in integrated care, and La Familia was an early adopter of the integrated behavioral health model. Along with other innovative programs—like healthcare for the homeless and Suboxone clinics for opioid and heroin addicted pregnant women—La Familia has long integrated behavioral health into their primary care practice and have used CHWs to make crucial patient connections. Making the Link Over the past 10 years, La Familia has refined their integrated behavioral health services, and CHWs have played a key role. La Familia makes depression, anxiety, violence, and substance abuse screenings part of their routine primary care visits. Adapting from available tools, La Familia’s behavioral health team developed their own screening tool, tailored to the needs of their patients. Modeled after the Screening, Brief Intervention, and Referral to Treatment tool (SBHIRT), it is delivered to every patient at their annual physical or well child/teen visit or when they present with symptoms of depression. If a patient screens positive on the tool, the primary care clinician may refer to in-house behavioral health counselors. The CHW will then manage that patient’s connection between the primary care visit and the behavioral health intake, rapidly refer to outside services as needed, and ensure compliance and follow up with prescribed care. CHWs may also do home visits to help assess a patient’s home situation for clues to inform their behavioral health plan, and will reach out to patients who don’t show up for scheduled visits. Peer-to-Peer Connections According to Dr. Johnson, 75 percent of La Familia’s patients are Hispanic/Latino and many have limited English proficiency. In addition, 40 percent are uninsured, 65 percent are under 100 percent of the poverty line, and many are undocumented. Many patients in La Familia’s behavioral health care are immigrant women who have faced violence and have a real fear of deportation; they are often reluctant to open up to their primary care provider about medical issues or behavioral health concerns. Opportunities to connect patients to helpful services may be lost if a patient doesn’t feel safe or doesn’t understand provider instructions. According to Dr. Johnson, one of the main benefits of having CHWs is “the ability of peer educators to provide a level of comfort in a peer way. Our bilingual community health worker can really relate to [these women].” That comfort immediately bridges gaps for vulnerable patients by forming a layer of trust and providing health care information in their own language. La Familia plans to continue using CHWs in their integrated behavioral health program and has sought out targeted training on important topics like de-escalation and trauma-informed care for their CHW team. By tapping into close community connections, La Familia’s CHWs are truly the secret to providing comprehensive, integrated behavioral health care. Learn more Interested in learning more about incorporating CHWs into your primary care practice? Visit the Primary Care Team Guide to find practical tools and resources to help your practice make the most of the community health worker role.

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