Primary Care Partners is a group
practice in Grand Junction, CO with 21 Family Physicians and 14
Pediatricians. To better manage the behavioral needs of our patients we
began collaborating at a distance with a local private counseling
group, Behavioral Health and Wellness, about 12 years ago. Over time
their staff and ours began to commute between offices and schedule joint
patient appointments. Our partnership benefited from grant funding
that promoted rapid diagnosis and treatment for ADHD. Through this
project our pediatricians co-facilitated diagnostic sessions with their
mental health staff.
Gauging our collaborative development using Doherty and McDaniels Five Level model,
we started at a combination of Level 1, minimal collaboration, with
referrals going to Behavioral Health and Wellness, along with some
minimal direct communication (Level 2) before a referral visit was
scheduled. This might have been a phone call or email, or faxed notes
from the physician visit.
Two of us, myself as the pediatrician and one behavioral health and
wellness counselor, started Level 3 (basic on- site collaboration) by
traveling to and from each other's sites (7 blocks down a street), to
have joint visits for certain complex patients or those who tried to
"split" the physician and mental health counselor. This was time
consuming and I often scheduled my visits to the mental health office on
my days off; impractical but doable. In 2004 Primary Care Partners
moved into a new building that allowed us to rent space to the mental
health group. They now share a waiting room with our family
physicians. Our proximity promotes daily shared patient care including
joint visits, curbside consults, and availability for emergent
evaluations in both offices. In this way we have fully implemented
Level 3 (on-site collaboration) and sometimes level 4 (close
collaboration in a partly integrated system)
This year we had a family physician and pediatrician complete Sandy
Blount’s Primary Care Behavioral Health certificate program along with a
psychologist and family therapist from the mental health office. We
are also finalizing plans for a medical home that fully imbeds a few of
their counselors into both our family physician and pediatrician exam
Recently we finalized a contract between the private behavioral
health clinic and the state funded mental health center so that
Behavioral Health and Wellness will be able to see Medicaid patients in
the Pediatric office for up to 6 visits, for initial evaluation and
stabilization. The requirements include a "warm" hand off by the
physician, bringing the counselor into the room to meet the patient and
family, and integrating the note from the counselor into our electronic
health record that day.
We begin this program in a few weeks. If a client needs more that 6
mental health visits, they will be referred over to the mental health
center, hopefully to a select group of clinicians ready to take the
referrals without waiting time. The exciting thing about this program
is that we have Medicaid patients served DIRECTLY in our office, the
same way private pay or CHP (Colorado Children's Health program) clients
Our physicians have continued to develop this relationship because we have benefited by many positive outcomes:
1. A patient in crisis in our office has immediate intervention with the on-site mental health staff.
2.Accurate diagnosis and medication
management is much easier when supported by a thorough work-up and
on-going consultation by a mental health specialist.
3. Patient satisfaction increases with the integrated therapeutic relationship of physician and mental health providers.
4. Our mental health partners save us time through continually providing updated records.