Reducing Health Disparities through Integrated Behavioral Health: A Model for Training

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Reducing Health Disparities through Integrated
Behavioral Health A Model for Training

• Cambre Horne-Brooks Ana J. Bridges
• Kim Shuler Trey Andrews
• Community Clinic University of
  Arkansas

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Colloquium Outline

• Introduction to training grant
• Community needs
• Training model components
• History and mission of Community Clinic
• Case examples
• Q A

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Community Needs

• Northwest Arkansas is
• More rural than the average US state
• Home to the fastest growing Latino population in
  the US
• Home to the largest population of Marshallese
  immigrants

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Between 2000 and 2005
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Community Needs

• Compared to the national average, Arkansas
  residents are
• Poorer
• Less educated
• Less likely to be insured
• Figures are worse for ethnic minorities

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Yes

• Four County Needs Assessment, 2004

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Community Needs

• Compared to the national average, Arkansas
  residents are
• More likely to suffer from chronic diseases, such
  as diabetes
• More likely to smoke cigarettes
• More likely to be overweight or obese
• Less likely to engage in physical activity

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Community Needs

• Mental health is worse for NW Arkansas residents
  living in poverty
• Illness/Health Concern lt20,000 gt50,000
• Health fair/poor 40 5
• Mental health fair/poor 56 34
• Rarely/never receive
• social/emotional support 9 1
• Dissatisfied with life 8 1
• Diabetic 10 3
• Cigarette smoker 16 12
• Binge drinker
• (5 drinks per occasion) 40 21
• Physically inactive 38 13
• Uninsured 40 5

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Community Needs

• Health disparities are larger for Latinos and
  Marshallese residents of NWA
• Health care utilization differs by ethnic group
  membership

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Mental Healths Burden on Primary Care

• Primary care services sought for mental health
  concerns
• Estimated 40 of PCP time spent on mental health
• Depression 3rd most common reason for PCP visit
• PCPs not well trained to recognize mental health
  problems
• Only 20 of MDD patients correctly diagnosed

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Mental Health Professionals

• Few providers for low-income, uninsured people
• Few speak foreign language
• Most emphasize traditional 50-minute hour in
  special office or clinic
• Low integration of physical and mental health

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Integrated Behavioral Health Care
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Integrated Behavioral Health Care

• Rationale
• Reduces stigma
• Increases access
• Reduces health care costs
• Increases satisfaction with services
• Improves physical and mental health
• Looks different
• Types of presenting concerns
• Frequency length of contact
• Focus on consultation

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Training Goals

• Increase of psychology trainees who pursue
  careers related to health disparities
• Foster a professional identity and base knowledge
  that increases comprehensive, culturally
  competent, quality mental health care
• Provide clinical training to meets the needs of
  medically underserved communities
• Improve behavioral health of NWA medically
  underserved residents

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Training Components

• Coursework, language immersion, seminars
• Outreach
• Clinical training
• Research