Primary Care, Psychiatry, Psychotherapy and Care Management Working Together

“We want the relationship with the patient to begin at the primary care level and have the provider send the referral to us if they feel it’s clinically needed,” said Christopher Chadwick, Community Health’s Director of Behavioral Health and Medication Assisted Treatment (MAT) Services. “It’s a clinical decision made by their primary care provider for their own comfort levels and the complexity of the patient.”

“When I started at Community Health, Primary Care and Behavioral Health were two separate pillars,” said Chadwick. “What we have done is integrate the teams and improve our collaboration. As a result, we have seen an explosion in referrals from primary care providers. There are resources available, and patients are being offered opportunities they might not have been offered before.”

“At Community Health, I was able to have my therapy, psychiatrist, and primary care in one safe place, close to home. Overall, my experience has been positive and very welcoming. I feel like I am supposed to be there.”  – Community Health Behavioral Health patient

Psychiatry, Psychotherapy, and Care Management

“A family recently switched primary care to Community Health because of our psychiatric services. Their child was placed into psychiatric services in two weeks at Community Health. They’d been told there was a two-year wait at their previous healthcare organization.” Chadwick said.

Last year, the Behavioral Health team saw a 72% increase in unique patients served from the year before. There were more than 33,000 patient encounters in 2022 including a 50% increase in pediatric patients. Chadwick said they were able to increase the number of people they have reached by focusing on health outcomes through:

• screenings to detect social determinants of health, suicide, and drug abuse
• collaboration with hospitals to align patients with behavioral health follow-up treatment
• distribution of opioid overdose kits
• care management

An example of a positive care management outcome Chadwick points to is that of a young high-risk individual who was struggling and not coping with thoughts of suicide. This behavioral health patient had multiple emergency room visits. Through the work with the Community Health Care Management Team, in collaboration with the behavioral health staff, the individual went from an average of 35 Emergency Department visits a month down to none. A behavioral health Care Manager helped the patient connect with needed resources, including assistance with transportation, food, and social services, facilitated ongoing behavioral health and medical healthcare, and developed a treatment plan.

The outcome? The individual has become self-sufficient, is four months free of self-harm and has learned how to live independently.

Addiction Services

Behavioral Health Care Managers are helping to bridge the gaps in care working in collaboration with behavioral health providers in MAT, pediatrics, adults and transitions care, assisting with patients who have been in the emergency department or inpatient.
“The MAT population has been getting busier, especially recently,” said Whalen Layne, RN, BSN, CCM, Behavioral Health’s Care Management Lead. “To have access to behavioral health services, you must be a Community Health primary care patient.”

“MAT is one exception we have,” Chadwick said. “We have a program called “Rapid Access to Medication program (RAM). If a person is identified as needing MAT treatment and doesn’t have primary care established with us, we will bring them right into the MAT program as long as they agree to establish primary care with us within 60 days.”

“Despite huge heroic efforts by the state of Vermont to improve substance abuse treatment, there are still significant problems and gaps. The overdose death rates are still very high; death by suicide for people with a substance abuse history is still very high, and there are still wait lists to get into our treatment hub. There are significant barriers even though we are way ahead of other states in terms of treating substance abuse disorders,” Chadwick said.

“I am so grateful for our life now. I think a lot of addiction has to do with mental health. My husband and I both did therapy at Community Health as part of the program. I tell people, if you don’t want to get clean it doesn’t matter how many friends or family want you to. It has to be you that does it.”  –  Community Health behavioral health patient

The Behavioral Health Team

The Behavioral Health team is skilled, licensed and trained in a broad range of services for pediatric, adult and geriatric individuals providing psychiatry, counseling, care management and substance abuse treatment. The team consists of these four groups:

Psychiatric team

• Conducts psychiatric evaluations and medication management for all ages
• Staff includes a psychiatrist/medical doctor and advanced practice registered nurse (APRN)

Psychotherapy team

• Behavioral health and substance use counseling services for patients aged six and above and includes individual, family and group counseling
• Master’s degree-level providers licensed in social work, clinical mental health counseling, alcohol and drug counseling

Care Management team

• Behavioral health services and MAT
• RN and medical assistant level team members provide care management services for behavioral health and substance use treatment

Support team

• Directly assist providers in the management of patient services
• Medical assistant and licensed practical nurse staff

In addition to the behavioral health staff, all Community Health clinicians are trained in suicide screening and certified in collaborative assessment and management of suicidality. Every Community Health location, except dental, has access to gun locks for securing firearms, a program started last year in collaboration with Moms Demand Action for Gun Sense in America, a grassroots movement focused on public safety measures and encouraging responsible gun ownership.

Behavioral Health services are available at all Community Health locations, with MAT treatment available at the Castleton, Mettowee, Brandon and North Main Street Rutland locations, as well as through individual primary care providers.