Health care leaders are learning that removing silos between physical and mental health care not only benefits patients, but also helps with the recruitment and retention of desperately needed behavioral health specialists. In this conversation, Stacey Ouellette, director of Behavioral Health Integration with Maine Behavioral Healthcare, discusses the positive impact integrated care has had on workplace productivity and satisfaction, and how it's made their teams more connected across the organization.

Tom Haederle

Behavioral health specialists are in short supply pretty much everywhere. But health care leaders are finding out that knocking down the traditional walls between physical and mental health care not only benefits patients, but also helps with the recruitment and retention of the behavioral health specialists that so many providers and patients need more of.

Tom Haederle

Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. These days, integrating physical and behavioral health care is increasingly a seamless part of the overall care experience, what health professionals call a "warm handoff" between physical and behavioral health providers for those patients who need both. This integration is good for patients and is also a significant factor in keeping many health care workers, both in physical and behavioral health, engaged and much happier in their jobs.

Tom Haederle

In today's podcast hosted by the AHA's Rebecca Chickey, senior director of Behavioral Health Services, we hear from Stacey Ouellette, director of Behavioral Health Integration with Maine Behavioral Health Care, on her organization's experience with the positive impact integrated care has had on workplace productivity and satisfaction.

Rebecca Chickey

Thank you Tom. Indeed, it is an honor to be here with Stacey today from Maine Health and Maine Behavioral Health. We are going to discuss the value of integration. I know you've heard this from me before, but she's here with us today specifically to talk about how integrated physical and behavioral health care can improve workforce productivity and perhaps even more important, worker satisfaction.

Rebecca Chickey

We all know that hospitals and health systems have been struggling to recruit and retain qualified workers across a variety of clinical areas, but in behavioral health, that was a challenge even prior to the COVID pandemic. So, Stacey, can you share with the listeners what are some of the specifics that you've experienced around the challenges of recruiting and retaining health care workers in behavioral health?

Stacey Ouellette

Yeah, absolutely so it's always been a little bit of a challenge. The work pool is not that deep really. But definitely with the pandemic it worsened. It wasn't uncommon for us as a program in Maine Behavioral Health Care to have a few positions vacant at a time. But when the pandemic hit, it jumped up quickly to around 20, we're a program of about 100,

Stacey Ouellette

so put that into context there. But it was a shock really, having that many positions to recruit for. And the challenge was there just weren't many applicants out there. And the ones that were out there, you know, that we interviewed, were really looking for that work-life balance. So as a program, we needed to at the time consider how we were, you know, bringing people in and providing them with this sort of work-life balance so that we could keep them right?

Stacey Ouellette

Retention is key. Some of those vacancies were due to growth, not because everybody was leaving. So the demand grew at the same time. And so we needed to, continuously work on recruitment so that we could have the adequate staffing to support the needs and the practices. In terms of the retention piece, really trying to lean in to integrated care can offer people in the role.

Stacey Ouellette

I'll often hear, you know, having access to the primary care provider, it just makes the job better. It makes it easier because you can really coordinate that care. And it's the care team working together for the sake of the patient. Having the role integrated into their primary care and or specialty care practices that we're in can definitely make a difference in terms of that satisfaction with the work.

Rebecca Chickey

So if I may, integration in primary care is something that I think has really caught on across the United States. While it is not in every community or every county, it is something that we're seeing grow each and every day, thankfully, because as we know, particularly early on in an individual struggling with a psychiatric or substance use disorder, often they're seeking care from their primary care physician first.

Rebecca Chickey

So it's very important that that primary care office have access to behavioral health clinicians so that they, too, can be more excited about their job each and every day, as well as feel more comfortable in providing the holistic care that the patient needs. But I'm wondering, you mentioned specialty care. I hear a little bit about this across the country.

Rebecca Chickey

Would you mind sharing what specialties you have gone into? Sometimes people consider pediatrics as a specialty, while others define it as primary care. So what does that mean for Maine Health?

Stacey Ouellette

For us currently, yes, we are in all of the pediatric practices. We are also in practices such as neurology, cardiology, weight management programs, aka bariatrics, pain management programs. So a lot of the diabetes and endocrinology, a lot of the specialties, where patients get their care outside of the primary care home, we're starting to integrate into as well.

Stacey Ouellette

Women's health is another one that we're in. And so it's just it's the same, just that we're integrated into these specialties, providing that support there. Similar to that of primary care you mentioned, you know, you alluded to the patients and trusting their provider. Right? So when the provider identifies or the patient identifies a concern or a need and they're able to do a handoff, a warm handoff with the behavioral health clinician right there on site, it just gains access to care, right?

Stacey Ouellette

And that trust is there because the provider recommended it and usually patients trust their providers. So by us entering some of these specialty practices we're also to be able to support the patients there at those sites as well.

Rebecca Chickey

I'm going to add a little bit of a personal story here because, phrase that you said a "warm handoff" has a really strong meaning for me. My older son, who is now doing incredibly well and in fact is going diving in Bali in October - not that I'm nervous about that at all - but, nonetheless, he's doing much better.

Rebecca Chickey

But he suffered a major depressive episode while he was in undergraduate school. And, you know, he was screened and diagnosed with depression. The handoff was to send a 19 year-old male in college an email with the contact information for two therapists that they wished him the best of luck to see if he could get an appointment.

Rebecca Chickey

That is the opposite of a warm hand off just for those of you wondering. I have a great depth and appreciation for the true value and importance of a warm handoff. Meeting the next person, knowing that you are, not just being put on hold per se. So what I'm hearing, if I can summarize to date: there are a number of important success factors related to integrating physical and behavioral health as it relates to recruiting and retaining qualified health care workers, particularly in the behavioral health field, but also in other specialty areas.

Rebecca Chickey

I think you alluded to this, that, primary care physicians or the clinicians in many of the specialties that you mentioned: cardiology, neurology, women's health. I don't want to assume so I'm going to ask you to validate this: Have you also heard from those clinicians who are not trained in behavioral health that is something that they value that has added value and, improve their satisfaction, in their day-to-day work.

Stacey Ouellette

We as a program, do a provider satisfaction survey every year to 18 months to get some feedback on how things are going. And that is one of the questions that we ask overall, you know, their satisfaction as well as does having an integrated clinician in their practice help make their job easier? And unanimously, all pretty much agree with that,

Stacey Ouellette

strongly agree with that concept that having an integrated clinician in the setting helps make their jobs easier, but also just it helps support them, right? And managing the complexities of the patients.

Rebecca Chickey

Rebecca Chickey

Rebecca Chickey

I'm going to put you on the spot here a little bit, Stacey, and ask you to personalize this. I mean, we've seen a lot of studies, for instance, the University of Michigan's Behavioral Health Workforce Research Center, you know, they've come out and they've said, when we've done this research, it's, you know, increased employee productivity. It's stabilized primary care physicians workloads.

Rebecca Chickey

It better allows them to refer patients more effectively and in a timely fashion. But sometimes research seems so impersonal when the listeners are sitting here thinking, could I really do this at my organization? Can you share just a story or two about how you have seen this play out? I know you've talked generally, but how if you, you know, maybe a personal story of how this has impacted, or maybe quotes that you've heard from clinicians at Maine Health.

Stacey Ouellette

One quote that always will stay with me is from that provider satisfaction survey, where one provider, said, this is better than Christmas morning, having behavioral health in our practice because they have access to that support. You know, we've worked to make ourselves available and accessible to support the primary care or specialty care teams and managing the complexity of the patients.

Stacey Ouellette

They're in the moment. And so when we're able to respond, when a patient presents with a concern...we hear time and time again, that just helps them to feel confident, right? The medical providers to feel confident like they know how to respond. Their response might be let's get the behavioral health clinician and get them connected to you so that they can they can help us out.

Stacey Ouellette

I have personally been working, when I worked in one practice was pulled in this will stick with me for probably a very long time, but I was pulled in for a warm handoff. Patient was suicidal, and together the medical provider and I had a conversation with the patient. I did some assessing. We made a safety plan. Patient.

Stacey Ouellette

I provided some education, some validation as to why this person was feeling this way and together as a team, patient included in that team, we all felt good about next steps, and patient left with a plan and came back and continued some treatment. And I think like those examples just demonstrate how having integrated behavioral health in the practices can help improve productivity of the whole care team, right?

Stacey Ouellette

Can help improve confidence and competence in the work that we do. And to the patient, it hopefully helps with patient satisfaction, right? Like it improves their confidence. Like this team's got me, right? They they're all wrapped around. They're working together. They all are on the same page. So those types of examples just demonstrate how integrating behavioral health can have an impact on multiple individuals and outcomes.

Rebecca Chickey

That's phenomenal. Thank you. And thank you for making it personal to you as well. Truly meaningful. Well, as we begin to look towards the end of our podcast here, I'm going to ask two questions. One is thinking back over the last several years as you built out this integrated care system, what are a couple of the things that you think made this successful?

Rebecca Chickey

Where do I start? You know, what do I what are the two anchors that I need to have in place in order to replicate what Maine Health has done? What would you say, to the listeners? And the other one is, do you have a call to action for the listeners?

Stacey Ouellette

Use a team, right? So identifying perhaps a provider champion to help support the initiation of this, have leadership on board, which requires perhaps educating, informing of how integrated behavioral health care can be useful for the organization. Give them resources and studies that have demonstrated utility of the role within the primary care settings. It is a whole team approach. It is the medical champion.

Stacey Ouellette

It's behavioral health. It's your billing and finance folks at the table and being flexible, really being willing to try things and adjust. Doing perhaps like a PDSA cycle, so that you can learn and grow and adjust. I would say use resources out there. There's a lot of great people doing this work across the country. The Collaborative Family Health Care Association, CFHA is one group that I, belong to, and they have helped me tremendously

Stacey Ouellette

just as a collective group. They help with questions, they help provide guidance. There's a lot of people out there doing this, so you're not alone. Use your resources. Connect to people, ask questions. People doing this usually really love to share and help others because we believe in it.

Rebecca Chickey

I will add on, you added, you may have to educate, and one of the reasons we're doing this podcast is to continue to draw attention to an issue brief that we released, the AHA released last fall. Basically, the short version of the title is "Integration - The Time is Now." It's only four pages. It has almost 30 references of evidence-based research, showing the multiple ways in which integrating physical and behavioral health can provide value in a multitude of ways, just as you have shared many of them with us here today.

Rebecca Chickey

So I would point to that as an educational resource and an easy read. Four pages. Most of us can do that, and, you know, skim that in a minute. So thank you so much, Stacey, for, again, as I started for your willingness to share your time and expertise, you are doing champions work. We greatly appreciate it.

Rebecca Chickey

I know our listeners do too. You've just inspired someone to start on this journey. So thank you.

Stacey Ouellette

Thank you.

Tom Haederle

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