Dr. Jones talks with Megan Neace and Sharon Allen-Kinney about Integrated Behavioral Health ( IBH ) and how it works in their rural context of eastern Kentucky. They discuss what they do, the opioid epidemic, IBH as a force for social change, and the need for social workers in medical settings.
Integrated Behavioral Healthcare (IBH) is an approach to treating “the whole person” by coordinating physical and mental (behavioral) health services within primary care medical settings.Social workers are well-suited to IBH due to their training in clinical and case management skills. Social workers treat patients with mental health and substance abuse problems within the medical setting as well as support psychosocial wellness by linking patients to resources and referrals.
For more information regarding IBH at the University of Kentucky College of Social Work as well as the available stipends of $10,000 for full-time students and $5,000 for part-time students please visit: https://socialwork.uky.edu/msw/integrated-behavioral-health/
Middle Music: Solo Guitar “7” by Matt LeGroulx is licensed under a Attribution-NonCommercial-ShareAlike 3.0 International License.
Transcripts are created using a combination of speech recognition software and human transcription and may contain errors. Please check the full audio podcast in context before quoting in print.
Episode 24 – Social Work Conversations – Understanding Integrated Behavioral Health ( IBH ) with Megan Neace and Sharon Allen-Kinney
Blake: [00:00:02] Hello and welcome to the social work Conversations podcast produced by the University of Kentucky College of Social Work. My name is Blake Jones. Here we explore the intersection of social work research practice and education. Our goal is to showcase the amazing people associated with our college and to give our listeners practical tools that they can use to change the world.
Blake: [00:00:25] Well I’m joined today by Sharon Allen-Kinney and Megan Neace here in the studio and thank you all so much for joining me today.
Megan: [00:00:34] Thank you for having me.
Sharon: [00:00:35] Good to be here
Blake: [00:00:35] I know you had a little bit of a drive from from Morehead which is about an hour from Lexington. So thanks for getting up early and coming. And Megan I want to start out you were my students several years ago and I want to start out congratulating you because you just got some very special news. Tell us about that.
Megan: [00:00:52] I actually just passed my LCSW exam on tuesday and very excited about that.
Blake: [00:00:57] That’s great. And you cried a little bit.
Megan: [00:00:59] Yes I did. I’m sure everyone around me thought I had failed because we immediately find out pass or fail and what I saw passed. I was just so overwhelmed with emotion it just came out in tears. But I was just so relieved to pass that.
Blake: [00:01:13] That’s great. I know you’ve worked really hard for a long time so congratulations.
Megan: [00:01:18] Well, Thank you.
Blake: [00:01:20] So I want to start out by this podcast is about the IBH program and I’m going to try to stay away from acronyms here. So Sharon tell us a little bit what IBH means and where did it come from?
Sharon: [00:01:36] Well it’s definitely a need in different areas to have integration of behavioral health into family medicine and primary care centers. There are so many areas that have no access to behavioral health services. And it’s a way to integrate it into a place that the patients are already going. It does multiple things including cuts down the stigma of seeking mental health services because you can get it right in the same clinic where your medical provider is and it serves a need in areas where there’s just not a lot of access to behavioral health services and so you work as a team with your medical providers and they become more aware of behavioral health symptoms in their patients and are able to access therapists that are are integrated into those clinics.
Blake: [00:02:41] Yeah. So so let’s back up and talk about the old model of treating patients and in your world you call them patients.
Sharon: [00:02:51] Correct.
Blake: [00:02:53] Treating them say they had some mental health issue but they also had medical issues going on. Tell us a little bit about the older model of what it used to be like to treat a patient like that.[00:03:06] Well I actually worked initially in comprehensive care centers. So initially that is how it was done you would see a patient you would identify him in a medical center and identify behavioral health issues and you would attempt to refer them to comprehensive care centers that are in every county and ideally hope that they show up for those appointments. You know a lot of times are issues that would create barriers to that you know other family members there or just the stigma of going to the mental health center such as comprehensive care that a lot of times the compliance wasn’t there because it wasn’t convenient for those variety of reasons. So that’s kind of the old motto and certainly has its place still there’s a lot of work being done by the comprehensive care centers but it’s. I think much easier for patients now that they can go to one location and get that so.
Blake: [00:04:20] So it truly is integrated and we’ll – in a in a moment I’ll ask you about maybe some resistance to that. Right. People always resistant to change. We’ll talk about that. But I should have done this at the beginning but let’s let’s formally introduce you. I want to know what your your roles are specifically so Sharon will start with you.
Sharon: [00:04:42] OK. I’m in the Morehead clinic at Morehead St. Clair clinic. It’s a family medicine clinic. So they take care of all ages and My role there: I have kind of two duties there because I work with the residents from University of Kentucky that are doing a rural track in their residency. So I do didactics with them on a monthly basis and then work as a clinician in the family medicine clinic as well where I take warm handoffs throughout the day. I have several patients that I follow. The goal was to do you know four to six sessions with him. But it doesn’t always work because of the limited resources in the area. Sometimes we have to go a little longer. I always tell Megan it’s kind of a 60 40 split and hopefully we can get 60 percent of our patients in and out in four to six six <inaudible> sessions. But there will be some that we have longer term but that’s kind of my role is providing consultation with the medical staff you know making recommendations for treatment and providing you know short term interventions in the family medicine clinic.
Blake: [00:06:07] And we should say because this is we have listeners really all over the world Morehead Kentucky is in the eastern part of Kentucky right.
Sharon: [00:06:16] Correct.
Blake: [00:06:17] Appalachia what we call Morehead Appalachia.
Sharon: [00:06:19] Yes I think so.
Blake: [00:06:22] So we’ll talk about that in a moment kind of the special needs of people who live in eastern Kentucky and Appalachia at large. But Megan what do you do.
Megan: [00:06:32] I do something very similar to what Sharon does except I work in what I would consider even more rural areas. I work in and Carter County and Elliott County. And so we have a bit more limited access to things than even what people in Morehead do but I play the same role I work as a clinician. I do follow patients. And like she said I’m always kind of consulting with her about the 60 40 split because like in Carter County I work in a small town called Olive Hill in and technically the only therapist in town. So if you have anything else you have to go to like Carter like Grayson or you have to go to Morehead or it’s you have to drive. I have a lot of patients who walk to see me so I’m constantly kind of trying to maintain that 60 40. So that’s definitely something I’m working on all the time. But again clinical work consulting with my co-workers so working with doctors and are practitioners on identifying signs of behavioral health. And I do some resident education just because I really enjoy working with the residents and helping educate them.
Blake: [00:07:42] That’s good. I want to go back to a term that you used earlier Sharon called warm handoff. Yes. What is a warm handoff?
Sharon: [00:07:52] A warm handoff is how we get I would say probably 80 percent of our patients come from warm handoffs and those are when a medical provider is in with a patient. They recognize that there is some mental health component to the issues going on with that patient and they have a means of reaching Megan or myself. And we basically go into the room introduce ourselves in this warm hand off and talk to the patient about behavioral health services that are available in the clinic. We may even do some very brief interventions that day if they’re having anxiety and panic symptoms will teach briefly some relaxation techniques and cognitive challenges and then assist them in getting set up for some sessions with us going forward.
Megan: [00:08:49] I’d just like to build on that. I love the idea of the warm handoff because it takes away so much of the uncertainty of meeting this behavioral health person because there is such a still even today a stigma around behavioral health and just being able for us to come in and just say oh yeah hey this is me and just have that kind of short brief interaction with them makes them so much more comfortable with coming back and beginning services.
Blake: [00:09:13] Yeah that’s good because they know you.
Megan: [00:09:15] Yeah.
Blake: [00:09:16] Then at that point. Right.
Blake: [00:09:18] I know that we would be really remiss in this conversation if we didn’t talk about money. And I think I may have this wrong. Tell me if I’m wrong about this but it seems like one of the goals of integrated behavioral health is to streamline treatment and ultimately to save money. Right.
Sharon: [00:09:38] Right.
Blake: [00:09:38] Tell me about that. What does it. Does it work?
Sharon: [00:09:42] It absolutely does. There is a huge percentage of some of the medical appointments I end up being consumed with behavioral health issues. And so it really frees up the medical staff to stay focused on the specifics of blood pressure and heart disease and things like that. And we then can take care of those mental health conditions that will a lot of times consume medical appointments, slow down the whole process of the providers trying to get coverage to each of their three or four exam rooms they get hung up in one. And it just causes a huge backlog and patients have had to be rescheduled or you know we’re annoyed because of the long wait. So this frees up the medical staff to stay focused on taking care of those issues and then passing off the mental health issues to us.
Blake: [00:10:45] You know often think about the the medical system and the three of us sitting around this table are educated, middle-class people and sometimes navigating the medical system in my life at least is just terrible. I have a son who just turned 18 and now I can’t get his medical records and I can’t help him with medicine and do these things and so we’re back and forth back and forth. I can imagine someone with mental health challenges trying to navigate a medical system. It’s really really hard.
Megan: [00:11:25] For sure. I think one of the first things that begin to work on is understanding the medical system and helping patients learn how to advocate for themselves. That’s definitely something I touch on because it is such a complicated system. Like you said we’re all at this table educated and it’s still difficult for us to understand it but a lot of times specially in our rural areas we’re seeing undereducated people and sometimes I have patients who can’t even read. So part of what I have to do is some case management stuff. So helping them understand what the paperwork is that they’re getting and helping work through that with them and just navigating that. And like I said the biggest thing I really like to work on is advocating for themselves because a lot of times they don’t understand and they’re too hesitant to ask. They don’t feel comfortable enough to say hey I’m not understanding this. Can you explain it to me in a different way. So it’s definitely something I really like to work on is building up that sense of empowerment so that they feel confident enough to ask for help.
Blake: [00:12:25] So this goes over into the social change and social justice part of Social Work. Do you ever see yourselves as social change agents in your job?
Sharon: [00:12:36] Absolutely. I definitely feel that’s the case. And it’s it’s part of the funnest part of the job I think is is seeing the change that we can make and help people accessing things that they didn’t even know were available for them and being a part of that is is a lot of fun.
Blake: [00:12:57] I know that Kentucky really every state has been hit by the opioid epidemic as we’re taping this new CDC report just came out yesterday and something like 70 over 70000 people have overdosed overdosed in 2017. How do you see that playing out in your work in eastern Kentucky and what what do you do the both of you address the opiate – the opioid crisis?
Megan: [00:13:28] Well I definitely think that both of us can share different aspects of this question. So I think that Sharon and I were actually talking about it on the way up here. I think that what we see a lot of is the fallout of opioid addiction. So I’ll let her touch more on that on the seeing of the grandparents and children of people who are addicted. And I think that the way that I mostly approach it is to help the residents that I work with to be aware of what they’re prescribing and to ensure that if you if this is a necessity for this person that we get them in behavioral health treatment so we can try to prevent this from becoming an addiction and to just be aware of what we’re doing and make sure that we’re cognizant of that.
Sharon: [00:14:18] Part of what is being done now with St. Clair family medicine is they do have Suboxone clinics and they’re providing that in a more of a central location so that the clinics that are in existence can refer in there. We also have one location that actually has the Suboxone treatment going on in the Family Medicine Clinic in Menifee County because it is remote so it is being done there then the rest of the clinic is referring to this central location. But as Megan mentioned we see so many grandparents who are raising children or their grandchildren because of the addiction of their their own children. And so we end up spending a lot of time working with them on parenting because it’s a very confusing role for the parent. For patients who want to be grandparent but they’re now raising these children. So we deal a lot with that. I do see a few patients who are in Suboxone treatment especially I have seen pregnant women who are in Suboxone treatment say in Lexington but they can’t come often enough to get their behavioral health appointments that are required. So I will I will see them in the clinic and then send the documentation to their provider of their Subutex. Because it’s you know a required part of that but there’s not a lot of people doing the Subutex so they they end up in locations like Lexington that are good drives. So I do some treatment with them in the clinic there where I work.
Blake: [00:16:08] So we talked about eastern Kentucky and sort of the special challenges that that people have there in terms of poverty and just access to care. You know I – I want you to think back about why you became a social worker. And you know this model of really integrating social workers are very important in this model right.
Megan: [00:16:37] Yes.
Blake: [00:16:38] Clinical social workers especially are very important. Why do you think it’s so important to have clinical social workers in this model?
Megan: [00:16:47] I think it’s extremely important because we see the person and environment. We don’t just see what conditions are coming in with. We don’t just see what symptoms they’re having. We look at everything that’s contributing to these symptoms and we build from a strength based model so we don’t we don’t want to only see what’s going wrong we want to see what’s going right and help them build on that. And I think that’s just such a great approach to this integrated care model.
Blake: [00:17:16] Sharon what do you think – do you agree? ha ha…
Sharon: [00:17:18] 100 percent. It’s it’s a very different approach from some other disciplines because we do see more of a w hole Person in their environment and how they’re contributing factors. Get them to the place they are when they start seeing us. I think it does benefit the patients that there is clinical social workers there available to them.
Blake: [00:17:45] what’s the most challenging part of your job.
Sharon: [00:17:51] Probably. I mean when I’ve started where I am now at Family Medicine there had never been any body in that role so becoming part of that team because you know people just would kind of rush through maybe write a prescription for a medication and there would be no follow up. Just basically continue writing that prescription versus now there’s somebody there that can actually do cognitive behavioral therapy with them to maybe eventually have the goal of getting them off medication in time because they develop skills that help them manage the symptoms or resolve the symptoms so that that I think is a great part of the job is to be able to tear down some of those barriers. The physicians or nurse practitioners just didn’t consider that being a real need. And now to me I mean we’re relied on tremendously now we have a very team approach and they rely on us so much and it’s a fun fun thing to see that kind of barrier torn down that we’re as an equal to the providers that are we are considered providers in our family medicine clinics and that’s I think a big change over time.
Blake: [00:19:20] That’s really good. I want you if you can Megan to share a story or maybe obviously we’ll leave out the details of the patient’s name and all of that. But can you can you share a story with us about how you’ve managed to help someone?
Megan: [00:19:40] Yes I have a middle aged woman who I’ve started seeing because she was actually related to anxiety depression symptoms and she was having unmanage diabetes. So I actually started seeing her in an attempt to help not only with her anxiety and depression but to help her learn to better manage her diabetes. And so the more that we talked and the more we unraveled in therapy I actually learned that she was a victim of domestic violence. And so through a strength based approach I was help her. I was able to help her gain a sense of empowerment and confidence in herself to the point that she was able to not only leave that marriage but to file for divorce and to advocate for herself in that divorce. And I think the most rewarding day that I’ve ever had in this job is when she came back and she was she was in tears and she was like I’m so thankful that you were here because if I didn’t have you to help me learn my value I would still be in an abusive place where I didn’t I wasn’t happy.
Blake: [00:21:03] Sharon how about you do you have a story you can tell us.
Sharon: [00:21:05] I do and it’s more on the medical side. Remember this young young man who I saw early on in my time there in Morehead and he had been in the Comprehensive Care program seen there for some time and I remember he was on. I believe it was Adderall and I remember as soon as I started assessing this individual I knew that this is not the appropriate medicine. It was actually not hyperactivity. This man was dealing with it was mania. And he’s on a stimulant which has only made him worse than he was I think 20 27 years old and just struggling day to day was not able to maintain a job and was just really struggling day to day to get along with his family to be able to function. And he had had a lot of traumatic things happen father and a sister who had committed suicide. So just a really volatile situation. And I was able to work with his medical provider. He was eventually gotten off the Adderall. Got on a mood stabilizer and I followed him for probably about a year. And I’ll never forget our last appointment when he was so grateful to have come to somebody who looked beyond just those initial symptoms and really dug deep and we were able to get him on a medicine that helped him get back to work helped him maintain relationships and learn to deal with these ups and downs in moods. And. You know that last appointement was just something else. His provider came to me the other day and had seen him for a follow up medical appointment and said he is still so grateful that you were here in this environment with us so that we could all consult together and really get to the bottom of what was going on with him and so that those kinds of stories motivate me and keep me going when we’re able to figure out something that gives this person their stability back and their ability to function day to day in their lives so that I think would not have happened if there wasn’t integration in the family medicine clinic there.
Blake: [00:23:35] So that’s great. That’s really the heart of intergrated of an integrative approach right.
Sharon: [00:23:40] Right.
Blake: [00:23:40] What you just described in that in that patient. Megan I want to finish up by asking you a question. You know we have social work students who listen to this podcast and you know you were my student a few years back and you know I’m sure in our class we talked about you know what do you want to do as a career and you were drawn to this model for a reason. And were you to talk about if there’s a social work student out there listening that’s interested in the IBH concept as a practicum or something. What what advice would you give to them?
Megan: [00:24:21] I would say make sure that this is something you definitely want to explore because it is a very high energy environment. We’re constantly on the move. We have like we were talking earlier about what our typical day is and sometimes I have a patient in my office that patient in the lobby somebody waiting to meet me on a warm handoff a doctor ask needing a medication consult. And so you have to be able to kind of adapt to that high energy surrounding. But I also think it’s super important that you are open to that integrated approach. And for me I always knew that that was something I wanted to do because I’m all about access to care. I want people to be able to access the things they need as they need them. And growing up in eastern Kentucky that was really hard to do. Like even as a kid it was hard for us to make all of our appointments because they were here here here and having all of that in a central location. It’s just amazing to me to be able to share that with with my patients and provide those services to them. So I think you have to be fully invested in that model in order to be successful in it.
Blake: [00:25:34] So someone who just wants to go and sort of see someone for 50 minutes in a office by themselves with no interruptions they would not do well in your job. <ha ha>.
Megan: [00:25:45] They would not do well in this field. You have to be able to adapt to your situations. And I’m so thankful to the IBH program because like I said I’m trained in this. Like we we learned how to do these brief interventions in how to interact with our team and so I’m so thankful to have that opportunity. But you have to be ready for anything that can get thrown at you it’s not a you have seven or eight patients on your schedule. No one’s going to interrupt during a session. Like I said it’s constantly changing and you’re constantly adapting. But I think that’s the beauty of it is there’s always something new and there’s always someone new that you can help.
Blake: [00:26:25] That’s great. Well I want to thank you both for coming on today. This has been a fascinating conversation I’ve heard about your work through through the grapevine. And we we should also mention you know Lynn Hunter here at our college of social work has been such an integral part of this program and Pam Pam weeks as well on our college and really appreciate their support and help in this. And I just thank you for for using your lives in this way. We described you as pioneers. <ha ha> I don’t know if you think of yourselves as pioneers but you really are. I mean I think this is the wave of the future I hope it is because it just makes sense.
Sharon: [00:27:07] He really does.
Blake: [00:27:08] It really does. And so thanks for coming on and Megan Good luck with your new LCSW really proud of you.
Megan: [00:27:16] Thank you.
Blake: [00:27:17] Yeah thanks for coming on.
Sharon: [00:27:19] Thank you.
Blake: [00:27:20] You’ve been listening to the social work conversations podcast. Thanks for joining us. And now let’s move this conversation into action.
announcer: [00:27:31] This production is made possible by the support of the University of Kentucky College of Social Work. Interim Dean and Vail and all the faculty and staff who support researching contemporary social problems and prepare students for the social work profession. Hosted by Dr. Blake Jones produced by Jason Johnston with thanks to our webmaster Jonathan Hagee. Music by Billy McLaughlin. To find out more about the UK College of Social Work and this podcast visit https://socialwork.uky.edu/podcast