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

1. 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

2. Colloquium Outline • Introduction to training grant • Community needs • Training model & components • History and mission of Community Clinic • Case examples • Q & A

3. 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

4. Between 2000 and 2005

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

6. % Yes Four County Needs Assessment, 2004

7. 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

8. Community Needs • Mental health is worse for NW Arkansas residents living in poverty Illness/Health Concern % <$20,000 % >50,000 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%

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

10. Mental Health’s 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

11. 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

12. Integrated Behavioral Health Care

13. 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

14. 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

15. Training Components • Coursework, language immersion, seminars • Outreach • Clinical training • Research