February 22, 2017

Behavioral Health Integration: Empowered medical assistants are at the forefront


Kaiser Permanente Washington Medical Assistant Santino Telles describes an initiative that’s improving patients’ lives — while increasing his joy and pride in his work.

Group Health (now Kaiser Permanente Washington) launched the Behavioral Health Integration (BHI) initiative as a pilot to develop BHI work flow in its Northgate, Olympia, and Everett medical centers in 2015. As part of BHI, all primary care patients are screened annually for depression and unhealthy alcohol or substance use. If the results indicate a need for further care, a social worker partners as part of the primary care team to help develop a treatment plan. After a successful pilot test, Kaiser Permanente Washington leadership approved extending BHI to all 25 primary care locations starting in January 2016.

In this commentary, Northgate Medical Assistant (MA) Santino Telles, MAC, talks about the important role MAs play in BHI’s success — and how BHI has helped make his work more meaningful and rewarding.

When my fellow Northgate MAs and I first heard about BHI, we all thought, “oh, more paperwork, more work for us.” But BHI is so much more than paperwork — it’s a chance to get closer to our patients and to make a real difference in their lives.

MAs are the first touch point in BHI. We are the first ones to see patients’ answers on the questionnaires, which ask about their feelings of depression and about their drinking and substance use. If a patient’s answers indicate that they’re having trouble with any of these things, we notify the social worker or the provider so that the patient can get the right care right away.

All the MAs at Northgate received training on how to engage patients in talking about sensitive topics like depression and unhealthy drinking since patients may have questions — and we learned that the key was to not stigmatize. So we don’t use words like “alcoholic” or “drug abuser.” Patients realize that we’re not judging them or asking them to admit to anything. We’re just talking about their behavioral health — and approaching drugs and alcohol use as part of that.

Most patients answer these questions honestly. Then we, the MAs, are able to respond in an objective way. We simply say, “This is what you’ve told us.” That lets patients know that they’re being heard instead of judged.

I’ve been surprised by how rarely patients respond with, “It’s none of your business.” In fact, about four out of 10 will say, “Thank goodness you asked about this,” or “Thank you for caring.”

Saving and improving lives: How BHI provides care ‘on another level’

I realized pretty quickly after getting started with BHI that screening patients really didn’t take much more time. And it’s obvious that it has a positive impact. Since implementing BHI at Northgate, we’ve been able to identify and provide care for many more depressed and anxious patients. These are usually people who have learned to hide it pretty well. With social work and behavioral health services in the building, the initiative gives them quick access to help.

We once had a patient say, “I’m going to kill myself today.” And through social work and behavioral health upstairs we were able to provide appropriate follow-up care right away. It was great to see that particular patient walk through the door a couple weeks later. The patient is still anxious and still having some negative thoughts, but now they know we are here to help them. And they are on the road to a better managed life.

Another remarkable thing about BHI is how it helps us identify unhealthy alcohol use and gives us a new perspective on chronic disease management. For example, if we have a patient with diabetes, and we discover they’re depressed and drinking heavily … maybe that’s why they’re not checking their blood sugar or taking their meds. If we address their depression and unhealthy alcohol use, maybe they will take better care of their diabetes.

Overall, BHI lets patients know we’re on another level with how we provide care. We are reaching out to identify struggles they’re having that would probably have gone unnoticed. We’re letting them know that we can help them get through struggles — and that we’ll do so without stigmatizing or judging them.

‘I feel empowered’: How BHI has elevated the role of the MA

BHI has allowed MAs to take control and ownership of their part in the process of care. I love the fact that, as an MA, I am seen as important enough to be able to interact with patients on this level. It makes me feel like the doctors value my perspective and trust my judgment. My fellow MAs and I feel empowered, and we’re proud that we get to help bring behavioral health services to patients who need them — but who might not get them if not for us using our training and skills.

“This is my clinic. This is my patient.”

With this overall integration across Kaiser Permanente Washington, MAs have been at the forefront. BHI gives us this feeling like, “This is my clinic. This is my patient.” It’s a beautiful thing to be a big part of somebody’s betterment. We see suicidal patients who walk back in a week later, and you see that they’re doing better. It’s rewarding on such a deep level. BHI even helps in my personal life, too. It reminds me to slow down and check in with myself.

For all the MAs who read this, I would say this: Love your job, have fun with it, and know that you’re important. And know that you as the MA are the spearhead of BHI, the initial point of contact for patients. Be proud of this work and make it your own.

by Santino Telles

Learn more about Kaiser Permanente Washington Health Research Institute and sign up for our free monthly newsletter.