Behavioral health support in primary care clinics

Podcast: Providing patients with quick access to behavioral health support

Behavioral health support in primary care clinics

Episode Transcript

Courtney Collen (Host): Hello and welcome. You are listening to the Health and Wellness Podcast brought to you by Sanford Health. I’m your host, Courtney Collen with Sanford Health News. This series begins new conversations and continues the important ones, all designed to keep you well, physically and mentally featuring our Sanford Health experts.

This episode continues the conversation about the Integrated Health Therapist program at Sanford Health. After my last episode chatting with clinical psychologist, Dr. Jeff Leichter who leads the program, I learned there are nearly 50 therapists and bedded into more than 60 primary care clinics across the Sanford Health network. One of those therapists is Chelsea Christiansen, LICSW. She’s at the Sanford South Clinic in Bismarck, North Dakota.

Chelsea, thanks so much for being with us.

Chelsea Christensen (Guest): Thank you.

Courtney Collen (Host): So you are embedded into that clinic in Bismarck. Tell us more about your role through this IHT program.

Chelsea Christensen: I’m a licensed clinical social worker here in North Dakota and I am in bedded within the Sanford South Clinic as the integrated health therapist. And my role here is kind of a multitude of things. But the primary role is to be a quick access to patients who are needing behavioral health support. So, if a provider is seeing a patient here in the clinic and there is some sort of concern for anxiety, depression, pretty much any mental health concern, they can be directly referred to me, or I can see some of them same day within the clinic, which gives them a quick easy access to a behavioral health provider. I think another important role here as well is for us to just kind of help even our providers navigate where or how, or what services someone might benefit from within this field of behavioral health.

Courtney Collen (Host): What would you say are the, are the biggest benefits to having somebody like you embedded into a clinic?

Chelsea Christensen: I think one of the biggest benefits is being able to address somebody’s somebody’s need right when they’re coming in expressing that they need concern for that. So behavioral health concerns often come with a lot of stigma. So to even get to a clinic can be quite difficult for some people for them just to traditionally be turned around in a referrals, being sent out where they’re having to wait, you know, weeks and weeks and weeks to get in for a substance use or a behavioral health concern. So, when somebody is here in the clinic, they’re kind of ripe for that information, right. They’re ready for that help. And so let’s just slide somebody right in there and kind of address those needs. One of the other things that I think is important for this role or with this role in that is just being able to educate sometimes on some of the simple things like, you know, these are signs and symptoms of anxiety or depression… this is what you’re experiencing, kind of normalizing some of those things for people. And then also just being able to provide a coping strategy that they can take. In my personal way of practicing integrated health therapy, I always want to try to send somebody home with a coping strategy, something they can kind of sink their teeth into and really take with them that might help whether that’s you know, behavioral activation for improving mood or relaxation techniques, breathing techniques, something that they can take that they know, ‘hey, this, this might work and we might practice you know, really quickly in the clinic’. And then I think one of the other nice things too for people is that I hear quite regularly, ‘Oh, I, you know, I’m just so nervous about counseling. I’m so nervous about engaging in that strategy’. And this might be after visiting with them for 20 minutes, half an hour, sometimes an hour. And I then look at them and say, ‘well, how bad was this?’ Right? Like we just talked for an hour and this is a counseling session. So it can really kind of ease some of the concern for seeking out that additional service.

Listen: Importance of an integrated health therapist

Courtney Collen (Host): Is there a specific age range you typically work with?

Chelsea Christensen: I’m not quite set up to do the younger, younger kids in my clinic. I do kind of tell my providers, I will see everybody at least one time. So whether a five or six year-old comes in with their parents and I just try to transition them to the right spot for them, I just am not well set up for that here. So I really like to make sure that when I sit down with some of my younger kids, that they’re able to have a conversation and interact with me at that level and if I feel that they’re maybe needing more of that play therapy or more of a comfortable environment than an office with a desk, then I try to just coordinate their care to somebody who can provide that service to best fit their needs. But yeah, I’ve seen anyone from kids all the way up to 80 and 90 year-olds. So we kind of get the whole gamut here with an integrated care role and that also makes it fun because you just kinda see a lot of different needs for different people in different areas of their life.

Courtney Collen (Host): What are some of the more common concerns you’re seeing and hearing about at your clinic?

Chelsea Christensen: I think we’re seeing a lot of concerns with how we adjust to this new world that we’re in? So at the start of the COVID pandemic around March and in April, it was a lot of working from home and my school is disrupted and I’m struggling with school and those changes in routines and a lot of fear about COVID. So we addressed a lot of those things and now it’s kind of like, okay, you know, things are here to stay for a while. And how do I adjust to this? So I’ve talked with teachers being concerned about returning to school and how am I going to manage all of that? And I’ve talked with students about how am I going to manage at school with all of these changes. I’ve talked with people about changes in work, I used to have structure, and I did really well with that and that my structure really helped my mental health before and now I’ve lost all of that. So people are really losing a lot of the, their coping strategies or their coping techniques that they had used previously. Like just being able to go to the gym, hanging out with friends, you know, taking a little trip, like all of these different things that really helped their mental health have been changed for us. So how do we gather new tools in our tool belt to help our mental health and how do we adjust some of our thinking about progress within work and all of those various concepts that have just been kind of tipped upside down and shaken about.

Courtney Collen (Host): If you could pass along one piece of advice or maybe a coping strategy, how can we ease some of that anxiety that we’re feeling?

Chelsea Christensen: Just an overall great practice for anybody who’s feeling anxious is maybe trying to engage in some of those relaxation techniques and mindfulness type techniques. There are tons of apps out there that you can download that have those, you can find all sorts of relaxation techniques just by doing a quick search online. The way I explain anxiety is it really is kind of like our fight, flight, or freeze responses that are kicking in. And so it’s really helpful for us when we come upon a danger, if we’re hiking and there’s a bear in the woods or something like that, but this-term sort of anxiety and stress with that we’re not meant to manage that for long periods of time. It’s meant to be very specific and life-saving. And so we can counter those feelings by that relaxation and getting the relaxation component to kick in in our body. Another great reminder or a little technique that you can use is just to simply ask yourself ‘what is the best outcome of the situation that I’m anxious about and what is the most likely?’ When we’re faced with those anxiety producing things, we go to that worst outcome, right? Like that’s the easiest for us to come to because that’s where we go. We were trying to save ourselves from this worst outcome. So just simply reminding ourselves that there is a best outcome and this is what that could be. And there’s also a most likely outcome, which probably is not as bad as the worst outcome. Right? And that can just kind of quickly ease some of our are angst about any situation that we’re in. And then especially with COVID like remaining really focused on like, what are the facts that we know? So, at the start of the COVID pandemic, there was a lot of, you know, COVID happening in New York and it hadn’t really hit here yet in North Dakota, at least. And so a lot of people were watching national news, right? Being really concerned about the COVID pandemic out there, but here we didn’t have those numbers. And so just reminding people to really focus on, on the facts of what’s happening around them can be very helpful instead of some of those bigger picture components.

Courtney Collen (Host): Let’s say someone comes in for their wellness exam or routine visit, and the appointment starts to shift because there’s a realization that this patient needs a little bit more and could really benefit from sitting down to talk to a professional like you. So, how do you become someone that these patients rely on?

Chelsea Christensen: I think a lot of it has to do with our providers and I’ve been at this clinic for just about three years. I have gained I feel a lot of trust with the providers. So a lot of it is how a provider kind of presents me as well. And a lot of times it’s not like the counselor Chelsea’s coming in, you know, they might call me the IHT or the integrated health therapist. But a lot of my providers will just simply say, ‘she’s gonna know where we need to get you’ and they put a lot of I guess, build that trust just from the introduction. But then when I go in to talk to people, I, I always say that I’m here to just listen to what’s going on. We’re going to see what’s been happening for you. Like, just share your story with me. And then we’re going to talk about some tools, the coping strategies, whatever that looks like. And we’re going to ask also at the end and discuss what are they looking for? My idea of what should happen sometimes as a counselor is not maybe where somebody is at. So if I push for somebody to go directly straight to treatment for substance use, that might not be on their radar. So what does that look like to them? Do you wanna start with an AA group? Do you want to, you know, start with a licensed addiction counselor at an outpatient level, you know, just really, what are you feeling comfortable doing? And I think that helps set us up together as a team, and this is what’s best for, for everybody involved and especially for the patient to be able to guide their own care and what they’re looking at, do we have to step in sometimes for safety reasons and that sort of thing? Absolutely. But as best we can, we try to leave that up to the patient and help guide that scenario. The other piece is sometimes patients are not ready to engage with another counselor. Maybe they’re not quite ready to get some trauma counseling for a trauma or that sort of thing. So then sometimes what we can do as an integrated health therapist is kind of bridge them to that next level of service. So sure we can work on some coping strategies for depression or anxiety or the things that you’re ready to work on, and we can get you to where you need to go at some point in the future.

Courtney Collen (Host): If somebody is struggling and would really benefit from talking to somebody like you, an integrated health therapist, where would you suggest they begin?

Chelsea Christensen: They could do a couple of things. One: just reaching out to their primary care provider to see, especially within Bismarck, we only have a few here. Seeing if they have access to that, otherwise you know, one of the beauties of integrated health therapy within our primary care clinics is sometimes we can even capture that patient before they get in to see their provider. So we have had some patients call in and say, ‘I really need to get in today to talk about my depression or anxiety’. And then our front desk staff just kind of know, ‘Hey, they don’t have an opening, they’ll talk to the provider’, or maybe they’ll call me and say, Hey, can we get this person in to see Chelsea today because this is their primary need? So, contacting the primary care clinic, seeing if it’s available, seeing if they could maybe schedule with that person first or talking with their primary first.

Courtney Collen (Host): On the flip side, what if someone might be hesitant to reach out and ask for help? What do you want them to know?

Chelsea Christensen: So one of the things I tell my patients often is we, for whatever reason, have created a stigma around mental health and really I try to view mental health and I encourage other people to try to view it as a health condition just like any other health condition. We can’t function without our heart. And we also can’t function without our brains and where a lot of the mental health concerns kind of start. And so treating are treating that just like any other health condition, I often compare it to like diabetes or our heart health and those types of things, and all of those pieces have to function well in order for us to be well. And so trying to break it down into more of like a medical term or a medical condition versus a mental health, behavioral health concern.

Courtney Collen (Host): How much do you personally enjoy what you do and providing this type of care?

Chelsea Christensen: I love the variety that I get every day. I really love being able to break down the mental health symptoms and, and just breaking down the barriers and the stigmas around mental health for people and just seeing sometimes that light bulb go ‘you’re right, this is something that I need to take that’s very important’, or even just being able to connect people with a counselor that I think might help them. That counselor might not always be me and that’s fine. The goal is to try to help people improve. And so sometimes we do need to make that referral out and just being able to get somebody connected with another counselor, that’s really going to be able to help them and being able for them to leave my office feeling more comfortable with you know, maybe something that’s new for them that they haven’t really thought about addressing before. And being able to see that, you know, maybe for, for a time, if, if nothing else they’ve been able to get some support for something that a lot of us.

Courtney Collen (Host): Is there anything else that you wanted to add?

Chelsea Christensen: If you are struggling with a mental health concern, substance use concern with something like suicidal thoughts or self-harm, don’t hesitate to ask for that support. Sometimes it’s easy to put off addressing those concerns, feeling like we’ve gone to every counselor in the area, or that it’s really hard to get into behavioral health, but you never know what’s available at your clinics and you never know if we’re going to find a good fit for you and it can really make a difference for our overall well-being, if we can kind of address those mental health and behavioral health concerns as well. So don’t be afraid to ask. You never know what’s hidden in our Sanford clinics.

Courtney Collen (Host): Well, I really enjoyed learning more about the integrated health therapy program and your role in Bismarck. Thank you so much for your time and for all that you do. Thank you. This was another episode of the “Health and Wellness” podcast series by Sanford Health and Courtney Collen. Thanks for being here.

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Posted In Allied Health, Behavioral Health, Bismarck, Family Medicine