Evidence of TAMMS’ success, which receives both private and public support, is in its recent expansion. Initially implemented at two community and two university clinics, the program doubled in size last year. Plans are underway to secure funding for longer-term implementation and sustainability.
In the Boston area, Brigham and Women’s Advanced Primary Care Associates has implemented a behavioral care model whose success is contingent on the careful coordination of three physician-led teams, according to clinic director Stuart Pollack, MD. On each of these teams, the gateways to mental health care are the medical assistants (MAs), who at the outset of each patient visit administer two standard screening tools, PHQ-2 and PHQ-9, to assess whether patients might benefit from behavioral health care.
If patients’ scores on these tests indicate a certain level of depression, the MAs consult with their physician to assess whether social work intervention is warranted. If so, the social workers assigned to patients stay in touch with them throughout their course of care at Brigham, checking in with them during and between visits to the practice and regularly apprising both the primary care physician and consulting psychiatrist of patients’ progress.
The psychiatrist is viewed as an essential team member and attends meetings of the practice.
Members of each of the three physician-led teams include a physician assistant, two MAs, a licensed practical nurse and a social worker. These three teams tap into the expertise of the consulting psychiatrist, as well as a pharmacist, nutritionist and nurse care manager, who are all on staff.
The STEPS Forward module also addresses questions such as whether behavioralists can be shared among multiple physician-led teams in a practice and recommends lifestyle-counseling training resources. The module may be completed for continuing medical education credit. The AMA’s STEPS Forward collection features 43 practice-improvement modules. Several come thanks to a grant from, and in collaboration with, the Transforming Clinical Practices Initiative.