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

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

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

Between 2000 and 2005

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

% Yes Four County Needs Assessment, 2004

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

Community Needs Mental health is worse for NW Arkansas residents living in poverty Illness/Health Concern% 50,000 Health “fair/poor”40%5% Mental health “fair/poor”56%34% Rarely/never receive social/emotional support9%1% Dissatisfied with life8%1% Diabetic10%3% Cigarette smoker16%12% Binge drinker (5+ drinks per occasion)40%21% Physically inactive38%13% Uninsured40%5%

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

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 = 3 rd most common reason for PCP visit PCPs not well trained to recognize mental health problems Only 20% of MDD patients correctly diagnosed

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

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

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

Training Components Coursework, language immersion, seminars Outreach Clinical training Research