Tulsa Fellow Jim Scholl enjoys seeing his patients cry. In fact, he says, tears are the most rewarding part of his project integrating behavioral health and primary care services at True Blue Neighbors Behavioral Health Clinic and Community Health Connection, Inc. in Tulsa’s Kendall-Whittier neighborhood.
Scholl, a clinical psychology doctoral student at the University of Tulsa, isn’t deliberately trying to upset his patients. It’s just that most of them are unaccustomed to being offered an opportunity to discuss their mental health symptoms at a doctor’s office.
“The vast majority of individuals suffering from mental health symptoms and disorders never have their symptoms addressed, even though these symptoms are often present during primary care visits,” Scholl says.
“When someone makes an appointment with a psychologist, it’s intentional,” he adds. “They have thought about it, they most likely have the desire to change, and they have an idea of what they’re getting into. They’re not expecting to discuss their mental health in primary care, which I presume is why about 50 percent of the patients I see cry during our first meeting. In this context, answering a simple question like, ‘What do you do to take care of yourself emotionally?’ can be overwhelming once someone starts to unpack their emotions. They often tell me, “‘No one has ever asked me that before.’”
In an attempt to alleviate the disjointed connection between medical and psychological care, the project applies an interdisciplinary, integrated approach to care focused on patient outcomes. This is accomplished by directly embedding behavioral health providers in primary care, meeting regularly with the providers to discuss patient progress, and troubleshooting different approaches to treatment when there is apparent resistance. Information is shared between the primary care clinic (Community Health Connection) and a neighboring behavioral health clinic (True Blue Neighbors Behavioral Health Clinic) to ensure a coordinated approach to treatment. And training is being provided to primary care providers on the utility of behavioral health providers in primary care, and how to best identify and treat psychological disorders.
Scholl’s project grew out of a discussion he had in 2015 with University of Tulsa President Dr. Gerry Clancy, who was then president of the University of Oklahoma-Tulsa and a presenter for OU’s Community Medicine Summer Institute, in which Scholl was a participant. Seated together during a bus tour of Tulsa to explore the visual cues of health disparities, they struck up a conversation about Scholl’s research interest in traumatic stress. They debated the efficacy of using antidepressants to treat PTSD, given the small, weak evidence base. As Scholl recalls, Clancy observed that the question was just one of the many reasons that psychologists were needed in primary care. Clancy’s remark resonated with Scholl, who already had experience as a research assistant in a primary care setting and had long been interested in taking an interdisciplinary approach to his research. But it wasn’t until he heard Clancy, who also founded ASF’s Tulsa chapter in 2015, talk about the need for psychological care in a primary healthcare setting, that Scholl considered building it into his training as a clinician in graduate school.
Scholl applied for a Schweitzer Fellowship in order to address the need in Tulsa to incorporate psychological care into primary healthcare settings. “After learning more about the Fellowship, I knew that this project could become a reality with the backing of ASF, my academic mentors, and the larger institutions involved,” says Scholl. “Eight months into the Fellowship year this has held true. While the project evolves on a daily basis, it all started on that fortuitous bus ride almost two years ago.”
With concerns that sustaining his project will require financial investment, Scholl is creating a marketing plan in addition to documenting evidence of the program’s efficacy. “The potential for success and positive patient health outcomes is tremendous,” says Scholl. “The team at my site has already met with a number of community partners, informing them of our efforts, successes, and goals for the future. Once the integrated model is up and running it can essentially be self-sustaining.”
Scholl adds that he was pleasantly surprised to meet so many like-minded people through the Fellowship “We share a belief that it is time to rethink how the United States delivers health care. The emphasis needs to be on patient care not financial outcomes. We represent a generation that believes all persons are entitled to benefit from the contributions of health care, and deserve equal quality in the processes, procedures and service.”
“Being a Schweitzer Fellow means being an agent of change,” Scholl says. “This project has allowed me to customize my graduate education. I have had unique opportunities that have ultimately shaped my interests and career goals. Being a Schweitzer Fellow means being part of a community that shares my ideals and inspires me to work harder.”