Reno, NV
In 2015, Northern Nevada HOPES, a community health center in Reno, NV, integrated behavioral health into their HIV medical care model to improve care for their patients with HIV. If a patient reports a mental health or substance use concern to a medical provider or screens positive through a mental health or substance use assessment, a co-located behavioral health provider joins the medical provider and patient in the exam room for a triage assessment and next steps. In Nevada, a state where there are significant shortages of behavioral health providers and long wait times for care, patients with HIV at Northern Nevada HOPES have immediate access to behavioral health services.
Untreated or poorly managed mental health and substance use disorders detrimentally affect quality of life for people with HIV. They also lower a person’s capacity to engage with and stay in HIV care, adhere to antiretroviral therapy (ART), and reach and maintain viral suppression. By integrating behavioral health into HIV medical care, patients can access services sooner with more streamlined communication among providers. With a provider shortage in Nevada, Northern Nevada HOPES has created direct access to behavioral health care for patients when they are already in the clinic for their HIV appointments.
“Our aim is for our patients to be able to come to HOPES as their primary medical home and receive all the services and support they need in one place.”
Northern Nevada HOPES co-locates behavioral health providers in their medical clinics, so that patients have immediate access to behavioral health care during clinic visits.
At every HIV medical visit, medical providers conduct mental health and substance use screening using standardized tools: the Patient Health Questionnaire-2 (PHQ2), the Alcohol Use Disorders Identification Test (AUDIT), and the Drug Abuse Screening Test (DAST-10).
If a patient screens positive during standardized assessments or they report a mental health or substance use concern to their medical provider during an HIV appointment, a behavioral health provider will join the patient and medical provider in the exam room for a triage assessment and to determine next steps for the patient. This can include short-term therapy with the behavioral health provider in the clinic (up to 12 sessions), intensive outpatient program, medication-assisted treatment, or crisis intervention and referral to inpatient psychiatric services in more acute cases.
In 2022, 198 patients with HIV accessed behavioral health services, for a total of 1,049 behavioral health visits during the year.
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Source: Verbal communication with Northern Nevada HOPES
Staffing. Initially starting with one provider, the behavioral health integration team has grown to include seven behavioral health care providers across the three Northern Nevada HOPES locations. One provider splits their time (50%/50%) seeing patients and providing administrative support to the program.
Training. All integrated staff train at the Integrated Care Training Academy, within Cherokee Health Systems. All new behavioral health integration staff shadow experienced providers, review all integrated care workflows, and refer to training materials from Cherokee Health.
Collaboration with the medical team. The behavioral health integration team and medical provider team meet once a month to discuss workflow updates and problem-solve any challenges. The behavioral health integration team leader attends medical and case management team meetings to update staff on any workflow changes and to answer questions.
All behavioral health providers’ salaries are funded through billing third party payers, Ryan White HIV/AIDS Program funding, and FQHC funding. As noted above, the program has grown and as of 2024, it currently has seven behavioral health care providers across the three Northern Nevada HOPES locations.
- Most behavioral health providers are not trained on integrated care models, and therefore, required this type of training once hired.
- Ongoing communication between the medical, case management, and behavioral health staff who are part of the integrated team, ensures that everyone is up to date with the behavioral health integration workflows.