Just-in-time Consultation for the Mental Health Surge: Implementation of Behavioral Health Precepting to Reduce Distress and Advance Skills During COVID-19.

Among the many side effects of the COVID-19 pandemic, the exponential rise of mental health distress remains a considerable threat to public health, to wellness among our healthcare professionals, and yet another source of suffering for the patients and families they care for. Pre-pandemic efforts to integrate behavioral health into primary and specialty medical care comprise a critical foundation for responding to this distress as a vital aspect of whole-person/whole-family health; the surge in need, and in distress of our healthcare workforce, demonstrated that those efforts alone would be inadequate. Knowing that we could no longer keep up with referrals or demand, two primary care clinical sites implemented a model of real-time consultation to support its trainees, supervising clinicians, staff, and patients as an augmentation to simple referral for care, particularly when wait times became astronomical. This presentation will focus not only on clinical impact but on the professional development and perspectives of resident learners, behavioral health staff and trainees, and faculty in these academic medicine practices.

Two clinical sites serving primarily underserved and marginalized patients implemented “office hours” with the design to field just-in-time referral questions, respond to requests to help with linking patients to community mental health and well-being resources, and to help with management of patient crisis. We collected baseline data at one site describing provider satisfaction with behavioral health integration at the outset of implementation and repeated the satisfaction measure 6m after beginning. Each site utilized the same basic structure for “office hours” with one site offering the service for 5 half days/week and the other offering the service for 9. Each site tracked consult volume per half day, provider type/role, primary and secondary reasons for consult, time spent on consult, disposition, presence of crisis, and whether the BH team member had direct contact with the patient. Consultations were provided in person as well as telehealth. Feedback from learners and faculty was collected and utilized to refine the model of consultation and promote collaboration.

Preliminary data demonstrate feasibility and promising results of implementing this intervention both for clinical care and for optimizing learning. The majority of consultations were from resident physicians, were related to traditional mental health concerns and overall consultations were brief in duration. Since the inception of office we have seen not only a reduction in average monthly behavioral health referrals but also an increase in consultation frequency which enhances just in time learning. Feedback from learners across sites was uniformly positive; areas for refinement were identified by learners and staff, alike.

After attending this session, participants will be able to:
• Consider the impact of real-time BH consultation to enhance clinical care and enhance interprofessional education and learning
• Identify key components for real-time consultation with an eye toward implementation in other sites
• Discern specific milestones for learners in health professions that can be achieved using this model