Reducing Health Disparities
through Integrated Behavioral
Health: A Model for Training
Cambre Horne-Brooks
Kim Shuler
Ana J. Bridges
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
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Percent Growth in Hispanic Population
Between 2000 and 2005
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
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
Health “fair/poor”
Mental health “fair/poor”
Rarely/never receive
social/emotional support
Dissatisfied with life
Diabetic
Cigarette smoker
Binge drinker
(5+ drinks per occasion)
Physically inactive
Uninsured
% <$20,000
40%
56%
% >50,000
5%
34%
9%
8%
10%
16%
1%
1%
3%
12%
40%
38%
40%
21%
13%
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 = 3rd 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
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