Hogg Foundation for Mental Health

Integrated Health Care Grantee Spotlight: Peoples Community Clinic

June 1, 2007

When People's Community Clinic Executive Director Regina Rogoff was first hired in 2003, she took the clinic's doctors away from their Austin office to get acquainted.

"I asked them to tell me the one thing they needed that would make the biggest impact on their day-to-day work," said Rogoff. "Help handling their patients' mental health problems was at the top of their list."

So, when the Hogg Foundation for Mental Health launched its Integrated Health Care Initiative in 2005, Rogoff jumped at an opportunity to address her staff's needs.

In April 2006, the Hogg Foundation awarded the Austin clinic $275,255 over three years to implement collaborative care, an evidence-based model for detecting and treating mental health problems in primary care settings. The foundation's support includes extensive technical assistance and funding to cover key staff and supplies. People's leveraged the Hogg Foundation grant to secure additional funds from St. David's Community Health Foundation in Austin, which is paying for patients' psychiatric medications.

Now, one year into the program, People's primary care providers are getting the help they wanted.

Close to 100 patients have been enrolled in the program, and about 30 have already successfully "graduated." Although the program is still young, People's has already achieved a treatment success rate typically seen in carefully controlled clinical trials.

At the heart of People's flourishing collaborative care program is the Integrated Behavioral Health (IBH) Program team.

Social worker Megan Barnes Zesati is the clinic's care manager and linchpin of the People's team. Trained at The University of Texas at Austin, Ms. Zesati is an experienced licensed clinical social worker, who previously worked in health clinics in Mexico and California.

In her role as care manager, she educates patients about their mental health diagnoses and prescribed care and tracks their response to treatment. Zesati also provides short-term psychotherapy to a portion of her patients.

"Patients say they feel cared for," says Zesati. She calls them on a weekly basis during the first month of starting a new medication and follows up with them regularly as their treatment continues. Zesati makes sure her patients do not "fall through the cracks." They know she is available to them and can call her for support.

Zesati is aided by Dr. Rick March, an Austin Travis County Mental Health Mental Retardation Center psychiatrist who supervises Zesati and provides consultation to the team. March meets weekly with Zesati to review her caseload and to make recommendations for patients not responding to treatment. Sometimes he sees a particularly challenging patient to clarify a diagnosis or treatment plan. He is also available to People's providers who have questions about their patients' care.

Social worker Jodi Harris helps Zesati with patient assessments and serves as care manager for a small caseload of less severely ill patients. She also sees some patients for counseling.

Director of Social Services Robin Rosell and physician Richard Peavey provide the behind-the-scenes support that allows the team to function so well. Rosell works closely with Zesati and Harris, coordinating the interaction between the clinic's medical staff and the program team. Peavey has played a critical role in building investment in the program among the clinic's numerous providers.

The IBH Program has had a big impact in treating the "whole" patient at the clinic. Like most busy primary care clinics, People's has struggled to address patients' mental health needs while managing their multiple health problems all within the typical 7-minute doctor's appointment.

"With the IBH Program, patient's have the opportunity to talk with a mental health professional about their issue, get more feedback about options for treatment, and, when therapy is initiated, have someone to more closely monitor their progress," says Peavey. "The backup provision of psychiatric evaluation for more difficult cases is also enormously helpful."

All of this makes the care for the patient more comprehensive and more human. "It's a relief for the practitioner to know that the patient has someone checking in with them and who can sound the alert if there's a problem," said Peavey.

Rosell says the technical assistance provided by the Hogg Foundation has been particularly important in their success to date. The technical assistance includes a web-based patient database that the team uses to track patients enrolled in the program. It also includes expert training and consultation from a group of University of Washington psychiatrists who originated the collaborative care model.

In September 2006, University of Washington psychiatry faculty provided People's and the other Hogg Foundation grantees with initial training in the model. Since then, the grantees have had regular consultation with the faculty. Dr. Wayne Katon, one of the founders of collaborative care, has been among the consultants working closely with the People's team. He and his UW colleagues have been impressed by People's progress, calling them a "model program" in collaborative care.

Rosell cites their patients' positive outcomes as one sign of the program's success to date, but sees the program's impact manifested in other ways.

"The providers are paying more attention to mental health issues now," says Rosell. "Not only are they more comfortable prescribing psychiatric medications, they are more comfortable prescribing those medications at the necessary levels."

"The need for mental health expertise has long been recognized at the clinic," says Rosell, who has worked at People's for over 10 years. "The program has supported the primary care providers in dealing with mental health issues and created true integrated health care."

As the People's team looks to Year 2 of the program, their main concern is finding ways to manage the high demand for mental health services. They are looking at creative ways to see more patients, such as using social work interns and group approaches to treatment. They are also investigating community partnerships, like their current arrangement with Jewish Family Services that can increase the treatment options available to their patients.

Founded in 1970 by a group of volunteer doctors and nurses, People's Community Clinic is Austin's only independent clinic offering comprehensive health and wellness care to improve the health of uninsured or underinsured Central Texas families.