Contributions from Postdoctoral Fellows

Through an advanced training program in integrated care, postdoctoral fellows have assisted with the implementation and management of key components of integrative programming.

  • One fellow helped create a referral facilitation and tracking system. The behavioral health team uses the system to make seamless referrals to a specialty clinic and track, quantify, and subsequently evaluate and improve the success of these referrals.
  • Another fellow helped implement culturally informed interventions for AI/AN children in response to findings from the Ages and Stages Questionnaire, a tool for assessing pediatric development progress. The fellow worked with tribal elders to adapt these interventions to include culturally based activities appropriate for AI/AN children.
  • This year, a new postdoctoral fellow will join the team. He will focus on integrating Indigenous services within the primary clinic, including the use of traditional medicines and ceremonies for health and wellness.

Integration of Traditional Medicine

Made possible under the BH2I program, the IHB primary clinic has incorporated traditional healing options into its services. The team has used BH2I funds to purchase traditional medicines and has plans to establish a smudge/prayer room for patients.

A behavioral health team member shared this story about a patient at a local inpatient treatment program who was in early recovery for a substance use disorder.

“I was asked to meet with this patient due to his increased anxiety and thoughts of wanting to leave treatment. When I met with him, early into our meeting, he disclosed that he was a survivor of childhood sexual abuse. It seemed as if he just needed to tell someone and get it out, and as soon as he did, he became quite decompensated and was tearful. I focused on grounding him and getting him contained using mindfulness skills, but 10 minutes in, he was still somewhat shaken up. I asked him if he wanted to smudge, and he readily said yes. I was able to connect with our Indigenous services team, and we met outside of the medical clinic and smudged. As we started the process of smudging, it was evident how this settled him. His breathing become more regular, his shoulders relaxed, and he seemed to let go. It has been several weeks since, and he has returned weekly to his medication-assisted treatment appointments and continues to be involved in his inpatient substance abuse treatment.”

Screenings for Social Determinants of Health

The IHB behavioral health team recently hired a care coordinator to focus on conducting regular assessments for patients on unmet needs related to social determinants of health.

Social determinants of health are the conditions and environments within which people live and which affect their health, functioning, and quality-of-life outcomes and risks. Using the PRAPARE assessment tool, the team screens for unmet patient needs. During this screening, the care coordinator asks about and offers traditional medicines. He also helps connect patients with support services, such as by helping them apply for rental assistance.

Increased Provider Availability

The BH2I program has enhanced provider availability. Since other team members can take on certain tasks under the integrated care model, the primary care provider and behavioral health provider have more availability to focus on urgent issues.

A behavioral health team member shared an example of how this capacity for prompt provider responsiveness benefited a patient who visited the vaccine clinic to receive a COVID-19 vaccine.

“It was imperative that the patient be vaccinated as soon as possible due to her severe asthma. The patient’s mom noted that she had taken her daughter to several clinics and [had] not been able to get her daughter vaccinated due to her extreme anxiety/phobia of needles/shots. The 12-year-old wanted to get vaccinated and knew its importance, but when the nurse would approach her, her fear response overwhelms her, and she pulls away and leaves the area. After several minutes of trying, the COVID-19 clinic called Dr. Peri, the behavioral health consultant. Dr. Peri assessed the situation and determined that her anxiety reached the phobic level. Over an hour and a half, Dr. Peri focused on educating the patient, her mother, and the COVID-19 nurse on fear response, exposure techniques to address phobia, and the use of relaxation and grounding. The patient was able to make much gain on her anxiety but was unable to complete the vaccine that day. We tried again in 2 days, and she was given instructions on how to work on the phobia. With home practice, the patient was able to work through her anxiety and was able to get the shot within 45 minutes.”