Guidance Clinic’s Award Winning Program Gets Results

Special to Larson Newspaper

When the Verde Valley Guidance Clinic implemented its new primary care integration program last year, there was plenty of hope for good outcomes.  Making primary medical care available, convenient, and easy to access for the Clinic’s seriously mentally ill consumers was the obvious first goal.  Improving the overall health of this population in response to a growing realization that persons with serious mental illness suffered a higher incidence of hypertension, diabetes, and other preventable diseases was the primary objective.  Helping people live longer, healthier lives motivated the Clinic’s investment in a new 14,000 square foot building designed specifically to integrate primary medical care with psychiatry.  Improving self esteem wasn’t high on the list of expected outcomes.

But that is exactly what has happened in many cases according to the Clinic’s Medical Director, Dr. Francis Gagliardi.

“It’s good to see that their response to good medical care actually improves self esteem, said Gagliardi. They are starting to take more pride in themselves, feeling they have more control over their health, and engaging in exercise, diet and following medical advice more closely.”

Dr. Gagliardi says the most rewarding piece of the integration program is seeing patients who are finally getting good medical care respond both physically and psychologically.

“Sometimes our patients felt their medical issues weren’t being heard, that they were treated as second class citizens, and that providers thought their physical illnesses were all in their head.  Some, who have been afraid to go to the doctor, now see that their conditions are treatable and they are relieved of the stress and worry about the unknown.”

Family Nurse Practitioner Jessie Peters, who staffs the primary care facility two days a week says it is exciting and fulfilling to see a population that hasn’t had a lot of primary care, and eye opening to see the range of etiology presented.  Like Dr. Gagliardi, she says that patients are surprised and relieved to find that problems can be identified and treated quickly, with noticeable results.  She says that many of the patients she sees haven’t had a physical exam in decades, and that diagnostic testing and treatment are making a big difference in patient health.

Both Dr. Gagliardi and Ms. Peters said coordination of care is greatly improved by the integration program, and that Verde Valley Guidance Clinic staff has been very supportive in making sure consumers are aware of the services available and facilitating access by helping with scheduling, transportation and follow-up.

The Verde Valley Guidance Clinic’s primary care integration program is the result of years of planning and collaboration.  The Clinic’s Board of Directors authorized the project.  The City of Cottonwood’s Industrial Development Authority helped with low interest funding through the Clinic’s banking partners.  BFL Healthcare Inc., under the leadership of Dr. Scott Bingham, contracts to staff the primary care clinic.  NARBHA funded the furnishings for the building.  The Guidance Center of Flagstaff provides pharmacy services.  Even the architects and the contractor took special interest in creating a building uniquely suited to the task at hand.

Before a shovelful of dirt was turned, Verde Valley Guidance Clinic C.E.O Robert Cartia spent months researching integration projects around the country.  Taking the best ideas from existing programs and adapting them to local needs, a plan was adopted that offers patient centered one-stop healthcare for persons with serious mental illness.

Co-location was a key to the Verde Valley Guidance Clinic plan.  Rather than taking behavioral health professionals to the primary care setting or trying to coordinate services among separately located providers, the Verde plan was to provide psychiatric services, primary care, and pharmacy service all under one roof on the same campus where clients come for case management, group therapy, and other Clinic services. The primary care facility consists of a doctor’s office, three examination rooms, a triage room, and a blood draw room.  The building was named after the late Ike Olsen, a long time local supporter of community behavioral health care and the Verde Valley Guidance Clinic in particular.

At the building’s dedication last August, keynote speaker Laura Galbraith, Director of Policy and Advocacy for the National Council for Community Behavioral Healthcare, described the Verde Valley program as being on the cutting edge of innovative integration programs around the country.  This August, the facility attracted a visit from Linda Rosenberg, President and CEO of the National Council and one of the nation’s leading mental health experts.

Over one hundred and forty consumers have now enrolled in the program, which recently expanded to cover the General Mental Health and Substance Abuse population in addition to Title 19 SMI consumers.

While Dr. Gagliardi’s anecdotal reports of physical and psychological improvement in the condition of participating consumers is encouraging, scientific study will indicate the program’s effectiveness over time.  The Clinic has contracted with Dr. Tom Destefano of Northern Arizona University to conduct a study of the long term impact on patient health.  The program also has a teaching component, hosting an intern from the Doctor of Behavioral Health Degree Program at Arizona State University.

Looking forward, CEO Cartia believes that the Verde Valley Guidance Clinic’s integration program may put the Clinic out in front of the changes expected to result from the recent health care reform legislation.  As the “medical home” model is adopted in all phases of health care, behavioral health providers have an opportunity to adopt a best practice in their own field which can inform the national transition.

Integration, as adopted by the Verde Valley Guidance Clinic, provides a brighter future for consumers and a satisfying degree of success for those who provide their care, both behavioral and physical.