Grantee Profile: Tahoe Forest Health System 

The Georgia Health Policy Center recently spoke to Eileen Knudson, R.N., director of behavioral health at Tahoe Forest Hospital about their efforts to increase early identification of mental health needs and access to behavioral health services through integration of behavioral health into primary care clinics. 

To date, what has been the biggest accomplishment or an early win in your program?  

I think an important aspect was the solid collaboration we had with the primary care team clinics, and that has made a remarkable difference. Also, hiring the behavioral health intensivist has enabled us to provide follow-up care with positive medical provider feedback.  

This has improved access to the behavioral health professionals. When we did community health needs assessments in 2011, 2014, and 2017, they all depicted the same thing — that we had very minimal access to mental health care in our community. This program really helped address some of those gaps and barriers and laid the groundwork to expand the behavioral health program. This grant provides a solid foundation to help demonstrate the need and the impact to the community.  

What is a tip you would share with an organization launching a similar behavioral health integration program?  

When we hired the behavioral health intensivist, we had her shadow each medical provider to develop trust and a strong referral relationship. This proved to be a real positive. Building consensus and workflow processes take a lot longer than you actually think they will, especially during COVID-19, but this helped. 

During the pandemic major problems have arisen in behavioral health, with exacerbation of symptoms for both mental health and substance use disorders. I think it is really important to keep the education and training going. It is not just a one-time thing. There will always be new people and the environment has changed with physicians learning to move from face-to-face patient visits to telephone and video conferencing. So, given all that was going on, some of the initial education that we started with in this program may have been overshadowed, as it was not at the top of physicians’ priority list. So, it is necessary to reinforce with ongoing staff education and training, and it is important to set aside these resources prior to launching the program. Having a respected, provider champion to help launch the project is also important.  

How does your Federal Office of Rural Health Policy Health Services program fit into your broader health improvement efforts? 

The findings of our community needs assessments support the expansion of the behavioral health program. So, we started with a few clinicians — a clinical psychologist and a nurse practitioner — both working in the medication assisted treatment program, but this grant made a huge leap into the mental health program, adding the behavioral health intensivist that is integrated into primary care. And, with mental health in the limelight, as far as disparities and tackling health equity, I think we are poised to make a difference for our community because we have already have workflow process that address those issues. 

What will your organization be doing more of or differently to emerge stronger from the pandemic? 

I think addressing disparities and health equity is easier now, since these issues in the news. COVID-19 had the unintentional effect of helping us strengthen community partnerships. Before the pandemic, we met quarterly with the directors of the various community programs, but since COVID-19 hit, we started meeting almost weekly or every two weeks and the directors are developing a whole-person community health plan so that we can address all of these issues, particularly, around behavioral health. Our behavioral health intensivist saw a 200% increase in her referrals after COVID started. The pandemic also helped improve telehealth visits by helping to gain trust with our patients to feel more comfortable. We have much fewer no-shows since COVID-19. I think a lot of it has to do with people’s other barriers, such as transport and time restraints with the childcare. So, I think telehealth has had markedly better receptive reception and our whole team has been really satisfied utilizing the telehealth programming. 

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