BHL Concept as Applied to the VISN

There are 3 key elements of the BHL highlighted in the figure below.

• Case identification – This builds off of existing screening and the ability to use casefinding for “new antidepressant” use. Given the emphasis on integrated care, those patients already engaged in MH/SA specialty services are referred back to their primary MH/SA team. We have existing software to modify the clinical reminders and casefinders to complete this step.
• Initial assessment and early intervention – Patients identified in step 1 are referred to a regional coordinating center. All referred patients are called and assessed using a structured interview. This interview process would identify 4 basic groups of patients:
• Subsyndromal patients (those not meeting diagnostic criteria). For depression cases, patients are monitored weekly for 8 weeks (watchful waiting) to determine the need for further care. Alcohol patients receive a structured brief alcohol intervention with a follow-up at 3 months.
• Newly treated cases of depression. These patients would enroll in a monitoring program to be assessed at 2, 6, and 9 weeks. Those responding receive no further care. Those not responding are referred on to disease management.
• “Routine Cases.” These patients would enroll in a local disease management program with a Behavioral Health Specialist (BHS), who would help the Primary Care Provider manage the patient. This is algorithm based, and includes psychoeducation and motivational/problem solving techniques.
• Complex case. Those with possible psychosis, drug addiction, mania, etc are referred to specialty care, with the BHS providing a link and motivational follow-up to enhance engagement.
• Disease management and referral management delivered locally with regional support and supervision.

Psychoeducation is incorporated at each point with letters and materials sent to patients. Structured reports are placed on the clinical chart after each component.

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