An Inside Look at Integrated Health Care: A Conversation With Henry Salas

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This post was co-authored with Ike Evans, public affairs specialist.

The Hogg Foundation for Mental Health is proud of the work that is being undertaken by its integrated health care grantees. The challenges of integrating physical and behavioral health care, doing so in a culturally competent manner, and constructing models of service delivery that can thrive in the most underserved areas, are present unique opportunities for testing and advancing innovation. For this reason, the strenuous efforts of our grantees should be praised and celebrated. 

In this Q&A, we talk to Henry Salas, chief executive officer of Community Health Centers of South Central Texas, a Federally-Qualified Health Center (FQHC) and Hogg grantee, about his organization’s unique partnership with Bluebonnet Trails MHMR, a Local Mental Health Authority.

Hogg: You’re in an area of South Central Texas that has a large concentration of Latinos. How is delivering integrated health care to this population different from treatment as usual?

Salas: You’ve got to understand the cultural health beliefs and practices that your community has, because the biggest issue that you run into is that they don’t want to come for care unless there’s pain involved, or unless they’re feeling completely sick. So, with hypertension, if there’s no pain involved, there’s no problem; with diabetes, if there’s no pain involved, there’s no problem. You have to inform and educate them, and spend a lot of time in the community talking about physical health conditions, mental health and wellness and prevention to see that it’s important for them to come to the clinic before they feel that way or get really sick.

Hogg: How has your relationship with Hogg helped you to refine your own understanding of what you’re doing?

Salas: I’ll tell you what was real significant that funding from the Hogg Foundation helped us do: When we first started integrating our services, and we started receiving patients from the local mental health authority, we would see them the first time, sometimes the second time, and then we would lose them. We’d find them again when they got into crisis, because they weren’t being followed. The grant that we submitted to the Hogg Foundation was specifically to help us with those kinds of things, to help us make connections and to have a staff member that would do the critical follow-up to prevent patients from ending up in the jails or the emergency room anymore.

With the Health Care Coordinator, the position that we got funded by Hogg, we were able to make the critical connection or linkage, because we started realizing that at times some of our patients needed more traditional mental health case management, and Bluebonnet Trails, the local mental health authority, was able to follow them and provide them the needed case management services. So, what we discovered is that both our agencies could work together, coordinate services and provide whole health services at the same time; that it wasn’t a matter of Bluebonnet turning them over and then we would provide the care for them. And for those who move into recovery, we are able to provide their whole health needs at our clinic, thus, creating greater capacity for Bluebonnet Trails to serve those who are most in need of mental health services due to the seriousness of their mental health condition.

The Health Care Coordinator also helped us develop stronger partnerships and get involved more closely with the hospital, the school district and the other social service agencies in our community. So, that funding helped transform our clinic to be more responsive to the community, to increase access to care and to provide more consistent and better quality care.

Hogg: What remain some of the most significant challenges that you face in integrated health care?

Salas: One, that there are two languages being spoken: there is the mental health authority language, and there is the FQHC language. We have to constantly educate one other on what certain things mean—an “encounter,” for us, is a “visit” for them. The physical environment, and the way that we build that, is also a challenge. We’ve been working so that nobody feels like, “This is the Bluebonnet Trails waiting area, and this is the Community Health Centers of South Central Texas waiting area”; it’s all one.

Hogg: Can you give an example of a tangible benefit that comes with having an organization like the Hogg Foundation in your corner?

Salas: I’ll give you one specific example. We were struggling to figure out, “How do we tell this story?” The ability to share our journey, our challenges, our successes, and our lessons learned with other provider organizations wanting to become an integrated care delivery system. I was talking to Alejandra Posada (coordinator of Hogg Foundation IHC Learning Communities) and Rick Ybarra (Hogg Foundation program officer), and they connected us to Dr. Toni Watt at Texas State University. Dr. Watt was able to come in and help us with our evaluation efforts and program structure, and we were now able to identify different stages toward developing this integrated model.

We have two organizations with similar missions that are trying to work as one to serve the community. We don’t have control over Bluebonnet’s staff, and Bluebonnet doesn’t have control over our staff. However, because we’re working together, it’s not a matter of control, but it’s a matter of collaboration.  We weren’t able to put that into words, and the Hogg Foundation helped us by getting us connected to Dr. Watt. She helped put that structure together, and also identified that in some areas, we may be reaching too far, and that we needed to regroup and in some cases scale back some of these efforts and think about how we were going to do them a little bit differently.

Hogg: In closing, what sort of feedback are you getting from the community that’s indicating to you that you’re on the right track?

We gave a presentation to all the other Hogg-funded centers, and at that presentation we had speakers representing medical providers, mental health providers, and the school district. All of them were able to give input about what they were hearing out in the community; they’re members of the community. Also, our patients don’t see the difference anymore between going to the receptionist that’s being paid by Bluebonnet Trails and the receptionist that’s paid by us. They just walk up and get taken care of. These are things we didn’t have before. Because of the Health Care Coordinator position, and the support of the Hogg Foundation, we’re now able to implement things that we could only imagine before.

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