Magazine article Behavioral Healthcare Executive

Screening Is a Two-Way Street: SSTAR Drives Screening for Primary and Behavioral Health Concerns at Home and throughout the Community

Magazine article Behavioral Healthcare Executive

Screening Is a Two-Way Street: SSTAR Drives Screening for Primary and Behavioral Health Concerns at Home and throughout the Community

Article excerpt

Stanley Street Treatment and Resources (SSTAR) in Fall River, Mass., has been ahead of the curve since its founding in 1977. As the first agency in the state to provide alcohol and drug treatment in the same place, integrating services was a core component of its mission, and continues to be today.

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"In the 1980s, I was in Washington and heard Benny Primm [of SAMHSA] talking about holistic care," says Nancy Paull, CEO of SSTAR. "It just resonated with me, and it's been my mission ever since."

The 1980s brought integration of a different sort--specifically, the integration of addiction and mental health services--but it laid the foundation for SSTAR's future. With the integration of mental health and substance use care, SSTAR also found itself developing services to meet the influx of patients needing HIV/AIDS treatment, from counseling to testing. Without SSTAR's services, HIV/AIDS patients in the community would have to travel to Boston or Providence for treatment.

"Our medical director was saying people should be able to get this kind of care in their own community," Paull says. "So we decided to open up a primary healthcare clinic."

A bumpy road to one-stop healthcare

Development of the SSTAR primary care clinic--which started off as just two renovated exam rooms onsite at its treatment facility--began in 1990 and got off the ground in 1993. And although there were more than enough patients to justify its services, the clinic lost more than $250,000 in its first year.

"Right around that time, a recession hit and a lot of people started coming in," Paull says. "Not just people who didn't have addictions, but a lot of people who had lost their healthcare."

Even with just one nurse and one physician on staff, the primary care clinic drained SSTAR's capital reserves, putting Paull's vision of a one-stop shop for complete healthcare in danger of extinction.

But after SSTAR reached out to the Massachusetts League of Community Health Centers for guidance, the future of its integrated services became clear: It would have to achieve federally qualified health center (FQHC) status to stay afloat.

After it became a FQHC, increased Medicaid rates supported SSTAR's expanded services. The primary care clinic has since grown to successfully serve 6,000 patients per year.

New services, new challenges

Because every patient that accesses SSTAR's primary care services is screened for behavioral health disorders, the facility seeks physicians with certain qualities for their FQHC staff. Namely, these physicians must have some interest in behavioral health, but not necessarily experience.

"We get a lot of new physicians that we can help train," Paull says. "We kind of like that." SSTAR also looks for physicians who "are willing to grow and change" along with its evolving services.

To ensure that primary care physicians are equipped to screen and treat patients with behavioral health disorders, SSTAR requires that each becomes Suboxone waivered to treat opiate addiction and completes detox rounds as part of their on-call schedule.

The screening and cross-referral from one service line to the next should ensure comprehensive care for SSTAR's patients. But, Paull says, there are some big problems that still stand in the way.

"The biggest problem we have around behavioral healthcare is the lack of psychiatric time," she says. …

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