Patients experience primary care firsthand, offering valuable insights into the accessibility, scope, coordination, and continuity of services. Their feedback can help identify gaps, refine innovations, and ensure that enhancements truly improve patient-centered care. By integrating patient perspectives, healthcare systems can more effectively tailor and assess improvements in the 4Cs, leading to more responsive, efficient, and effective primary care delivery.

I am sharing a few excerpts from a family interview I conducted a few years ago that illustrates how integrated behavioral health enhances the four primary care functions. These excerpts also emphasize the interconnection between those functions and the role of integrated care in removing the stigma associated with mental health and strengthening the patient-provider relationship.

The interview, which featured a mother and her 8-year-old daughter’s experience with the care received at Pediatric Care Associates in Springfield, Mass, provided a unique and valuable perspective. Jamie Devine, DSW, is this practice’s integrated behavioral health clinician. The value of her role is consistently highlighted throughout the interview, as it is the trust in all their providers. I have permission from Mom to share this interview, but her and her daughter’s names are withheld for privacy and confidentiality purposes.

1. First Contact (Accessible, timely use of healthcare services and removal of stigma)

“I feel like every doctor’s office should have their own mental health provider in their office. I think it’s so convenient, especially to have the provider just come in. Let’s say Jamie didn’t meet the patient, but it was just more of a check-in. They have that individual there that can provide those services and then potentially have them, you know if they need to get services. So, I think it’s amazing.”

“I know that there is a generation before me that is against therapy and has negative stigmas attached to it. And I think that now having the provider in the office that can help maybe eliminate some of that negative stigma and have it in a comfortable environment makes the transition easy. And so it’s like, if you were against it, well, let me introduce you to our mental health provider while we’re doing your physical, just so you’re aware. Or if there’s a concern today, ‘Hey, let me introduce you,’ so a therapeutic relationship can start right off. And they don’t even realize what we’re doing is trying to strengthen that. Now, you may have a session starting soon. So, I think it’s definitely a benefit to have that.”

Child’s Perspective:

• “Do you think it’s easier to come to the doctor because we have Jamie, or do you think it’s harder?”
• “Easier because whenever I see Jamie, she makes me smile. Sometimes we make fidgets. Sometimes she makes special treats. Because whenever I see her, she, um, tells me to do stuff to get my anxiety out, so when I see her, I just think of what she tells me to do.”

2. Comprehensiveness (Broad range of services including mental health care)

“Being able to go to the doctor and them giving me the opportunity to ask questions before meeting Jamie and them already having that background information was beneficial to me.”

“And it’s more, as you say, the collaborative effort. So, any concerns that I may have that are mental health but may also be medical, they were able to piggyback. Last week there were some concerns. We were able to meet with Jamie. Then right after the doctor was already aware and then the doctor was able to provide their part of the appointment. It wasn’t like now we have to wait another 4 weeks before we can do this.”

“It’s just a lot more comfortable in this setting. If there’s any concerns, you can go right to your provider, and you don’t have to feel like no one’s on your side.”

“Jamie pops into different appointments. Especially if the children are crying or maybe in distrust or whatever it may be, so she’s able to provide a service and calm them down. Not saying the doctors don’t know how, but you know, mental health providers have a different set of skills that are able to help the children.”

“I think just the type of provider she is and having been put in this atmosphere and then that communication, that relationship… I think it’s amazing.”

3. Coordination (Ensuring integration between medical and mental health services)

“I think in Jamie’s role, again, it’s awesome because a lot of the times as a provider, we rely on information that’s given to us by the patient. Being able to collaborate with the provider, you have more information. So now you may necessarily not be able to bring it up, but you can kind of fact-check or kind of ask questions in regard to that that may allude to it and maybe prompt the parent or the child to bring up some information.”

“So, I think, especially from the historical part of it, it provides more of a background and allows the providers such as Jamie to have even more information to be able to help out.”

“That’s definitely a bonus and also for the mental health provider and the doctor to communicate and come up with an even stronger treatment plan and kind of throw ideas out of what they may have seen or different behaviors in different settings.”

4. Continuity (Long-term patient-provider relationships fostering trust and better care)

“Because the provider knows how I am and knows what my concerns are due to us being with them for eight years already. They’re like, ‘no, mom, you will be okay.’ So, they knew that this would be a fit.”

“One of the things I must say is that my daughter definitely looks forward to coming to the doctor. Jamie has been a major part of her life.”

“She’s introduced by her doctor, so it’s a lot more comfortable. There are just many factors that I thought were way more convenient than I’ve seen in the past. If there was a concern about medication, I could speak right to her doctor. So, it’s just the timing and the comfortability because now my daughter doesn’t have to meet a whole other stranger.”

“There isn’t like that battle or the doctor is not listening to her, or she’s not listening to the doctor. You can tell that the communication is very fluid here, which makes it a lot easier. If I have a concern, I can go to her, or if I go to the doctor, I know that it’s going to get to Jamie.”

“I personally love Jamie. I told Jamie she’s never allowed to leave. And I know I can’t keep her forever and ever. Eventually, everyone has to grow, but I think it’s definitely a benefit to have a mental health provider in the doctor’s office.”

Thank you Note

I thank this family for their generosity, and I’m humbled by the valuable insights they shared during this interview. Their perspectives have the power to inspire and motivate others to gather patient and family insights, thereby enhancing integrated care. I also want to thank the Pediatric Care Associates team (Magdalena Czerkawska, MD, FAAP, Beata Tyminska-Paluchowska, MD, FAAP, and Sarah Osgood, CPNP, and Jamie Devine, DSW, LICSW) for introducing me to this family and allowing me to showcase the value of their work. I could not be prouder to collaborate with this team.

References

Jimenez, G., Matchar, D., Koh, G. C. H., Tyagi, S., van der Kleij, R. M. J. J., Chavannes, N. H., & Car, J. (2021). Revisiting the four core functions (4Cs) of primary care: Operational definitions and complexities. Primary Health Care Research & Development, 22, e68, 1–9. https://doi.org/10.1017/S146342362100066