Case Study 3

Integrated Behavioral Health Cultural Competency and Systems of Care Case Study Ana Carter is a 44-year-old African American woman who lives in a small rural town in North Carolina. She works part-time and cares for her two teenage sons and her elderly mother, who has early-stage dementia. Ana has a long-standing relationship with the local community health center, which recently transitioned to an integrated behavioral health (IBH) model that includes a nurse practitioner (NP), a behavioral health consultant (BHC a licensed clinical social worker), and an occupational therapist (OT) who supports patients experiencing functional barriers related to health, stress, and daily routines. During a routine primary care visit for persistent fatigue, tension headaches, and trouble sleeping, Ana briefly mentioned feeling worn down and not herself. The NP told her that her symptoms might be related to stress or depression and said shed like Ana to talk to someone real quick before leaving. Without much explanation, the NP walked Ana down the hall and introduced her to the BHC. Ana met with the BHC for about 15 minutes. The BHC asked about her mood, energy, and stress, and introduced a simple breathing technique. Ana was polite but reserved. She nodded during the session but gave short answers. No written information or explanation about behavioral health services was provided, and Ana was not asked whether she wanted to meet with the BHC or given a chance to ask questions. At checkout, the medical assistant briefly mentioned that Ana might also meet with OT next time to help with routines and stress. Ana did not understand what that meant and did not ask for clarification. Later that week, Ana called the clinic to ask if she was now in counseling, whether it would affect her medical record, and what occupational therapy for stress meant. She said she wasnt sure what that visit was for and felt uncomfortable not knowing what was happening. She also said she didnt want anyone thinking she was crazy or being sent for mental health without her agreeing to it. The idea of seeing another provider felt overwhelming when she was already stretched thin caring for her family. After hearing this feedback, the NP, BHC, and OT reflected on their assumptions and workflow. They realized they had not clearly explained what integrated behavioral health is, what each team members role involves, or that Ana had a choice in whether to participate. They also recognized that the language they used – talk to someone, meet with OT for stress – assumed familiarity with healthcare systems and professional roles that many patients do not have. The team developed: 1. A short verbal script in plain, welcoming language explaining IBH 2. A one-page handout describing the roles of the NP, BHC, and OT 3. A new workflow step that explicitly asks patients whether they would like to meet with any IBH team member Ana was contacted and invited to return for a follow-up visit. At that visit: * The NP explained that IBH means having a small team in one place to help with stress, health, and daily life. * The BHC clarified that behavioral health visits are optional and focused on practical support. * The OT explained, My role is to help people figure out how stress and health are affecting their day-to-day life like sleep, energy, routines, and caring for others. Ana asked questions about privacy, time commitment, and whether she had to continue. The team emphasized that she was in control of whether and how she engaged. Ana chose to return for another visit and agreed to meet briefly with both the BHC and OT. Afterward, she said, I appreciate being asked. It helps to know Im not just being told what to do. Submit a narrative addressing the following: 1. What assumptions did the care team make during Anas initial visit? 2. How did the lack of clear explanation and informed choice impact Anas experience and trust? 3. In what ways did the care team demonstrate cultural humility in their response? 4. How might OT, social work, and medical providers work together to support Anas daily functioning, stress, and caregiving responsibilities in culturally responsive ways? hi