Sierra Family Medical Clinic a pioneer in mental health services integration
December 13, 2012
Fresh out of his medical residency, 32-year-old physician Peter Van Houten had always envisioned opening a small clinic in a rural community. A graduate of the University of California, San Francisco, School of Medicine, he opted to settle on the San Juan Ridge, and began looking for the perfect clinic location.
The year was 1982.
"I found an old storage shed that had a backhoe in it," Van Houten said with a laugh. "Once I got the backhoe out and refurbished it, I hired a receptionist and opened the doors."
Thinking he might work about two days a week, he was shocked when 10 people showed up on the first day.
“I’m more passionate about this than when I started 30 years ago ... Every day when I go home I realize that someone’s life was changed because we’re here.”
— Dr. Peter Van Houten
"That was the fewest number of patients I've ever seen in one day," he said. "I was stunned by the demand. I never stopped working — by the end of that first month I was exhausted."
With roughly 60 percent of the clinic's patients indigent — many on Medi-Cal or part of the County Medical Services Program (CMSP) — Van Houten noticed an undeniable trend.
"There was a surprising number of behavioral health issues," he said. "As with many rural frontier areas, some move here and begin to feel isolated while others seek out the isolation because they don't function well in urban or suburban communities. I quickly realized I needed to become an expert in behavioral health and substance abuse."
Flashing forward 30 years, today the Sierra Family Medical Clinic on Tyler Foote Road has 50 employees and has become known nationally for its model of "integrated health care," which offers medical care, behavioral health and dental services all in one location.
Van Houten, who serves as medical director and CEO of the nonprofit clinic, regularly attends conferences and webinars to talk about the clinic's innovative model. He is the only physician to be deemed a "Rural Champion" by the California Rural Health Association.
What sets the clinic apart, says Van Houten, is the strategy of having behavioral health personnel on site when a patient comes in to see their primary care physician.
"We're actively using psychiatrists for consult right here in the office. They're on our staff," he said. "By having these services in the same location, we're able to get patients help right away. It's acknowledging that the head and the body are actually connected. We're able to talk daily about the well-being of our patients."
Referring a patient to a therapist on site has made all the difference, he said.
"We've found that only 40 percent return if we refer them to a therapist off site," said Van Houten. "Eighty percent return if we refer them right then and there to an on-site therapist and discuss their case with them. We've demolished the stigma around behavioral health and substance abuse issues — people don't feel labeled or judged."
When a primary care provider introduces a patient to a mental health worker or behavioralist, it's called a "warm hand-off," he said, a technique that is — among other things — used for newly diagnosed depression, insomnia, weight control, substance abuse, smoking and newly diagnosed bipolar disorder. In fact, Van Houten now has training videos on YouTube.com that have been viewed by thousands of health-care professionals via the Integrated Behavioral Health Project's website.
In addition to on-site mental health workers, Van Houten recognized that many patients often need help in other areas of their lives and wanted to provide assistance. To that end, Lael Walz was solely hired three years ago to act as a "concierge" to patients by helping them apply for Medi-Cal, find places to get food, affordable housing and job training, while taking their job limitations into consideration.
"Lael has helped us so much because therapists don't always have the time to help with these kinds of life challenges," said Van Houten. "She's also able to help family members get support."
Beyond its well-known behavioral health services, the Sierra Family Medical Clinic is a full-service medical and dental clinic. Patients come in for routine physicals, health-care monitoring, illnesses, accidents and minor emergencies, women's health exams, pediatric care, mental-health counseling, dental services, among other things.
"We're like an old-fashioned doctor's office — we're an independent facility, so we're not under pressure to move patients through our doors like parts on an assembly line," said Van Houten. "My patients include retired judges, telecommuters, people in the film industry — every part of the social strata. When I look at my list of patients for the day it's like seeing a list of friends. Yet an important aspect of our work is to ensure to the best of our abilities that all residents in our area, regardless of income, have access to health care.
"This aspect of our work is subsidized by donations from the community, by federal, state and private grants, and by our staff itself, who have chosen to help meet the health needs of a rural community rather than seek the higher salaries they might receive in another setting."
SFMC also has a mobile dental clinic that regularly travels to the Salvation Army, Women of Worth, the town of Oregon House and five separate schools. At least a third of the students seen at the schools are the first in their family to have ever seen a dentist, Van Houten said. Plans are in the works to open a satellite clinic in Oregon House in 2013, as another clinic there has recently closed.
If Van Houten had unlimited resources, he said he'd love to see the clinic's model of behavioral health spread throughout the country, especially in isolated communities.
"I'm more passionate about this than when I started 30 years ago," he said. "Now I see how many people can use our unique services. Every day when I go home I realize that someone's life was changed because we're here."
To contact staff writer Cory Fisher email firstname.lastname@example.org or call (530) 477-4203.
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