By Marti Webb Slay
Christina Pierpaoli Parker, PhD, DBSM was doing her Fellowship at the University of Toronto when she first noticed a discrepancy in addressing behavioral medicine. It was then that Parker, who is now a clinical psychologist and behavioral sleep medicine doctor in UAB’s Department of Psychiatry and Behavioral Neurobiology, conceptualized a clinic that would provide evidence-based behavioral services in primary and specialty care settings. She has brought this idea from concept to reality with the opening of the Integrated Behavioral Medicine Service Clinic (iBeMS) in 2020.
Much of Parker’s research has focused on the intersection of adults’ physical and psychological health. “There is no physical health without mental and behavioral health,” she said. “Behavior undergirds the development, prevention, and treatment of most preventable, chronic diseases.
“Targeting prevention and early intervention, iBeMS uses a collaborative care model to provide brief, stepped care to patients with mild to moderate psychiatric symptoms that are contributing to chronic health conditions in a primary care setting. We provide same-day service to patients who may be experiencing common psychiatric symptoms, including anxiety, depression, and insomnia. We’ve found this diverts referrals out of primary care, increases access to both primary and psychiatric care, and improves patient health outcomes.”
Parker offered three reasons for starting the clinic. “First, many medical conditions contain significant psychological comorbidities,” she said. “Behavior undergirds every facet of the health process, from disease onset to rehabilitation. Second, the problem actually lives in primary care. Primary care has been dubbed the de facto mental health system in the United States since the 1970s because most patients will seek mental health services there, not from a mental health provider, largely because of inaccessibility. The third is increased accessibility and continuity of care.
“Unfortunately, only about 50 percent of patients with a mental disorder are correctly identified in primary care. Integrating behavioral health into medical settings democratizes access to mental health treatment and normalizes behavioral health as a part of physical health. And in many cases, it helps to ease the burden of existing medical conditions.”
Patients and referring physicians have a variety of avenues for accessing iBeMS. The clinic offers a same-day service for patients scheduled to see their primary or specialty care physician. If either the physician recognizes distress or the patients articulates it, the physician has access to Parker or her students and can request same-day assessment or intervention. If the patient qualifies for iBeMS care, they usually return for six to eight visits, and are then discharged on a one, three, or six month schedule.
“If a patient is having a panic attack, for example, we work collaboratively with their primary care provider to assess and intervene in real time and devise a treatment plan for follow up. It’s patient-centered, one-stop shopping,” Parker said.
For patients with severe mental illness, substance use, or complex trauma, the iBeMs team will work as ambassadors to get them where they need to be for more appropriate, longer-term care.
The clinic also offers same-day consultation and liaison services for physicians. “These consultations aid physicians’ decision-making and intervention for patients with psychiatric symptoms, almost like a curbside, clinical coaching service,” Parker said. “For example, if a provider is trying to differentiate between unipolar and bipolar depression, I may not see the patient, but will work through the clinical algorithm with her in real time.”
The clinic also offers more traditional scheduled appointments for patients not actively in distress but referred by their physician for brief behavioral treatment.
Research on results is ongoing, but the approach overall is proving to be successful. “Our preliminary findings reveal that a course of six to eight visits of iBeMS treatment is associated with rapid, durable, and clinically significant changes in anxiety and depressive symptoms,” Parker said. “Additional inquiry continues to explore the contributions of these interventions to improved physical health outcomes as well as decreased healthcare costs. We have reason to believe, based on existing research, that integrated care can reduce healthcare costs, improve outcomes, and increase access to primary psychiatric care because it goes for the jugular of most healthcare challenges: mental health.”
There are plans to expand the clinic, but it currently rotates between three locations at UAB Gardendale, The Kirklin Clinic, and The Camellia Medical Group.
