Questions and Answers with Koby Ritter, Registered Nurse and Army BHCF

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As a BHCF, what is a typical day like for you?

A typical day for the BHCF begins with a morning huddle. Some clinics may have several groups holding huddles; in that case, the BHCF should alternate attending any huddles that pertain to his or her patient caseload.  After a quick social stroll through the halls, mostly to check in with the providers and keep my face fresh in their minds, I would end up in my office to begin the best part of my day…talking with my patients. 

Before each contact, I spend some time reviewing the electronic medical record to see what has happened with my patients since our last contact (any medical or behavioral health visits, current medications, need for refills, etc.)  The majority of my day is then spent contacting my patients for initial, routine or as-needed calls.  A good portion of my time is also spent leaving messages and/or re-scheduling the contact for a more appropriate time for the patient.  During each contact, I am entering the information into FIRST STEPS, a web-based support tool specifically designed for the BHCF role.  A note summarizing the entire contact, to include current scores, medication adherence, self-management goals and behavioral health services, is composed and entered into the patient’s permanent electronic medical record in the form of a teleconference for the provider to review.

On a weekly basis, I meet with the internal behavioral health consultant (IBHC) to review some of the patients on my caseload. The IBHC is there to oversee my caseload and make recommendations to relay via a teleconference to the primary care provider. Many of my patients are also seeing the IBHC, which really enhances the team approach to symptom improvement.

When not actively contacting patients or staffing with the IBHC, I spend a lot of time following up on provider orders, making PRN calls and providing refresher training on my role as needed.

What do you like most about being a BHCF?

The best part about my role is the interaction I have with my patients. I work really hard from the very beginning to build the rapport, to prove to my patients that I am there for them and that they can trust me.  I want them to know that when I say I’m going to do something, whether it’s assisting with an appointment, getting a refill or simply a follow-up call, I’m going to do it!  I stress that I am part of a team whose only focus is to help them feel better. I treasure the opportunity to assist our heroes and their families in any way possible.

As a BHCF, what has been a challenge that you've had and what have you done to overcome it?

As with any new position, there’s bound to be a few challenges. The one that comes to mind for me was educating the clinic staff on my role. When I arrived at my clinic, nobody knew who I was or why I was there. I have heard many similar stories from other BHCFs who were subsequently given numerous other responsibilities that were not related to their roles.

So how did I overcome this? Luckily, I had wonderful clinic leadership who were open to listening to me and fully supportive of implementing a successful primary care behavioral health program. After briefing clinic leadership and obtaining their support, I held clinic-wide training on my role and how it interacts with the other roles in the clinic. In clinics with an IBHC, it would be very beneficial for the BHCF and IBHC to approach this training as a team, further demonstrating this valuable partnership. This, along with frequent face-to-face follow up visits around the clinic, really helped to kick start and maintain the program in the right direction.

From a multi-disciplinary perspective, what can a PCM (or PCMH team) do to make you more effective in facilitating care for patients?

Great question! And the answer is...allow us to help them manage the care of their patients! I want providers to understand the value of care facilitation. We are here to help the patient follow the plan that the PCM intended for them. We provide routine follow up, education and assistance with overcoming barriers. We will keep the team updated on the status of the patients we share on a routine basis. We can assist with patient's appointments, medication refills and goal setting. And yes, it's ok (even recommended) to involve both the BHCF as well as the IBHC. While we work closely together, our roles are very different...so refer away!