Grant-funded program helps ASU interns learn holistic care

Arizona State University’s College of Health Solutions has teamed up with the School of Social Work for an integrated behavioral health clinical internship.

The four-year initiative is funded by a $1.9 million grant from the U.S. Health Resources and Services Administration. Through the internships, approximately 120 students will gain knowledge and experience addressing a wide spectrum of conditions that impact people’s health.

“Arizona has among the highest rates of behavioral health disorders and the largest proportion of underserved areas in the nation,” said William Riley, primary investigator on the grant and a professor of health care delivery in the College of Health Solutions. “The internship will prioritize chronically underserved areas characterized by a staggering burden of illness and the highest youth suicide rates in the nation.”

Integrated behavioral health is a team-based approach to patient care that looks at the complete person and the factors affecting physical and mental health.

“Chronic diseases like hypertension or diabetes often stem from lifestyle choices, particularly obesity tied to poor nutrition and physical activity,” said Ronald O’Donnell, a clinical professor of behavioral health in the College of Health Solutions and a lead on this project. “We know that psychiatric and substance abuse problems are also very common with these conditions.” 

While chronic diseases are medical issues, social workers can be effective at helping people get the support they need to address these concerns.

“Physicians and nurses are primarily focused on acute medical care, which means medication management largely, and they haven't got the time or training to help coach patients on how to stop smoking, increase physical activity, lose weight or address alcohol and depression,” O’Donnell said. “These things require a behavioral expert, which could be social workers, physicians, nurses or psychologists. We wanted to offer behavioral health expertise to social work students because social workers are widely available. It's a large workforce, and they’re already very well-rounded in patient engagement.”

Riley, O’Donnell and other members of the College of Health Solutions faculty put together an online curriculum for the students who land these behavioral health internships. The learning platform includes assigned reading, videos, interactive learning experiences and exams to ensure students are making good progress in their studies. Although the semester’s work is essentially self-paced, students have access to a forum for posting questions and getting answers from their professors. 

The first cohort of students participating in this program started their internships in January. There are 12 social work master's students in the program, and more will be added each term as the project team adds more sites at which the students can work.

Currently, the interns are working in primary care clinics, which may sound like an odd place for a social worker, but O’Donnell explained it this way: “Suppose a physician is seeing a diabetes patient and the patient brings up being depressed or having alcohol problems. The physician can do what they call a warm hand-off, saying ‘I have my social worker here, and you can talk to her about your concerns.’”

“Many clients not only need behavioral health issues addressed, they may also need housing, financial assistance, food, clothing or shelter,” said Cynthia Peters, manager of field education for the School of Social Work. “Social work students can provide community resources for the high-risk population.”

Lisa Kramer is a student participating in the program. She said she has seen its benefits during her work at Jewish Family & Children’s Service.

“At our site, we provide intake and assessment for behavioral health, psychiatric evaluation, medication monitoring, counseling and primary care services,” Kramer said. “We also have case managers, health navigators, youth and family specialists that help individuals receive the support they need.”

The program is focused on addressing the needs of underserved communities such as Arizona’s Native American population and the LGBTQ community.

“We have evidence that integrated health care has two benefits,” O’Donnell said. “First of all, we know that if you get a referral from your physician to go see a psychologist or social worker, most patients don't make the appointment. They simply don't go. So, we're addressing that problem.”

More important, though, is the impact that the warm hand-off could have. As O’Donnell pointed out, when people address obesity before developing diabetes or depression before self-medicating with alcohol, they’re less likely to need more comprehensive care.

“If you can have people improve their health and address their depression or other problems, they'll have fewer adverse consequences,” he said. “That results in less cost for hospitals or emergency room visits. It's an opportunity to save money in the health care system while also benefiting patients and their families.”

Story by Weldon B. Johnson and Kelly Krause.