UA Psychologists Awarded Contract to Bolster Services for Pain, Behavioral Health

TUSCALOOSA, Ala. — A team of psychology researchers at The University of Alabama has been awarded a two-year contract from the Patient-Centered Outcomes Research Institute to help integrate behavioral health and chronic pain treatment plans into Alabama’s 15 federally-qualified health centers.

Dr. Beverly Thorn, UA professor of psychology, received a Eugene Washington PCORI Engagement Award for approximately $250,000 to start the Alabama Initiative for Integrated Primary Care-Behavioral Health Services which, over the next two years, will work with leaders and staff members of health centers throughout the state to assess their capacity for the integration of behavioral health into their clinics.

The project is running concurrently with the team’s $1.3 million PCORI-funded study, “Reducing Disparities with Literacy-Adapted Psychosocial Treatments for Chronic Pain: A Comparative Trial,” a randomized controlled trial comparing literacy-adapted, group cognitive-behavioral therapy for pain education to typical medical treatment.

“With the Engagement Award, we’re assessing needs and barriers to behavioral health integration into primary care settings in Alabama, broadening the definition of behavioral health to include chronic illness — particularly chronic pain — then setting the stage for the results of our current trial, when that becomes available in two years,” Thorn said.

“PCORI holds a very strong value of implementing effective treatments back into the community immediately,” Thorn said. “In order for us to be ready to start disseminating and implementing those results, we’re laying the groundwork with this smaller award.

“We will know how the federally-qualified health centers work, what their realistic constraints are, and how to best adapt our treatments to fit their needs. Also, by the time we are ready to implement our treatments, the FQHCs will know, and hopefully trust, us as University professionals who are interested and committed to helping them with their real-life treatment problems.”

The integration of behavioral health into primary care isn’t a major component of federally-qualified health centers, where physicians treat a high-volume of patients who have limited health care resources or none at all, Thorn said. When behavioral health is considered, it is usually conceptualized as mental health counseling or substance abuse treatment.

Although private sector health centers are starting to recognize the value of integrating behavioral health into primary care, settings serving uninsured or low-income patients have not had the resources to do so, she said.

Additionally, behavioral health treatment for chronic illnesses, such as obesity, asthma, diabetes and high blood pressure, is a newer concept, as is conceptualizing or managing chronic pain as a chronic illness.

Federally-supported health centers must also show specific quality outcomes in order to qualify for funding. While the severity of diabetes can be measured with blood AIC levels, the severity of chronic pain is much more subjective, and there are no direct quality metrics that can be used to show effective treatment.

“Physicians don’t have very many tools to treat people with chronic pain, and the measurement of pain is a subjective one,” Thorn said. “We thus have to measure treatment success indirectly.

“Health Centers are trying like heck to get emergency room visits down,” she said. “If we can show that patients in our program go less frequently, that’s something that would be meaningful to [health center physicians]. Also, assessing and treating depression or medication overuse … that would be relevant to federally-funded health centers who must show meaningful use outcomes.”

Dr. Colette DeMonte, a post-doctoral fellow and ALHEALTH project coordinator, said key stakeholder interviews began in November and should be completed by March.

Then, researchers will take analyses of the responses from 15 health center administrators, 15 clinical staff personnel and 15 patients, to create and distribute a needs assessment survey back to the health centers.

A final step of the ALHEALTH project is to offer training to clinical staff at the Health Centers to help them integrate behavioral health approaches into the treatment of their patients with chronic pain.