Name
PCBH Outside the Clinic? Piloting PCBH within Assisted Living & Skilled Nursing Facilities. Lessons Learned & How-To's.
Description

This session will focus on a pilot program combining the forces of two separate programs within an FQHC system to provide geriatric, largely homebound, patients holistic healthcare. At Community Health of Central Washington (CHCW), there is a program called Senior Residential Care (SR Care) wherein primary care providers go into Assisted Living Facilities (ALFs) and Skilled Nursing Facilities (SNFs) to provide primary care to homebound patients (both short-term & long-term residents) who otherwise cannot physically come into a clinic. CHCWs Primary Care Behavioral Health (PCBH) department has spent the last 18 months piloting a program where one Behavioral Health Consultant and one SR Care Primary Care Provider pair up to provide holistic care to residents of ALFs and SNFs in the local eastern Washington area. Primary and behavioral healthcare can be difficult for these patient-residents to access, despite best efforts of integrating telehealth modalities since the COVID-19 pandemic back in 2020; therefore, this pilot program has aimed to bridge that gap and provide services to those who would otherwise suffer from lack of physical and behavioral healthcare.

Speakers
Ryan Grieb-Boggess, LMHC
Lacey Sheppard, LICSW
Shayla Moniz, PsyD
Co-Authors
Sarah Cook, DO, Family Physician, Community Health of Central Washington, Yakima, WA
Julie Wells, ARNP, Senior Residential Care, Community Health of Central Washington, Yakima, WA
April May, ARNP, Senior Residential Care, Community Health of Central Washington, Yakima, WA
Content Level
All Audience
Tags
Complex Patient Care, Geriatrics, Primary Care Behavioral Health Model
Session Type
Concurrent
Objective 1
Describe how to integrate behaviorally trained providers into in-home primary care operating in ALFs & SNFs.
Objective 2
Utilize concepts and behaviors to practice and maintain fidelity of PCBH model outside of the traditional clinic setting, specifically in ALFs and SNFs.
Objective 3
Learn about common barriers to holistic healthcare and interventions that are specific to geriatric populations within the context of ALFs and SNFs.
Content Reference 1

Temkin-Greener, H., Guo, W., McGarry, B., & Cai, S. (2024). Serious mental illness in assisted living communities: Association with nursing home placement. Journal of the American Medical Directors Association, 25(5), 917–922. https://doi.org/10.1016/j.jamda.2024.02.015

Content Reference 2

Morlett Paredes, A., Lee, E. E., Chik, L., Gupta, S., Palmer, B. W., Palinkas, L. A., ... & Jeste, D. V. (2021). Qualitative study of loneliness in a senior housing community: The Importance of wisdom and other coping strategies. Aging & mental health, 25(3), 559-566.

Content Reference 3

Webb, L. M., & Chen, C. Y. (2021). The COVID‐19 pandemic's impact on older adults' mental health: Contributing factors, coping strategies, and opportunities for improvement. International journal of geriatric psychiatry, 37(1), 10-1002.

Content Reference 4

Reynolds 3rd, C. F., Jeste, D. V., Sachdev, P. S., & Blazer, D. G. (2022). Mental health care for older adults: Recent advances and new directions in clinical practice and research. World Psychiatry, 21(3), 336-363.

Content Reference 5

Laksmi, P. W., Dinakrisma, A. A., Abdiel, T., Susanto, A. P., Pujitresnani, A., Lukmana, A. A. I., & Yusuf, P. A. (2024). Digital divide: Knowledge, attitudes and practices toward mobile phone and apps use among Indonesian older adults residing in a megapolitan city. Gerontechnology, 23(1). Content Reference 6 (Below) Choi, N. G., Choi, B. Y., & Marti, C. N. (2025). Digital divide among homebound and semi-homebound older adults. Journal of Applied Gerontology, 44(6), 970-980.