Involves using SBIRT, a behavioral health screening process
By William K. Alcorn
When One Health Ohio medical doctors ask their patients how they are doing physically, they also take a few minutes to screen them for emotional and behavioral health problems.
One Health mental-health professionals reverse the process to determine if their patients need to see a medical doctor,
This process, called Screening, Behavioral Intervention and Referral to Treatment, is referred to as the “fifth vital sign” by Dr. Ronald Dwinnells, chief executive officer of One Health Ohio, a federally qualified health center.
“When people visit their medical providers, four vital signs — temperature, pulse, breathing rate and blood pressure — are usually the first things checked to ensure that the basic vital portions of our health are intact,” said Dr. Dwinnells.
SBIRT is an integrated health care philosophy or mechanism to screen and help people who have behavioral-health issues and get them help and treatment as quickly as possible, said Dr. Dwinnells, whose organization is considered a pioneer of the concept and has received federal and state funding for additional research.
Headquarters for One Health Ohio is at Youngs-town Community Health Center at 726 Wick Ave., Youngstown.
Other One Health Ohio facilities are: Warren West Health Center, 716 Tod Ave. SW, Warren; Good Samaritan Health Center, 1390 S. Arch Ave., Alliance; Lloyd McCoy Health Center, 1977 Niles Road SE, Warren; East Market Pediatrics, 1032 E. Market St., Warren; and Market Street Pediatrics, 1821 E. Market St., Warren (currently closed for renovations).
“Our clinical research project on SBIRT has gained considerable attention in the health care world,” said Dr. Dwinnells.
Recently, one of his research articles on SBIRT was accepted for publication in The Annals of Family Medicine, a national medical journal; and locally, OHO received an award from Youngstown’s Neil Kennedy Recovery Center recognizing OHO’s efforts to integrate and support behavioral health and medical care.
By incorporating a screening process for behavioral-health issues, Dr. Dwinnells said OHO identified 70 percent of its patients as having some type of behavioral health problem, such as alcoholism, drug abuse or depression.
This is significant because most people do not go to the medical doctors because they have a drinking, drug or depression problem; they usually go because of some tangible physical problem such as a headache or sore throat, he said.
Also, in general, doctors do not ask patients if they are depressed or abusing anything. As a result, patients often suffer in silence until it is too late, he said.
A pre-screening questionnaire consisting of five questions is given with every medical visit, to make sure their well-being check is complete.
If the questionnaire garners any positive answers, there are more detailed tests: Drug Abuse Screening Test, Alcohol Use Disorders Identification Test, and Patient Health Questionnaire for Depression.
“The reason SBIRT and the integration of behavioral and primary health care is so big in the health world is that it has never been done on this large of a scale,” said Dr. Dwinnells.
Also, he had a very personal reason for wanting to see screening for behavioral problems instituted through SBIRT: His father’s depression that led to his eventual suicide was not identified by a medical doctor.
“Perhaps if a health clinician had intervened to address my father’s depression before it was too late, he might have lived. That is an unrealized possibility that he said has guided his efforts to integrate behavioral health into primary-care settings in his own work.