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Case Study: Shepherd’s Clinic

Location: Baltimore, Maryland
Budget: $725,000
Patient visits in 2011: 6,500

Abstract

Shepherd’s Clinic has a long-standing relationship with Baltimore-area residents. For over 20 years the clinic has provided primary and specialty care to the economically disadvantaged by building sustainable relationships with community stakeholders and engaging patients on a personal level. In 2008, the clinic expanded its behavioral health services by implementing an integrated care model. Taking a holistic approach to mental health and primary health integration, the number of patients who have benefited from these services tripled since the onset of the initiative. Program evaluation is a top priority; therefore several management and public health tools are used to measure health outcomes, which also provide concrete data for fundraising and grant making opportunities.  

Increasing access to behavioral health services

The only free clinic in Baltimore, Shepherd’s Clinic has evolved from a townhouse basement operation to a 10,000 square foot freestanding clinic. In 2011, the clinic provided over 6,500 patient visits, an increase of 25 percent from 2010. Sixty-eight percent of the clinic’s patients are African-American and all of the patients earn less than 200 percent of the federal poverty income level. While the clinic has experienced an unprecedented surge in patients during the recession—over 1,000 since 2008—volunteer hours have significantly increased as well. With only three full-time and seven part-time staff, the clinic relies on over 350 volunteers to provide quality care. Overall, the integration of behavioral health services, which also relies on volunteer providers, has greatly enhanced patient access to care. 

Over the past three years the clinic has taken great strides toward expanding capacity for mental health services. With an $180,000 grant from a Baltimore-based foundation, the clinic created an integrated behavioral health program. The program set three main objectives for the three-year grant period including:

  • Recruitment of a full-time coordinator to manage the program and volunteers
  • Design, develop, and pilot of individual/group therapy sessions, psychoeducational workshops, and support groups
  • Recruiting and training volunteer providers to enhance program sustainability

The program provides psychiatric, psychotherapeutic, and case management services. Screening tools are used to evaluate mental health issues from the onset. During the first year of the program, the clinic experienced a 3.2 percent increase in behavioral health-related patient visits. By year three, over 14 percent of all patients were utilizing the clinic’s behavioral health services; an increase of 488 percent from the pre-grant period.

Screening for behavioral health issues

The clinic uses a Patient Health Questionnaire (PHQ) developed by Columbia University’s School of Public Health, to evaluate mental health issues during patient orientation. The assessment identifies for depression, anxiety, panic disorders, eating disorders, bulimia, alcohol and drug abuse, partner violence, somatic disorders, and community and family information. The PHQ helps providers determine appropriate treatment plans and offers qualitative data that help to evaluate the clinic’s impact. This assessment is the clinic’s leading screening tool.  

Taking a holistic approach to behavioral health integration

In 2010, Shepherd’s Clinic established the Joy Wellness Center (JWC), which was part of a preventive approach to combat chronic disease in clinic patients. During the first year of operation, the JWC provided holistic services to over 400 patients. Among the wide range of wellness modalities available, the JWC offers stress reduction and cooking classes in addition to yoga, acupuncture, and massage. Nutrition classes are conducted by dieticians, nutritionists, and chefs who use ingredients from the clinic’s community garden.        

Using university students to increase clinic capacity

Partnerships with local universities have enhanced the clinic’s impact and ability to report health outcomes. Recent and ongoing projects include the use of post-baccalaureate and pre-med students to measure the effectiveness of internal practices. John Hopkins MPH students have helped to assess the physiological advantages to patients who attend JWC activities. Under the supervision, two MSW interns from the University of Maryland School of Social Work provide psychotherapeutic services on a yearly basis.     

Lessons Learned

  • Taking a holistic approach to behavioral health is feasible in a free clinic setting
    Although the clinic started as a primary care provider, addressing patients’ socioeconomic issues quickly surfaced as being a critical need. Mental health and wellness activities such as yoga and nutrition education classes are well-attended and have increased the clinic’s ability to be a patient-centered medical home.  
  • Using a behavioral health screening tool is essential
    The Patient Health Questionnaire is the leading assessment tool for Shepherd’s Clinic. Data collected through the questionnaire helps to inform treatment plans, measure patient progress, and prepare quantitative and qualitative reporting.   
  • A SWOT analysis helped to focus organizational and programmatic priorities
    Shepherd’s Clinic conducted a SWOT (strengths-weaknesses-opportunities-threats) analysis in 2010. The survey captured a random sample of over 100 patients and volunteers. Feedback overwhelmingly supported the clinic’s integrative care model and set future priorities such as improving marketing efforts and expanding weekday evening hours.