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Published on March 01, 2016

Integrated Behavioral Health Model Gives Stephanie Rollins Hope

Stephanie RollinsStephanie Rollins was homeless, addicted to drugs and feeling alone as she suffered from anxiety, depression, diabetes and other chronic ailments.

Without healthcare providers to monitor her illnesses and behavioral health issues, she was treated at Concord Hospital as frequently as twice a month because her illnesses quickly became emergencies.

“I didn’t care about anything,” said Stephanie, who is 45. “I was pretty much killing myself.”

Now, as a patient at Concord Hospital Medical Group Concord Family Medicine, Stephanie is the center of a team that includes healthcare providers who look after her medical and mental health – integrated care for the whole person.

Even though she is worried as she loses her eyesight from diabetes, she is more hopeful about her future because her support team is but a phone call or office visit away.

“It’s because they treat me more like a person and not as a patient, and it makes a big difference,” she said.

Stephanie’s Concord Family Medicine team includes nurse navigator Brenda Lovely, who has known Stephanie for five years – three as a staff nurse at the practice and the last two as nurse navigator. Clinical social worker Shannon Rose began seeing Stephanie in the spring of 2015 as part of Concord Hospital Medical Group’s integrated behavioral health collaboration with Riverbend Community Mental Health.

“I wouldn’t give these two up for anything,” Stephanie said. “They have been there for me more than anybody in my whole life.”

Their goal is to keep Stephanie healthy, at home, not at the Hospital. As a first step, Brenda connected Stephanie with resources that enabled her to get an apartment in early 2015. Having a place to live reduced the extreme stress of being homeless, so Stephanie was able to focus more on her health – physical and mental.

Shannon and Brenda often confer on Stephanie’s care – Shannon making sure medical problems are addressed if they come up during behavioral health counseling and Brenda alerting Shannon if behavioral health issues arise during medical treatment.

“We are treating the whole person when we integrate their care. Our focus is Stephanie or any of our patients and making sure that they are getting all of their needs met, whether they are medical or behavioral health, and keeping them out of the Hospital as much as possible,” Shannon said.

As nurse navigator, Brenda checks with Stephanie regularly, helping her manage her diabetes or obtain medication, hopefully detecting complications or other ailments before they become serious enough to require hospitalization.

Stephanie said the integrated care approach has made a big difference. She cares more about her own condition and now is adamant about keeping her healthcare appointments because she sees a team that cares about her.

She’s focusing more on positive aspects of her life and even began studying online this fall toward becoming a drug and alcohol abuse counselor.