Since joining the Bree Collaborative as the Implementation Manager this past Fall, I have been completely in awe of the breadth and scope of work the Bree Collaborative recommendations cover.  That said, the idea of trying to implement all 30+ recommendations around the entire state seemed like a daunting and impossible task that might never take root.

First, we decided to trim down our implementation efforts and focus on integrating behavioral health into primary care. Behavioral health issues are common and often go untreated due to stigma, lack of screening, and lack of access to appropriate care. Behavioral health integration into primary care is one way of addressing these barriers, and providing necessary care.

Over the last two months, I completed site visits with 12 primary care clinics throughout Washington State that make up our Behavioral Health Integration Initiative Pilot Group. I traveled over 1,000 miles, growing relationships with clinics from Aberdeen to Pullman.  Each site completed a baseline assessment of their current level of integration and developed a quality improvement action plan to help advance their integration programs. We talked about their individual community needs and clinic struggles, as well as their successes and deep relationships with the people and families they serve.  Each clinic represents a unique plot within our overall healthcare landscape.

Implementation is a journey made up of trial and error, success and failure, frustration and satisfaction. But ultimately, it is also a journey of hope; wherever you are planted in the larger garden of healthcare, we all do this work with the hope of improving the lives of those around us.  At times this goal may feel like we are stuck in the dead of winter, with no hope of seeing the sun again.   We sometimes forget the flowers gathering strength just below the surface as we face the weeds that keep us from reaching our goal – lack of community resources, lack of funding, increased social and economic challenges for our patients, staffing issues, physical space issues, and ever changing policies.

As I reflect on my time with our pilot group clinics, despite their different needs and struggles, I think about the common thread within each conversation.  What I heard in every clinic even among the frustration, was that glimmer of hope. Hope that our leadership remains supportive of behavioral health integration. Hope that even though a pilot we tried last year didn’t work, maybe this one will.  Hope that we can find creative ways to meet our patient’s needs with the resources we have.

Without hope, this work simply could not continue. Without hope that we can improve the lives of those around us, none of our clinics would have started this implementation journey with me. Hope brings our Bree community together, fertilizing the ground of our healthcare system, reminding us to look for the flowers finding their way to the sun. The roots of our success are just beneath the surface, preparing to bloom.

Amy Etzel
Implementation Manager
Bree Collaborative