Report from our Medical Director: Medical-Dental-Mental Health Integration

Unique to Arlington Free Clinic’s approach is our holistic model of not only medical care, but also behavioral health support, medications, dental – even access to resources “beyond the exam room” like assistance with food and rent – all under one roof. 

Our model opens a world of opportunity for enhancing care, by coordinating and integrating services rather than simply co-locating these services. A great example of the benefits of integrated care is prevention/early detection of conditions that have strong linkages across healthcare disciplines, such as diabetes and gum disease. Collaborative practice is highly regarded as effective and is a model whose promise we will work to maximize at AFC over the coming year – in particular, through the integration of primary care with our dental and mental health programs. 

Medical-Dental Integration 

While AFC has had an onsite dental clinic since 2019, our challenge is to move beyond co-location and truly integrate. Over the coming year, we plan to take full advantage of the proximity of our dental and medical providers – educating volunteers, staff, and patients about the importance of oral health and how closely it is connected to overall health, particularly for those with chronic diseases. We’re adding blood pressure screenings to every dental appointment to improve early identification of hypertensive patients and are including questions related to oral health history during the medical intake process.  

We recently joined a learning collaborative hosted by the Virginia Health Catalyst, a coalition working to ensure Virginians have equitable access to comprehensive care that includes oral health. We will take what we learn from the Catalyst’s integration experts and our peer clinics who are wrestling with similar challenges to expand and enhance our approach to integrating our dental and medical services with the goal of improving health outcomes for our patients.  

Medical-Mental Health Integration 

Over half of AFC patients screen positive for issues related to mental health or a history of trauma. Many have anxiety or depression, often the result of having experienced violence or trauma that impairs their ability to manage their overall health, care for themselves or their family, and contribute to their community.  

Wait times for new mental health consults average 4 months, resulting in deteriorating health status and risk of loss-to-follow-up. While we’re always working to recruit new mental health volunteers, AFC’s model provides a unique opportunity for us to maximize the use of primary care providers. Since PCPs prescribe most of the antidepressants in the US, these clinicians are well-suited to identify and treat behavioral health issues. We aim to give our PCPs additional tools to successfully address many of our patients’ mental health needs and increase our team’s ability to distinguish between patients who truly need a mental health referral and those who are experiencing episodic symptoms that could be managed in primary care. This will increase access to timely, appropriate mental healthcare and reduce unnecessary psychiatric referrals, preserving this limited clinical resource for cases that require this level of care. 

Through AFC’s efforts to better integrate our dental and mental health programs with primary care, we aim to expand the high-quality, comprehensive care that we deliver to our 1,500 low-income, uninsured patients, and push ourselves to pursue highly innovative ideas with the potential for significant and sustained impact.