Primary and Behavioral Health Care Integration at UNC WakeBrook.

Project: Research project


This Project will provide integrated behavioral and health care for patients in the Wake County, North Carolina (NC) area who have a serious mental illness (SMI) and who currently have or are at-risk for developing a chronic physical illness. Patients will receive care at WakeBrook (WB), a behavioral health facility located in Raleigh, NC, in coordination with the North Carolina Department of Health and two Physicians Networks.
Within Wake County, NC, the demographic breakdown is 61% Caucasian, 19% African American, 10% Hispanic or Latino, 6% Asian or Pacific Islander, 3% other race, 51% female, and an average age of 34.5 years. The population served at WB tends to include: 1. a higher proportion of African Americans, males, homeless, and under-insured and uninsured individuals; 2. a lower proportion of Hispanic or Latino individuals; and 3. an older patient population.
The majority of WB consumers have a psychotic disorder (schizophrenia or schizoaffective disorder) or a mood disorder with psychosis (bipolar disorder with psychosis or major depression with psychosis), and have or are at high risk for developing significant medical co-morbidities. In addition, patients at WB often have major gaps in preventive care (e.g., colorectal screening, mammograms, and pap smears). WB consumers exhibit a variety of pre-existing health conditions and concerns, including hypertension, asthma/COPD, diabetes, current tobacco use, and BMI’s in excess of 30 or 40.
The specific aims and goals of this proposal are to strengthen primary and behavioral integration at WB using the following strategies:
1. Patient-Centered Care: Provide patient-centered, evidenced-based primary care to seriously mentally ill patients who are in need of a primary care provider, on WB’s mental health campus in an atmosphere designed to promote overall recovery.
2. Comprehensive Care: A) Partner with Department of Public Health (NCDPH) to promote health and wellness using evidence-based clinical and community-based interventions, including through the use of motivational interviewing; B) Expand scope of relevant primary care services by adding on-site pharmacy and basic dental services.
3. Coordination of Care: Establish an inter-disciplinary treatment team, including peer support specialists and clinical care managers, to develop and implement treatment plans that improve care coordination and health outcomes.
4. Assure Quality and Safety: Utilize a continuous quality improvement data driven program to measure implementation fidelity, improvements in quality and cost, modify interventions, and engage local EDs, hospitals, and community provider in these efforts.
We estimate to serve the following number of patients: Year 1 - 175; Year 2 - 325; Year 3 - 500; and Year 4 - 750. This totals to 1,750 patients served during the lifetime of the project. However, we expect the sustainable programs put in place to continue to serve patients for years to come.
Effective start/end date9/30/159/29/19


  • Substance Abuse and Mental Health Services Administration (SAMHSA)


Primary Health Care
Psychotic Disorders
Hispanic Americans
Quality Improvement
African Americans
Motivational Interviewing
Delivery of Health Care
Papanicolaou Test
Patient-Centered Care
Preexisting Condition Coverage
Preventive Medicine
Health Facilities
Mentally Ill Persons
Tobacco Use
Mood Disorders
Bipolar Disorder
Chronic Obstructive Pulmonary Disease