As the number of adults over the age of 75 continues to rise in the United States, there is an increasing need for health care services tailored to treat common geriatric issues ranging from chronic diseases to loneliness. Yet, due to a national shortage of geriatric-trained primary care and mental health clinicians, many older adults face barriers to care and long wait times. At the University of Colorado Anschutz, leaders have implemented a unique approach to address this pressing need: the integrated behavioral health program at UCHealth Seniors Clinics.
Under this program, when an older adult patient is at their primary care appointment and expresses they need help changing a behavior — such as regularly taking their medications or developing skills to cope with grief — they are connected in real time to a behavioral health specialist.
“We can see patients without delay, helping address issues more upstream before clinical symptoms evolve into something more severe,” says program director Samantha Farro, PhD, a psychologist and assistant professor of geriatric medicine at the CU Anschutz Department of Medicine.
Farro, who built the program over the past decade, leads a “small but mighty team” of behavioral health providers who work at the UCHealth Seniors Clinic at the CU Anschutz campus and at a satellite clinic in Lone Tree. By working in tandem with primary care providers, the team strives to empower patients to improve their health by adopting new behavioral patterns.
“Behavior affects so much related to health,” Farro says. “We aim to provide solution-focused interventions to patients who have a health goal in mind — it could be a mental health goal, physical health goal, or a bit of both.”
Since childhood, Farro has been fascinated with how the human brain works. Wanting to apply this to help others, she became a clinical psychologist and discovered a passion for working with older adults, who she describes as a resilient, savvy, and insightful population. She was hired nearly 10 years ago to launch the first full-time integrated behavioral health program in primary care for older adults at CU Anschutz.
“We developed this population-based model to specifically address the needs of our geriatric medicine clinic,” she says.
Patients at the UCHealth Seniors Clinic are aged 75 and older and almost all of them are “medically complex,” meaning they are often managing multiple chronic diseases, Farro explains. To help these patients, the clinic offers several embedded services including social work, pharmacy, dementia support, and a behavioral health program.
“Our clinic is quite unique, nationally speaking, as we have a lot of expertise related to this population and offer a variety of advanced primary care services,” Farro says. “If a patient is seeing a primary care provider and something comes up related to behavioral health, the provider may do a warm handoff so the patient is seen in real time.”
Most of the time, Farro and her team meet patients in person, though they also offer virtual telehealth care for patients who may face transportation or other barriers. As an embedded part of the clinic, Farro and her team routinely consult with primary care providers to offer a comprehensive, team-based approach to caring for patients. While Farro directs the program and provides behavioral health services at CU Anschutz, clinical social worker and geriatric medicine instructor Emily Haller, MBA, LCSW, leads this work at the Lone Tree clinic.
“Anytime we work with a patient, we coordinate closely with their medical care providers as part of the process,” Farro says. “If the patient’s case is complex, we can co-develop treatment plans.”
A common misconception is that behavioral health services focus solely on mental health issues such as depression and anxiety, Farro explains, but she also helps address other facets of health including insomnia, dietary changes, and management of chronic diseases, including diabetes.
“Our role is dynamic. We help patients who are trying to improve their health through the use of behavior change,” she says. “There are few health conditions that are not influenced by a lifestyle component — what we choose to eat, drink, and do in our daily lives impacts so much of our physical and mental health. For example, if you have diabetes, it matters if you are regularly testing your blood sugar levels.
“My area of expertise is working collaboratively with patients to identify strategies and actions they can implement in their day-to-day to help them move toward their health goals,” she adds. “All of the interventions we do are evidence-based interventions.”
For example, if a patient is diagnosed with sleep apnea and needs to start using a CPAP machine, Farro may meet with the patient to help them get used to using the machine and improve implementation of the treatment.
“We know the adjustment to using a CPAP machine can be challenging, so I might use motivational interviewing or cognitive behavioral therapy techniques, for instance, to help the patient,” she says.
Farro’s team does not offer services long term. Rather, she typically meets with a patient two to four times over the course of several months to assess whether they’ve been able to successfully implement their behavioral health goals and have experienced a reduction in the bothersome symptoms they were experiencing.
“We want to give patients time to try their goals and see what the result is for themselves,” she says. “If they come back in and say, ‘I tried this and it didn't work,’ then we’ll pivot and try something else.”
A national shortage of mental health professionals often means patients face long wait times for care. Farro hopes her team’s services can help patients so that they don’t require specialty care. Over the years, her team has successfully helped patients who are dealing with issues like anxiety, grief, and social isolation through behavioral health interventions.
If a patient needs specialty care, such as therapy, Farro’s team provides resources to the patient for those services and serves as a “bridge support” while the patient waits to access services.
“Our goal is to increase access to care, reduce stigma, and reduce the number of patients who are given a referral to a specialist but don’t end up actually seeing them,” she says.
Among the many patients Farro has helped, one that stands out was an older adult woman whose family was concerned about a change in her behavior.
At the woman's primary care appointment, family members who accompanied her explained to the provider that she'd become socially withdrawn from family, often isolating herself. Social isolation can be a major risk factor for brain health, and research shows that loneliness and isolation can increase the risk of morbidity and mortality, Farro explains. Given that social interaction is important for protecting health, Farro often helps patients learn to engage with others.
Farro was immediately connected to the woman through a warm handoff, she says. During their initial appointment, Farro learned that the woman was living in a multigenerational household but wasn’t engaging with family members. She often remained alone in her room, sparking concern among her loved ones.
“We screened for depression, and she screened positive. She also told me she felt depressed,” Farro says. “I asked her, ‘If you could change one thing about your day that you think would help reduce your depression, what would it be?’ And she said, ‘If one of my family members would walk with me around the block once a day.’ It was immediate — she knew exactly what would work for her.”
Farro loved the idea because it would offer social connection, and research shows that even brief exercise can help boost a person’s mood. Together, they set a specific goal for her to walk 15-20 minutes outside with a family member each day, and after each time she accomplished this, she would mark it on a calendar — a technique proven to help reinforce goals.
A month later, they met for a follow-up appointment, and Farro says the patient was so proud to bring her calendar in and show off the progress she made.
“When we screened for depression again, she no longer screened positive, and many of her symptoms had resolved,” Farro says. “I always tell patients to focus on one goal, but what inevitably happens is that as a person starts to feel better, they will do more things. For her, she started sharing meals again with her family and was engaging more with others. It led to this positive ripple effect.
"I was so proud, she was so proud, and her family was so excited,” she adds. “I love empowering patients to feel more control of their health, and it’s something I get to do every day.”
As Farro reflects on the impact of the program over the past decade, she sees its value for patients and clinicians alike.
“Research has demonstrated better clinical outcomes for patients through this value-based enhanced primary care,” she says. “Research also shows that when primary care clinics have programs like mine embedded in their clinic, they show lower burnout rates for clinicians and higher satisfaction.”
Farro’s heard positive feedback firsthand from clinicians, saying she recalls one primary care provider told her, “I can’t imagine doing geriatric primary care without behavioral health as a fundamental aspect of it. It’s so integrated into everything that we do.”
Farro and Haller also strive to build up the workforce of providers who have expertise in how to best care for the older adult population. For instance, Farro is serving as a consultant to CU Medicine as it establishes behavioral health services at a local geriatric medicine clinic in the Cherry Creek area. Meanwhile, Haller worked with the Colorado Behavioral Health Administration and the CU Anschutz Department of Psychiatry on a project called Priority Populations to educate more behavioral health providers about the unique needs of older adults.
“Our division also has something similar to that — it’s called GeriCare Everywhere — where we’re trying to educate students across different disciplines, from physical therapy to dental medicine, about how to care for older adults,” Farro says.
Although Farro has many goals for the integrated behavioral health care program, her top priority is the patient.
“This program is meant to meet patients where they are and improve their health, and my team always views the patient as the expert on themselves,” she says. “We provide consultation, we provide support, we provide ideas — but ultimately, the patient knows what's going to work best for themselves."