When Tara Stanfield talks about her first job out of graduate school, her gratitude tumbles out faster than her words.
“It was a great place to be raised,” said Stanfield.
And that tells you a lot, because her formative professional “raising” came at Bluegrass.org (now New Vista) in Powell County as a mental health technician when the opioid epidemic was in full swing but resources to fight it were almost non-existent.
“We were providing a service that everyone was looking away from,” she said.
And, as the only mental health care providers in the area, with no hospital in town, Stanfield said they did the best they could.
“There was no Medicaid reimbursement, no drug court, nowhere to send people,” she said. “There was just us, a group of people with the same mission, working together.”
Tara Stanfield
Teamwork is also mission critical in Stanfield’s current role as director of integrated health services for HealthFirst Bluegrass Inc., a federally qualified community health center that provides a multitude of health services to underserved communities in the region.
Stanfield joined the Lexington-based nonprofit when it opened in 2017 after seeing firsthand how physical, mental and environmental health are so closely tied together, she said, and how addressing these areas under a model of holistic health care can help improve patients’ outcomes and quality of life.
Stanfield is responsible for facilitating HealthFirst’s model of integrated health care, which includes pairing one behavioral health consultant and one community health worker with every four primary care providers. Along with medical assistants, interpreters and nurses, these team members work together to address not only a patient’s physical health needs, but also underlying emotional and behavioral issues that aren’t easily diagnosed during a typical primary care visit, such as depression, substance abuse, domestic violence, housing insecurity and anxiety.
“The one-to-four ratio gives us a good chance to provide on-demand intervention when the issue is at its freshest and likely motivation at its highest,” Stanfield said.
HealthFirst has about 250 employees and 15 locations around Fayette County that include three primary care sites, with pharmacies at two sites and a women’s clinic at one.
HealthFirst also operates nine school-based clinics in high-needs areas; two health-care-for-the-homeless sites; and a freestanding dental clinic, as well as two mobile dental clinics. On the mental health side, they have a team that comprises psychiatrists, psychiatric nurse practitioners, behavioral health consultants and community health workers, as well as a wellness center for patients who need ongoing therapy.
Primary care providers immediately embraced the integrated approach, Stanfield said. Having these behavioral health specialists and community health workers on call when a patient needs extra support allows them to not only better focus on providing primary care, but also reassures them that root causes are being addressed.
“They don’t have the time to dig into those [issues] like they’d want to,” she said, citing a few examples. “Our behavioral health consultants can work with those patients, whether they need help with something like weight loss or motivation around medication adherence. They also do a ton of work with diabetes and hypertension.”
Stanfield will be the first to admit that offering these services simultaneously can be difficult because it requires a lot of flexibility on the parts of therapists and other behavioral health staff.
“It’s really backward from the way therapists were trained, which was ‘here’s your schedule; here’s who you are going to see; here’s all the information about them;’ versus a primary care doctor popping their head out of a door 20 times a day, saying ‘Hey, can you come help me with this,’” she said. “And you have no idea what you are walking into. It might be a little bit of depression; it might be someone actively psychotic.
“Hiring integrated care staff who can handle lots of quick information, prioritize needs, communicate effectively with different personalities and different professional levels, and support a fast-paced clinical environment is the foundation block for how it all works,” she said.
Stanfield is used to adapting quickly and making the most of available resources.
When she was promoted to clinical coordinator in Powell County after several years as a therapist, more funding had become available to fight opioid addiction. With that increased funding and through a concerted group effort, the community began to see positive impacts.
“I loved the local people and how they stuck together,” she said. “As tragedy worked its way through families in the county, the community wrapped itself around them and supported one another.”
Having grown up in the tiny community of Camargo outside of Mt. Sterling, Stanfield knows rural communities. She was active in FFA (Future Farmers of America) throughout high school and became an agriculture major when she attended Eastern Kentucky University. But after taking a psychology class as an elective, she let one of her agriculture professors know she was switching majors.
“The professor told me, ‘You won’t be able to do much psychology with the cattle,’” she recalled.
Stanfield went on to get a master’s degree in social work from the University of Kentucky. She later earned a master’s in public administration as she worked for Bluegrass.org, moving up in management to oversee 17 Central Kentucky counties as regional director of substance abuse operations before going to work at HealthFirst.
HealthFirst’s integrated care model is particularly helpful in identifying and aiding treatment for addiction and other mental health issues. Because of the attached stigma, it’s difficult motivating people to seek help, Stanfield said.
“It’s a rare moment that someone wakes up and says, ‘I want to go talk about my hardest thing that I am suffering from that’s really emotionally painful with a complete stranger.' Most people, though, will go to primary care. And you want to ... show them we are just members of your medical team, same as anyone else you’d come to see here.” — Tara Stanfield, director of integrated health services for HealthFirst Bluegrass Inc.
“It’s a rare moment that someone wakes up and says, ‘I want to go talk about my hardest thing that I am suffering from that’s really emotionally painful with a complete stranger,’” she said. “It’s hard to make yourself go to those appointments. Most people, though, will go to primary care. And you want to strike while that window is open and the iron is hot, while they have a problem, and show them we are just members of your medical team, same as anyone else you’d come to see here.”
In the future, Stanfield wants to find a way to quantify how well integrative health is working with HealthFirst’s approximately 23,000 patients. Stanfield said quantifying behavioral health improvements and cost savings around systemic and societal issues has always been difficult, but it’s another challenge in a series of many that she is willing to undertake.
“We want to be able to lobby and pitch what our worth is,” she said. “Anecdotally, we know it on patient experience. We regularly get mail thanking us for going above and beyond. And we have some data [for particular chronic conditions like diabetes or high blood pressure]. But being able to say, from a big-scale picture, that this is the way everyone should be doing health care, not just a federally qualified community health center that has funding for it? That’s really what I want my next step to be and what I feel like it should be.”