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The Acute Community Care Program (ACCP), otherwise known as mobile integrated health, which is based at Commonwealth Care Alliance (CCA) in Massachusetts uses specially trained paramedics to respond to urgent care calls to evaluate and treat patients, as appropriate, within their home or institutional residences (e.g., nursing homes) with the goal of avoiding unnecessary emergency department visits and potential hospital admissions. The population served by ACCP at CCA are clinically complex, socio-economically disadvantaged patients with heavy burdens of multimorbidity and physical and mental health disability. Funded by PCORI, we used in-depth, open-ended interviews to examine the training and skills, workplace experiences, and satisfaction of paramedics. We interviewed 23 people who are either ACCP paramedics or non-ACCP paramedics. Using a thematic analysis approach for qualitative analysis, we found important themes around Interpersonal skills and attributes of paramedics along with challenges of the profession. In particular, we found that paramedics: (1) report frequently working with patients with psychiatric needs; (2) report having inadequate behavioral health training; and (3) have many challenges in managing patients with psychiatric needs where they rely heavily on their experience and/or strong interpersonal skills, not training to address the needs of this population. This data indicates that there is a gap in paramedic training related to behavioral health. It is important to build the competencies of paramedics working in mobile integrated health so this workforce can appropriately respond to patients with psychiatric needs in order to better serve this population.

The Center for Aging and Disability Education and Research at Boston University in collaboration with the Age-Friendly New Bedford Coalition and New Bedford Council on Aging received funding from Tufts Health Plan Foundation to build an educational campaign focused on reducing the stigma of mental illness and increasing awareness of the effects of social isolation in the community. In order for older adults to be fully engaged in community life, behavioral health concerns need to be addressed with a focus on social isolation, depression, and substance use. Many Age Friendly efforts don’t address these issues even though significant numbers of older adults are impacted. Without a community-wide capacity building effort, behavioral health issues among older adults often fade into the background. The first phase of this program will develop a greater awareness of the impact of behavioral health concerns and stigma. This campaign will be developed in multiple languages reflecting the area’s diverse population. In the second year of the grant, training will be provided for key stakeholders, including aging service providers, clergy, first responders, and resident coordinators focusing on the need to effectively identify and respond to older adults with behavioral health concerns. Early results on the anti-stigma campaign are showing positive impacts. Using the Depression Stigma Scale, we measured perceived stigma among older adults pre and post workshop participation. We found statistically significant changes in how older adults perceive depression after participation in the workshop. A pilot training program is underway and results are forthcoming in May 2018.