A listening ear and a guide when members are in great need
When a member’s name and phone number land on the desk of Melody Chappel, James Patterson, Rachel Siegel, or Carmel Steger, it’s a good thing. That information is now in the hands of one of four licensed independent clinical social workers who are care managers in the Tufts Health Plan Behavioral Health Department.
They’ve seen a lot. From members who want to stop drinking to those who want to stop using heroin. Parents with children who are struggling with mental illness. Teachers overcome with anxiety and depression.
As a behavioral health care manager for Tufts Health Plan, James Patterson’s job is to connect with members at critical times in their lives, like when they’ve left a hospital emergency room. Or if they or a family member is in a detox program.
“We reach out to them to make sure that they are successful when they leave the hospital,” Patterson says. “When they first have to go back to their lives and manage and cope.”
It’s not necessarily the worst day of their lives, he says, “it’s usually the day after.”
“They’re already dealing with something that is overwhelming, and then they have to also figure out how to get the care that they need,” he says.
That’s when he or a member of the team will call and offer support. He walks them through treatment options. He gives information. He guides them through their benefits. And most of all, he listens.
“Care management is all about connecting a member who’s struggling with resources that are oftentimes right in their backyard,” he says. That name and phone number are a lifeline.
The first phone call
Carmel Steger has worked for Tufts Health Plan for 21 years. As part of the behavioral health team, she works with members of all ages and enjoys talking to them on a regular basis.
But the first call to a member can always be a challenge, she says, and her colleagues agree.
“We have a little information to go on,” Steger says. “Why were they in the hospital, what led up to this? Is this their first detox or their fifteenth?”
But those topics are not something she’ll bring up right away. She’ll start by explaining who she is, and that she’s there to help.
“Sometimes you don’t think your insurance company has this sort of resource, but we definitely do,” she says.
It takes some time to establish trust. “I say that I know it might be hard to talk to somebody over the phone, and I try to hear their feedback about that,” she says.
For many, it’s the first time they’ve spoken to anyone at all. “You start where someone is willing to speak,” she says. “You try to build some understanding about the way they’re feeling.”
Through her calls, Steger makes an assessment. She answers questions. She is clear: This is not over-the-phone therapy. And above all, this call is confidential.
It’s “the chance to try and offer them a sense of hope,” she says. From then on, a one-time call may turn into a weekly call. And a weekly call can be exactly what a member needs to get better.
A helping hand, a listening ear
“Mental health isn’t the sentence that it was decades ago,” says Melody Chappel, another member of the behavioral health team. “That’s something that, as a society, we don’t necessarily see or appreciate enough.”
She talks with her members about their medications and the importance of seeing their providers. Through her calls, she gets to know them, and sees them through to improvement, however long it takes.
“People can live really full, productive, meaningful lives and still have a mental health diagnosis. It’s a part of you, but it doesn’t have to define you.”
Behavioral health conditions fill a wide spectrum. Substance use disorder, including alcohol dependency and opioid addiction, is one major part of what the behavioral health team encounters.
“We see quite a bit of our members struggling with recovery but, you know, really doing their best to go through a detox or rehab program,” says Rachel Siegel, a 10-year veteran of the team.
“We're catching them now after they’ve been through quite a lot,” she says.
The behavioral health team has connected thousands of members to resources: from therapists to specialists, methadone clinics, group programs, hospital recovery programs, residential treatment, and more.
“If they need a therapist, we find a therapist. If they need a doctor, we find a doctor,” Siegel says. “I tell people that I’m going to help them, and I actually do,” she says. Siegel and her members work together; the member identifies the gap and Siegel works on building the bridge. That bridge could be helping to find a specialty provider, or advocating for their needs with their current providers.
And she knows she’s done her job when a member says “thank you.”
“We see people get better,” Chappel says. “That’s why I do what I do, and that’s why I like it.”
“I just hope that people, anybody who would see this, would know that it’s okay to ask for help,” Patterson says. “They don’t have to be alone with what they’re struggling with.”