Social Worker - Primary Care Mental Health Integration

About the role

Primary Care Mental Health Integration (PCMHI) is an essential component of the Patient Aligned Care Team (PACT), providing timely evidence‑based mental and behavioral health support within primary care through the Collocated Collaborative Care (CCC) and Collaborative Care Management (CoCM) models.

Responsibilities

• Serve as a licensed psychologist embedded in PACT as part of the PCMHI team.
• Function as the interface between Primary Care and Specialty Mental Health using an integrated, population‑based model emphasizing timely access, same‑day consultation, brief evidence‑based interventions, and close collaboration with Primary Care Providers (PCPs).
• Provide assessment, diagnostic clarification, behavioral health interventions, consultation, and care coordination for Veterans presenting with common mental health and behavioral medicine concerns.
• Offer same‑day access via warm hand‑offs, brief functional assessments, risk assessment, measurement‑based care, and time‑limited evidence‑based interventions.
• Collaborate closely with PCPs, nursing, pharmacy, social work, and other interdisciplinary team members to improve clinical outcomes, enhance patient engagement, and reduce barriers to specialty mental health services.
• Address service areas including depression, anxiety, insomnia, chronic pain, substance misuse, tobacco cessation, weight management, health behavior change, chronic disease self‑management, and adjustment to medical illness.
• Participate in program evaluation, quality improvement, staff education regarding PCMHI models, and system‑wide consultation while maintaining