Sentara expands program to embed therapists in primary care practices

In 2022, Gussie Belisario moved back to Elizabeth City, North Carolina, to help care for her mother, who was dealing with memory loss.

Belisario had generalized anxiety disorder herself. She started having panic attacks her senior year of high school. After returning to her hometown, she balanced her caretaking duties with part-time work as a speech language pathologist. As stress from her new life accumulated, she started looking for a therapist.

Luckily for her, she didn’t have to look far. She found one down the hall from her doctor’s office, the result of a Sentara program to embed therapists in primary care practices.

Having a therapist at the same office as her doctor meant less driving and less time away from her mother.

“The access is just amazing,” Belisario said. “It makes life a lot easier for someone in my position.”

A ‘whole-person approach’

Sentara launched the embedded therapist program in 2020 with the goal of increasing access to mental health services. After an overwhelmingly positive reception by both patients and providers, Sentara is in the process of expanding the program.

The integrated approach brings mental and physical care under one roof, said Dr. Charles Dunham, executive director of medical operations for behavioral health, which includes mental health and substance use disorders.

“There’s a lot less stigma related to mental healthcare post Covid,” said Dr. Dunham. “But there’s still stigma. This has made mental healthcare part of routine medical care, and that has helped a lot of people.”

The model breaks down barriers and offers a “whole-person approach,” said Katie Bush, director of behavioral health services.

“A lot of behavioral health care is already happening in primary care,” said Bush. “Whatever direct support we can give primary care, the better.”

Sentara is in the process of hiring two more embedded therapists serving the Hampton Roads region, with one specializing in children. This is on top of five embedded therapists already working at practices in Virginia’s Hampton Roads region, northern Virginia, and northeastern North Carolina, as well as a sixth slated to start in the Virginia Peninsula in June. In addition to treating patients from their practice, the embedded therapists accept referrals from other providers.

The program’s growth has already produced a dramatic increase in services. After hiring 3 embedded therapists in 2024, Sentara’s team completed 5,513 patient visits in 2024, a 54% increase from 2023.

An in-house therapist

Amelia Walker, a licensed clinical social worker, sees patients three days a week at a Sentara Family Medicine practice in Elizabeth City, offering treatment for issues like anxiety, depression, and attention-deficit hyperactivity disorder (ADHD). She works remotely two days a week, which gives patients the option to meet virtually. Her patients include Belisario.

Walker said treating patients at the practice has already helped break down barriers to mental healthcare services.

“If patients are nervous or have never sought counseling services, the doctor or advanced practice provider can say we’ve got someone in-house,” Walker explained. “Their provider can literally walk them to my office.”

Walker said she meets regularly with the primary care team to discuss patients and share information, which helps with care.

“It’s been really helpful to communicate with the primary care providers.”

Rebecca Cohen, a licensed professional counselor, sees patients at a Sentara Internal Medicine practice in Virginia Beach, Virginia. Like Walker, she has a hybrid schedule, working in the office three days a week.

Cohen describes the new, integrated model as a “one stop shop” and said the new approach “eases access.”

She added, “People love having all their providers at the same place.”

In addition to dealing with lingering effects from the pandemic, many of her patients have been navigating political stress, regardless of their beliefs, she said.

Therapy offers a “safe, unbiased space to talk about what you think is relevant and important,” as well as provide a “path to healing.”

“When our mental health is better, we have more capacity to do better in other areas.”

To learn more about mental health services, talk to your provider today.