Insights From the Field: Behavioral Care Coordinator Karen Olvera, LCSW, CADC

After more than 20 years as a social worker, Karen Olvera, LCSW, CADC, has seen firsthand what can happen when patients lack the right support at the right time.

Before becoming a behavioral care coordinator in the Collaborative Behavioral Health Program (CBHP) at Northwestern Medicine, she spent 10 years as an Emergency Department social worker and also worked in Inpatient Psychiatry. In those settings, she often saw patients improve with intervention, only to return in crisis when they lacked ongoing support after discharge.

“With ED care, there’s a lot of recidivism,” says Olvera. She recalls that patients received care, and then returned to the Emergency Department “because they didn’t have support once they left.”

That experience shaped her interest in CBHP and the collaborative care model (CoCM). Olvera wanted a role where she could provide care earlier, stay connected with patients and see them make meaningful improvements over time. When the opportunity came to help implement the model in Chicago’s west suburbs, she was drawn to its team-based structure and focus on outcomes.

“The model fascinated me — working with the primary care physician, patient and psychiatric consultant to improve patient outcomes,” she says.

Behavioral Health Is Whole-Person Health

For Olvera, whole-person care means recognizing that behavioral health is inseparable from physical health, daily functioning, family systems, social context and access to resources.

That perspective is one reason behavioral care coordinators are so valuable in primary care. Primary care clinicians are often the first place patients turn when they are struggling, but they are also managing significant demands. Behavioral care coordinators like Olvera help extend the care team’s capacity by taking time to understand a patient’s symptoms, background, barriers and goals.

“Doctors are amazing,” she says, but she notes they often don’t have the time to understand all of those pieces in a standard visit. “Bringing us in is helpful.”

Reducing Barriers to Care

Improving access to mental health care is especially important to Olvera because she has seen how many barriers patients face, from insurance limitations and clinician shortages to rural geography, long wait times and uncertainty about where to go.

“There are limited providers that take certain insurances, especially in rural areas,” says Olvera. “Being able to access care in those areas where it’s very limited can make a meaningful difference.”

The CBHP helps reduce those barriers by embedding behavioral health support within primary care. Patients are referred by a physician they already know and trust, connected quickly with someone in the same health system and supported through follow-up rather than being left to navigate the next step alone.

For some patients, that can be the difference between engaging in care and slipping back into crisis.

“If patients can’t access care when they need it, a crisis could hit again,” says Olvera.

A Team of Four, Centered on the Patient

Olvera was also drawn to the program because it is evidence-based and team-oriented. She describes the care team as four people working together: the patient, the primary care clinician, the psychiatric consultant and the behavioral care coordinator.

“I love the team aspect,” she says. “We’re all working together to help the patient feel better.”

Just as important, the model gives patients ownership in their care. Rather than care being done to them, Olvera sees the process as something done with them. Patients help identify what they want to change, what goals matter and what support feels realistic.

“It’s motivating to see patients engage in the process,” Olvera says.

Helping Patients Move Forward

Olvera remembers one patient who entered the program after experiencing symptoms that had not improved despite multiple approaches. When Olvera reached out, it was clear to her that the patient was facing challenges but was engaged and wanted help.

Through the program, Olvera and the care team worked to refine the patient’s treatment plan and identify a therapist with the right specialty for their needs.

Over time, the patient’s outlook began to shift. By the end of the program, their mood had improved, and they credited the program with helping them feel better. The patient continued working with the therapist, expanded their social circle and began doing things they enjoyed again.

Supporting Patients and Clinicians

The program also supports primary care clinicians, who may be managing patients with varying levels of behavioral health needs, but have limited time and resources. Olvera helps identify appropriate treatment options, specialty resources, higher levels of care and community-based services.

Medication management is another important part of the model. When a patient has tried multiple medications without improvement, the psychiatric consultant can recommend another path. Olvera then follows up with the patient through the early stages of that plan, especially when side effects, discouragement or uncertainty arise.

For primary care clinicians, that support can bring reassurance.

“They know their patients are taken care of, and that gives them peace of mind,” she says.

Meaningful Patient Progress

One of Olvera’s favorite moments is showing patients how far they have come. She regularly reviews symptom scales and can point to concrete progress over time: a depression score that dropped from 19 to 4, or an anxiety score that decreased from 17 to 5.

But the progress isn’t just numerical. Patients develop coping skills, practice goal-setting and learn how to manage future moments of sadness or anxiety before those moments become overwhelming.

“It’s not that they’re never going to have moments of feeling sad or anxious,” says Olvera. “The difference is that they have tools to handle those moments. It won’t be like it was before.”

As Olvera’s experience shows, collaborative care is more than a program. It is a way to help patients feel less alone, support physicians and make behavioral health what it should be: an integrated part of whole-person care.

Looking for more guidance on building and sustaining integrated behavioral health programs? Explore additional tools and resources from Northwestern Medicine West Health Accelerator.