This is an overview of triage pathway for those with mental health and substance use conditions with clinical cutoffs and referral options based on screening.

1. Mental Health Symptom and Action Form
Adapted From SBIRT Oregon Model
Created by Michael Changaris, Psy.D.
Wright Institute Integrated Health Psychology Training Program Coordinator
For Primary Care
Behavioral Health Integration Team

2. IV
III
II
Low Risk
I
Low to No
Symptoms
High Risk: Symptoms Likely
Significantly impacting health,
functioning & quality of life
Low Risk: Watchful waiting,
brief intervention possible
consult assessment.
Low to No Risk:
No intervention at
this time.
Mod Risk: Likely presence of
symptoms impacting health,
functioning & quality of life

3. ZONE Symptoms &
Impact on Health
ACTIONS
Level IV – SEVERE SYMPTOMS
PC-PTSD (PTSD) 4
GAD-7 (Anxiety) 14 - 21
PHQ-9 (Depression) 20 - 27
Severe Symptoms that likely
significantly impacting health,
mental health, functioning and
quality of life.
Acute tx needed quickly.
I. Team based care and care
coordination.
II. Psychiatric Med. Consult
III. Safety Assessment (SI/HI)
IV. Brief Int. w/ BHC
Level III – MODERATE SYMPT.
PC-PTSD (PTSD) 2 - 3
GAD-7 (Anxiety) 10 - 14
PHQ-9 (Depression) 10 - 19
Moderate Symptoms that will
likely have long term negative
impacts on health and fxn if not
treated. Pos. exacerbating existing
health conditions
I. Medication Eval. or
Brief EVP psychotherapy.
II. Warm H/O BHC Assess
Risk & Tx. Needs
III. Referral to Adj. Tx.
IV. R/O Pos Health Factors.
Level II – MILD TO NO SYMPT.
PC-PTSD (PTSD) 1
GAD-7 (Anxiety) 5 - 9
PHQ-9 (Depression) 5 - 9
Mild to No Symptoms Possible
indications of symptoms that
could lead to MH conditions
developing. Watchful waiting and
preventative tx.
I. Watchful waiting
II. Consider further
assessment w/ BHC
III. Brief Intervention w/ BHC
Level I - NO SYMPTOMS
PC-PTSD (PTSD) 0
GAD-7 (Anxiety) < 5
PHQ-9 (Depression) < 5
No Symptoms
Consider preventative referral for
stress management and other
health skills with BHC
I. No intervention
II. Preventative stress and
health skills with BHC.

4. HEALTH RISKS OF UNTREATED MENTAL HEALTH SYMPTOMS
Headaches/Migraines, Memory Loss
Insomnia and Concentration Problems
Long-term risk of Alzheimer's and other
neurodegenerative disease
Weight Gain/Loss, Change in Health
Behaviors, Poor Diet, Obesity
Premature Aging
Lower immune function, overall
inflammatory factors elevated,
slower wound healing
Heart Disease, Hypertension (HTN),
Hyperlipidemia, Atherosclerosis,
Arrhythmias, Angina
Use of substances to cope with
symptoms: Smoking, EtOH, Drugs
Irritable Bowl Syndrome, GERD,
Digestive challenges, other
Gastrointestinal problems.
Increased risk of Type II Diabetes
Poor Sugar and Insulin Processing
Increased symptoms of pain and risk of
chronic pain conditions.
Worsened symptoms of asthma,
COPD, and other breathing
conditions.
Difficulty fulfilling obligations, working,
schooling, self care and adherence to
health care treatments.
Risk of sexual dysfunction and
high-risk sexual behavior
Risk for limited mobility, social isolation, &
slower recovery from surgery.

5. LEVEL OF HEALTH RISK
Level IV – High Risk
Significant health risks if mental health symptoms
remain untreated leading to risk for early death.
Level III – Moderate Risk
Risk to health and increased risk of severe mental
health symptoms developing if untreated.
Level II – Minimal Risk
Some risk to health and mental health
preventative treatment can help stop mental
health symptoms from developing
Level I – Low Risk
Low risk of health and mental health symptoms
education and skills can increase resilience.
COMMON HEALTH
COMORBIDITIES
q Hypertension (HTN)
q Cardiovascular Disease (CVD)
q Hyperlipidemia
q Arrhythmias
q Heart Attack
q Stroke
q Insomnia
q Memory problems
q Poor Diet and Poor Exercise
q Difficulty following through w/ tx.
q Irritable Bowl Syndrome
q Fibromyalgia
q Chronic Pain
q Hypothyroidism
q Hyperthyroidism
q Asthma
q COPD
q Smoking
q Substance Use Disorders