Behavioral Health Model Research Articles

Evaluating Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes: Quantitative Findings from the Ryan White HIV/AIDS Program Special Projects of National Significance Black Men Who Have Sex with Men Initiative.

The Black Men who have Sex with Men (MSM) Initiative was implemented at eight sites to engage and retain Black MSM in HIV medical care and supportive services (SS) by addressing their behavioral health (BH) care needs. Using a pre-post design and generalized logistic mixed-effects models adjusting for patient-level random effects, site, baseline age, and baseline mental health status, we evaluated whether participants experienced increased postintervention attainment of (1) Awareness of HIV medical care, BH care, and SS; (2) Screening, referral, linkage, receipt, and engagement in HIV care, BH care, and SS; and (3) Retention, antiretroviral therapy prescription, and suppressed viral load. Among 758 evaluated participants, the proportion of participants who were aware of, screened for, screened positive for, and referred to BH and SS, retention in care (72% to 79%), and viral load suppression (68% to 75%) increased between baseline and postintervention. Among participants who screened positive and received BH services were statistically more likely to be linked to [OR, 1.34 (95% CI: 1.08-1.66)] and retained in [OR, 1.36 (95% CI: 1.00-1.83)] care. Among those who screened positive and received SS were statistically more likely to be retained in care [OR, 1.54 (95% CI: 1.07-2.22)]. Measures of linkage to care declined significantly during the study period, perhaps because of COVID-19 that delayed in-person care. This study suggests that interventions designed to increase utilization of BH services and SS can be effective at improving retention in care and viral load suppression among Black MSM, at least among those currently using HIV services.

Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men Who Have Sex with Men: A Ryan White HIV/AIDS Program Part F Special Projects of National Significance.

Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men Who Have Sex with Men: A Ryan White HIV/AIDS Program Part F Special Projects of National Significance.

Prioritizing Flexibility, Human Connection, and Representation: Findings from the Qualitative Process Evaluation of the Special Projects of National Significance Black Men Who Have Sex with Men Initiative.

Previous research has identified significant unmet need for behavioral health care services for Black men who have sex with men (Black MSM); this challenge has been linked to poorer overall health and well-being. Health Resources and Services Administration (HRSA) funded a Special Projects of National Significance (SPNS) Initiative, Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men, with a goal to integrate behavioral health and clinical care services using four different evidence-informed models of care, ultimately improving HIV health outcomes. NORC at the University of Chicago conducted a multisite evaluation to assess the success of this Initiative, including a qualitative process evaluation that examined adaptations, services, integration activities, recruitment methods, and fidelity. The process evaluation described methods and processes used by demonstration sites to achieve their goals. This included challenges or barriers to implementation and the associated adaptations, notably due to the COVID-19 Public Health Emergency. Our study found key themes that indicated successful implementation were flexible service delivery, human connection, and client representation. We recommend future replicators apply these lessons learned in diverse health care and community settings that serve Black MSM. Additional information about the interventions can be found on TargetHIV.

Let's Integrate! The Case for Bringing Behavioral Health to Nursing Home-Based Post-Acute and Subacute Care.

Behavioral health (BH) concerns are prevalent among residents (eg, depression, anxiety, and insomnia), family care partners (eg, depression and burden), and staff (eg, burnout and depression) in nursing home-based post-acute and subacute care, referred to as skilled nursing facility (SNF) care. When untreated, BH concerns can lead to negative care outcomes, including limited functional improvements, longer lengths of stay, and elevated risk of rehospitalization and mortality. Despite the high clinical need, the field lacks evidence and consensus regarding an optimal model of BH services and roles for BH clinicians in SNFs. Developing such a model can inform the testing of BH interventions that best align with clinical operations, moving the field toward answering questions regarding the effectiveness and implementation of BH services in SNFs. Evidence-based BH models from the primary care literature include coordinated, colocated, and integrated care, each of which present potential benefits and challenges for the SNF setting. In this special article, we argue that an integrated model of BH services in SNFs may (1) increase access to and engagement with BH; (2) strengthen positive biopsychosocial resident outcomes and quality of care; and (3) prevent or improve BH concerns among stakeholders involved in resident care, including family care partners and staff. From our evidence-based discussion, we propose a Stepped-Care Model of Integrated BH for SNFs that can help clarify the scope of practice and clinical roles for licensed BH clinicians in this setting (eg, psychologists, clinical social workers, master's-level counselors). We conclude with a discussion of policy and research implications with a focus on potential policy changes that may be necessary for BH integration in SNFs. Future research to establish feasibility, clinical benefit (eg, efficacy, effectiveness), and financial justification for our proposed model is needed. This article can serve as a guide for such future research endeavors.

Delinquency, substance use, and risky sexual behaviors among youth who are involved in the justice system and predominantly reside in rural communities: patterns and associated risk factors

ABSTRACT There is a significant gap in research examining the prevalence of problem behaviors among youth involved in the juvenile justice system in rural areas. The current study sought to address this gap by exploring the behavioral patterns of 210 youth who were on juvenile probation in predominantly rural counties and who were identified as having a substance use disorder. First, we examined the correlation among 7 problem behaviors representing different forms of substance use, delinquency, and sexual risk-taking and 8 risk factors related to recent service utilization, internalizing and externalizing difficulties, and social support networks. Then, we used latent class analysis (LCA) to identify distinct behavioral profiles based on the observed problem behaviors. LCA identified a 3-class model representing distinct groups labeled Experimenting (70%), Polysubstance Use + Delinquent Behaviors (24%), and Diverse Delinquent Behaviors (6%). Finally, we assessed differences (i.e., ANOVA, χ2) in each risk factor across the behavioral profiles. Important similarities and differences in the association among the problem behaviors, behavioral profiles, and the risk factors were revealed. These findings underscore the need for an interconnected behavioral health model within rural juvenile justice systems that is able to address youths’ multidimensional needs including criminogenic, behavioral, and physical health needs.

Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men Who Have Sex With Men (Black MSM Initiative): Protocol for Program Evaluation

BackgroundThe HIV epidemic in the United States disproportionately affects Black communities. Nearly half of Black men who have sex with men (MSM) will be diagnosed with HIV in their lifetime. There is a significant unmet need for behavioral health care services among Black MSM, and untreated behavioral health needs make it less likely the person is retained in HIV care.ObjectiveThis paper offers a description of the Implementation of Evidence-Informed Behavioral Health Models to Improve HIV Health Outcomes for Black Men who have Sex with Men (Black MSM) Initiative, a program to integrate clinical care and behavioral health/supportive services for Black MSM with HIV. The Black MSM Initiative is funded through the Health Resources & Services Administration HIV/AIDS Bureau Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance.MethodsThe components of the Black MSM Initiative include providing technical assistance to 8 Initiative demonstration sites; conducting a comprehensive and culturally responsive, mixed method, multisite evaluation; and disseminating evaluation findings and lessons learned to the RWHAP community.ResultsAs of December 31, 2020, demonstration sites enrolled 809 clients in the multisite evaluation. The research team will continue evaluation data collection through December 2021 for analysis and dissemination starting in 2022. The Black MSM Initiative fully supports the US Department of Health and Human Services’ Ending the HIV Epidemic in the United States Initiative.ConclusionsIn order to succeed, providers and programs will need to engage populations traditionally considered “hard to reach,” like many people receiving RWHAP services. Findings and lessons learned from the Black MSM Initiative will expand the tool kit of solutions to support and retain Black MSM in HIV care, furthering the goals of the Ending the HIV Epidemic Initiative and the RWHAP.International Registered Report Identifier (IRRID)DERR1-10.2196/36025

Report from the field: A model of behavioral health integration with pediatric providers.

Children with mental health needs are currently not able to access adequate resources. This report from the field describes the ongoing implementation of an integrated behavioral health model in the state of Texas. The Child Psychiatry Access Network (CPAN) leverages primary care providers (PCPs) in the treatment and management of childhood psychiatric disorders. Data are reported as of November 2021 from consultations placed by PCPs over the preceding 17 months. During that time period, following consultation with the CPAN team, over 90% of PCPs were comfortable delivering the recommended mental health care directly to their patients. This suggests that CPAN is a feasible integrated behavioral health approach to address the shortage of child and adolescent psychiatrists.

Integration of primary care and behavioral health services in midwestern community health centers: A mixed methods study.

Integrating behavioral health (BH) and primary care is an important strategy to improve health behaviors, mental health, and substance misuse, particularly at community health centers (CHCs) where disease burden is high and access to mental health services is low. Components of different integrated BH models are often combined in practice. It is unknown which components distinguish developing versus established integrated BH programs. A survey was mailed to 128 CHCs in 10 Midwestern states in 2016. Generalized estimating equation models were used to assess associations between program characteristics and stage of integration implementation (precontemplation, contemplation, preparation, action, or maintenance). Content analysis of open-ended responses identified integration barriers. Response rate was 60% (N = 77). Most CHCs had colocated BH and primary care services, warm hand-offs from primary care to BH clinicians, shared scheduling and electronic health record (EHR) systems, and depression and substance use disorder screening. Thirty-two CHCs (42%) indicated they had completed integration and were focused on quality improvement (maintenance). Being in the maintenance stage was associated with having a psychologist on staff (odds ratio [OR] = 7.16, 95% confidence interval [CI] [2.76, 18.55]), a system for tracking referrals (OR = 3.42, 95% CI [1.03, 11.36]), a registry (OR = 2.71, 95% CI [1.86, 3.94]), PCMH designation (OR = 2.82, 95% CI [1.48, 5.37]), and a lower proportion of Black/African American patients (OR = .82, 95% CI [.75, .89]). The most common barriers to integration were difficulty recruiting and retaining BH clinicians and inadequate reimbursement. CHCs have implemented many foundational components of integrated BH. Future work should address barriers to integration and racial disparities in access to integrated BH. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Primary Care Treatment Integrating Motivation and Exposure for PTSD Symptoms and Hazardous Alcohol Use: A Case Series

Symptoms of posttraumatic stress disorder (PTSD) and hazardous alcohol use are highly comorbid. Research on integrated interventions to address PTSD symptoms and hazardous alcohol use concurrently has demonstrated efficacy, yet integrated treatments are underutilized. Both patient (e.g., stigma, scheduling/logistics) and clinician (e.g., concern about symptom exacerbation and/or treatment dropout) barriers may impede utilization of integrated interventions among those with comorbid PTSD symptoms and hazardous alcohol use. Primary care behavioral health models (PCBH), in which embedded behavioral health providers deliver treatment to individuals with mild or moderate behavioral health symptoms in primary care, may help address treatment barriers by offering accessible behavioral health interventions in a destigmatizing setting. This paper presents two case examples from a randomized controlled trial testing the efficacy of an integrated intervention for PTSD symptoms and hazardous alcohol use developed for and delivered in primary care. Outcome data and session-by-session content for two participants are included, along with discussion of barriers encountered during the course of treatment. Clinician-suggested strategies for navigating barriers to facilitate utilization of integrated interventions for PTSD symptoms and hazardous alcohol use are also discussed.

Closing the gap: Collaborative care addresses social determinants of health.

Social determinants of health have a significant impact on individual and community health outcomes. Using an integrated behavioral health model at a primary care clinic-a Federally Qualified Health Center-NPs led an interdisciplinary team to address outcome measures that are influenced by social determinants of health.

The syndemic effects of adverse mental health conditions and polysubstance use on being at risk of clinical depression among marginally housed and homeless transitional age youth living in San Francisco, California.

The objective of this study was to identify the correlates of being at risk of clinical depression and examine the role of syndemic factors among marginally housed and homeless transitional age youth (TAY). From 2017–2018, 100 TAY between the ages of 18 and 24 in San Francisco were recruited from Larkin Street Youth Services into a cross-sectional study. Participants completed surveys on mental health, substance use, and HIV risk behaviors. A syndemic score ranging from 0–3 was calculated by summing dichotomous measures of moderate or severe anxiety in the past two weeks, PTSD symptoms in the past month and polysubstance use in the past three months. We used modified Poisson regression with robust error variances to identify the correlates of being at risk of clinical depression in the past week, all primary effects measures were modeled separately. Among 100 participants, the average age was 21 (SD = 1.7), 67% were male, 38% were Multiracial, 54% identified as gay, lesbian, bisexual or pansexual, 13% were unstably housed, 50% were homeless and 23% were living with HIV. The majority (74%) were at risk of clinical depression, 51% had symptoms of moderate or severe anxiety, 80% exhibited symptoms of PTSD and 33% reported polysubstance use. After controlling for age in years, gender, race/ethnicity and sexual orientation, factors independently associated with being at risk of clinical depression were; symptoms of moderate or severe anxiety (adjusted risk ratio [aRR] = 1.62, 95% confidence interval [CI] = 1.23–2.12, P<0.001), symptoms of PTSD (aRR = 3.78, 95% CI = 1.58–9.04, P = 0.003), polysubstance use (aRR = 1.33, 95% CI = 1.06–1.68), P = 0.012), an increasing syndemic score (aRR = 1.40, 95% CI = 1.21–1.62), P<0.001), and having one, two or three syndemic factors (compared to none); (aRR = 2.68, 95% CI = 1.08–6.65, P = 0.032), (aRR = 3.24, 95% CI = 1.24–7.83, P = 0.003) and (aRR = 3.97, 95% CI = 1.65–9.52, P = 0.002), respectively. Integrated behavioral health models that treat co-occurring disorders simultaneously are needed to reduce syndemic risk among marginally housed and homeless TAY.

Aile Hekimliğine Olan Talebi Etkileyen Faktörler: Davranışsal Model İçin Türkiye Verilerinden Kanıtlar

This study aims to investigate the effects of chronic diseases and socio-economic factors on the demand for family medicine. The basic approach used is Andersen's behavioral health model. The variables used in the analysis were obtained from the “TurkStat Health Survey” micro data set for 2016. Three models were established to determine the degree of chronic disease data and socio-economic variables affecting health demand. Binary Logit regression analysis was used in the analysis of models. The variables such as gender, age, employment status, learning difficulties, concentration problems, treatment costs covered by the Social Security Institution (SGK), having a reliable relative, receiving help from neighbors, delaying health care appointments, having chronic hypertension and diabetes are the variables that influence the condition of receiving service from the family medicine (p

A Multidisciplinary, Family-Oriented Approach to Caring for Parents After Miscarriage: The Integrated Behavioral Health Model of Care.

Miscarriage is increasingly gaining recognition, both in scientific literature and media outlets, as a loss that has significant and lasting effects on parents, though often disenfranchised and overlooked by both personal support networks and healthcare providers. For both men and women, miscarriage can usher in intense grief, despair, and difficulty coping, and for women in particular, there is evidence of increased prevalence of depression, anxiety, and post-traumatic stress. Additionally, miscarriage can contribute to decreased relationship satisfaction and increased risk of separation, all while stigma and disenfranchisement create a sense of isolation. Despite this increased need for support, research indicates that many parents experience their healthcare providers as dismissive of the significance of the loss and as primarily focusing only on the physical elements of care. Research exploring the barriers to providers engaging in more biopsychosocial-oriented care has identified time constraints, lack of resources, lack of training in addressing loss, and compassion fatigue as key areas for intervention. This paper will review the biopsychosocial elements of miscarriage and discuss a multidisciplinary, family-oriented approach that can be implemented in healthcare settings to ensure a high quality and holistic level of care for individuals, couples, and families experiencing pregnancy loss.

Improving Primary Care Behavioral Health Integration in an Academic Internal Medicine Practice: 2-Year Follow-Up.

This report details ongoing efforts to improve integration in the 2 years following implementation of the Primary Care Behavioral Health model at a general internal medicine clinic of an urban academic medical center. Efforts were informed by a modified version of the validated Level of Integration Measure, sent to all faculty and staff annually. At baseline, results indicated that the domains of systems integration, training, and integrated clinical practices had the greatest need for improvement. Over the 2 years, the authors increased availability of behavioral medicine appointments, improved depression screening processes, offered behavioral health training for providers, disseminated clinical decision support tools, and provided updates about integration progress during clinic meetings. Follow-up survey results demonstrated that physicians and staff perceived improvements in integration overall and in targeted domains. However, the main ongoing barrier to integration was insufficient behavioral health staff to meet patient demand for behavioral health services.

The Impact of Brief Interventions on Functioning Among those Demonstrating Anxiety, Depressive, and Adjustment Disorder Symptoms in Primary Care: The Effectiveness of the Primary Care Behavioral Health (PCBH) Model.

Limited scalability combined with limited opportunities for patients to receive evidence-based interventions in traditional behavioral health treatment models for anxiety and depression creates a gap in access to adequate care. Primary Care Behavioral Health (PCBH) is one model of treatment in which behavioral health consultants (BHC) work directly within primary care settings, but there is limited evidence regarding the effectiveness of this model of care. The functional outcomes and appointment characteristics of Beneficiaries (N = 5402) within the military healthcare system were assessed. The study sample was predominately Caucasian, female, military dependents seen for 2 to 4 appointments. A reliable change index revealed that 17.2% showed reliable improvement and 2.4% showed reliable deterioration (p < .05). Of individuals with a severe Behavioral Health Measure-20 score at baseline, 81.5% showed some improvement at their final appointment, with 33% demonstrating reliable improvement. A mixed model analysis was used to determine the predictive value of appointment characteristics. All relations were significant (p < .001), except the between-subjects effect of appointment duration. Appointment duration revealed individuals reported worse functioning at the start of atypically long appointments. Individuals with generally longer intervals between appointments reported worse functioning, but an atypically long interval predicted better functioning at the following appointment. As it relates to number of appointments, individuals with more total appointments reported worse functioning outcomes, with generally better functioning across appointments. Overall, these data support the effectiveness of time-limited care provided through the PCBH model.

A model for the assessment, care, and treatment of suicidal risk within the military intelligence community

ABSTRACT This paper describes the development of a behavioral health and wellness model into the US Army Intelligence and Security Command (INSCOM) to address concerns about suicide within this community. In response to stresses existing within the intelligence community (IC), INSCOM partnered with the Army Public Health Center (APHC) to assess the health and wellbeing of Command personnel. A Community Health Assessment (CHA) survey was conducted (N = 2,704 Soldiers; N = 959 Civilians) that included focus groups across three installations and secondary source data. Six key areas were prioritized: suicide behavior, behavioral health access to care and health promotion, behavioral health stigma and maintaining clearances, workplace environment, sleep health, and overall fitness. Several actions were implemented to address the report’s findings and recommendations. A Command Surgeon office was established within INSCOM. An INSCOM Health Assessment and Readiness Team (I-HART) was established. The Deputy Undersecretary of the Army provided support to address suicide within INSCOM by approving 4 highly qualified experts (HQE’s) in behavioral health and clinical suicidology to provide research oversight and make recommendations. The Command General approved 8 behavioral health providers. There are planned research efforts within the command focusing on scalable and technology enabled care delivery to improve mental well-being and decrease suicides.

Disparities in pediatric psychosocial oncology utilization

Integratedbehavioral health models have been proposed as care delivery approaches to mitigate mental health disparities in primary care settings. However, these models have not yet been widely adopted or evaluated in pediatric oncology medical homes. We conducted a retrospective cohort study of 394 children with newly diagnosed cancer at Dana-Farber/Boston Children's Cancer and Blood Disorders Center (DF/BCH) from April 2013 to January 2017. Baseline sociodemographic characteristics and psychiatry utilization outcomes at 12months following diagnosis were abstracted from the medical record. The severity of household material hardship (HMH), a concrete poverty exposure, at diagnosis and race/ethnicity were characterized by parent report using the Psychosocial Assessment Tool 2.0 (PAT). Associations between sociodemographic characteristics and receipt of psychiatry consultation were assessed with multivariable logistic regression models. Among 394 children, 29% received a psychiatric consultation within 12months postdiagnosis. Of these, 88% received a new psychiatric diagnosis, 76% received a psychopharmacologic recommendation, and 62% received a new behavioral intervention recommendation. In multivariable logistic regression adjusting for age, cancer diagnosis, and PAT total score, there was no statistically significant association between HMH severity or household income and psychiatry utilization. Children who identified as racial/ethnic minorities were significantly less likely to receive a psychiatry consultation (OR=0.48, 95% CI=0.27-0.84). In a pediatric oncology medical home with an integrated behavioral health model, socioeconomic status was not associated with disparate psychiatry utilization. However, there remained a profound racial/ethnic disparity in psychiatry utilization, highlighting the need for additional research and care delivery intervention.

The primary care behavioral health model (PCBH) and medication for opioid use disorder (MOUD): Integrated models for primary care

ABSTRACT Recent decades have witnessed increases in (a) integrated physical and behavioral health services and (b) the treatment of opioid use disorders (OUD) in primary care settings – also known as office-based opioid treatments (OBOT) – using a combination of medication and psychosocial support. Providing these services requires a workforce trained to address addiction’s psychosocial components and interventions addressing addiction’s biological and neurological mechanisms. This paper examines the implementation factors, clinic workflow and roles, and administrative considerations of two models of integrated care in order to identify ways of increasing treatment capacity and expanding OUD treatment uptake in integrated primary care settings.

Measuring Productivity in Primary Care Behavioral Health: A Delphi Study.

High productivity by behavioral health consultants (BHC) is a defining aspect of the primary care behavioral health (PCBH) model to maximize access to care and is often measured by patient volume. Studies of productivity in health care settings suggest a single productivity target may not be optimal. We used a Delphi method to obtain expert consensus on an operational definition of high productivity by BHCs in the PCBH model. Clinicians, managers, and researchers in PCBH were recruited to participate in a multi-round survey using a modified Delphi technique and develop consensus on PCBH productivity metrics. Ten participants completed all three survey rounds and rated 28 metrics. After three rounds, two direct metrics (average number of billable BHC visits each day; number of patients seen per day) received at least 80% consensus as "Essential", two received at least 50%, and five received less than 50%. One influencer (level of integration at the practice) received at least 80% consensus as "Very Much" influential, 19 received at least 50%, and eight items received less than 50%. Several themes arose from participant comments. PCBH productivity can be interpreted as being high volume. Numerous practice factors influence how productive a BHC may be. Future studies should determine the feasibility of our metrics in clinical practice, establish productivity expectations based on patient needs and clinic resources, and identify patient-, clinician-, or practice-level moderators of productivity.

Mammogram Adherence Among Filipino American Women.

Filipino American women experience breast cancer disparities including being diagnosed with breast cancer at a younger age and at a later stage. More Filipino women have breast cancer tumors that are ER-negative or overexpress Her2-neu. These disparities could be effectively minimized with screening mammograms. This study aims to determine factors that influence mammogram adherence in Filipino American women using Andersen's Behavioral Health Model of Services for Vulnerable Populations as the conceptual framework. Logistic regression models determined the influence of predisposing, enabling and need variables with mammogram adherence. Among all variables-breast cancer literacy, mammogram reminder, sociocultural deterrents, cultural beliefs, and years of residence in the United States-only a mammogram reminder from a healthcare provider was significantly associated with mammogram adherence. Convenience and snowballing sampling generated a group of women who were highly-educated Filipinas limiting the generalizability of the study's findings.