Integrated Health Care Settings Research Articles

Expanding the Behavioral Health Workforce: Pediatric Psychologists Training Master’s Level Students in Integrated Healthcare

ABSTRACT As mental and behavioral health needs continue to rise, additional providers are needed to expand the behavioral health workforce. Integrated behavioral health services result in increased access, reduced stigma, and improved quality of patient care. Psychologists are in a unique position to provide training to future mental health professionals in integrated settings, across multiple levels of training, and particularly to future master’s level providers, which make up the majority of the mental health workforce. The U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) Behavioral Health Workplace Education and Training (BHWET) Program aims to increase the behavioral health workforce in order to improve access to services. A priority is placed on care for children, adolescents, and transitional aged youth who are at risk for behavioral health disorders and highlights team-based approaches to care in integrated settings. An overview is provided of a HRSA BHWET funded training program implemented with master’s level students. Students completed clinical field placements in one of several integrated care settings and were provided specialized training in the areas of evidence-based treatments, integrated healthcare, and quality improvement. The overarching purpose of the Integrated Behavioral Services Training and Education Program (I-STEP) was to improve access to behavioral health services for underserved children and their families by expanding the behavioral health workforce. This was achieved through training master’s level counseling students to provide evidence-based services in integrated healthcare settings. I-STEP program goals, challenges, outcomes, and lessons learned are presented.

Training Social Work Master’s Students for Integrated Health Care Settings: The Importance of Specialized Education

ABSTRACT Integrated health care poses a unique opportunity for social workers to deliver person-centered, empowering, and collaborative care addressing all aspects of patient health. This study analyzed four years of data from a project designed to train social work master’s students to be effective members on integrated teams. Students that participated in the project achieved statistically significant levels of improvement from pre- to posttests with large effect sizes on the Behavioral Health Consultant Core Competency Tool skills (n = 93, Cohen’s d = -1.752, t(92) = -16.894, p < .001) and the Team Skills Scale (n = 94, Cohen’s d = -1.558, t(93) = -15.101, p < .001). Wilcoxon signed-rank tests confirmed improvements. No existing evaluations of integrated training for social work students capture behavioral health competencies data. Offering specialized training in integrated behavioral health work to students has immense potential benefit for outgoing social workers seeking to support patients.

What Attributes of Integrated Health Care for Mental Health Are the Most Important to Potential Consumers? A Relative Ranking Study.

Integrated health care (IHC) is efficacious, cost-effective, and more attractive to some consumers than traditional standalone psychotherapy, but the specific characteristics of IHC that drive this enhanced attraction have yet to be explored among potential future mental health consumers. As such, this brief report documents the results of a survey of 428 US adults who were asked to rank order the relative personal importance of seven characteristics (e.g., self-stigma mitigation, prompt appointment, saving money). These seven characteristics have been characterized in the IHC literature as potential beneficial elements of seeking mental health care from a provider in certain integrated health care settings. Getting sufficient information about one's health and treatment from one's provider was rated as most important, whereas co-location of mental/medical care and treatment privacy were rated as least important. The authors found evidence for select hypothesized demographic effects (e.g., interprovider communication rated more important for older adults) on how these factors were ranked. Professionals invested in developing and improving mental health care systems that are attractive and accessible to consumers in need of mental health care can consider the present findings when making decisions about which characteristics (e.g., getting sufficient information) should be maximized in the design and marketing of such systems. Future research, particularly longitudinal studies that assess prospective treatment seeking behavior, can build on the present study by examining the degree to which these attributes attract consumers to IHC settings.

Development of Preliminary Integrated Health Care Clinical Competencies for United States Doctor of Chiropractic Programs: A Modified Delphi Consensus Process.

There has been rapid growth of chiropractors pursuing career opportunities in both public and private hospitals and other integrated care settings. Chiropractors that prosper in integrated care settings deliver patient-centered care, focus on the institutional mission, understand and adhere to organizational rules, and are proficient in navigating complex systems. The Council on Chiropractic Education Accreditation Standards do not outline specific meta-competencies for integrated care clinical training. The purpose of this study was to develop preliminary integrated health care competencies for DC programs to guide the advancement of clinical chiropractic education. A systematic literature search was performed. Articles were screened for eligibility and extracted in duplicate. Domains and seed statements were generated from this literature, piloted at a conference workshop, and evaluated via a modified Delphi consensus process. Of 42 invited, 36 chiropractors participated as panelists. Public comment period yielded 20 comments, none resulting in substantive changes to the competencies. Of 1718 citations, 23 articles met eligibility criteria. After 2 modified Delphi rounds, consensus was reached on all competency statements. A total of 78 competency statements were agreed upon, which encompassed 4 domains and 11 subdomains. The 4 domains were: 1) Collaboration, (2) Clinical Excellence, (3) Communication, and (4) Systems Administration. We identified 78 preliminary competencies appropriate for preparing DC students and early career chiropractors for clinical practice in integrated healthcare settings. Educational programs may consider these competencies for curricular design and reform to strengthen DC program graduates for integrated practice, advanced training, and employment.

Burden of Medically Attended Diarrhea and Outpatient Clostridioides difficile Infection Among Persons in 2 Large Integrated Healthcare Settings, 2016-2021.

Identification of Clostridioides difficile infection (CDI) in the community setting is increasing. We describe testing for CDI among patients with medically attended diarrhea (MAD) in the outpatient setting, and the incidence of outpatient CDI. This was a retrospective cohort study among members ≥18 years of age from Kaiser Permanente Southern California and Kaiser Permanente Northwest from 1 January 2016 through 31 December 2021. MAD was identified by outpatient diarrheal International Classification of Diseases, Tenth Revision diagnosis codes, and CDI through positive laboratory results. Outpatient CDI was defined by no hospitalization ≤7 days after specimen collection. Incidence rates (IRs) of outpatient CDI were stratified by select demographic and clinical variables. Outpatient CDI burden 12 months following index date was measured by CDI-associated healthcare visits, and CDI testing and treatment. We identified 777 533 MAD episodes; 12.1% (93 964/777 533) were tested for CDI. Of those tested, 10.8% (10 110/93 964) were positive. Outpatient CDI IR was 51.0 (95% confidence interval [CI], 49.8-52.2) per 100 000 person-years, decreasing from 58.2 (95% CI, 55.7-60.7) in 2016 to 45.7 (95% CI, 43.7-47.8) in 2021. Approximately 44% (n = 4200) received an antibiotic 30 days prior to index date and 84.1% (n = 8006) CDIs were "community-associated" (no hospitalizations 12 weeks prior to index date). Of outpatient CDIs, 6.7% (n = 526) had a CDI-associated hospitalization ≤12 months. There was a high incidence of outpatient CDI despite infrequent CDI testing among patients with MAD. The majority of those with outpatient CDI had no recent antibiotic use and no recent hospitalization. Further studies are needed to understand the source and management of medically attended outpatient CDI.

Primary Care Supervision: A Community of Practice.

The goal of this project was to determine the feasibility of a Community of Practice (CoP) model to support behavioural health (BH) clinical supervisor professional development. Fourteen supervisors participated in 13 CoP-focused workshops focused on supervision within the Primary Care Behavioural Health (PCBH) model over a 4-year period. These workshops occurred twice a semester (in person and virtually) for supervisors hosting students participating in a Health Resources and Services Administration (HRSA) Behavioural Health Workforce Education Training (BHWET) grant. The program focused on preparing masters-level clinical mental health counselling students to function as Behavioural Health Consultants (BHCs) in primary care settings in rural and urban areas. Supervisors completed post-workshop surveys on their satisfaction with the content and the impact of the workshop content on building their PCBH supervision skills. Supervisors were satisfied with the content presented during the CoP workshops as well as indicated improvements in their confidence with providing supervision within the PCBH model. Areas of improved confidence and competence included supervision in integrated health care settings, topics discussed in primary care, and telehealth visits. Overall, this demonstrates an approach to building supervisor confidence in working with pre-licensure trainees within the PCBH model. CoP workshops show promise as an approach that institutions of higher education and health care organisation can adopt to improve clinical teaching and supervision in primary care as well as support supervisors in the community who work with trainees in primary care.

Policies during COVID-19 and their impact on immigrant families' psychological well-being: A critically engaged practice.

The COVID-19 pandemic has exacerbated, and complicated stressors related to immigrant families' experience with U.S. immigration policies. This article uses a critically engaged practice (CEP) framework to examine three policies and their implications for the health and well-being of immigrant families during the COVID-19 pandemic (a) Detention and Removal of Alien Parents or Legal Guardians policy, (b) Order Suspending the Right to Introduce Certain Persons from Countries where a Quarantinable Communicable Disease Exists, and (c) Field Guidance on Deportability and Inadmissibility on Public Charge Grounds. Our article presents a CEP framework to empower clinicians in integrated healthcare settings to better understand and communicate policies with their patients. Policy-informed CEP asks clinicians to (a) remain current with policy change; (b) have the ability to interpret policy and or policy change to clients; and (c) be aware of not only the primary effects of policy on the family but also the secondary impacts to their system. Clinical implications are provided. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

COVID-19 mortality among veterans with serious mental illness in the veterans health administration

ObjectivePersons with serious mental illness (SMI: schizophrenia-spectrum disorders, bipolar disorder) experience increased risk of mortality after contracting COVID-19 based on the results of several international evaluations. However, information about COVID-19 mortality risk among patients with SMI in the Veterans Health Administration (VHA) has been limited, precluding identification of protective factors. The current evaluation was conducted to assess COVID-19 mortality risk among VHA patients with SMI and to evaluate potential protective factors in mitigating mortality risk following a positive COVID-19 diagnosis. MethodsNational VHA administrative data was used to identify all patients (N = 52,916) who received a positive COVID-19 test result between March 1, 2020, and September 30, 2020. Mortality risk was assessed by SMI status via bivariate comparisons and multivariate regression analyses. ResultsIn unadjusted analyses, VHA patients with SMI overall and patients with bipolar disorder in particular did not experience increased mortality risk in the 30 days following a positive COVID test, although patients with schizophrenia had increased risk. Within adjusted analyses, patients with schizophrenia remained at increased mortality risk (OR = 1.38), but at reduced levels relative to previous evaluations in other healthcare settings. ConclusionsWithin VHA, patients with schizophrenia, but not those with bipolar disorder, experience increased mortality risk in the 30 days following a positive COVID-19 test. Large integrated healthcare settings such as VHA may offer services which may protect against COVID-19 mortality for vulnerable groups such as persons with SMI. Additional work is needed to identify practices which may reduce the risk of COVID-19 mortality among persons with SMI.

Increasing Social Work’s Stake in Interprofessional Practice

Integrated behavioral healthcare is becoming increasingly important and central to social work practice as the healthcare field shifts from a solely disease model of health to a more holistic approach. Researchers have also noted the need for studies demonstrating effective models for incorporating integrated healthcare training into schools of social work. Studies that demonstrate the effects of integrated training have the potential to provide legitimacy to these training programs, an important step in furthering their adoption within schools of social work in the United States and abroad. The training program described here was designed to increase the number of MSW social workers who provide trauma-informed, culturally relevant, evidence-based behavioral health prevention and intervention practices at integrated healthcare settings. This study used a pre- and post-survey design with non-participating MSW students as a control group. Findings indicate significant increases in knowledge, skills, and attitudes for training participants. A recommendation for further research is to explore to what extent graduates transfer their enhanced knowledge to the workplace.

Preparing a Workforce of Care Coordinators to Address Patient Mental Health Needs in the Digital Age: Training and Needs Identification.

Care coordinators (CCs) are specialized healthcare providers and often the primary point of contact for patients with multiple medical and mental health comorbidities in integrated healthcare settings. Prior work shows CCs have lower comfort addressing mental health than physical health concerns. Digital mental health interventions can support CCs' management of patient mental health needs, but training gaps must be addressed prior to a digital mental health intervention's implementation. As part of a quality improvement initiative, a 1-hour training focused on the assessment and management of depression and suicide-related thoughts and behaviors was delivered to CCs within a large midwestern healthcare system's Division of Ambulatory Care Coordination. CCs completed online surveys prior to and following the training. Training resulted in increased comfort working with clinical populations, including patients who experience suicide-related thoughts and behaviors. Gains around screening for suicide risk were modest. Brief trainings for CCs can address training gaps, however, ongoing training and case consultation may also be indicated.

Assessing counseling student self-reported competencies in primary care behavioral health.

Professional counselors are becoming increasingly represented in the Primary Care Behavioral Health (PCBH) workforce. Accordingly, models for training these professionals to work in integrated health care settings are needed. This article presents the results of 34 master's level counseling students' self-reported competencies in PCBH as a result of a PCBH training program. Results indicated that students' self-perceived competence across all domains increased over time. Implications for the function of self-reported skill development in students training as behavioral health consultants in primary care are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

9.1 Screening for Early Emerging Mental Experiences (SEE ME), a Model for Early Detection of Psychosis in US Primary Care

9.1 Screening for Early Emerging Mental Experiences (SEE ME), a Model for Early Detection of Psychosis in US Primary Care

Working With Older Adults in Integrated Health Care: Social Workers' Perspective.

Objective: Older adults are a rapidly growing segment of the global population; a paucity of research exists on social workers supporting this vulnerable group in integrated health care that focuses on both physical and behavioral health. To fill the gap, this study explored social workers' perspectives of working with older adults in integrated healthcare settings. Methods: Using qualitative methods, a constant comparison data analysis approach was conducted to identify themes. Results: Themes included: (1) working with and highlighting the unique needs of older adults in integrated health, (2) identifying skills needed for working as a social worker within integrated healthcare settings, (3) supporting patient families, and (4) needing to make decisions on behalf of patients. Discussion: Study findings demonstrate social workers as key members of interdisciplinary team as well as highlight the unique needs, skills, and challenges for working with older adults in integrated healthcare settings.

Social workers' experiences in integrated health care during the COVID-19 pandemic.

Summary The massive spread of the novel COVID-19 virus across the globe has been disruptive to all providers within integrated healthcare systems, including social workers. The literature on how the pandemic has impacted medical workers are emerging. The present article explored the experiences of social workers. A purposive sample of 40 social workers in integrated healthcare settings was interviewed from September to November 2020 prior to vaccine availability to learn about how they managed the earlier months of the pandemic. A constant comparison approach was used to analyze the data. Findings Themes identified included: (1) how social workers felt about safety in their work environments; (2) what it was like for social workers to transition to remote work; (3) how the pandemic affected social workers’ workload and mental health; and (4) what were the preparedness issues and lessons learned. Applications This study adds to the existing literature on provider experiences of the pandemic in integrated health care with social workers’ voices. This additional perspective may contribute to better preparedness of behavioral health services and taking care of social workers in future crises.

"Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women": Correction.

Reports an error in "Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women" by Katherine M. Iverson, Sara B. Danitz, Mary Driscoll, Dawne Vogt, Alison B. Hamilton, Megan R. Gerber, Shannon Wiltsey Stirman, Danielle R. Shayani, Michael K. Suvak and Melissa E. Dichter (Psychological Services, Advanced Online Publication, Jun 10, 2021, np). In the original article, the columns in Table 3 were misaligned such that the data presented in the columns did not correspond with the correct variable. Additionally, for clarity, the table should have presented a separate column "n" for sample size and displayed total scores for the Personal Progress Scale (PPS) as opposed to mean scores. None of these errors impacted the results or conclusions. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2021-53476-001). This article describes the rationale, development, and preliminary examination of a brief, variable-length (up to six sessions), modular-based counseling intervention for women who experience intimate partner violence (IPV). Recovering from IPV through Strengths and Empowerment (RISE) is an empowerment and skills-focused treatment that incorporates Motivational Interviewing. RISE was developed to fill the gap in interventions for women who disclose IPV within integrated healthcare settings such as the Veterans Health Administration (VHA). Fifteen women Veterans with past-year IPV participated in an open trial at two VHA hospitals to evaluate the potential helpfulness, feasibility, and acceptability of RISE using a mixed-methods approach to assessment. Qualitative feedback from women Veterans and five RISE clinicians (psychologists and social workers) was collected posttreatment. Descriptive analyses of quantitative psychosocial outcomes before and after the intervention provide evidence of support for RISE as potentially helpful in improving psychosocial well-being. High retention and high satisfaction ratings, along with positive qualitative feedback from both IPV survivor participants and clinicians, supported intervention feasibility and acceptability. Overall, this pilot study offers feasibility and acceptability data for RISE as a potentially helpful intervention for women experiencing past-year IPV. Refinements to RISE based on the open trial and subsequent testing of the clinical effectiveness of the intervention are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Recovering from intimate partner violence through Strengths and Empowerment (RISE): Development, pilot testing, and refinement of a patient-centered brief counseling intervention for women.

[Correction Notice: An Erratum for this article was reported online in Psychological Services on May 12 2022 (see record 2022-63047-001). In the original article, the columns in Table 3 were misaligned such that the data presented in the columns did not correspond with the correct variable. Additionally, for clarity, the table should have presented a separate column "n" for sample size and displayed total scores for the Personal Progress Scale (PPS) as opposed to mean scores. None of these errors impacted the results or conclusions. All versions of this article have been corrected.] This article describes the rationale, development, and preliminary examination of a brief, variable-length (up to six sessions), modular-based counseling intervention for women who experience intimate partner violence (IPV). Recovering from IPV through Strengths and Empowerment (RISE) is an empowerment and skills-focused treatment that incorporates Motivational Interviewing. RISE was developed to fill the gap in interventions for women who disclose IPV within integrated healthcare settings such as the Veterans Health Administration (VHA). Fifteen women Veterans with past-year IPV participated in an open trial at two VHA hospitals to evaluate the potential helpfulness, feasibility, and acceptability of RISE using a mixed-methods approach to assessment. Qualitative feedback from women Veterans and five RISE clinicians (psychologists and social workers) was collected posttreatment. Descriptive analyses of quantitative psychosocial outcomes before and after the intervention provide evidence of support for RISE as potentially helpful in improving psychosocial well-being. High retention and high satisfaction ratings, along with positive qualitative feedback from both IPV survivor participants and clinicians, supported intervention feasibility and acceptability. Overall, this pilot study offers feasibility and acceptability data for RISE as a potentially helpful intervention for women experiencing past-year IPV. Refinements to RISE based on the open trial and subsequent testing of the clinical effectiveness of the intervention are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Preparing Effective InterProfessional Teams to Meet the Needs of Older Adults in Integrated Healthcare Settings

Background: Gerontology education has evolved from focusing primarily on the individual practitioner outcomes to promoting integrated, inter-professional team approaches to integrated care. Practicum training and service learning are effective pedagogy for paraprofessionals in integrated care settings to support clinicians and advance their effectiveness in meeting the needs of older adults. Interprofessional education (IPE) aims to enhance the capacity of practitioners to work collaboratively as integrated team members. Yet, little is known about the implementation of IPE in colleges and universities that are not affiliated with a medical center or medical school. This presentation will describe the implementation of IPE in a School of Social Work without a medical school system. We will explore students’ experiences with the implementation, facilitation, and evaluation of this workforce development model, and will discuss both challenges and successes. Methods: Narrative data collected over the past two-year period with social work student participants in IPE reflect their perspectives on the selection process for the specialized training, placement in an interprofessional integrated care setting, and the learning experience. Participants represented cohorts of more than 200 trainees. Results: Challenges of effective interprofessional health care teams include the approach taken to integrating the teams, level of knowledge and skills required to be an effective team member, and the need for supervision within integrated care experiences. Successes include increased professional self-efficacy. Participants reported post-completion of IPE, (1) desirable outcomes achieved for their patients, such as care satisfaction and role satisfaction for themselves as practitioners.

Using Latent Class Analysis to Understand Social Worker Roles in Integrated Health Care

ABSTRACT Purpose: Social work (SW) is a profession that fulfills important roles on integrated health teams, yet there remains a lack of clarity on SW’s functions. The current study sought to identify typologies of SW’s roles on integrated care teams using latent class analysis (LCA). Method: An electronic survey was developed, piloted, and administered to Masters level SW students and practitioners in integrated health care settings (N = 395) regarding weekly use of interventions. LCA was conducted to estimate latent sub-groups of respondents. Results: Respondents reported an average of 14.6 (SD = 4.7) interventions. Five classes of SW roles were identified and varied by setting and focus. One class (13%) completed a hybrid function providing behavioral health and social care interventions. Conclusions: Classes of SW roles on teams may reflect varying models of integrated care. A flexible SW on the team may adapt to patient and clinic needs, but increases the opportunity for role confusion.

Ethics in integrated health care: social workers’ perspective

ABSTRACT The proliferation of integrated health care in which a holistic approach of physical and behavioral health is addressed by multiple providers is quickly evolving to be the standard of care in the United States. Social workers are well-suited to be key members of these interdisciplinary teams. As a reference point for professional conduct, social workers are guided by a set of ethical standards. Given the nature of integrated healthcare settings, social workers may encounter unprecedented ethical challenges. This study provides an exploratory examination of the ethical situations among social workers in integrated health care.

Measures Evaluating Patient Satisfaction in Integrated Health Care Settings: A Systematic Review.

Integrated health care includes joint, outpatient delivery of medical and behavioral health services. Traditional patient satisfaction measures might fail to capture the discrete delivery approaches in this model. To identify patient satisfaction measures used in integrated health care settings, a systematic review was conducted of US-based studies conducted in adult outpatient integrated care settings from 1999 through 2020. Study quality was assessed using standards recommended by the COSMIN guidelines. The review yielded a sample of 23 studies, consisting of 10 standardized measures and 6 self-developed tools. All studies/measures met at least one of the identified COSMIN guidelines, demonstrating quality of the measures. While most measures evaluated key elements of integration, including access, communication, and relationships, only one standardized measure evaluated elements of care specific to practice in integrated care. Findings suggest a need for a comprehensive patient satisfaction measure that captures important aspects of the integrated health care experience.