Integration Of Behavioral Health Services Research Articles

Does the integration of behavioral health services in a primary care practice lead to improved outcomes in patients with PTSD?

Cerimele, Angelina DO; Ibarra Yamamoto, Tiana DO; Walsh, Kyle MD; Wilkinson, Savannah DO; Ginoza, Jeremy A. DO Author Information

Mental Health 911: Advocating for the Integration of Behavioral Health Services in Pediatric Hospital Emergency Departments

The coronavirus disease pandemic of 2019 has led to increased concern in mental health needs among pediatric populations. As the number of pediatric mental health emergency department visits have increased, so has the need for integrated behavioral health services in hospitals. This paper describes a standard of mental health care and the benefits of providing mental health services in pediatric hospital settings. The Trauma Mental Health Counseling Program, Hurt-2-Healing (H2H™) was developed and implemented in a Level-1 pediatric hospital and has served a total of 1,523 pediatric trauma patients and their caregivers since 2021. This program established a new hospital-based standard of mental healthcare for pediatric trauma patients and their caregivers. A questionnaire was developed to evaluate the efficacy of the Hurt-2-Healing program within domains such as openness to seeking counseling, psychoeducation, helpfulness of counseling, and ability to cope with the traumatic injury. The majority of (83%) patients/caregivers had no previous counseling experience prior to hospital admittance. Questionnaire responses indicated that after receiving mental health services, caregivers felt more aware of their children’s mental health needs and reported being more open to seeking future mental health counseling services for their child. Further, most respondents were in strong agreement that receiving mental health counseling services during the hospital stay was helpful. These results highlight the need for, and benefit of, providing a standard of care integrating behavioral health services in pediatric hospitals.

BEYOND HOUSING

Abstract Social isolation and loneliness in older adults are a public health challenge that has been exacerbated during the COVID pandemic. While quarantining although it was necessary to protect individuals from the virus, older adults lost their usual social supports, connectedness, and relationships. Research has shown that loneliness and social isolation have many negative effects on a person’s physical and mental health. This presentation will describe an initiative of Age Friendly RI which addressed the problem of social isolation among older adults living in a congregate housing community who struggled with stress, anxiety, depression, and exacerbation of mental illness. Through a partnership between a state college and a community based mental health center, and supported with grant funding, behavioral health services and supports were embedded in the housing community. The project was multi-faceted involving community health workers and a community support professional who provided outreach and emotional support, the use of technology to help residents connect with medical providers or loved ones or enjoy music, games, movies, and students who provided outreach and taught older adults how to use technology. A social isolation scale was administered to identify residents at high risk of social isolation and targeted intervention. The evaluation of the program will be discussed in terms of the interventions implemented and the outcomes realized, including resident well-being and satisfaction. Finally, it will suggest a pathway for sustaining the integration of behavioral health services in housing to better meet the behavioral health needs of older residents beyond the pandemic.

Interventions for Integrating Behavioral Health Services Into HIV Clinical Care: A Narrative Review.

The integration of behavioral health services within human immunodeficiency virus (HIV) care settings holds promise for improving substance use, mental health, and HIV-related health outcomes for people with HIV. As part of an initiative funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we conducted a narrative review of interventions focused on behavioral health integration (BHI) in HIV care in the United States (US). Our literature search yielded 19 intervention studies published between 2010 and 2021. We categorized the interventions under 6 approaches: collaborative care; screening, brief intervention, and referral to treatment (SBIRT); patient-reported outcomes (PROs); onsite psychological consultation; integration of addiction specialists; and integration of buprenorphine/naloxone (BUP/NX) treatment. All intervention approaches appeared feasible to implement in diverse HIV care settings and most showed improvements in behavioral health outcomes; however, measurement of HIV outcomes was limited. Future research studies of BHI interventions should evaluate HIV outcomes and assess facilitators and barriers to intervention uptake.

Integration of behavioral health services and adolescent depression screening in primary care.

Integration of behavioral health services and adolescent depression screening in primary care.

Supporting youth mental health during the COVID-19 pandemic.

Supporting youth mental health during the COVID-19 pandemic.

Implementation of School-Based Behavioral Health Services Over Time: A Longitudinal, Multi-level Qualitative Study

Behavioral health practitioners recognize how critical the process of implementation is to the successful use of evidence-based practices. It is further recognized that implementation is a complex, time-consuming process and that successful implementation often occurs in stages. Capitalizing on a national evaluation examining the implementation of school-based behavioral health (SBBH) services, this project involved an analysis of qualitative interview data to assess the unique barriers and facilitators that arise across time and organizational levels in the implementation of SBBH services. Forty-eight semi-structured telephone interviews were analyzed across 3 years and two organizational levels in seven sites (n = 48). Qualitative analysis identified five major implementation facilitators including communication and collaboration, data utilization, leadership, planning, and training. Major barriers to implementation included systemic state/governmental barriers, workforce shortages, and funding issues. While there were small changes in the relative importance of these facilitators and barriers over time and by organizational level, the most salient barriers and facilitators remained important across all 3 years of the study. Differences across organizational levels included greater emphasis at local levels for facilitators such as training and leadership and a greater emphasis at state levels for state/governmental barriers. Results suggest that while the importance of given facilitators and barriers changes as implementation progresses, the major factors that contribute to implementation are likely to remain unchanged over time. Effective communication/collaboration among stakeholders remains a powerful facilitator across time, and systemic state/governmental barriers remain a potent barrier. Implications for increasing successful integration of behavioral health services in public school settings are discussed.

A Program Evaluation of Behavioral Health Integration in a Freestanding Birth Center.

The objective of this evaluation was to evaluate the integration of behavioral health services at a freestanding birth center. Program evaluation included (1) retrospective health record reviews and (2) provider and client evaluation of satisfaction. In May 2017, an urban freestanding birth center initiated grant-funded integrated behavioral health services. Participants included women receiving perinatal care from May 2016 to April 2018 (n = 831). Clients (n = 414) and providers (n = 9) were surveyed through e-mail, with 166 (40%) and 7 (78%) responses, respectively. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale. Screening and treatment of depression were identified from health records. The on-site therapist saw 21% of women who birthed during the program's first year. Compared with the year before the program began, in the program's first year, more women were screened for depression at least once (401/415 (96.6%) vs 413/415 (99.5%), P = .002) and more women with an indication received treatment (62.5% [105/168] vs 34.5% [38/110], P < .001). Provider and client satisfaction was high. The on-site therapist provided services easily integrated into the freestanding birth center practice, resulting in increased depression screening and treatment, with overwhelming client and provider satisfaction.

Integrating behavioral health services at employer-sponsored health clinics: A descriptive analysis.

Approximately, 20% of adults in the United States have a behavioral health concern, resulting in $732M in direct medical spending and over 5 million lost workdays annually. Employers bear a substantial share of these costs. The objective of this study was to describe the integration of behavioral health services at employer-sponsored health clinics. Retrospective cohort analysis of patients seen for individual behavioral health services from 1/1/2018 to 12/31/2018 in employer-sponsored clinics. Among the 2,954 patients cared for by a behavioral health provider, 49% met criteria for moderate or severe depression and/or anxiety. The median duration between appointment scheduling and a behavioral health triage visit was 2 days (SD = 7.2 days), and median interval to an initial psychotherapy visit was 10 days (SD = 14 days). The mean number of visits with a behavioral health provider within the initial 3 months after presenting for care was 5.3 visits (SD = 2.8 visits). During the course of treatment, anxiety (Generalized Anxiety Disorder-7 [GAD-7] scores) decreased by 31% and depression (Patient Health Questionnaire-9 [PHQ-9] scores) decreased by 24%. Patient satisfaction with their behavioral health care was excellent. Integrating behavioral health services into employer-sponsored clinics can result in timely access to psychotherapy, improvements in clinical symptoms, and excellent patient satisfaction. Employers interested in providing greater access to behavioral health care should evaluate integrating such services into onsite or near-site health clinics. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Integration of Behavioral Health Services into Primary Pediatric Care: The behind the scenes story of a pilot study in Southeast, Texas

Integration of Behavioral Health Services into Primary Pediatric Care: The behind the scenes story of a pilot study in Southeast, Texas

Introduction to the special issue on integrated pediatric primary care: Placing “how” in the context of now.

The integration of behavioral health services into pediatric primary care settings has expanded rapidly in recent years, and pediatric psychologists have played a prominent role in this development. As integrated care becomes mainstream, there is a growing need to develop and disseminate pragmatic strategies for maximizing the reach and impact of behavioral services in primary care. This special issue in includes papers focused on 4 central themes: understanding and increasing engagement with integrated primary care services, identifying barriers and facilitators to implementation, reducing health disparities, and workforce development. In this introduction to the special issue, we preview each of these contributions and consider their implications in the context of the 2 great pandemics of our time: COVID-19 and systemic racial injustice. The work included in this special issue provides clear examples of strategies clinicians can use to analyze and improve their clinical services, articulates methods of adapting interventions to particular patient populations, and sets a roadmap for the future of integrated primary care psychology.

Supplemental Material for Integration of Behavioral Health Services and Adolescent Depression Screening in Primary Care

Supplemental Material for Integration of Behavioral Health Services and Adolescent Depression Screening in Primary Care

Behavioral health policy for improving population health and wellbeing: opportunities for investment in evidence-based policymaking.

The high cost of behavioral health problems across the population continues to highlight the need to integrate high-quality behavioral interventions across a variety of service settings. To successfully achieve such a system-wide transformation will require supporting federal policies that invest in sustainable high-quality services. To support these efforts we provide a mixed-method study of all federal mental health legislation over the last three decades. Results indicate that mental and behavioral health policies have grown. Further, specific characteristics that comprise bills that are successfully enacted into law are identified. Finally, opportunities for the field to engage with policymakers to support widespread integration of behavioral health services are offered.

Psychologist and Physician Inter-Professional Collaborative Experiences in Primary Care Integration.

In recent years, the subject of integrated healthcare, including the integration of behavioral health services into primary care, within the healthcare field has been increasingly of interest to researchers, providers, and policy makers. However, little is known about the experiences of providers within integrated care and the impact of these experiences on inter-professional relationships and collaboration. The researchers aimed to explore differences in providers' perspectives, including inter-professional collaboration and overall job satisfaction, by provider type and level of integration. The current study uses a mixed method exploratory approach, gathering both qualitative and quantitative data to investigate the perspectives of providers (both psychologists and physicians) on their work together. This study included 30 psychologists and 30 primary care physicians from three levels of healthcare integration (traditional/coordinated, co-located, and integrated). As hypothesized, results indicated that providers in integrated settings were the most satisfied with their collaboration with other providers. Furthermore, the providers' narratives revealed promising insights which contribute to a broader understanding of how to improve the relationships between psychologists and primary care physicians in integrated healthcare and other settings.

Using the Omaha System to Evaluate the Integration of Behavioral Health Services into Nurse-Led Primary Health Care

ABSTRACTIntegrating behavioral health services into nurse-led primary care at one location ensures that individuals receive a comprehensive array of preventive and restorative services, based on their varying needs. A formative program evaluation of a federally funded behavioral health integration (BHI) project in a small nurse-led clinic used the Omaha System taxonomy to explore the changes in the documented practice of providers due to the BHI implementation. The evaluation provided evidence of the benefits of a collaborative care model to urban low-income, underserved, adults who were predominantly African American/Blacks.

Integrating Behavioral Healthcare and Primary Care, Appropriate Balance on What Model is Driving Care, and, the Whole Spectrum of Individuals are Coming Through the Door….

With the integration of behavioral health services into primary care and other medical specialties, the community of providers and the public must address a number of questions, including: What models of care are there for these services? What kinds of providers supply these services? Are these providers trained behavioral health providers or extenders in some form? And, as these systems of care are constructed, who makes use of them? The purpose of this study is to address these questions as well as to consider some of the challenges of attending to the spectrum of needs that will arise as integrated healthcare services expand. Consideration of these questions may serve to clarify the impact that these models of healthcare will have in ways that may be readily apparent and, at the same time, in ways that may besubtler and less comprehensible. Addressing these questions is also intended to facilitate discussions within healthcare systems and among providers concerning which models of care best respond to specific populations. In turn, proactively answering these questions will, for the foreseeable future, shape not only behavioral healthcare, in perhaps small or large ways, but also healthcare in general.

Direct primary care-Where does integrated behavioral health fit?

Primary care is increasingly viewed as key to growing health system market share in value-based purchasing strategies for both public- and private-sector programs. Yet not all primary care physicians are interested in becoming part of large multispecialty practices or working in employed arrangements. Instead, a growing number of physicians are launching independent direct primary care (DPC) practices in order to maintain professional autonomy, mitigate burnout, and ensure long-term meaningful engagement with patients and families. Given that the typical size of a DPC care team is small, what does this mean for integrating behavioral health? As primary care evolves under various payment and delivery models, the integration of behavioral health services will require adaptability based on practice size, scope of practice, patient acuity, and payment model. Indeed, advocates of integrated behavioral health can "skate to where the puck is going to be"1 by familiarizing themselves with innovations in primary care, such as the DPC model. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Improving Patient Care through Collaborative Consultation Integration: a Quality Improvement Initiative.

Evidence suggests that interdisciplinary care leads to improvements in patient care and efficiency. To determine whether integrating inpatient hospital behavioral health services would result in improved perceptions of patient care and efficiency, team members (N= 23) were surveyed 1year after integration on measures of patient care, efficiency, and personal satisfaction. A majority of respondents believed integration improved patient care and efficiency. Overall satisfaction was high. The results suggest integration of behavioral health services improves individual perceptions of patient care, efficiency, and satisfaction.

EConsult Mental Health: Electronic Referral and Consultation to Integrate Primary Care and Mental Health.

We describe the implementation of a novel electronic platform for specialty referral and consultation, eConsult Mental Health. This innovation aims to address mental health care access and coordination challenges in the nation's second largest public health system in Los Angeles. eConsult Mental Health is one of the largest documented electronic platforms to facilitate the integration of behavioral health services in primary care. Although implementation has been met with barriers unique to mental health care, eConsult Mental Health appears to be a promising tool to expand the spectrum of care for Los Angeles County safety net primary care providers in patient-centered medical homes.

Integrated primary care: patient perceptions and the role of mental health stigma.

Some patients are more willing to see a behavioral health provider within primary care. The purpose of this study was to evaluate the patients' perspectives of having access to a psychologist within primary care and to investigate whether mental health stigma affected preferences. In total, 36 patients completed questionnaires after seeing a psychologist in primary care. Patients were satisfied with having a primary care psychologist involved in their care. Most patients were more likely to see the psychologist in primary care and those who preferred this indicated higher levels of mental health stigma. The overarching theme for why patients saw a psychologist in primary care was convenience. Mental health stigma may also have played a role. Results suggest that providing integrated services may reach patients who may not have otherwise sought services in a behavioral health clinic. Findings from this study encourage the continued integration of behavioral health services.