Integration Of Behavioral Health Care Research Articles

Quality Indicators for Physical and Behavioral Health Care Integration.

Quality Indicators for Physical and Behavioral Health Care Integration.

Diagnoses, intervention strategies, and rates of functional improvement in integrated behavioral health care patients.

Compared with more traditional mental health care, integrated behavioral health care (IBHC) offers greater access to services and earlier identification and intervention of behavioral and mental health difficulties. The current study examined demographic, diagnostic, and intervention factors that predict positive changes for IBHC patients. Participants were 1,150 consecutive patients (mean age = 30.10 years, 66.6% female, 60.1% Hispanic, 47.9% uninsured) seen for IBHC services at 2 primary care clinics over a 34-month period. Patients presented with depressive (23.2%), anxiety (18.6%), adjustment (11.3%), and childhood externalizing (7.6%) disorders, with 25.7% of patients receiving no diagnosis. The most commonly delivered interventions included behavioral activation (26.1%), behavioral medicine-specific consultation (14.6%), relaxation training (10.3%), and parent-management training (8.5%). There was high concordance between diagnoses and evidence-based intervention selection. We used latent growth curve modeling to explore predictors of baseline global assessment of functioning (GAF) and improvements in GAF across sessions, utilizing data from a subset of 117 patients who attended at least 3 behavioral health visits. Hispanic ethnicity and being insured predicted higher baseline GAF, while patients with an anxiety disorder had lower baseline GAF than patients with other diagnoses. Controlling for primary diagnosis, patients receiving behavioral activation or exposure therapy improved at faster rates than patients receiving other interventions. Demographic variables did not relate to rates of improvement. Results suggest even brief IBHC interventions can be focused, targeting specific patient concerns with evidence-based treatment components. (PsycINFO Database Record

Evaluating the process of mental health and primary care integration: The Vermont Integration Profile

Objective We developed and tested a measure to identify level of primary care behavioral health integration. We produced a thirty item, six domain electronically delivered measure, and a total score. Methods We generated a convenience sample of 137 survey responses, including 104 primary care practices. We provided each practice a summary of their own data, and generated a data base of all submissions. We calculated descriptive statistics. Results The mean total score was 56/100. The Vermont Integration Profile (VIP) discriminated between types of practices in the direction hypothesized. Initial test retest reliability was good. Conclusion The VIP demonstrated good feasibility and construct validity, initial reliability, low provider demand and good discrimination between types of practices.

Making Integrated Care a Reality: Lessons Learned From Heartland Health Outreach's Integration Implementation

The health care challenges of people experiencing homelessness are complicated and complex. Programs that provide integrated primary and behavioral health care may best treat this population's medical, mental health, and substance use problems. However, these services are often siloed within and across organizations, resulting in uncoordinated care. Using the conceptual framework proposed by Heath and colleagues (2013), we describe the successful primary and behavioral healthcare integration implementation efforts of Heartland Health Outreach, a national leader in health care services for people experiencing homelessness. Factors that help and hinder integration implementation and lessons learned are discussed.

An Evidence Roadmap for Implementation of Integrated Behavioral Health under the Affordable Care Act.

The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to better address mental and behavioral health needs. The integration of behavioral health and primary care is increasingly viewed as an answer to address such needs, and it is advisable that evidence-based models and interventions be implemented whenever possible with fidelity. At the same time, there are few evidence-based models, especially beyond depression and anxiety, and thus further research and evaluation is needed. Resources being allocated to adoption of models of integrated behavioral health care (IBHC) should include quality improvement, evaluation, and translational research efforts using mixed methodology to enhance the evidence base for IBHC in the context of health care reform. This paper covers six key aspects of the evidence for IBHC, consistent with mental and behavioral health elements of the ACA related to infrastructure, payments, and workforce. The evidence for major IBHC models is summarized, as well as evidence for targeted populations and conditions, education and training, information technology, implementation, and cost and sustainability.

Integrated Behavioral Health Medical Management

The general purpose of this article is to inform our peers about the integration of Behavioral Health Care into Medical Management in a Patient Center Medical Home. 1. The specific purpose of this report is to provide details of the work flow we have planned and implemented to accomplish this objective; with the hope that others in a variety of settings will attempt to customize this model to meet their patient needs and facilitate the work of their staff in order to enhance the quality of integrated care. 2. It is important to have a behavioral management plan because it introduces both structure and acts as a tool to monitor the many facets of a patient’s care that may be affected by the use of controlled substances. In order to provide the highest level of care each provider must be aware of current happenings as well as all practicing within the same guidelines. This will help to ensure that each patient is receiving the highest level of care with the least invasive and potentially dangerous measures. 3. With this goal in mind, perhaps one of the simplest ways to ensure this is to show the utmost respect for each patient and what they are currently struggling with. This must be recognized and delivered by each part of the healthcare team that interacts with the patient. This includes but is not limited to the receptionist, medical assistant, nurse, medical doctor, therapist, and psychiatrist.

Few ACOs pursue innovative models that integrate care for mental illness and substance abuse with primary care.

Accountable care organizations (ACOs) may be well positioned to increase the focus on managing behavioral health conditions (mental health and substance abuse) through the integration of behavioral health treatment and primary care. We used a mixed-methods research design to examine the extent to which ACOs are clinically, organizationally, and financially integrating behavioral health care and primary care. We used data from 257 respondents to the National Survey of Accountable Care Organizations, a nationally representative survey of ACOs. The data were supplemented with semistructured, in-depth interviews with clinical leaders at sixteen ACOs purposively sampled to represent the spectrum of behavioral health integration. We found that most ACOs hold responsibility for some behavioral health care costs, and 42 percent include behavioral health specialists among their providers. However, integration of behavioral health care and primary care remains low, with most ACOs pursuing traditional fragmented approaches to physical and behavioral health care and only a minority implementing innovative models. Contract design and contextual factors appear to influence the extent to which ACOs integrate behavioral health care. Nevertheless, the ACO model has the potential to create opportunities for improving behavioral health care and integrating it with primary care.

AMA to Work With APA, Other Groups on Integrated Care

AMA to Work With APA, Other Groups on Integrated Care

What Does It Take for Primary Care Practices to Truly Deliver Behavioral Health Care?

In what may be the largest state government behavioral health endeavor nationally, New York State (NYS) is more than midway into a federally supported initiative to fully integrate behavioral health care into ambulatory, primary care resident training sites, beginning with selected academic medical centers (AMCs). This is not simply to detect and refer, nor to colocate medical and mental health services under the same roof or down the hall from each other; it is the integration of behavioral health care, starting with adults with depression, into the standard operations of the primary care practice—no different from how these practices serve people with diabetes mellitus, asthma, or cardiovascular diseases. The goal, over time, is statewide dissemination. In this Viewpoint, I describe the circumstances and the interagency partnership that permitted this initiative to be launched (ie, its essential elements, its tough implementation challenges, and what must be done for sustainability).

Integrated Services and Suicide Prevention Training

The objective of this article is to highlight the benefits of a suicide integration training embedded in an integrated services delivery system. Specifically, the article examines the relationship between the tenets of the training and the low incidence of suicidality experienced at a large mental health agency in Western Massachusetts. Through its new integrated service system, both behavioral health and primary care services are delivered at the Center for Human Development (CHD). On the basis of the experiences of CHD, effective suicide prevention training is essential for maintaining an almost nonexistent suicide rate. The training was developed by Nina Slovik, LICSW, and employed at CHD. It incorporates elements of different practice modalities such as motivational interviewing, the construct of hope, and authenticity. The idea of the "authentic relationship" is emphasized by Slovik. Authenticity is characterized by no pretense that a clinician has something to teach. It is better expressed by the question, genuinely delivered: "So how are you doing?" While clinicians may not always be able to accurately assess a person's suicide risk, looking at the larger context, collaborating as a partner rather than as an expert, and helping find meaning and purpose will improve the chances to recognize risk and provide a positive intervention. Another important difference found at CHD is its use of care managers, a hybridization of medical and mental health case managers, to provide wraparound services and closely monitor the psychological and medical health of CHD's clients through the new integrated services program. • Care management in an integrated service program utilizes a hybrid form of medical and mental health case management. • Contact with primary care providers is common prior to suicide events. • Facets of successful suicide prevention training include motivational interviewing and the construct of hope. • Establishing a genuine and authentic relationship with clients may save lives.

Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? Initial Findings.

Integrated behavioral health care (IBHC) is a model of mental health care service delivery that seeks to reduce stigma and service utilization barriers by embedding mental health professionals into the primary care team. This study explored whether IBHC service referrals, utilization, and outcomes were comparable for Latinos and non-Latino White primary care patients. Data for the current study were collected from 793 consecutive patients (63.8% Latino; M age = 29.02 years [SD = 17.96]; 35.1% under 18 years; 65.3% women; 54.3% uninsured) seen for behavioral health services in 2 primary care clinics during a 10.5 month period. The most common presenting concerns were depression (21.6%), anxiety (18.5%), adjustment disorder (13.0%), and externalizing behavior problems (9.8%). Results revealed that while Latino patients had significantly lower self-reported psychiatric distress, significantly higher clinician-assigned global assessment of functioning scores, and fewer received a psychiatric diagnosis at their initial visit compared to non-Latino White patients, both groups had comparable utilization rates, comparable and clinically significant improvements in symptoms (Cohen's d values > .50), and expressed high satisfaction with integrated behavioral services. These data provide preliminary evidence suggesting integration of behavioral health services into primary care clinics may help reduce mental health disparities for Latinos.

Rural Health Networks: Adapting to a Changing Health Care Environment

Unemployment and financial struggles affect big and small communities alike. The current economic climate, coupled with changes to the health care environment, presents a unique opportunity for health care providers and community leaders to collaborate, integrate and network. The benefits of health networks are and can be tremendous during times of economic hardships. It takes great effort to assimilate different entities, but the effort is well worth the positive health impact on a community. The Rural Health Network Development Program (RHND) in the federal Office of Rural Health Policy (ORHP) provides an opportunity not only to assist rural communities in meeting unmet health needs, but also to collect data to document health impact in a way that can allow duplication of successes in both rural and urban communities. A rural health network is defined as “a formal organizational arrangement among rural health care providers (and possibly insurers and social service providers) that uses the resources of more than one existing organization and specifies the objectives and methods by which various collaborative functions are achieved.” Rural health networks are designed to respond to an unmet community need and provide benefits to both network partners and the community served by the network in a collaborative or integrative matter. Rural health care providers and rural communities have a plethora of stories relating to how networks have provided substantial benefit in the form of cost savings, implementation of electronic health records, integration of behavioral health care in primary care settings, and a multitude of other healthrelated projects. Yet, there is very little evidence-based data to support the claim that networks can and have improved the rural health care system, which limits the duplication of many of these rural health network projects. The RHND Program was initially created in the late 1990s in response to modifications to the health care delivery system that directly impacted rural providers. During that era, changes were being made to the underlying system of health care financing and delivery, including: a move from fee-for-service payments to capitation and other risk-sharing payment methods; the implementation of market-based strategies for containing costs; an increase in integrated health care organizations; and a move toward more managed care. Rural stakeholders were concerned that the shift to more managed costs would cause people to lose sight of the unique needs of rural patients and providers. Similarly, there are significant changes to our current health care environment, and rural communities and their providers will need to adapt to ensure adequate health services. The current changes that may affect rural health care providers and communities include: (1) improving the quality of care by focusing on patient value as opposed to patient volume;

Women’s Health During Health Care Transformation

Women’s Health During Health Care Transformation

Homeless women and hazardous drinking: screening results in a primary health care setting.

Screening for alcohol use in primary care is underutilized, especially for women. The current study implemented systematic women's alcohol use screening in a health care for the homeless primary care program. All women (n=541) seeking care over 12 months were screened. Of the 541 screening forms returned, 80 women refused to answer the alcohol use questions. Of 461 completed screens, over 40% reported no alcohol use, while 43.8% reported hazardous drinking. Hazardous drinking was significantly associated with younger age, African American race, and living on the street or in a shelter. High rates of drinking were identified among women in different housing situations and use of systematic screening was beneficial to providers. Health care settings are important sites to identify hazardous drinking as well as alcohol disorders among women with unstable housing histories. The growing integration of behavioral health care into primary care, and the medical home concept, both provide opportunities for brief interventions for at-risk drinkers, as well as treatment options for those with alcohol use disorders that may be particularly appealing to women. Findings support further investigation of the relationship of housing stability to drinking, and suggest African American women may need special attention.

Integrating Primary Care Into Community Behavioral Health Settings: Programs and Early Implementation Experiences

This article describes the characteristics and early implementation experiences of community behavioral health agencies that received Primary and Behavioral Health Care Integration (PBHCI) grants from the Substance Abuse and Mental Health Services Administration to integrate primary care into programs for adults with serious mental illness. Data were collected from 56 programs, across 26 states, that received PBHCI grants in 2009 (N=13) or 2010 (N=43). The authors systematically extracted quantitative and qualitative information about program characteristics from grantee proposals and semistructured telephone interviews with core program staff. Quarterly reports submitted by grantees were coded to identify barriers to implementing integrated care. Grantees shared core features required by the grant but varied widely in terms of characteristics of the organization, such as size and location, and in the way services were integrated, such as through partnerships with a primary care agency. Barriers to program implementation at start-up included difficulty recruiting and retaining qualified staff and issues related to data collection and use of electronic health records, licensing and approvals, and physical space. By the end of the first year, some problems, such as space issues, were largely resolved, but other issues, including problems with staffing and data collection, remained. New challenges, such as patient recruitment, had emerged. Early implementation experiences of PBHCI grantees may inform other programs that seek to integrate primary care into behavioral health settings as part of new, large-scale government initiatives, such as specialty mental health homes.

Integrating behavioral health services into a university health center: Patient and provider satisfaction.

The goals of this study were to (a) describe an Integrated Behavioral Health Care (IBHC) program within a university health center and (b) assess provider and patient acceptability and satisfaction with the IBHC program, including behavioral health screening and clinical services of integrated behavioral health providers (BHPs). Fifteen providers (nine primary care providers and six nurses) and 79 patients (75% female, 65% Caucasian) completed program ratings in 2010. Providers completed an anonymous web-based questionnaire that assessed satisfaction with and acceptability of behavioral health screening and the IBHC program featuring integrated BHPs. Patients completed an anonymous web-based questionnaire that assessed program satisfaction and comfort with BHPs. Providers reported that behavioral health screening stimulated new conversations about behavioral health concerns, the BHPs provided clinically useful services, and patients benefited from the IBHC program. Patients reported satisfaction with behavioral health services and reported a willingness to meet again with BHPs. Providers and patients found the IBHC program beneficial to clinical care. Use of integrated BHPs can help university health centers support regular screening for mental and behavioral health issues. Care integration increases access to needed mental health treatment.

Primary and Behavioral Healthcare Integration: Threat or Opportunity for Addiction Treatment Organizations?

Nationwide, health care systems are experiencing an increasingly rapid pace of health reforms, especially in burgeoning areas such as health homes, accountable care organizations, which emphasize the growing need for bidirectional integration of primary care and behavioral health. Several articles in this issue of the Journal of Behavioral Health Services & Research explore care that requires collaboration between primary and behavioral health: “Predictors of primary care physicians’ self-reported intention to conduct suicide risk assessments” by Lisa M Hooper et al., “Outcomes associated with a cognitive-behavioral chronic pain management program implemented in three public HIV primary care clinics” by Jodie Anne Trafton et al., and the “Relationship between neighborhood characteristics and recruitment into adolescent family-based substance use prevention programs” by Hilary F. Byrnes et al. However, is this emphasis on integration a threat or opportunity for specialty addiction treatment organizations? A recent U.S. Substance Abuse and Mental Health Services Administration–U.S. Health Resources and Services Administration Center for Integrated Health Solutions survey 1 identified a growing number of specialty addictions treatment organizations that partner with community health centers, methadone treatment centers that qualify as Federally Qualified Health Centers, and residential treatment programs that offer primary care services onsite. Even state alcohol and drug authorities are focusing on integration at annual provider meetings and state training academies. In communities, specialty addiction treatment organizations have long held relationships with primary care practices. Historically, these relationships have ensured physicals for individuals entering residential care, interim services for pregnant women and individuals using intravenous drugs, and, more recently, medication interventions as a part of addiction treatment. New integration models serve to enhance providers’ opportunities to reach individuals in earlier stages of addiction, and the earlier treatment that follows could assuage damage to their bodies and improve overall treatment outcomes. Developing recovery plans which incorporate overall health, including exercise, prevention, and specific public health goals for chronic health problems, support recovery. In terms of Screening, Brief Intervention, and Referral to Treatment (SBIRT), specialty addiction professionals fill a gap in primary care settings by supporting “referral to treatment.” Without this involvement of addiction professionals, SBIRT programs often fail when a patient requires a

The Boston Health Care for the Homeless Program: A Public Health Framework

During the past 25 years, the Boston Health Care for the Homeless Program has evolved into a service model embodying the core functions and essential services of public health. Each year the program provides integrated medical, behavioral, and oral health care, as well as preventive services, to more than 11 000 homeless people. Services are delivered in clinics located in 2 teaching hospitals, 80 shelters and soup kitchens, and an innovative 104-bed medical respite unit. We explain the program's principles of care, describe the public health framework that undergirds the program, and offer lessons for the elimination of health disparities suffered by this vulnerable population.

A Convenient Truth

Back to table of contents Next article Taking IssueFull AccessA Convenient TruthSaul Feldman D.P.A.,Saul Feldman D.P.A.Search for more papers by this author,Published Online:1 Dec 2009https://doi.org/10.1176/ps.2009.60.12.1573AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The belief that integration with medical care would greatly enhance the quality of behavioral health services has become the conventional wisdom among behavioral health professionals. It is true that most people talk first to their physicians about behavioral health problems, that such problems exacerbate medical ones and vice versa, that people with behavioral disorders have medical needs that are often overlooked, and that there is too often a disconnect between behavioral health care and medical care.But has this become a convenient truth, a distraction from the long-standing integration problems within behavioral health itself? Is too little attention being paid to these problems? Are they not at least as damaging to good patient care as those caused by the lack of behavioral-medical integration?It seems to me that a displacement process may be occurring—an unconscious transfer of energy to issues and ideas that are less threatening and more acceptable to behavioral health professionals. It is more convenient to focus on medical-behavioral integration than on the serious problems related to integration and quality of care within behavioral health itself, problems that reflect deep-seated differences and disagreements about practice, policy, and prerogatives.I have spent many years as an executive in community mental health at the National Institute of Mental Health and in managed behavioral health at United Behavioral Health, and examples are not difficult to find. Ideological disagreements, competition for resources, separate organizational structures, and disparate training programs divide mental health services from substance abuse services. Behavioral health professionals are trained in separate professional silos, with slight if any interdisciplinary training and scant knowledge of important research published in professional journals other than their own. Progress in integrating service and science, and evidence-based practice with practice-based evidence, has been painfully slow, despite widespread acknowledgment of its importance. Integration of behavioral health care with the other human services, such as schools, housing, employment, and social services, so vital to prevention through early intervention, remains more a belief than a reality. Consumers and family members acknowledged to be a potentially important part of the behavioral health workforce have yet to be sufficiently integrated as such.These and other integration problems within behavioral health will not be easily or quickly resolved, even with greater conviction about the need to do so. It has been said that behavioral health professionals could well get into a circle if asked to form a firing squad. But at least the solutions rest within behavioral health rather than with others. And finding solutions would have a dramatic effect on the quality of behavioral health services in the future.San Francisco FiguresReferencesCited byDetailsCited byNone Volume 60Issue 12 December, 2009Pages 1573-1573PSYCHIATRIC SERVICES December 2009 Volume 60 Number 12 Metrics PDF download History Published online 1 December 2009 Published in print 1 December 2009

Reengineering clinical psychiatry in academic medical centers: processes and models of change.

Managed care poses a major threat to the future of clinical psychiatry in academic settings. High costs and an aversion to the business aspects of service delivery have left academic departments at a disadvantage in the marketplace. However, numerous departments have attempted to adapt to the current health care environment. On the basis of a review of these efforts, the authors identify the processes of change and seven models of change being employed to reengineer psychiatry within academic medical centers. The models are labeled transform, build, manage, buy, partner or affiliate, sell or lease, and consult. The authors discuss the strengths and weaknesses of these efforts and suggest three approaches to establishing the unique value of academic clinical services for purchasers and for the public. The first is to enhance productivity and clinical effectiveness through greater integration of clinical care, research, and training. The second is to take a leadership role in managing care, and the third is to advance the integration of behavioral health care with primary medical care and other specialties in the medical center.