C.R. Macchi, PhD | Arizona State University (original) (raw)
Papers by C.R. Macchi, PhD
Behavioral, psychosocial, and mental illness
Context: Most patients in need of behavioral health (BH) care are seen in primary care, which oft... more Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration. Objective: Test the effectiveness of a practice intervention designed to increase BH integration. Study Design: Pragmatic, cluster-randomized controlled trial. Setting: 43 primary care practices with on-site BH services in 13 states. Population: 2,460 adults with multiple chronic medical and behavioral conditions. Intervention: 24-month practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Outcomes: Primary outcomes were changes in the 8 Patient-Reported Outcomes Measurement Information System (PROMIS-29) domain scores. Secondary outcomes were changes in medication adherence, self-reported healthcare utilization, time lost due to disability, cardiovascular capacity, patient centeredness, provider empathy, and several conditionspecific measures. A sample of practice staff completed the Practice Integration Profile at each time point to estimate the degree of BH integration in that site. Practice-level case studies estimated the typical costs of implementing the intervention. Results: The intervention had no significant effect on any
Families, Systems, & Health
Despite multiple interventions and the increase of consumer spending on weight management, weight... more Despite multiple interventions and the increase of consumer spending on weight management, weight loss maintenance continues to allude most people. This study explores women's narratives and the ways they made meaning of their weight loss and weight loss maintenance experiences. Examining the processes occurring within the individual and the family context, this study investigated the potential differences between weight loss and weight loss maintenance processes. A grounded theory approach guided the study design, transcription coding, and data analysis. The results revealed four categories (cycles and patterns, fluctuations and thresholds, defining self, and contextual connections) emerging from the research participants' narratives describing their weight loss and weight loss maintenance experiences. An analytical framework, consisting of the examination of clustered categories using a multifocal lens and a toggling procedure, facilitated the development of multidimensional descriptions of the women's experiences and guided the process of analysis. The process of analysis was isomorphic to the process the women used to formulate their narratives. The women incorporated multiple dimensions of their experiences to create narratives that described and informed their weight loss and weight loss maintenance efforts. The analysis also revealed that weight loss and weight loss maintenance are multi-dimensional processes. The dimensions reflect both similarities and differences between the processes. Some women used heroic while others used integrative efforts to lose weight. Their efforts impacted the amount of overlap they experienced between the weight loss and weight loss maintenance processes. Implications for further studies are presented for using the analytical framework to understand the meaningmaking processes occurring with weight loss and weight loss maintenance. Potential clinical ix CHAPTER 4-RESULTS ..
Families, Systems, & Health, Sep 1, 2022
Families, Systems, & Health
INTRODUCTION An estimated 21 million Americans meet the criteria for a substance use disorder (SU... more INTRODUCTION An estimated 21 million Americans meet the criteria for a substance use disorder (SUD), whereas 24% of the population engages in risky alcohol use leading to tremendous health and economic impacts (Substance Abuse and Mental Health Services Administration, 2017). Opioid misuse is a national public health emergency, with an estimated 46,802 opioid-related deaths occurring in 2018 (National Center for Health Statistics, 2020). Despite the high prevalence of risky substance use and SUDs, preservice education related to screening for and treating SUDs in health and behavioral health professions is inadequate (Dimoff, Sayette, & Norcross, 2017; Russett & Williams, 2015; Savage et al., 2014; Tabak et al., 2012). A critical need exists for an interdisciplinary, implementation science-informed approach for developing academic training programs in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model within higher education systems. METHOD We delineate a training model implemented within 5 health and behavioral health disciplines (nursing, social work, clinical psychology, counseling psychology, and integrated behavioral health), informed by prominent implementation scientists (Proctor et al., 2011; Rogers, 2003). RESULTS Faculty surveys (n = 33), interviews (n = 24), and syllabi and training records reviews indicated the Brief Intervention, and Referral to Treatment model was infused into course content by 89.47% of trained faculty and sustained in 90.47% of course syllabi at project close. CONCLUSION The model demonstrated successful uptake and sustainability in higher education systems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Training to Deliver Integrated Care
Providers working with a team in primary care settings require training to develop the unique ski... more Providers working with a team in primary care settings require training to develop the unique skills needed in an integrated, team-based environment. Training focuses on developing a core set of skills that prepares team members to address patient behavioral issues. The training enhances and complements the foundational skills related to the member’s distinct function on the team. Training and workforce development programs begin by assessing the learner’s level of need then supporting core competency development. Integrated, team-based training programs and courses are aligned to address the interdependence of the three worlds (i.e., clinical, operational, financial) of healthcare delivery.
Families, systems & health : the journal of collaborative family healthcare, 2016
We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health in... more We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health integration in clinical practices with a focus on primary care (PC). Its 30 items, completed by providers, managers, and staff, provide an overall score and 6 domain scores derived from the Lexicon of Collaborative Care. We describe its history and psychometric properties. The PIP was tested in a convenience sample of practices. Linear regression compared scores across integration exemplars, PC with behavioral services, PC without behavioral services, and community mental health centers without PC. An additional sample rated 4 scenarios describing practices with varying degrees of integration. One hundred sixty-nine surveys were returned. Mean domain scores ran from 49 to 65. The mean total score was 55 (median 58; range 0-100) with high internal consistency (Cronbach's alpha = .95). The lowest total scores were for PC without behavioral health (27), followed by community mental health...
Journal of Marital and Family Therapy, 2013
This study examined whether home-based family therapists&... more This study examined whether home-based family therapists' (HBFT) workload and clinical experience were associated with therapists' professional quality of life directly and indirectly through self-care activities and frequency of clinical supervision. Hypotheses were tested using structural equation modeling with a sample of 225 home-based therapists. Results suggested that…
Families, Systems, & Health, 2013
Contemporary Family Therapy, 2010
Families, Systems, & Health, 2016
Insufficient knowledge exists regarding how to measure the presence and degree of integrated care... more Insufficient knowledge exists regarding how to measure the presence and degree of integrated care. Prior estimates of integration levels are neither grounded in theory nor psychometrically validated. They provide scant guidance to inform improvement activities, compare integration efforts, discriminate among practices by degree of integration, measure the effect of integration on quadruple aim outcomes, or address the needs of clinicians, regulators, and policymakers seeking new models of health care delivery and funding. We describe the development of the Practice Integration Profile (PIP), a novel instrument designed to measure levels of integrated behavioral health care within a primary care clinic. The PIP draws upon the Agency for Health care Research & Quality's (AHRQ) Lexicon of Collaborative Care which provides theoretic justification for a paradigm case of collaborative care. We used the key clauses of the Lexicon to derive domains of integration and generate measures corresponding to those key clauses. After reviewing currently used methods for identifying collaborative care, or integration, and identifying the need to improve on them, we describe a national collaboration to describe and evaluate the PIP. We also describe its potential use in practice improvement, research, responsiveness to multiple stakeholder needs, and other future directions.
Journal of Clinical Psychology in Medical Settings, 2021
Valid measures of behavioral health integration have the potential to enable comparisons of vario... more Valid measures of behavioral health integration have the potential to enable comparisons of various models of integration, contribute to the overall development of high-quality care, and evaluate outcomes that are strategically aligned with standard improvement efforts. The Practice Integration Profile has proven to discriminate among clinic types and integration efforts. We continued the validation of the measure’s internal consistency, intra-rater consistency, and inter-rater consistency with a separate and larger sample from a broader array of practices. We found that the Practice Integration Profile demonstrated a high level of internal consistency, suggesting empirically sound measurement of independent attributes of integration, and high reliability over time. The Practice Integration Profile provides internally consistent and interpretable results and can serve as both a quality improvement and health services research tool.
Graduate programs that train students to operate in team-based integrated care environments are i... more Graduate programs that train students to operate in team-based integrated care environments are increasingly provided in online platforms and target the development of competencies related to team-based collaborations. Evaluations tied to these and other competencies are making it possible to determine that students can apply the knowledge of team-based work in primary care practice settings. One evaluation tool is presented that proposes a link among behavioral health activities, behavioral anchors, and performance metrics that address each of the three worlds (i.e., clinical, operational, financial) of healthcare practice.
Background: Chronic diseases that drive morbidity, mortality, and health care costs are largely i... more Background: Chronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions ...
Health Services Research, 2019
Objective: To perform a factor analysis of the Practice Integration Profile (PIP), a 30-item prac... more Objective: To perform a factor analysis of the Practice Integration Profile (PIP), a 30-item practice-level measure of primary care and behavioral health integration derived from the Agency for Healthcare Research and Quality's Lexicon for Behavioral Health and Primary Care Integration. Data Sources: The PIP was completed by 735 individuals, representing 357 practices across the United States. Study Design: The study design was a cross-sectional survey. An exploratory factor analysis and assessment of internal consistency reliability via Cronbach's alpha were performed. Data Collection Methods: Participant responses were collected using REDCap, a secure , web-based data capture tool. Principal Findings: Five of the PIP's six domains had factor loadings for most items related to each factor representing the PIP of 0.50 or greater. However, one factor had items from two PIP domains that had loadings >0.50. A five-factor model with redistributed items resulted in improved factor loadings for all domains along with greater internal consistency reliability (>0.80). Conclusions: Five of the PIP's six domains demonstrated excellent internal consistency for measures of health care resources. Although minor improvements to strengthen the PIP are possible, it is a valid and reliable measure of the integration of primary care and behavioral health. K E Y W O R D S collaborative care, integrated behavioral health, integrated primary care, primary care behavioral health, psychometrics 1 | INTRODUC TI ON Primary care settings are integrating behavioral health providers in greater numbers using a variety of clinical models. 1 One model, Primary Care Behavioral Health (PCBH), calls for a Behavioral Health Consultant (BHC) to be included as a full member of the care team and for the BHC to provide treatment according to a primary care model of brief, focused, high-volume interventions instead of conducting traditional independent psychotherapy sessions. 2-4 Behavioral Health Consultants in this model are
Families, Systems, & Health, 2021
Introduction: An estimated 21 million Americans meet the criteria for a substance use disorder (S... more Introduction: An estimated 21 million Americans meet the criteria for a substance use disorder (SUD), whereas 24% of the population engages in risky alcohol use leading to tremendous health and economic impacts (Substance Abuse and Mental Health Ser- vices Administration, 2017). Opioid misuse is a national public health emergency, with an estimated 46,802 opioid-related deaths occurring in 2018 (National Center for Health Statistics, 2020). Despite the high prevalence of risky substance use and SUDs, preservice education related to screening for and treating SUDs in health and behav- ioral health professions is inadequate (Dimoff, Sayette, & Norcross, 2017; Russett & Williams, 2015; Savage et al., 2014; Tabak et al., 2012). A critical need exists for an interdisciplinary, implementation science–informed approach for developing academic training programs in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model within higher education systems. Method: We delineate a training model implemented within 5 health and behavioral health disciplines (nursing, social work, clinical psychology, counseling psychology, and integrated behavioral health), informed by prominent implementation scientists (Proctor et al., 2011; Rogers, 2003). Results: Faculty surveys (n 33), interviews (n 24), and syllabi and training records reviews indicated the Brief Intervention, and Referral to Treatment model was infused into course content by 89.47% of trained faculty and sustained in 90.47% of course syllabi at project close. Conclusion: The model demonstrated successful uptake and sustainability in higher education systems.
This study examined whether home-based family therapists' (HBFT) workload and clinical experience... more This study examined whether home-based family therapists' (HBFT) workload and clinical experience were associated with therapists' professional quality of life directly and indirectly through self-care activities and frequency of clinical supervision. Hypotheses were tested using structural equation modeling with a sample of 225 home-based therapists. Results suggested that therapists' workload and HBFT experience significantly predicted therapists' professional quality of life. These associations between therapists' workload and HBFT experience were partially mediated through participation in self-care and frequency of clinical supervision. Implications for improving therapists' quality of life are discussed as a function of therapists' workload, clinical experience, self-care, and supervision. Clinical work can have a negative emotional and psychological impact on therapists. Therapists' interactions with families and exposure to their descriptions of stress and trauma can produce feelings of depression, anxiety, and burnout (Farber & Heifetz, 1982; Rosenberg & Pace, 2006; Sprang, Clark, & Whitt-Woosley, 2007). Thus, it is imperative to understand the factors that can protect against these negative outcomes. Therapists who do not adequately attend to their own self-of-the-therapist concerns are less likely to provide their clients with quality service (Durtschi & McClellan, 2010). Furthermore, theoretical descriptions of home-based therapy have repeatedly suggested that providers engaging in these services face additional demands related to their unique roles and responsibilities (Macchi & O'Conner, 2010). Although a great deal of literature has been written describing home-based family therapy and the impact of this service on therapists (Boyd-Franklin & Bry, 2000; Cortes, 2004; Snyder & McCollum, 1999; Woods, 1988), much of this past work has been theoretical speculation about these processes. We extend previous research on therapists' professional quality of life by quantitatively testing the direct effects from therapists' home-based family therapy (HBFT) experience and perceived workload on their professional quality of life using survey data from 225 licensed therapists currently providing home-based family therapy services. Additionally, we examine self-care and frequency of clinical supervision as potential mediators of the association between clinical experience and perceived workload.
Introduction: We developed the Practice Integration Profile (PIP) to measure the degree of behavi... more Introduction: We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health integration in clinical practices with a focus on primary care (PC). Its 30 items, completed by providers, managers, and staff, provide an overall score and 6 domain scores derived from the Lexicon of Collaborative Care. We describe its history and psychometric properties. Method: The PIP was tested in a convenience sample of practices. Linear regression compared scores across integration exemplars, PC with behavioral services, PC without behavioral services, and community mental health centers without PC. An additional sample rated 4 scenarios describing practices with varying degrees of integration. Results: One hundred sixty-nine surveys were returned. Mean domain scores ran from 49 to 65. The mean total score was 55 (median 58; range 0 –100) with high internal consistency (Cronbach's alpha .95). The lowest total scores were for PC without behavioral health (27), followed by community mental health centers (44), PC with behavioral health (60), and the exemplars (86; p .001). Eleven respondents rerated their practices 37 to 194 days later. The mean change was 1.5 (standard deviation 11.1). Scenario scores were highly correlated with the degree of integration each scenario was designed to represent (Spearman's 0.71; P 0.0005). Discussion: These data suggest that the PIP is useful, has face, content, and internal validity, and distinguishes among types of practices with known variations in integration. We discuss how the PIP may support practices and policymakers in their integration efforts and researchers assessing the degree to which integration affects patient health outcomes.
Behavioral, psychosocial, and mental illness
Context: Most patients in need of behavioral health (BH) care are seen in primary care, which oft... more Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration. Objective: Test the effectiveness of a practice intervention designed to increase BH integration. Study Design: Pragmatic, cluster-randomized controlled trial. Setting: 43 primary care practices with on-site BH services in 13 states. Population: 2,460 adults with multiple chronic medical and behavioral conditions. Intervention: 24-month practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Outcomes: Primary outcomes were changes in the 8 Patient-Reported Outcomes Measurement Information System (PROMIS-29) domain scores. Secondary outcomes were changes in medication adherence, self-reported healthcare utilization, time lost due to disability, cardiovascular capacity, patient centeredness, provider empathy, and several conditionspecific measures. A sample of practice staff completed the Practice Integration Profile at each time point to estimate the degree of BH integration in that site. Practice-level case studies estimated the typical costs of implementing the intervention. Results: The intervention had no significant effect on any
Families, Systems, & Health
Despite multiple interventions and the increase of consumer spending on weight management, weight... more Despite multiple interventions and the increase of consumer spending on weight management, weight loss maintenance continues to allude most people. This study explores women's narratives and the ways they made meaning of their weight loss and weight loss maintenance experiences. Examining the processes occurring within the individual and the family context, this study investigated the potential differences between weight loss and weight loss maintenance processes. A grounded theory approach guided the study design, transcription coding, and data analysis. The results revealed four categories (cycles and patterns, fluctuations and thresholds, defining self, and contextual connections) emerging from the research participants' narratives describing their weight loss and weight loss maintenance experiences. An analytical framework, consisting of the examination of clustered categories using a multifocal lens and a toggling procedure, facilitated the development of multidimensional descriptions of the women's experiences and guided the process of analysis. The process of analysis was isomorphic to the process the women used to formulate their narratives. The women incorporated multiple dimensions of their experiences to create narratives that described and informed their weight loss and weight loss maintenance efforts. The analysis also revealed that weight loss and weight loss maintenance are multi-dimensional processes. The dimensions reflect both similarities and differences between the processes. Some women used heroic while others used integrative efforts to lose weight. Their efforts impacted the amount of overlap they experienced between the weight loss and weight loss maintenance processes. Implications for further studies are presented for using the analytical framework to understand the meaningmaking processes occurring with weight loss and weight loss maintenance. Potential clinical ix CHAPTER 4-RESULTS ..
Families, Systems, & Health, Sep 1, 2022
Families, Systems, & Health
INTRODUCTION An estimated 21 million Americans meet the criteria for a substance use disorder (SU... more INTRODUCTION An estimated 21 million Americans meet the criteria for a substance use disorder (SUD), whereas 24% of the population engages in risky alcohol use leading to tremendous health and economic impacts (Substance Abuse and Mental Health Services Administration, 2017). Opioid misuse is a national public health emergency, with an estimated 46,802 opioid-related deaths occurring in 2018 (National Center for Health Statistics, 2020). Despite the high prevalence of risky substance use and SUDs, preservice education related to screening for and treating SUDs in health and behavioral health professions is inadequate (Dimoff, Sayette, & Norcross, 2017; Russett & Williams, 2015; Savage et al., 2014; Tabak et al., 2012). A critical need exists for an interdisciplinary, implementation science-informed approach for developing academic training programs in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model within higher education systems. METHOD We delineate a training model implemented within 5 health and behavioral health disciplines (nursing, social work, clinical psychology, counseling psychology, and integrated behavioral health), informed by prominent implementation scientists (Proctor et al., 2011; Rogers, 2003). RESULTS Faculty surveys (n = 33), interviews (n = 24), and syllabi and training records reviews indicated the Brief Intervention, and Referral to Treatment model was infused into course content by 89.47% of trained faculty and sustained in 90.47% of course syllabi at project close. CONCLUSION The model demonstrated successful uptake and sustainability in higher education systems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Training to Deliver Integrated Care
Providers working with a team in primary care settings require training to develop the unique ski... more Providers working with a team in primary care settings require training to develop the unique skills needed in an integrated, team-based environment. Training focuses on developing a core set of skills that prepares team members to address patient behavioral issues. The training enhances and complements the foundational skills related to the member’s distinct function on the team. Training and workforce development programs begin by assessing the learner’s level of need then supporting core competency development. Integrated, team-based training programs and courses are aligned to address the interdependence of the three worlds (i.e., clinical, operational, financial) of healthcare delivery.
Families, systems & health : the journal of collaborative family healthcare, 2016
We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health in... more We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health integration in clinical practices with a focus on primary care (PC). Its 30 items, completed by providers, managers, and staff, provide an overall score and 6 domain scores derived from the Lexicon of Collaborative Care. We describe its history and psychometric properties. The PIP was tested in a convenience sample of practices. Linear regression compared scores across integration exemplars, PC with behavioral services, PC without behavioral services, and community mental health centers without PC. An additional sample rated 4 scenarios describing practices with varying degrees of integration. One hundred sixty-nine surveys were returned. Mean domain scores ran from 49 to 65. The mean total score was 55 (median 58; range 0-100) with high internal consistency (Cronbach's alpha = .95). The lowest total scores were for PC without behavioral health (27), followed by community mental health...
Journal of Marital and Family Therapy, 2013
This study examined whether home-based family therapists&... more This study examined whether home-based family therapists' (HBFT) workload and clinical experience were associated with therapists' professional quality of life directly and indirectly through self-care activities and frequency of clinical supervision. Hypotheses were tested using structural equation modeling with a sample of 225 home-based therapists. Results suggested that…
Families, Systems, & Health, 2013
Contemporary Family Therapy, 2010
Families, Systems, & Health, 2016
Insufficient knowledge exists regarding how to measure the presence and degree of integrated care... more Insufficient knowledge exists regarding how to measure the presence and degree of integrated care. Prior estimates of integration levels are neither grounded in theory nor psychometrically validated. They provide scant guidance to inform improvement activities, compare integration efforts, discriminate among practices by degree of integration, measure the effect of integration on quadruple aim outcomes, or address the needs of clinicians, regulators, and policymakers seeking new models of health care delivery and funding. We describe the development of the Practice Integration Profile (PIP), a novel instrument designed to measure levels of integrated behavioral health care within a primary care clinic. The PIP draws upon the Agency for Health care Research & Quality's (AHRQ) Lexicon of Collaborative Care which provides theoretic justification for a paradigm case of collaborative care. We used the key clauses of the Lexicon to derive domains of integration and generate measures corresponding to those key clauses. After reviewing currently used methods for identifying collaborative care, or integration, and identifying the need to improve on them, we describe a national collaboration to describe and evaluate the PIP. We also describe its potential use in practice improvement, research, responsiveness to multiple stakeholder needs, and other future directions.
Journal of Clinical Psychology in Medical Settings, 2021
Valid measures of behavioral health integration have the potential to enable comparisons of vario... more Valid measures of behavioral health integration have the potential to enable comparisons of various models of integration, contribute to the overall development of high-quality care, and evaluate outcomes that are strategically aligned with standard improvement efforts. The Practice Integration Profile has proven to discriminate among clinic types and integration efforts. We continued the validation of the measure’s internal consistency, intra-rater consistency, and inter-rater consistency with a separate and larger sample from a broader array of practices. We found that the Practice Integration Profile demonstrated a high level of internal consistency, suggesting empirically sound measurement of independent attributes of integration, and high reliability over time. The Practice Integration Profile provides internally consistent and interpretable results and can serve as both a quality improvement and health services research tool.
Graduate programs that train students to operate in team-based integrated care environments are i... more Graduate programs that train students to operate in team-based integrated care environments are increasingly provided in online platforms and target the development of competencies related to team-based collaborations. Evaluations tied to these and other competencies are making it possible to determine that students can apply the knowledge of team-based work in primary care practice settings. One evaluation tool is presented that proposes a link among behavioral health activities, behavioral anchors, and performance metrics that address each of the three worlds (i.e., clinical, operational, financial) of healthcare practice.
Background: Chronic diseases that drive morbidity, mortality, and health care costs are largely i... more Background: Chronic diseases that drive morbidity, mortality, and health care costs are largely influenced by human behavior. Behavioral health conditions such as anxiety, depression, and substance use disorders can often be effectively managed. The majority of patients in need of behavioral health care are seen in primary care, which often has difficulty responding. Some primary care practices are providing integrated behavioral health care (IBH), where primary care and behavioral health providers work together, in one location, using a team-based approach. Research suggests there may be an association between IBH and improved patient outcomes. However, it is often difficult for practices to achieve high levels of integration. The Integrating Behavioral Health and Primary Care study responds to this need by testing the effectiveness of a comprehensive practice-level intervention designed to improve outcomes in patients with multiple chronic medical and behavioral health conditions ...
Health Services Research, 2019
Objective: To perform a factor analysis of the Practice Integration Profile (PIP), a 30-item prac... more Objective: To perform a factor analysis of the Practice Integration Profile (PIP), a 30-item practice-level measure of primary care and behavioral health integration derived from the Agency for Healthcare Research and Quality's Lexicon for Behavioral Health and Primary Care Integration. Data Sources: The PIP was completed by 735 individuals, representing 357 practices across the United States. Study Design: The study design was a cross-sectional survey. An exploratory factor analysis and assessment of internal consistency reliability via Cronbach's alpha were performed. Data Collection Methods: Participant responses were collected using REDCap, a secure , web-based data capture tool. Principal Findings: Five of the PIP's six domains had factor loadings for most items related to each factor representing the PIP of 0.50 or greater. However, one factor had items from two PIP domains that had loadings >0.50. A five-factor model with redistributed items resulted in improved factor loadings for all domains along with greater internal consistency reliability (>0.80). Conclusions: Five of the PIP's six domains demonstrated excellent internal consistency for measures of health care resources. Although minor improvements to strengthen the PIP are possible, it is a valid and reliable measure of the integration of primary care and behavioral health. K E Y W O R D S collaborative care, integrated behavioral health, integrated primary care, primary care behavioral health, psychometrics 1 | INTRODUC TI ON Primary care settings are integrating behavioral health providers in greater numbers using a variety of clinical models. 1 One model, Primary Care Behavioral Health (PCBH), calls for a Behavioral Health Consultant (BHC) to be included as a full member of the care team and for the BHC to provide treatment according to a primary care model of brief, focused, high-volume interventions instead of conducting traditional independent psychotherapy sessions. 2-4 Behavioral Health Consultants in this model are
Families, Systems, & Health, 2021
Introduction: An estimated 21 million Americans meet the criteria for a substance use disorder (S... more Introduction: An estimated 21 million Americans meet the criteria for a substance use disorder (SUD), whereas 24% of the population engages in risky alcohol use leading to tremendous health and economic impacts (Substance Abuse and Mental Health Ser- vices Administration, 2017). Opioid misuse is a national public health emergency, with an estimated 46,802 opioid-related deaths occurring in 2018 (National Center for Health Statistics, 2020). Despite the high prevalence of risky substance use and SUDs, preservice education related to screening for and treating SUDs in health and behav- ioral health professions is inadequate (Dimoff, Sayette, & Norcross, 2017; Russett & Williams, 2015; Savage et al., 2014; Tabak et al., 2012). A critical need exists for an interdisciplinary, implementation science–informed approach for developing academic training programs in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model within higher education systems. Method: We delineate a training model implemented within 5 health and behavioral health disciplines (nursing, social work, clinical psychology, counseling psychology, and integrated behavioral health), informed by prominent implementation scientists (Proctor et al., 2011; Rogers, 2003). Results: Faculty surveys (n 33), interviews (n 24), and syllabi and training records reviews indicated the Brief Intervention, and Referral to Treatment model was infused into course content by 89.47% of trained faculty and sustained in 90.47% of course syllabi at project close. Conclusion: The model demonstrated successful uptake and sustainability in higher education systems.
This study examined whether home-based family therapists' (HBFT) workload and clinical experience... more This study examined whether home-based family therapists' (HBFT) workload and clinical experience were associated with therapists' professional quality of life directly and indirectly through self-care activities and frequency of clinical supervision. Hypotheses were tested using structural equation modeling with a sample of 225 home-based therapists. Results suggested that therapists' workload and HBFT experience significantly predicted therapists' professional quality of life. These associations between therapists' workload and HBFT experience were partially mediated through participation in self-care and frequency of clinical supervision. Implications for improving therapists' quality of life are discussed as a function of therapists' workload, clinical experience, self-care, and supervision. Clinical work can have a negative emotional and psychological impact on therapists. Therapists' interactions with families and exposure to their descriptions of stress and trauma can produce feelings of depression, anxiety, and burnout (Farber & Heifetz, 1982; Rosenberg & Pace, 2006; Sprang, Clark, & Whitt-Woosley, 2007). Thus, it is imperative to understand the factors that can protect against these negative outcomes. Therapists who do not adequately attend to their own self-of-the-therapist concerns are less likely to provide their clients with quality service (Durtschi & McClellan, 2010). Furthermore, theoretical descriptions of home-based therapy have repeatedly suggested that providers engaging in these services face additional demands related to their unique roles and responsibilities (Macchi & O'Conner, 2010). Although a great deal of literature has been written describing home-based family therapy and the impact of this service on therapists (Boyd-Franklin & Bry, 2000; Cortes, 2004; Snyder & McCollum, 1999; Woods, 1988), much of this past work has been theoretical speculation about these processes. We extend previous research on therapists' professional quality of life by quantitatively testing the direct effects from therapists' home-based family therapy (HBFT) experience and perceived workload on their professional quality of life using survey data from 225 licensed therapists currently providing home-based family therapy services. Additionally, we examine self-care and frequency of clinical supervision as potential mediators of the association between clinical experience and perceived workload.
Introduction: We developed the Practice Integration Profile (PIP) to measure the degree of behavi... more Introduction: We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health integration in clinical practices with a focus on primary care (PC). Its 30 items, completed by providers, managers, and staff, provide an overall score and 6 domain scores derived from the Lexicon of Collaborative Care. We describe its history and psychometric properties. Method: The PIP was tested in a convenience sample of practices. Linear regression compared scores across integration exemplars, PC with behavioral services, PC without behavioral services, and community mental health centers without PC. An additional sample rated 4 scenarios describing practices with varying degrees of integration. Results: One hundred sixty-nine surveys were returned. Mean domain scores ran from 49 to 65. The mean total score was 55 (median 58; range 0 –100) with high internal consistency (Cronbach's alpha .95). The lowest total scores were for PC without behavioral health (27), followed by community mental health centers (44), PC with behavioral health (60), and the exemplars (86; p .001). Eleven respondents rerated their practices 37 to 194 days later. The mean change was 1.5 (standard deviation 11.1). Scenario scores were highly correlated with the degree of integration each scenario was designed to represent (Spearman's 0.71; P 0.0005). Discussion: These data suggest that the PIP is useful, has face, content, and internal validity, and distinguishes among types of practices with known variations in integration. We discuss how the PIP may support practices and policymakers in their integration efforts and researchers assessing the degree to which integration affects patient health outcomes.