Putting NH on the Path to Primary Care and Behavioral Health Integration - Alexander Blount, EdD (Antioch Univ, New England) (original) (raw)
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RePEc: Research Papers in Economics, 2012
and the Board of Directors' chair for UCare Minnesota, the fourth largest Minnesota HMO. His work focuses on the integration of behavioral medicine into primary care, population-based health, as well as family therapy and improving the care of patients with chronic illness. Dr. Baird is currently an active participant in the Minnesota Department of Human Services Children's Psychiatric Consultation Protocols Workgroup, which will become a phone-based clinical resource for physicians prescribing atypical antipsychotic and ADHD medications for children. Dr. Baird also led the multidisciplinary team developing the Minnesota Complexity Assessment Method© which is currently being tested in collaboration with a variety of practices in Minnesota. In addition to being a physician, Dr. Baird is also a family therapist.
Integrated Primary Care: Organizing the Evidence
The evidence for bringing behavioral health services into primary care can be confusing. Studies are quite varied in the types of programs assessed, what impacts are assessed, what kind of therapy is offered, for what populations and on how broad a scale. By organizing the evidence into categories: whether the program is coordinated, co-located, or integrated, whether for a targeted or non-targeted patient population, offering specified or unspecified behavioral health services, in a small scale or extensive implementation, programs can be compared more easily. By noting what sorts of impacts are reported - improved access to services, clinical outcome, maintained improvement, improved compliance, patient satisfactions, provider satisfaction, cost effectiveness or medical cost offset - the most comprehensive overall assessment of this important approach to patients' needs can be encouraged.
Development and Validation of a Measure of Primary Care Behavioral Health Integration
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.
The Journal of the American Board of Family Medicine, 2014
Background: Integrated primary care, a health care delivery model that combines medical and behavioral health services, provides better patient access to care at a lower cost, with better outcomes compared with usual nonintegrated care models. The perspectives of primary care providers (PCPs) and behavioral health care providers (BHPs) toward integration are especially valuable because their input and endorsement are key to successful and sustained integration. However, there is little research assessing or comparing PCP and BHP perspectives on integration, especially in rural areas. The objective of this study was to identify rural PCP and BHP perspectives on integration.
Integrated primary care: A systematic review of program characteristics
Families, Systems, & Health, 2014
The integration of behavioral health services into primary care medical settings may be part of the solution to the fragmented health care system currently found in the United States. Although integrated primary care (IPC) is implemented in various locations across the United States, little information is available about how IPC is specifically practiced. Using a systematic review design, we extracted data from 76 articles to examine 6 categories of IPC program characteristics, including collaboration practices (e.g., shared decision-making, written communication, hallway conversations), program models, behavioral health interventions, behavioral health training and supervision, behavioral health provider type, and setting. Findings show that most IPC programs include psychoeducation, medication, follow-up contact, psychotherapy, and at least 1 care management strategy as part of treatment. Fewer than half of researchers report communication between providers, and even fewer report collaboration as a "shared decision making process." A third of researchers report training and/or supervising behavioral health providers to work in an IPC program, and a fourth report recruiting nurses as behavioral health providers. Of all the studies, family-based interventions were used in 1. We recommend that future researchers report more information about collaboration processes as well as training and supervision of behavioral health providers. We also recommend that researchers develop IPC programs that involve family members in treatment and better implement theory into future IPC programs to support conceptualization and replication of IPC program models.
Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention
2009
were largely theoretical, establishing the case for integrated care but not yet able to provide pragmatics and clinical how-tos, Hunter et al.'s book is the reverse. An understanding of the importance of integrating behavioral health into primary care is assumed by the authors, allowing for a focus instead on specific clinical strategies. The book represents a shift from a field that was flailing about in an attempt to deploy regular mental health approaches in primary care to
Families, Systems, & Health, 2014
Integrated behavioral health increases service utilization and treatment success, particularly with high-risk populations. This study assessed medical personnel's attitudes and perceptions of behavioral health clinicians (BHCs) in primary care using a brief self-report measure. A 6-item survey was given to medical providers (n ϭ 45) from a health care system that includes integrated behavioral health services. Survey items assessed providers' attitudes and perceptions about BHCs. Attitudes about behavioral health were largely favorable. For all items, 73.3% to 100% of participants endorsed strongly agree or agree. Chi-square analyses revealed that those who interacted more frequently with BHCs were more comfortable discussing behavioral health issues with their patients, 2 (6, n ϭ 45) ϭ 13.43, p Ͻ .05, and that physicians believe that BHCs help patients effectively address their behavioral health problems, 2 (2, n ϭ 45) ϭ 6.36, p Ͻ .05. Age, gender, and health center in which the providers worked were not significantly related to any survey items. Medical providers surveyed believe that BHCs are valuable members of integrated health care, improving their abilities to provide care and to address their patients' physical and behavioral health problems. Although these preliminary results are promising, the setting surveyed has well-integrated behavioral health care services and thus might not be representative of other settings without such integration. Future studies should address medical providers' opinions of BHCs in a variety of settings with larger samples.
Improving Primary Care Behavioral Health Integration in an Academic Internal Medicine Practice
American Journal of Medical Quality, 2021
This report details ongoing efforts to improve integration in the 2 years following implementation of the Primary Care Behavioral Health model at a general internal medicine clinic of an urban academic medical center. Efforts were informed by a modified version of the validated Level of Integration Measure, sent to all faculty and staff annually. At baseline, results indicated that the domains of systems integration, training, and integrated clinical practices had the greatest need for improvement. Over the 2 years, the authors increased availability of behavioral medicine appointments, improved depression screening processes, offered behavioral health training for providers, disseminated clinical decision support tools, and provided updates about integration progress during clinic meetings. Follow-up survey results demonstrated that physicians and staff perceived improvements in integration overall and in targeted domains. However, the main ongoing barrier to integration was insufficient behavioral health staff to meet patient demand for behavioral health services.