Advertisement

Behavioral Health and Care Enhancement: Building a Team to Do the Whole Job

  • Alexander Blount
Chapter

Abstract

For practices that are attempting to develop patient-centered team-based care, the addition of one or more behavioral health clinicians (BHC) is a logical step along the way. When done well, adding a behavioral health clinician enhances the fit of the expertise of the team to the needs of many of its patients. Behavioral health care within the primary care practice greatly increases access for patients by being a better fit to their understanding of their needs and therefore increasing its acceptability. The patterns of communication among team members that make for successful team-based care are the same ones that make for successful integration of a behavioral health clinician. The expertise that is added to the team by a behavioral health clinician can help to foster the change in “mental models of care” that has been discussed as underlying the transition to both patient-centered and team-based primary care. In addition, for patient with significant challenges in the area of the “social determinants of health,” a team member who is able to enhance the care provided by the team, sometimes called a navigator, care manager, case manager, or community health worker, is also a crucial part of an effective team.

Keywords

Behavioral health Integration Care management Team Healthcare reform 

References

  1. 1.
    Jabbarpour Y, DeMarchis E, Bazemore A, Grundy P. The impact of primary care practice transformation on cost, quality, and utilization: a systematic review of research published in 2016. Patient-Centered Primary Care Collaborative and Robert Graham Center. 2017. https://www.pcpcc.org/resource/impact-primary-care-practice-transformation-cost-quality-and-utilization
  2. 2.
    Mautner DB, Pang H, Brenner JC, Shea JA, Gross KS, Frasso R, Cannuscio CC. Generating hypotheses about care needs of high utilizers: lessons from patient interviews. Popul Health Manag. 2013;16:S26–33.CrossRefGoogle Scholar
  3. 3.
    Friedberg MW, Chen PG, Van Busum KR, et al. Factors affecting physician professional satisfaction and their implications for patient care, health systems, and health policy. Rand Health Q. 2014;3(4):1–122.PubMedPubMedCentralGoogle Scholar
  4. 4.
    De Marchis E, Knox M, Hessler D, et al. Physician burnout and higher clinic capacity to address patients’ social needs. J Am Board Fam Med. 2019;32:69–78.Google Scholar
  5. 5.
    Borrell-Carrio F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2:576–82.CrossRefGoogle Scholar
  6. 6.
    Regier D, Narrow w, Rae D, Manderscheid R, Locke B, Goodwin F. The de facto mental health and addictive disorders service system. Arch Gen Psychiatry. 1993;50:85–94.CrossRefGoogle Scholar
  7. 7.
    Blount A. An introduction to integrated primary care. In: Blount A, editor. Integrated primary care: the future of medical and mental health collaboration. New York: W. W. Norton; 1998. p. 1–43.Google Scholar
  8. 8.
    deGruy FV, Etz RS. Attending to the whole person in the patient-centered medical home: the case for incorporating mental healthcare, substance abuse care, and health behavior change. Fam Syst Health. 2010;28:298–307.CrossRefGoogle Scholar
  9. 9.
    Vickers KS, Ridgeway JL, Hathaway JC, Egginton JS, Kaderlik AB, Katzelnick DJ. Integration of mental health resources in a primary care setting leads to increased provider satisfaction and patient access. Gen Hosp Psychiatry. 2013;35:461–7.CrossRefGoogle Scholar
  10. 10.
    Blount A, Bayona J. Toward a system of integrated primary care. Fam Syst Med. 1994;12(2):171–82.CrossRefGoogle Scholar
  11. 11.
    Katon W, von Korff M, Lin E, Walker E, Simon GE, Bush T, Robinson P, Russon J. Collaborative management to achieve treatment guidelines: impact on depression in primary care. JAMA. 1995;273:1026–31.CrossRefGoogle Scholar
  12. 12.
    Blount A. Integrated primary care: Organizing the evidence. Fam Syst Health. 2003;21:121–34.CrossRefGoogle Scholar
  13. 13.
    Kathol R, deGruy F, Rollman B. Value-based financially sustainable behavioral health components in patient-centered medical homes. Ann Fam Med. 2014;12:172–5.CrossRefGoogle Scholar
  14. 14.
    Strosahl K. Integrating behavioral health and primary care services: the primary mental health care model. In: Blount A, editor. Integrated primary care: the future of medical and mental health collaboration. New York: W. W. Norton & Co; 1998. p. 139–66.Google Scholar
  15. 15.
    Unutzer J, Harbin H, Schoenbaum M, Druss B. The collaborative care model: an approach for integrating physical and mental health care in Medicaid Health Homes. Medicaid Health Home Brief; May, 2013.Google Scholar
  16. 16.
    Coventry PA, Hudson JL, Kontopantelis E, et al. Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomized controlled trials. PLoS One. 2014;9(9):e108114.CrossRefGoogle Scholar
  17. 17.
    Tice JA, Ollendorf DA, Reed SJ, Shore KK, Weissberg J, Pearson SD. Integrating behavioral health into primary care. Institute for Clinical and Economic Review. 2015. https://icer-review.org/material/bhi-final-report/
  18. 18.
    Pincus HA, Pechura C, Keyser D, Bachman J, Houtsinger JK. Depression in primary care: learning lessons in a national quality improvement program. Admin Pol Ment Health. 2006;33:2–15.CrossRefGoogle Scholar
  19. 19.
    Unutzer J. Which flavor of integrated care? Psychiatric News. 2016. https://psychnews.psychiatryonline.org/doi/full/10.1176%2Fappi.pn.2014.10b25
  20. 20.
    Davis MM, Gunn R, Cifuentes M, Khatri P, Hall J, Gilchrist E, Peek CJ, Klowden M, Lazerus JA, Miller BF, Cohen DJ. Clinical workflows and the associated tasks and behaviors to support delivery of integrated behavioral health and primary care. J Ambul Care Manage. 2019;42:51–65.CrossRefGoogle Scholar
  21. 21.
    Thota AB, Sipe TA, Byard GJ, et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med. 2012;42:525–38.CrossRefGoogle Scholar
  22. 22.
    Huffman JC, Niazi SK, Rundell JR, Sharpe M, Katon WJ. Essential articles on collaborative care models for the treatment of psychiatric disorders in medical settings: a publication by the academy of psychosomatic medicine research and evidence-based practice committee. Psychosomatics. 2013.  https://doi.org/10.1016/j.psym.2013.09.002.CrossRefGoogle Scholar
  23. 23.
    Cohen DJ, Balasubramanian BA, Davis M, Hall J, Gunn R, Stange KC, Green LA, Miller WL, Crabtree BF, England MJ, Clark K, Miller BF. Understanding care integration from the ground up: five organizing constructs that shape integrated practices. JABFM. 2015;28(Supplement 1):S7–S20.CrossRefGoogle Scholar
  24. 24.
    Patterson J, Peek CJ, Heinrich RL, Bischoff R, Scherger J. Mental health professionals in medical settings. New York: Norton; 2002.Google Scholar
  25. 25.
    Blount A, Schoenbaum M, Kathol R, Rollman B, Thomas M, O’Donohue W, Peek CJ. The economics of behavioral health services in medical settings: a summary of the evidence. Prof Psychol Res Pr. 2007;38:290–7.CrossRefGoogle Scholar
  26. 26.
    Hall J, Cohen DJ, Davis M, et al. Preparing the workforce for behavioral health and primary care integration. J Am Board Fam Med. 2015;28(Supplement 1):S41–51.CrossRefGoogle Scholar
  27. 27.
    Ratzliff AH, Unutzer J, Pasqualy M. Training psychiatrists for integrated care. In: Raney L, editor. Integrated care: working at the interface of primary care and behavioral health. Arlington: American Psychiatric Association Publishing; 2015.CrossRefGoogle Scholar
  28. 28.
    Conway A, O’Donnell C, Yates P. The effectiveness of the nurse care coordinator role on patient-reported and health service outcomes: a systematic review. Evaluation Health Prof. 2017;40:18–25.Google Scholar
  29. 29.
    Natale-Pereira A, Enard KR, Nevarez L, Jones LA. The role of patient navigators in eliminating health disparities. Cancer. 2011;117(15. Suppl):3543–52.CrossRefGoogle Scholar
  30. 30.
    Kangovi S, Mitra N, Norton L, et al. Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial. JAMA Intern Med. 2018;178:1635–43.CrossRefGoogle Scholar
  31. 31.
    Ferrer RL, Schlenker CG, Romero RL, et al. Advanced primary care in San Antonio: linking practice and community strategies to improve health. J Am Board Fam Med. 2013;26:288–98.CrossRefGoogle Scholar
  32. 32.
    Thom DH, Wolf J, Gardner H, et al. A qualitative study of how health coaches support patients in making health-related decisions and behavioral changes. Ann Fam Med. 2016;14:509–16.CrossRefGoogle Scholar
  33. 33.
    Blount A, Fauth J, Nordstrom A, Pearson S. Who will provide integrated care: assessing the workforce for the integration of behavioral health and primary care in New Hampshire. Concord: Endowment for Health; 2017.Google Scholar
  34. 34.
    Montori V. Why we revolt. Rochester: The Patient Revolution; 2017.Google Scholar
  35. 35.
    Gensichen J, Jaeger C, Peitz M, Torge M, Güthlin C, Mergenthal K, Kleppel V, Gerlach F, Peterson J. Health care assistants in primary care depression management: role perception, burdening factors and disease conception. Ann Fam Med. 2009;7:513–9.CrossRefGoogle Scholar

Resources

    Psychiatric Clinicians in Primary Care

    Competencies of Behavioral Health Clinicians

    1. https://makehealthwhole.org/. Make Health Whole is a website with the 8 Competencies for Primary Care Behavioral Health presented with video examples and further definition of each.
    2. Miller BF, Gilchrist EC, Ross KM, Wong SL, Blount A, Peek CJ. Core competencies for behavioral health providers working in primary care. In: Colorado consensus conference. 2016.Google Scholar
    3. McDaniel SH, Grus CL, Cubic BA, Hunter CL, Kearney LK, Schuman CC, et al. Competencies for psychology practice in primary care. Am Psychol. 2014;69(4):409.CrossRefGoogle Scholar
    4. Hoge MA, Morris JA, Laraia M, Pomerantz A, Farley T. Core competencies for integrated behavioral health and primary care. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions; 2014.Google Scholar

    Clinical Practices and Culture in Exemplary Settings

    1. An exhaustive study of the clinicians and practice patterns of primary care sites that are national examples of excellence conducted by the National Academy for the Integration of Behavioral Health and Primary Care, supported by the Agency for Healthcare Research and Quality. https://integrationacademy.ahrq.gov/products/professional-practices
    2. Choosing the people who will make be the team members you need: https://hbr.org/2018/10/rethinking-how-medicaid-patients-receive-care

    Support for Developing Integrated Primary Care

    1. AHRQ Integration Academy. The Playbook: A Guide to Integrating Care in Primary Care and Other Ambulatory Settings. https://integrationacademy.ahrq.gov/playbook/about-playbook
    2. AHRQ Integration Academy. Self-Assessment Checklist for Integrating Behavioral Health and Ambulatory Care. https://integrationacademy.ahrq.gov/playbook/integrating-behavioral-health-and-ambulatory-care-self-assessment-checklist
    3. AIMS Center Collaborative Care Implementation Guide. https://aims.uw.edu/collaborative-care/implementation-guide
    4. Meadows Mental Health Policy Institute. 2016. Best Practices in Integrated Behavioral Health: Identifying and Implementing Core Components. https://bit.ly/2Hcbb5z
    5. SAMHSA-HRSA Center for Integrated Health Solutions. A Quick Start Guide to Behavioral Health Integration for Safety-Net Primary Care Providers. https://www.integration.samhsa.gov/resource/quick-start-guide-to-behavioral-health-integration

    Literature on Behavioral Health Integration

    1. A current, searchable collection of literature, including journal articles, books and substantive reports done by the National Academy for the Integration of Behavioral Health and Primary Care, supported by the Agency for Healthcare Research and Quality. https://integrationacademy.ahrq.gov/products/literature-collection

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alexander Blount
    • 1
  1. 1.Department of Clinical PsychologyAntioch University New EnglandKeeneUSA

Personalised recommendations