Skip to main content
SpringerLink
Log in

Implementing Clinical Interventions in Integrated Behavioral Health Settings: Best Practices and Essential Elements

  • Chapter
  • First Online:
Integrated Behavioral Health in Primary Care

Abstract

The dissemination of Patient-Centered Medical Homes provides an opportunity for primary care practices to attend to the behavioral health and health behavior needs of its patients. This will often include the development of an integrated behavioral health care practice that expands the team membership and develops routines for anticipating and following patients, with a focus on managing a broad range of conditions. Implementation of a successful integrated behavioral health care practice requires attention to building a team, hiring and training that team, developing sustainable workflows, identifying empirically based interventions to include within a clinical pathway, and establishing processes for insuring quality care. This chapter will provide guidance to administrators and review empirical evidence when it exists on all of these topics.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Alexander, C. L., Amkoff, D. B., & Glass, C. R. (2010). Bringing psychotherapy to primary care: Innovations and challenges. Clinical Psychology: Science and Practice, 17, 191–214.

    Article  Google Scholar 

  • Alexopoulos, G. S., Reynolds, C. F., Bruce, M. L., et al. (2009). Reducing suicidal ideation and depression in older primary care patients: 24-month outcomes of the PROSPECT study. The American Journal of Psychiatry, 166, 882–890.

    Article  PubMed  Google Scholar 

  • Ashley, J. M., St Jeor, S. T., Schrage, J. P., Perumean-Chaney, S. E., Gilbertson, M. C., McCall, N. L., et al. (2001). Weight control in the physician’s office. Archives of Internal Medicine, 161, 1599–1604.

    Article  PubMed  Google Scholar 

  • Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2007). Screening, brief intervention, and referral to treatment (SBIRT): Toward a public health approach to the management of substance abuse. Substance Abuse, 28, 7–30.

    Article  PubMed  Google Scholar 

  • Beich, A., Thorsen, T., & Rollnick, S. (2003). Screening in brief intervention trials targeting excessive drinkers in general practice: Systematic review and meta-analysis. British Medical Journal, 327, 536–542.

    Article  PubMed  Google Scholar 

  • Bertholet, N., Daeppen, J. B., Wietlisbach, V., Fleming, M., & Burnand, B. (2005). Reduction of alcohol consumption by brief alcohol intervention in primary care: Systematic review and meta-analysis. Archives of Internal Medicine, 165, 986–995.

    Article  PubMed  Google Scholar 

  • Blount, F. A., & Miller, B. F. (2009). Addressing the workforce crisis in integrated primary care. Journal of Clinical Psychology in Medical Settings, 16, 113–119.

    Article  PubMed  Google Scholar 

  • Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. Journal of the American Medical Association, 288, 2469–2475.

    Article  PubMed  Google Scholar 

  • Bootzin, R. R., Epstein, D., & Wood, J. M. (1991). Stimulus control instructions. In P. Hauri (Ed.), Case studies in insomnia (pp. 19–28). New York: Plenum Publishing Corp.

    Chapter  Google Scholar 

  • Bourbeau, J., Julien, M., Maltais, F., Rouleau, M., Beaupre, A., Begin, R., et al. (2003). Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: A disease-­specific self-management intervention. Archives of Internal Medicine, 163, 585–591.

    Article  PubMed  Google Scholar 

  • Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.

    Article  PubMed  Google Scholar 

  • Chodosh, J., Morton, S. C., Mojica, W., Maglione, M., Suttorp, M. J., Hilton, L., et al. (2005). Meta-analysis: Chronic disease self-management programs for older adults. Annals of Internal Medicine, 143, 427–438.

    Article  PubMed  Google Scholar 

  • Chomienne, M., Grenier, J., Gaboury, I., Hogg, W., Ritchie, P., & Farmanova-Haynes, E. (2010). Family doctors and psychologists working together: Doctors’ and patients’ perspectives. Journal of Evaluation in Clinical Practice, 17, 282–287.

    Article  PubMed  Google Scholar 

  • Cummings, N. A., O’Donohue, W. T., & Cummings, J. L. (2009). The financial dimension of integrated behavioral/primary care. Journal of Clinical Psychology in Medical Settings, 16, 31–39.

    Article  PubMed  Google Scholar 

  • Dennis, S. M., Zwar, N., Griffiths, R., Roland, M., Hasan, I., Powell Davies, A., et al. (2008). Chronic disease management in primary care: From evidence to policy. Medical Journal of Australia, 188, S53–S56.

    PubMed  Google Scholar 

  • DeRubeis, R. J., & Crits-Christoph, P. (1998). Empirically supported individual and group psychological treatments for adult mental disorders. Journal of Consulting and Clinical Psychology, 66, 37–52.

    Article  PubMed  Google Scholar 

  • Dobmeyer, A. C., Rowan, A. B., Etherage, J. R., & Wilson, R. J. (2003). Training psychology interns in primary behavioral health care. Professional Psychology: Research and Practice, 34, 586–594.

    Article  Google Scholar 

  • Edinger, J. D., Olsen, M. K., Stechuchak, K. M., Means, M. K., Lineberger, M. D., Kirby, A., et al. (2009). Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominately with mixed psychiatric disorders: A randomized clinical trial. Sleep, 32, 499–510.

    PubMed  Google Scholar 

  • Edinger, J. D., & Sampson, W. S. (2003). A primary care “friendly” cognitive behavioral insomnia therapy. Sleep, 26, 117–182.

    Google Scholar 

  • Ely, A. C., Banitt, A., Befort, C., Hou, Q., Rhode, P. C., Grund, C., et al. (2008). Kansas primary care weighs in: A pilot randomized trial of chronic care model program for obesity in three rural Kansas primary care practices. The Journal of Rural Health, 24, 125–132.

    Article  PubMed  Google Scholar 

  • Farrar, S., Kates, N., Crustolo, A. M., & Nikolaou, L. (2001). Integrated model for mental health care: Are providers satisfied with it? Canadian Family Physician, 47, 2483–2488.

    PubMed  Google Scholar 

  • Fiore, M., Jaen, C. R., Baker, T. B., Bailey, B. C., Benowitz, N. L., Curry, S. L., et al. (2008). A clinical practice guideline for treating tobacco use and dependence: 2008 update a U.S. public health service report. American Journal of Preventive Medicine, 35, 158–176.

    Article  Google Scholar 

  • Freeman, D. (2007). Blending behavioral health into primary care at Cherokee Health Systems. The register report. Retrieved June 1, 2012, from http://www.nationalregister.org/trr_fall07_freeman.html

  • Funderburk, J. S., Maisto, S. A., Sugarman, D. E., Smucny, J., & Epling, J. (2008). How do alcohol brief interventions fit with models of integrated primary care? Families, Systems & Health, 26, 1–5.

    Article  Google Scholar 

  • Funderburk, J. S., Sugarman, D. E., Maisto, S. A., Ouimette, P., Schohn, M., Lantinga, L. J., et al. (2010). The description and evaluation of an integrated healthcare model. Families, Systems & Health, 28(2), 130–145.

    Article  Google Scholar 

  • Garcia-Shelton, L., & Vogel, M. E. (2002). Primary care health psychology training: A collaborative model with family practice. Professional Psychology: Research and Practice, 33, 546–556.

    Article  Google Scholar 

  • Guck, T. P., Guck, A. J., Brack, A., & Frey, D. R. (2007). No-show rates in partially integrated models of behavioral health care in a primary care setting. Families, Systems & Health, 25, 137–146.

    Article  Google Scholar 

  • Hunter, C. L., & Goodie, J. L. (2010). Operational and clinical components for integrated-­collaborative behavioral healthcare in the patient-centered medical home. Families, Systems & Health, 28, 308–321.

    Article  Google Scholar 

  • Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. (2009). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Integrated behavioral health for Depression in the Primary Care Setting: A Primer on VA’s TIDES Project. (2008). VHA, Office of Research and Development. http://www.hsrd.research.va.gov/publications/internal/depression_primer.pdf

  • Katon, W. J., Lin, E. H. B., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., et al. (2010). Integrated behavioral health for patients with depression and chronic illnesses. The New England Journal of Medicine, 363, 2611–2620.

    Article  PubMed  Google Scholar 

  • Katon, W., Unutzer, J., & Simon, G. (2004). Treatment of depression in primary care: Where we are, where we can go. Medical Care, 42, 1153–1157.

    Article  PubMed  Google Scholar 

  • Kessler, R. (2008). Integration of care is about money too: The health and behavior codes as an element of a new financial paradigm. Families, Systems & Health, 26, 207–216.

    Article  Google Scholar 

  • Klerman, G. K., Budman, S., Berwick, D., Weissman, M. W., Damico-White, J., Demby, A., et al. (1987). Efficacy of a brief psychosocial intervention for symptoms of stress and distress among patients in primary care. Medical Care, 25, 1078–1088.

    Article  PubMed  Google Scholar 

  • Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.

    Article  PubMed  Google Scholar 

  • Kroenke, K., Spitzer, R. L., Williams, J. B. W., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317–325.

    Article  PubMed  Google Scholar 

  • Logue, E., Sutton, K., Jarjoura, D., Smucker, W., Baughman, K., Capers, C., et al. (2005). Transtheoretical model-chronic disease care for obesity in primary care: A randomized trial. Obesity Research, 13, 917–927.

    Article  PubMed  Google Scholar 

  • Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A meta-analysis of motivational interviewing: Twenty-five years of empirical studies. Research on Social Work Practice, 20, 137–160.

    Article  Google Scholar 

  • McCrae, C. S., McGovern, R., Lukefahr, R., & Stripling, A. M. (2007). Research evaluating brief behavioral sleep treatments for rural elderly (RESTORE): A preliminary examination of effectiveness. The American Journal of Geriatric Psychiatry, 15, 979–982.

    Article  PubMed  Google Scholar 

  • McDaniel, S. H., Hargrove, D. S., Belar, C. D., Schroeder, C. S., & Freeman, E. L. (2004). Recommendations for education and training in primary care psychology. In R. G. Frank, S. H. McDaniel, J. H. Bray, & M. Heldring, (Eds.), Primary care psychology (pp. 63–92). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72, 1050–1062.

    Article  PubMed  Google Scholar 

  • Miranda, J., & Munoz, R. (1994). Intervention for minor depression in primary care patients. Psychosomatic Medicine, 56, 136–142.

    PubMed  Google Scholar 

  • Morgenthaler, T., Kramer, M., Alessi, C., Friedman, L., Boehlecke, B., Brown, T., et al. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: An update. An American Academy of Sleep Medicine report. Sleep: Journal of Sleep and Sleep Disorders Research, 29, 1415–1419.

    Google Scholar 

  • Morin, C. M., Belleville, G., Bélanger, L., & Ivers, H. (2011). The Insomnia Severity Index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep: Journal of Sleep and Sleep Disorders Research, 34, 601–608.

    Google Scholar 

  • Mossey, J. M., Knott, K. A., Higgins, M., & Talerico, K. (1996). Effectiveness of a psychosocial intervention, interpersonal counseling, for subdysthymic depression in the medically ill elderly. Journals of Gerontology, 51, 172–178.

    Google Scholar 

  • Mynors-Wallis, L., Davies, I., Gray, A., Barbour, F., & Gath, D. (1997). A randomized controlled trial and cost analysis of problem-solving treatment for emotional disorders given by community nurses in primary care. The British Journal of Psychiatry, 170, 113–119.

    Article  PubMed  Google Scholar 

  • Mynors-Wallis, L., Gath, D., Day, A., & Baker, F. (2000). Randomized controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care. British Medical Journal, 320, 26–30.

    Article  PubMed  Google Scholar 

  • O’Donohue, W., Byrd, M., Cummings, N., & Henderson, D. (2005). Behavioral integrative care: Treatments that work in the primary care setting. New York: Brunner-Routledge.

    Google Scholar 

  • Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America, 33, 557–577.

    Article  PubMed  Google Scholar 

  • Parkerson, G. R., Broadhead, W. E., & Tse, C. K. (1990). The Duke health profile. A 17-item measure of health and dysfunction. Medical Care, 28, 1056–1072.

    Article  PubMed  Google Scholar 

  • Peek, C. J., & Oftedahl, G. (2010). A consensus operational definition of Patient-Centered Medical Home (PCMH) also known as Health Care Home. University of Minnesota and Institute for Clinical Systems Improvement, 1–17

    Google Scholar 

  • Powell, V., Abreu, N., de Oliveira, I., & Sudak, D. (2008). Cognitive-behavioral therapy for depression. Revista Brasileira de Psiquiatria, 30, S73–S80.

    Article  PubMed  Google Scholar 

  • Robinson, P. (2005). Adapting empirically supported treatments to the primary care setting: A template for success. In W. T. O’Donohue, M. R. Byrd, N. A. Cummings, & D. A. Henderson (Eds.), Behavioral integrative care: Treatments that work in the primary care setting. New York: Brunner-Rutledge.

    Google Scholar 

  • Robinson, P. J., & Reiter, J. T. (2007). Behavioral consultation and primary care: A guide to integrating services. New York: Springer.

    Book  Google Scholar 

  • Roy-Byrne, P. P., Craske, M. G., Stein, M. B., Sullivan, G., Bystritsky, A., Katon, W., et al. (2005). A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Archives of General Psychiatry, 62, 290–298.

    Article  PubMed  Google Scholar 

  • Rubak, S., Sandboek, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: A systematic review and meta-analysis. British Journal of General Practice, 55, 305–312.

    PubMed  Google Scholar 

  • Rubenstein, L. V., Chaney, E. F., Ober, S., Felker, B., Sherman, S. E., Lanto, A., et al. (2010). Using evidence-based quality improvement methods for translating depression integrated behavioral health research into practice. Families, Systems & Health, 28, 91–113.

    Article  Google Scholar 

  • Saitz, R. (2010). Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinking. Drug and Alcohol Review, 29, 631–640.

    Article  PubMed  Google Scholar 

  • Saunders, J., Aasland, O., Babor, T., & de la Fuente, J. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption: II. Addiction, 88, 791–804.

    Article  PubMed  Google Scholar 

  • Scott, C., Tacchi, M. J., Jones, R., & Scott, J. (1997). Acute and one-year outcome of a randomised controlled trial of brief cognitive therapy for major depressive disorder in primary care. The British Journal of Psychiatry, 171, 131–134.

    Article  PubMed  Google Scholar 

  • Shochat, T., Umphress, J., Israel, A. G., & Acoli-Israel, S. (1999). Insomnia in primary care patients. Sleep, 22(2), S359–S365.

    PubMed  Google Scholar 

  • Spielman, A. J., Saskin, P., & Thorpy, M. J. (1987). Treatment of chronic insomnia by restriction of time in bed. Sleep: Journal of Sleep Research and Sleep Medicine, 10, 45–56.

    Google Scholar 

  • Stanley, M. A., Wilson, N. L., Novy, D. M., Rhoades, H. M., Wagener, P., Greisinger, A., et al. (2009). Cognitive behavior therapy for generalized anxiety disorder among older adults in primary care: A randomized clinical trial. Journal of the American Medical Association, 301(14), 1460–1467.

    Article  PubMed  Google Scholar 

  • Strosahl, K. (1998). Integrating behavioral health and primary care services: The primary mental health care model. In A. Blount (Ed.), Integrated primary care: The future of medical and mental health collaboration (pp. 139–166). New York: Norton & Co.

    Google Scholar 

  • Strosahl, K. (2000). The psychologist in primary health care. In A. J. Kent, M. Hersen, A. J. Kent, & M. Hersen (Eds.), A psychologist’s proactive guide to managed mental health care (pp. 87–112). Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Tsai, A. G., & Wadden, T. A. (2009). Treatment of obesity in primary care practice in the United States: A systematic review. Journal of General Internal Medicine, 24, 1073–1079.

    Article  PubMed  Google Scholar 

  • Unützer, J., Katon, W., Callahan, C. M., Williams, J., Hunkeler, E., Harpole, L., et al. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. Journal of the American Medical Association, 288, 2836–2845.

    Article  PubMed  Google Scholar 

  • U.S. Preventive Services Task Force. (1996). Guide to clinical preventive services (2nd ed., pp. 219–229). Washington, DC: Office of Disease Prevention and Health Promotion.

    Google Scholar 

  • U.S. Preventive Services Task Force (2003). Counseling to prevent tobacco use and tobacco-caused disease: recommendation statement. Rockville, MD: Agency for Healthcare Research and Quality. Accessed at http://www.uspreventiveservicestaskforce.org on 24 September 2008.

    Google Scholar 

  • US Department of Health and Human Services. National Institute on Alcohol Abuse and Alcoholism. (2005). Helping patients who drink too much: A clinician’s guide. Bethesda, MD: National Institute of Health.

    Google Scholar 

  • Vasilaki, E. I., Hosier, S. G., & Cox, W. M. (2006). The efficacy of motivational interviewing as a brief intervention for excessive drinking: A meta-analytic review. Alcohol and Alcoholism, 41, 328–335.

    Article  PubMed  Google Scholar 

  • Warsi, A., Wang, P. S., LaValley, M. P., Avorn, J., & Solomon, D. H. (2004). Self-management education programs in chronic disease: A systematic review and methodological critique of the literature. Archives of Internal Medicine, 164, 1641–1649.

    Article  PubMed  Google Scholar 

  • Whitlock, E. P., Orleans, C. T., Pender, N., & Allan, J. (2002). Evaluating primary care behavioral counseling interventions: An evidence-based approach. American Journal of Preventive Medicine, 22, 267–284.

    Article  PubMed  Google Scholar 

  • Wolf, N. J., & Hopko, D. R. (2008). Psychosocial and pharmacological interventions for depressed adults in primary care: A critical review. Clinical Psychology Review, 28, 131–161.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Integrated Primary Care, Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA

    Daniel J. Mullin Psy.D.

  2. Center for Integrated Health care, Syracuse VAMC, Syracuse, NY, USA

    Jennifer S. Funderburk Ph.D.

Authors
  1. Daniel J. Mullin Psy.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer S. Funderburk Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel J. Mullin Psy.D. .

Editor information

Editors and Affiliations

  1. , Northwestern Family Medicine Residency, Erie Family Health Center, W. North Avenue 2570, Chicago, 60647, Illinois, USA

    Mary R. Talen

  2. , Family Health Center, Concord Hospital, Pleasant St. 250, Concord, 03301, New Hampshire, USA

    Aimee Burke Valeras

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Mullin, D.J., Funderburk, J.S. (2013). Implementing Clinical Interventions in Integrated Behavioral Health Settings: Best Practices and Essential Elements. In: Talen, M., Burke Valeras, A. (eds) Integrated Behavioral Health in Primary Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6889-9_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6889-9_13

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6888-2

  • Online ISBN: 978-1-4614-6889-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation