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Integrated Behavioral Healthcare Models

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Training to Deliver Integrated Care

Abstract

The proliferation of integrated behavioral health over the past 30 years has been fostered by the development of a variety of practice models. While these models have evolved over time, the recognition of the need for, and development of, workforce development efforts has typically been slower to emerge. This chapter will describe the history and current state of models of integrated behavioral healthcare, as well as training initiatives and recommendations for key concepts to consider when selecting a practice model to implement.

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Correspondence to Colleen Clemency Cordes .

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Appendix: IBH Historical Development

Appendix: IBH Historical Development

References

Evolution of IBH

Seminal points in the history of IBH publications and training

1600s – Cartesian dualism, which views the mind and body as separate entities, is the prevailing view of healtha

1950s – Kaiser Permanente implements the first attempt at integrated (collaborative care) with prepaid psychology contacts

1967 – The American Academy of Pediatrics coins the term “medical home” for children with complex needsb

1971 – The term “medical model” is coined by R. D. Laing, who describes it as the “set of procedures in which all doctors are trained”

1977 – In response to Laing’s medical model, Engel publishes in paper on the biopsychosocial model of care, which emphasizes the influence of biological, social, and psychological factors associated with healthc

1980s – The “Hawaii Project” demonstrates medical cost offset as a result of collaboration between physicians and mental health providersd

1993 – The Collaborative Family Health Care Coalition (now CFHA) comprised of 15 colleagues from family medicine and family therapy meets for the first time to promote the integration of behavioral health and primary care

1996 – IOM defines primary care as the “provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal health needs, developing a sustained partnership with patients, and practicing in the context of family and communitye

1998 – Chronic Care Model (CCM) shifted attention to proactive, population-based approaches to patient chronic care management

Late 1990s – Several studies are published noting significant differences in the lifespans of patients with severe mental illness

1892 – Andrew Taylor Still founded the American School of Osteopathy, establishing the Doctor of Osteopathic medicine (D.O.) credential. Unlike the previously established M.D., D.O.s are trained to treat the cause of problems, rather than the ramifications of diseases, resulting in a more whole person

1969 – Family medicine is recognized as the 20th primary medical subspecialty, resulting in establishment of residency and board certification requirements. Understanding of behavioral science is viewed as a key element of trainingj

1989 – Kroenke and Mangelsdorff publish their article in the American Journal of Medicine indicating that the majority of primary care visits are related to behavioral factors (not diagnosed mental health disordersk)

1991 – The term “evidence-based medicine” emerges and becomes a central focus of medical education

1995 – CFHA holds its first national conference

1995 – Katon publishes his first article on the collaborative care modell

1998 – Alexander Blount publishes his book Integrated Primary Care: The Future of Medical and Mental Health Collaboration m

2001 – The Institute of Medicine endorses the principle of evidence-based practice

2006 – The Institute of Medicine articulates the critical need to integrated mental health and substance use in order to achieve quality healthcaref

2007 – The Patient-Centered Medical Home (PCMH) Joint Principles are establishedg

2009 – The World Health Organization launches its Mental Health Gap Action Program (mhGAP), aimed at improving access to evidence-based care in low-income countries by ensuring integration in primary care

2010 – The Affordable Care Act is passed, with provisions focused on reimbursement based on quality standards which promote integrated care

2010 – The US Department of Veterans Affairs launches its national implementation of Patient Aligned Care Teams (PACT), based on the PCMHh

2014 – The NCQA updates the PCMH Joint Principles to expand the importance and role of integration of behavioral health into the PCMHi

2004 – Frank, McDaniel, Bray, and Heldring publish their edited volume, Primary Care Psychology n

2007 – Patricia Robinson and Jeffrey Reiter publish Behavioral Consultation and Primary Care: A Guide to Integrating Services o

2007 – The University of Massachusetts Medical School launches a distance-learning training program in integrated primary care co-led by behavioral health clinicians and primary care providersp

2008 – Berwick, Nolan, and Whittington describe the Triple Aimq

2009 – The Interprofessional Education Collaborative (IPEC) is established; it publishes its first set of interprofessional competencies in 2011r

2009 – Hunter and colleagues publish Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention s

2009 – The Doctor of Behavioral Health (DBH) program at Arizona State University opens the first doctoral training program exclusively focused on training behavioral health providers in integrated primary care

2010 – Milbank Memorial Fund publishes its report on Evolving Models of Behavioral Health Integration in Primary Care t

2011- APA Report of the Primary Care Training Task Force is publishedu

2013 – AHRQ publishes the Lexicon for Behavioral Health and Primary Care Integration, providing a shared language for integrated primary carev

2013–present – There is a proliferation of both guild-specific and interprofessional competencies regarding the practice of integrated behavioral health in primary care

2016 – Corso et al. publish one of the first books focused on challenges with implementing primary care behavioral healthw

2017 – NCQA releases 2017 PCMH standards that more specifically articulate the value of behavioral health integration in primary care through the addition of a Behavioral Health Distinction Modulex

aDescartes, R., & Moriarty, M. (2008). Meditations on first philosophy: With selections from the objections and replies. Oxford, England: Oxford University Press.

bSia, C., Tonniges, T. F., Osterhus, E., & Taba, S. (2004). History of the medical home concept. Pediatrics, 113, 1473–1478.

cEngle, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136.

dCummings, N. S., Dorken, H., Pallak, M. S., & Henke, C. J. (1993). The impact of psychological intervention on health care costs and utilization: The Hawaii Medicaid Project. In N. A. Cummings, & M. S. Pallak (Eds.)., Medicaid, managed behavioral health and implications for public policy. Volume 2: Healthcare and Utilization Cost Series (pp. 3–23). San Francisco, CA: Foundation for Behavioral Health.

eInstitute of Medicine Committee on the future of Primary Care. (1996). Primary care: America’s health in a new era. Washington, DC: The National Academies Press.

fInstitute of Medicine. (2006). Improving the quality of health care for mental and substance-use conditions: Quality chasm series. Washington, DC: The National Academies Press.

gAmerican Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, & American Osteopathic Association (2007). Joint Principles of the Patient-Centered Medical Home. Retrieved from: http://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf

hYano, E. M., Bair, M. J., Carrasquillo, O., Krein, S. L., & Rubenstein, L. V. (2014). Patient Aligned Care Teams (PACT): VA’s journey to implementing patient-centered medical homes. Journal of General Internal Medicine, 29, 547–549.

iBaird, M., Blount, A, Brungardt, S., Dickinson, P., Dietrich, A., Epperly, T., et al. (2014). Joint principles: Integrating behavioral health care into the patient-centered medical home. Annals of Family Medicine, 12, 183–185.

jAmerican Board of Family Medicine. (n.d.). History of the specialty. Retrieved from: https://www.theabfm.org/about/history.aspx

kKroenke, K., & Mangelsdorff, A. D. (1989). Common symptoms in ambulatory care: Incidence, evaluation, therapy and outcomes. American Journal of Medicine, 86, 262–266. New York, NY: W. W. Norton & Company, Inc.

lKaton, W., Von Korff, M., Lin, E., Walker, E., Simon, G. E., Bush, T. et al. (1995). Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA, 273, 1026–1031.

mBlount, A., (Ed.) (1998). Integrated primary care: The future of medical and mental health collaboration.

nFrank, R. G., McDaniel, S. H., Bray, J. H., & Heldring, M. (Eds.) (2004). Primary care psychology. Washington, DC: American Psychological Association.

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

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

qBerwick, D. M., Nolan, T. W., & Whittington, J. (2008). The Triple Aim: Care, health, and cost. Health Affairs, 27(3), 759–769.

rInterprofessional Education Collaborative. (n. d.). About the Interprofessional Education Collaborative (IPEC). Retrieved from: https://ipecollaborative.org/About_IPEC.html

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

tCollins, C., Hewson, D. L., Munger, R., & Wade, T. (2010). Evolving models of behavioral health integration in primary care. New York, NY: Milbank Memorial Fund.

uCubic, B., Neumann, C., Kearney, L., McGrath, R., Ruddy, B., Zamudio, A. (2011). Report of the primary care training task force to the APA Board of Educational Affairs. Retrieved from: https://www.apa.org/ed/graduate/task-force-report.pdf

vPeek, C. J. and the National Integration Academy Council. (2013). Lexicon for behavioral health and primary care integration: Concepts and definitions developed by expert consensus. Rockville, MD: Agency for Healthcare Research and Quality.

wCorso, K. A., Hunter, C. L., Dahl, O., Kallenbreg, G. A., & Manson, L. (2016). Integrating behavioral health into the medical home: A rapid implementation guide. Phoenix, MD: Greenbranch Publishing.

xNCQA. (2017). Patient-centered medical home (PCMH) recognition. Retrieved from: http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-pcmh

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Cordes, C.C., Reiter, J., Manson, L. (2018). Integrated Behavioral Healthcare Models. In: Macchi, C., Kessler, R. (eds) Training to Deliver Integrated Care. Springer, Cham. https://doi.org/10.1007/978-3-319-78850-0_2

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