Abstract
The integration of behavioral health and primary care has received much attention in the literature. Behavioral health providers (BHPs) in integrated settings are faced with different treatment constraints than those who work in specialty mental health. The existing literature focuses on what BHPs should do in primary care settings; however, little research exists specifying what BHPs are actually doing. This study provides a glimpse into what types of interventions BHPs are using, and what types of patients they are seeing, in primary care. A chart review was conducted of patients (N = 180) seen by BHPs in five Veterans Affairs primary care clinics. Depression was the most common diagnosis, while less common presenting problems included substance abuse/dependence, psychosis, and bipolar disorder. Common interventions used were medical management, psycho-education, elements of cognitive-behavioral therapy (CBT), and supportive psychotherapy. Future research should examine the efficacy of brief interventions in primary care settings.
Similar content being viewed by others
References
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.
Bien, T. H., Miller, W. R., & Tonigan, J. S. (1993). Brief interventions for alcohol problems: A review. Addiction, 88, 315–335.
Blount, A. (1998). Integrated primary care: The future of medical and mental health collaboration. New York: W.W. Norton & Company, Inc.
Bluestein, D., & Cubic, B. A. (2009). Psychologists and primary care physicians: A training model for creating collaborative relationships. Journal of Clinical Psychology in Medical Settings, 16, 101–112.
Bush, K. R., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Archives of Internal Medicine, 158, 1789–1795.
Butler, M., Kane, R. L., McAlpine, D., Kathol, R. G., Fu, S. S., Hagedorn, H., et al. (2008). Integration of mental health/substance abuse and primary care no. 173 (Pub. No. 09-E003). Rockville, MD: Agency for Healthcare Research and Quality.
Cummings, N. A., O’Donohue, W., Hayes, S. C., & Follette, V. (Eds.). (2001). Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice. San Diego, CA: Academic Press.
Devine, E., & Reif-Schneider, E. (1995). A meta-analysis of the effects of psychoeducational care in adults with hypertension. Nursing Research, 44, 237–245.
Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658–670.
Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., et al. (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76, 468–477.
Doherty, W. J. (1995). The why’s and levels of collaborative family health care. Family Systems Medicine, 13, 275–281.
Dym, B., & Berman, S. (1986). The primary health care team: Family physician and family therapist in joint practice. Family Systems Medicine, 4, 9–21.
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 predominantly with mixed psychiatric disorders: A randomized clinical trial. Sleep, 32, 499–510.
Edinger, J. D., & Sampson, W. S. (2003). A primary care “friendly” cognitive behavioral insomnia therapy. Sleep, 26, 177–182.
Frank, R., McDaniel, S. H., Bray, J., & Heldring, M. (Eds.). (2004). Primary care psychology. Washington, DC: American Psychological Association.
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 and Health, 26, 1–15.
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 and Health, 28, 130–145.
Hedrick, S. C., Chaney, E. F., Felker, B., Liu, C., Hasenberg, N., Heagerty, P., et al. (2003). Effectiveness of collaborative care depression treatment in Veterans’ Affairs primary care. Journal of General Internal Medicine, 18, 9–16.
Hunter, 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.
Institute of Medicine. (1990). Alcohol problems: Broadening the base of treatment. Washington, DC: National Academy Press.
Katon, W., Russo, J., Von Korff, M., Lin, E., Simon, G., Bush, T., et al. (2002). Long-term effects of a collaborative care intervention in persistently depressed primary care patients. Journal of General Internal Medicine, 17, 741–748.
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.
Leventhal, G., Baker, J., Archer, R. P., Cubic, B. A., & Hudson, B. O. (2004). Federal funds to train clinical psychologists for work with underserved population: The Bureau of Health Professions Graduate Psychology Education grants program. Journal of Clinical Psychology in Medical Settings, 11, 109–117.
Liu, C. F., Hedrick, S. C., Chaney, E. F., Heagerty, P., Felker, B., Hasenberg, N., et al. (2003). Cost effectiveness of collaborative care for depression in primary care veteran population. Psychiatric Services, 54, 698–704.
Löwe, B., Kroenke, K., & Gräfe, K. (2005). Detecting and monitoring depression with a two-item questionnaire (PHQ-2). Journal of Psychosomatic Research, 58, 163–171.
McDaniel, S. H., Belar, C. D., Schroeder, C., Hargrove, H. S., & Freeman, E. L. (2002). A training curriculum for professional psychologists working in primary care. Professional Psychology, 33, 65–72.
President’s New Freedom Commission on Mental Health. Final Report. (2003). Achieving the promise: Transforming mental health care in America (DHHS Publication No. SMA-03-3832). Retrieved January 26, 2009, from http:/www.mentalhealthcommission.gov
Prins, A., Ouimette, P., Kimerling, R., Cameron, R. P., Hugelshofer, D. S., Shaw-Hegwer, J., et al. (2003). The primary care PTSD screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry, 9, 9–14.
Robinson, P. J., & Reiter, J. T. (2007). Behavioral consultation and primary care: A guide to integrating services. New York: Springer.
Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., & Grant, M. (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.
Schaffer, S. D., & Tian, L. (2004). Promoting adherence: Effects of theory-based asthma education. Clinical Nursing Research, 13, 69–89.
Strosahl, K. (1998). Integrating behavioral health and primary care services: The primary mental health care model. In A. Blount (Ed.), Integrating primary care: The future of medical and mental health collaboration (pp. 139–166). New York: W.W Norton & Company Inc.
Vergouwen, A. C. M., Bakker, A., Katon, W. J., Verheij, T. J., & Koerselman, F. (2003). Improving adherence to antidepressants: A systematic review of interventions. Journal of Clinical Psychiatry, 64, 1415–1420.
VISN 2 Integrated Primary Care Work Group. (2003). Integrated primary care behavioral health services operations manual. Unpublished manual.
Zeiss, A. M., & Karlin, B. E. (2008). Integrating mental health and primary care services in the Department of Veterans Affairs health care system. Journal of Clinical Psychology in Medical Settings, 15, 73–78.
Acknowledgments
This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, and the Center for Integrated Healthcare.
Author information
Authors and Affiliations
Corresponding author
Additional information
The views expressed in this article are those of the authors and do not reflect the official policy of the Veteran’s Affair’s department or other departments of the U.S. government.
Rights and permissions
About this article
Cite this article
Funderburk, J.S., Sugarman, D.E., Labbe, A.K. et al. Behavioral Health Interventions Being Implemented in a VA Primary Care System. J Clin Psychol Med Settings 18, 22–29 (2011). https://doi.org/10.1007/s10880-011-9230-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-011-9230-y