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.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
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
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.
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.
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.
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.
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.
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.
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.
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.
Blount A, Bayona J. Toward a system of integrated primary care. Fam Syst Med. 1994;12(2):171–82.
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.
Blount A. Integrated primary care: Organizing the evidence. Fam Syst Health. 2003;21:121–34.
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.
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.
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.
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.
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/
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.
Unutzer J. Which flavor of integrated care? Psychiatric News. 2016. https://psychnews.psychiatryonline.org/doi/full/10.1176%2Fappi.pn.2014.10b25
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.
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.
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.
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.
Patterson J, Peek CJ, Heinrich RL, Bischoff R, Scherger J. Mental health professionals in medical settings. New York: Norton; 2002.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Montori V. Why we revolt. Rochester: The Patient Revolution; 2017.
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.
Resources
Psychiatric Clinicians in Primary Care
AIMS Center Psychiatric Consultant Training: https://aims.uw.edu/resource-library/primary-care-psychiatric-consultation-training-series
Competencies of Behavioral Health Clinicians
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.
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.
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.
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.
Clinical Practices and Culture in Exemplary Settings
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
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
AHRQ Integration Academy. The Playbook: A Guide to Integrating Care in Primary Care and Other Ambulatory Settings. https://integrationacademy.ahrq.gov/playbook/about-playbook
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
AIMS Center Collaborative Care Implementation Guide. https://aims.uw.edu/collaborative-care/implementation-guide
Meadows Mental Health Policy Institute. 2016. Best Practices in Integrated Behavioral Health: Identifying and Implementing Core Components. https://bit.ly/2Hcbb5z
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
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
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Blount, A. (2019). Behavioral Health and Care Enhancement: Building a Team to Do the Whole Job. In: Patient-Centered Primary Care. Springer, Cham. https://doi.org/10.1007/978-3-030-17645-7_3
Download citation
DOI: https://doi.org/10.1007/978-3-030-17645-7_3
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-17644-0
Online ISBN: 978-3-030-17645-7
eBook Packages: MedicineMedicine (R0)