Measuring Behavioral Health Integration in Primary Care Settings

Date: 

04/03/2015

A team of researchers led by Rodger Kessler has developed the Vermont Integration Profile (VIP), “a set of standardized measures of integrated care processes to use in both practice implementation and improvement efforts and in research.” As explained in the Research in Progress feature of the Health Psychologist Newsletter of the American Psychological Association Division 38, the VIP was developed based on the Lexicon created by National Integration Academy Council (NIAC) member C.J. Peek, PhD. The Lexicon is a set of concepts and definitions for what is meant by behavioral health and primary care integration, and was developed by expert consensus.

The VIP comprises 30 items in six dimensions: (1) practice workflow, (2) clinical services and providers, (3) workspace arrangement, (4) shared care and integration method, (5) case identification, and (6) patient engagement and retention. The VIP can also be used to calculate a total score for degree of integration. In a study with 139 respondents from 113 practices, the researchers were able to use the VIP to detect different levels of integration, which correlated with different types of practices. Exemplar sites, which were considered to be the most advanced in behavioral health integration, had an average total score of 62.04 out of 100, while Community Health Center and Medical Practices without Behavioral Health Care averaged only 35.76 out of 100. The fifth most current version of the VIP takes less than 10 minutes to complete and is automatically self-scored. Although the VIP is still being revised, the researchers are confident that they have created a “usable, theoretically drive set of measures relevant to the field and a product that can assist in the evaluation of behavioral health integration models.”

In commentary about the development of joint principles of Patient Centered Medical Homes (PCMHs), The Working Party Group on Integrated Behavioral Healthcare reiterated the importance of the integration of behavioral health into the delivery of primary and specialty medical care, and note it as a core principle of the PCMH.  Tools such as the VIP will allow researchers and practitioners to determine the effectiveness of various integrated care models.

The VIP research team states:

“There is a need to measure differences in approaches to behavioral health services in primary care settings. We have translated Peek’s theoretical construct of behavioral health integration into a brief self-report measure with encouraging early evidence of reliability and validity. Our hope is to further develop this instrument to evaluate and measure the processes associated with the growing presence of behavioral health in primary care…Although the VIP is undergoing continued testing and refinement, we believe we have established a usable, theoretically driven set of measures relevant to the field and a product that can assist in the evaluation of behavioral health integration models.”

The VIP can also be used to inform quality improvement efforts and evaluate the degree of practice integration in relation to differences in outcomes.

NOTE: The newsletter states that readers can contact Rodger Kessler, Ph.D., ABPP (Rodger.Kessler@med.uvm.edu) for questions regarding the VIP and copies of the instrument to review and complete.