Clinical & Community

Clinical & Community
Clinicians and patients are key components of the integration team.

Connecting the community engaged in integrated health care is a challenge. Often behavioral health and primary care providers may operate within the same building but not be aware of each other’s presence. The Academy aims to unite these disparate efforts and direct providers towards one another in an attempt to facilitate collaboration. In the same vein, the Academy aims to offer resources to patients and the community on integration including the identification of integrated practices they can access.

The U.S. health system is slowly but steadily moving toward an integrated health care model that merges behavioral health services in primary care medical settings. The need and justification for this integration have been well documented, yet the challenge lies with the details around its implementation. Across the nation, a number of pioneers are already providing services under an integrated model despite multiple barriers. These models hinge on training providers on how to best work together in an integrated environment.

Clinicians and patients are key components of the integration team. Creating a newly redesigned system of care that puts the patient back into the center of care delivery requires providers to better collaborate with each other and with patients and families. However, redesigning care delivery systems takes time. The University of Washington AIMS Center has proposed six steps to better integrate care and change care delivery. Its web site has several important resources to assist practices in better integrating behavioral health. Learn more about resources for and about clinicians and patients.

Check back here often to see updates on where integration is happening in your community.

Latest News

Until 2010, Federal agencies defined health disparities very generally as “differences in health among different population groups.” The term was originally coined not merely to describe “all possible health differences among all possible groups of people” but rather to refer specifically to the poorer health outcomes experienced by socially disadvantaged people. Thus,... Read more

In the first installment of the integrated care column in Psychiatric Services, Margaret A. Swarbrick, PhD, discusses the importance of wellness-oriented peer approaches. In peer-based approaches, individuals who have mental illness diagnoses and are current or former users of the mental health system offer aid and... Read more

Behavioral health disorders are a major public health problem in the United States. An estimated 26.4 percent of the U.S. population suffers from diagnosable mental disorders that are directly related to poor health outcomes, increased costs, and premature deaths. An estimated $113 billion was spent in mental health treatment in 2005, of which about $22 billion was spent in substance use... Read more

Access Community Health Centers is a federally qualified health center that provides integrated behavioral health and primary care services. With three integrated care clinics in Madison, Wisconsin, the Agency for Healthcare Research and Quality (AHRQ) has identified Access Community Health Centers as a... Read more

This report examined the evidence regarding the integration of behavioral health and primary care services for individuals with serious mental illness (SMI) and/or substance use disorder. Moderate evidence suggests that the use of fully integrated services or care management with enhanced collaboration improves mental health outcomes and the use of preventative services for adult patients with... Read more

Having access to behavioral health care is essential to positive health outcomes for children. Primary care providers have the responsibility of identifying and treating behavioral health issues in children, but they often lack the proper training and resources. The Massachusetts Child Psychiatry Access Project addressed this problem by providing child psychiatry consultations and specialized... Read more

The (AHRQ) Health IT Portfolio has a public Web (http://healthit.ahrq.gov/) that offers more than 10,000 documents, presentations, articles, and tools to health information technology (IT) researchers, implementers, and policymakers. The National Resource Center of Health IT (NRC) Web site offers over 20 tools and resources to support health IT research... Read more

The New York Health Foundation, through its Advancing Primary Care Initiative, recently funded a report by the RAND Corporation to examine the strategies used by New York State... Read more

Several leading medical organizations, including the Institute of Medicine and the American College of Surgeons, have... Read more

Effective collaboration within the practice team is essential in becoming a Patient-Centered Medical Home and improving overall health and efficiency. The Primary Care Team Guide ensures practices achieve improved care, productivity, and career satisfaction when shifting toward a team-based approach. The guide provides practice team members... Read more

In September 2014, the Agency for Healthcare Research and Quality (AHRQ) published the National Strategy for Quality Improvement in Health Care2014 Annual Progress Report to Congress.  As stated in this report’s Executive Summary,

“The National Quality... Read more

Coordinated patient-centered care is on the rise among medical providers aiming to improve health care quality while reducing overall costs. Last month, the U.S. Department of Health and Human Services announced an $840 million initiative to fund applicants who are transitioning to coordinated patient-centered care and are able to track progress toward measurable goals.

... Read more

In Building an Evidence Base for the Co-Occurrence of Chronic Disease and Psychiatric Distress and Impairment, published in the October 2014 issue of Preventing Chronic Disease, the comorbid nature of chronic disease and mental disorders is examined. In the United States, the number of people with multiple chronic conditions,... Read more

The CAHPS Patient-Centered Medical Home (PCMH) Survey (Adult Version), is a new instrument used to evaluate patients’ experiences with a practice and indicates how well the practice meets patient expectations. A new composite measure for “Comprehensiveness – Adult Behavioral” is based on three questions from the survey:

Q39: In the last 12 months, did anyone in... Read more

A study recently published in General Hospital Psychiatry found that veterans who received behavioral health screening in primary care are typically provided with adequate follow-up care. However, the care provided in all settings can be improved, along with supplementary efforts to align screening and treatment.... Read more

The Institute for Patient and Family Centered Care (IPFCC) provides leadership and resources for advancing the practice of patient- and family-centered care. IPFCC promotes collaborative, empowering partnerships among patients, families, and health care professionals and organizations.

IPFCC serves as an information resource center for patient and... Read more

Research from the April 2014 issue of American Mental Health Counselors Association’s (AMHCA) Journal of Mental Health Counseling (JMHC) indicates that, “integrating behavioral health and primary care poses the best shot at slowing down the rate of escalation in health care costs — bending the cost curve — that has been to driven... Read more

In 2010, the Veterans Health Administration (VHA) began the Patient Aligned Care Teams (PACT), a nationwide initiative “that reorganized care at all [their] primary care clinics in accordance with the patient-centered medical home [PCMH] model.” The goal of PACT is to provide comprehensive, longitudinal, patient-centered primary care by establishing team-based care, increasing... Read more

In the June 2014 issue of Families, Systems, & Health, the Journal of Collaborative Family Healthcare Association, there is a special Commentaries section on the "Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home." This is follow-up to “... Read more

The U.S. Department of Defense (DoD) was a pioneer in the integration of behavioral health and primary care and is widely acknowledged as an exemplar. This article by Christopher Hunter, et al. reviews the development of integrated behavioral health care in the DoD primary care clinics. The authors explain the crucial role of psychologists in this process. In addition to successfully promoting... Read more

This article by Susan H. McDaniel, PhD, and Frank V. deGruy III, MD, MSFM, serves as the introduction to the recent special issue of American Psychologist , the journal of the American Psychological Association (APA).  The authors point out that

... Read more

Two slide decks have been created:

Slide Deck 1: Why Behavioral Health Integration Is Critical to a Patient-Centered Medical Home (PCMH). This deck is appropriate for audiences with limited knowledge about the concept of integrated behavioral health, or for audiences that are already practicing PCMH but need to be convinced of the value of behavioral health integration. Slide Deck 2:... Read more

Major depression affects women twice as often as men over the lifetime. Women’s highest rates of depression occur during reproductive and menopausal transitions. Additionally, more than one-third of obstetrics-gynecology (OB/GYN) patients use their OB/GYN physician as their primary care provider, particularly those with limited income and limited or no health insurance. However, OB/GYN... Read more

Cardiovascular disease (CVD) is the leading cause of death in the United States.  All adults, regardless of risk for cardiovascular disease, can benefit from better nutrition, improved eating behaviors, and more physical activity. The U.S. Preventive Services Task Force (USPSTF) recently updated its 2003 recommendation on dietary counseling for adults with risk factors for cardiovascular... Read more

The Commonwealth Fund recently featured Behavioral Health Integration: Approaches from the Field in their newsletter. This article profiles health systems, hospitals, and community health centers that have adopted integrated behavioral health and primary care integration... Read more

A report, Eliminating Health Disparities through Culturally and Linguistically Centered Integrated Health Care Care:Consensus Statements, Recommendations, and Key Strategies from the Field was released in May 2014. It is the result of an expert consensus meeting convened by the U.S. Department of Health and Human Services Office of Minority Health convened to:

formulate consensus... Read more

Issues related to alcohol “are among the most significant public health issues in the United States and internationally.” The 2010 National Survey on Drug Use and Health reported that in the preceding year, 70% of Americans 18 years older (161 million adults) had used alcohol and that 9% of adults (20 million) had qualified for an alcohol or drug use disorder. Currently, about 18... Read more

San Mateo County’s public health system is now equipped to better treat substance abuse in all patients seen, thanks to Medical Director of Behavioral Health and Recovery Services Robert Paul Cabaj, M.D. “It was astonishing—the number of people in the public-health system with substance abuse issues,” Dr. Cabaj reported. “... Read more

Tracking measurable outcomes within integrated primary care is essential to develop effective systems. However, health care organizations are slow to establish these new procedures and systems given a lack of existing evidence-based measures. In a 2012 white paper, the Institute for Healthcare Improvement (IHI) proposed a menu of measures,... Read more

Community Care of North Carolina (CCNC) “a systemic care management intervention program” depends on the patient-centered medical home (PCMH) model to serve Medicaid recipients and their providers. A recently published study looked at the cost impact of their system of care “for nonelderly Medicaid recipients with... Read more

The Medicare Learning Network within the Centers for Medicare & Medicaid Services has published a guide for providers on changes in health laws that enhance a physician’s ability to address alcohol and substance use issues with their patients. Included in this guide is Medicare coverage information, behavioral counseling and intervention resources, and billing services guidelines.... Read more

A new partnership between the Association for American Medical Colleges (AAMC) and the American Psychological Association (APA) will provide free online access to psychological science resources for medical students, faculty, and health professionals. The collaboration marks the first ever psychological science collection in AAMC’s MedEdPORTAL, a repository of educational medical... Read more

A recent Innovation of the Agency for Healthcare Research and Quality (AHRQ) Health Care Innovations Exchange features an Illinois clinic offering integrated care to its clients. This Chicago clinic is provided by Project Brotherhood, a... Read more

The pace of integration has quickened over the last 2 years in the Denver metro area as an increasing number of county and private primary care clinics are integrating mental health professionals. Colorado health care providers and administrators are changing their thinking around health care delivery and confidence in this model is rising: "It’s just good care, and it’s... Read more

In the new Harvard Medical School (HMS) Center for Primary Care blog, Prime Time, Dr. Russell Phillips, William Applebaum Professor of Medicine at HMS and Director for the Center, states that recent tragedies have shed light on the United States’... Read more

Centerstone Health Partners and Unity Physician Partners have come together to begin offering integrated behavioral health and primary care to medically underserved patients within several clinics in late 2013 according to a recent press release. Unity Physician Partners provides integrated health care services with... Read more

A Utah clinic has recently begun integrating family medicine and mental health. When patients at Intermountain Healthcare’s Salt Lake Clinic exhibit symptoms of depression, their primary care... Read more

Five nonprofit organizations throughout Maine will be receiving $25,000 each in grants for connecting primary care providers with patients receiving mental health services and substance abuse treatment, according to an announcement from the... Read more

TEXAS:

Learning Community on Integrated Health Care

In efforts to promote integrated health care in Texas, the Hogg Foundation for Mental Health funded the Texas Learning Community (TLC) on Integrated Health Care in 2009-2011. The TLC convened primary care and mental health provider organizations from throughout the state to disseminate... Read more

In light of the recent tragedy at Sandy Hook Elementary School and the subsequent debates on gun control and mental health care, Karen Wolk Feinstein, president and CEO of the Jewish Healthcare Foundation, suggests improving behavioral health screening and intervention services in primary care settings as a way to potentially avoid such tragedies. As she sees... Read more

As health care leaders encourage the adoption of integrated models of health care, University of Colorado Hospital’s AF Williams Family Medicine clinic is working to integrate behavioral health services within their clinic.  At AF Williams, the psychology team that includes attending psychologists, post-doctoral... Read more

The first integrated primary care clinic in Monterey County, California plans to provide behavioral health services, medical care, and healthy life skills courses in nutrition, exercise, and other wellness areas. This integrated model will replace the behavioral health referral model in Monterey County such that this former system included primary-care-provider-based referral to mental health... Read more

Three years ago, Tri-County Mental Health Services (TCMHS) and their partners at Central Maine Healthcare’s Bridgton Hospital started a project funded by Maine Health Access Foundation to bring behavioral health providers into doctor’s offices at Naples Family Practice, North Bridgton Family Practice, Fryeburg Family Medicine, Bridgton Pediatrics and Bridgton Internal Medicine. As... Read more

The Maryland Department of Health and Mental Hygiene (DHMH), the Maryland State Department of Education (MSDE), the Johns Hopkins Bloomberg School of Public Health, the University of Maryland School of Medicine, and the Salisbury University Department of Social Work started the Maryland Behavioral Health Integration Program in Primary Care (B-HIPP) to support primary care physicians’... Read more

In a white paper on integration in college health centers, an American College Health Association (ACHA) task force concluded that, “An integrated approach between counseling and health services may allow for an alignment of support services and systems,... Read more

To add to the previous work of the ICARE (Integrated, Collaborative, Accessible, Respectful, Evidence-Based) Partnership in 2006, the North Carolina Center for Excellence in Integrated Care (the Center), Community Care of North Carolina (CCNC) and the North Carolina Division of Medical Assistance (DMA) are working together to promote integrated care in North Carolina.

Read more about... Read more

The Arizona Department of Health Services (ADHS) has developed a strategic plan based on the position that in order to be healthy, we need to take care of both our physical and behavioral health needs. The body and mind are not separate and thus, neither should the health care delivery system, especially for those with serious mental illness. People with serious mental illness die more than 25... Read more

Expert Insight

The Collaborative Family Healthcare Association (CFHA) blog recently reprinted a post by Dr. Alexander Blount. Dr. Blount looks back to provide a brief review of the history of integration. Of the current state of integration he says:

“We have to keep reminding each other not to ask does integration work? Does the PCMH work? Can integration save money? We have to... Read more

Thu, 07/02/2015

According to Dr. Parinda Khatri, Director of Integrated Care at Cherokee, Cherokee has an embedded behavioral health team in the primary care practice. The behavioral health team provides consultation, assessment, and intervention to address a number of issues ranging from traditional mental health (e.g., depression, anxiety, and diagnostic clarification) to health psychology issues (e.g., self-management of diabetes, asthma, healthy diet, smoking cessation programs for teenagers, etc.). In addition to the... Read more