Lexicon Development and Method 2013-2023

History and Creators

The Lexicon was originally created in 2013

The twenty members of AHRQ's National Integration Academy Council (NIAC) at that time1 were assembled as a broad-based expert panel from across disciplines, geographies, and expertise in language and methods of integration. The Lexicon was to be used by the field in general, not to be limited to, or based on, one model, exemplar, discipline, geographic region, or pioneering implementer group.

Creation of the Leixcon also included patient representatives, and those with, quality improvement, diversity-equity, and systems or insurance perspectives. This was a recognized group of thought leaders and pioneers in a position to create the field's first systematic functional definition, under the auspices of AHRQ.

The updated 2023 Lexicon

The 2023 NIAC is responsible for this update, with many of the 2013 members plus a substantial number of new members with different perspectives2. All listed NIAC members have reviewed and approved this update. As an update, it preserves the original 2013 structure with an Introduction, defining functions (part 1), and common differences between practices (part 2). It is an update, not a new resource and is considered a consensus product, which is defined below.

Requirements for a method to reach a definition that has standing in the field

  • Leads to systematic description of required functions—what you see in action, not just principles, values, intentions, and "anatomical" features.
  • Serves the practical purposes of a broad range of implementers of behavioral health and primary care integration including clearly describing the functions they are implementing.
  • A disciplined transparent process for reaching agreement—a good majority agree with the definitions (knowing they will evolve).
  • Involves actual implementers and users who already "speak" integrated behavioral health even if in their own disciplinary, role, or context-specific "dialects".
  • Specifies acceptable variations in the required functions—so it is not a rigid prescription and is capable of being locally tailored.
  • Is amenable to adjustments by an expanding circle of owners and contributors over time as the field evolves (not just an elite group coming up with a one-time declaration).

Methods for reaching the Lexicon definition

Methods for defining complex subject matters that meet the requirements exist in the published literature3. These methods were employed but the formal jargon associated with them disappears in the published Lexicon in favor of ordinary language.

Paradigm case formulation is a vehicle for creating a definition that maps both similarities and differences. This is the method employed to produce Part 1 of the Lexicon: What integrated behavioral health in primary care needs to look like in action4.

Parametric analysis builds on the paradigm case to create a specific vocabulary for how one instance of integrated behavioral health might differ from another. This produced Part 2 of the Lexicon: How integrated practices might differ from one another5.

The paradigm case and parameters amount to a set of interrelated concepts (like an extended definition) that can be used to describe functions to implement, what to expect from them, and compare practices, set standards, or ask research questions using a common vocabulary.

The consensus process

2013 NIAC. This group was led (first face-to-face, then via email) through an iterative process that progressively refined parts A-C below over several months until all participants believed it was good enough to use, knowing it would evolve.

A. Create a paradigm case of integrated behavioral health in action: An indisputable example that is deliberately aspirational, not necessarily representative of what you commonly find in practice but would be ideal. This step maps out the universal elements of integrated behavioral health.

B. Introduce alternatives of this paradigm case. The purpose of alternatives is to identify additional cases that we as a group also believe qualify as integrated behavioral health; in other words, "you could change X or delete Y and it would still be integrated behavioral health". This step maps the possible variations. The paradigm case and alternatives, when taken together, create our "definition" of behavioral health integrated with primary care.

C. Define parameters or dimensions for legitimate differences between practices. This is a vocabulary for how one integrated behavioral health practice might differ from another.

2023 NIAC. A Lexicon update was created by the first author, preserving the same basic architecture as the original: an introduction, part 1 defining functions, and part 2 discussing common differences among practices in how functions are carried out. The main changes were to convert to HTML for navigation as a website rather than PDF, update content to current practice, and update literature references.

This update was first reviewed by a subset of the NIAC, including some new members and some who participated in 2013. Next, the entire 2023 NIAC reviewed via email, with the general instruction to identify where the content was good enough to reuse, knowing it will evolve, and to identify what needs to change. The task was framed as an update to the existing resource, not a new product.

The updated Lexicon was then converted to HTML after resolving areas flagged by the 2023 NIAC and majority consensus supporting the new version. It was then shared with AHRQ and reviewed and approved for public dissemination. Subsequent adjustments based on literature and developments in the field can later be made easily to the web-based document under advisement by the NIAC.

1 2013 NIAC and other collaborators involved in the original Lexicon for Behavioral Health Integration with Primary Care and their affiliations at that time:

  • Macaran Baird MD, MS - University of Minnesota
  • Alexander Blount, EdD - University of Massachusetts
  • Ned Calonge, MD, MPH - The Colorado Trust
  • Teresa Chapa, PhD, MPA - U.S. Dept. of Health & Human Services; Office of Minority Health
  • Deborah Cohen, PhD - Oregon Health & Science University
  • Dave deBronkart - Patient representative; speaker and advocate
  • Frank deGruy, III, MD, MSFM (Chair) - University of Colorado
  • Barbara Degnan - Patient representative; Minnesota health care groups
  • Rita Havercamp, MSN, CNS - Kaiser Permanente
  • Roger Kathol, MD, CPE - Cartesian Solutions Inc.
  • Parinda Khatri, PhD - Cherokee Health System
  • Neil Korsen, MD, MSc - MaineHealth
  • Stephen Melek, FSA, MAAA - Milliman
  • Benjamin Miller, PsyD - University of Colorado
  • Garrett Moran, PhD - Westat
  • Charlotte Mullican, MPH - Agency for Healthcare Research and Quality (AHRQ)
  • Gary Oftedahl, MD - Institute for Clinical Systems Improvement (ICSI)
  • Steven Waldren, MD, MS - American Academy of Family Physicians (AAFP)
  • Jürgen Unützer, MD, MA, MPH - University of Washington
  • C.J. Peek, PhD (process leader; first author) - University of Minnesota

2 2023 NIAC members and other collaborators involved in this Lexicon update

  • Alexander Blount EdD - Family Medicine; University of Massachusetts
  • James Berry, DO - West Virginia University School of Medicine
  • Frank Verloin deGruy III, MD, MSFM - University of Colorado School of Medicine
  • Stephen DiGiovanni - MaineHealth
  • Mark Duncan MD - University of Washington
  • Danielle Durant, PhD, MBA, MS (Editor) - Westat 
  • Michael Hogan PhD - Former Mental Health Commissioner, State of New York
  • Parinda Khatri PhD - Cherokee Health Systems (Tennessee)
  • Neil Korsen MD, MSci - Maine Medical Center
  • Stephen Melek FSA, MAAA - Actuary
  • Beth McGinty PhD - Weill Cornell Medicine
  • Garrett Moran, PhD - Westat
  • Noah Nesin MD, FAAFP - Innovation Advisor, Penobscot Community Health Care, Maine
  • Stacy Ogbeide PsyD, ABPP, CSOWM - Primary Care Behavioral Health Strategies
  • James Stevens - Tribal Administrator, Native Village of Atka
  • Jennifer Yturriondobeitia MSW - Cornerstone Whole Healthcare Organization, Inc
  • C.J. Peek, PhD (process leader; first author) - University of Minnesota

3 Ossorio, PG. The Behavior of Persons. Descriptive Psychology Press, 2006.

4 Paradigm case formulation. Participants independently describe one incontrovertible case of integrated behavioral health ("no one could disagree this is a genuine instance of integrated behavioral health"). These are collated across participants to reveal the more general pattern and iteratively refined by the whole group. Then that group specifies how that case could be changed and remain genuine integrated behavioral health. 

5 Parametric analysis. Participants look at the paradigm case formulation (the extended definition) and identify the dimensions along which integrated behavioral health practices might legitimately differ from one another (e.g. by method of identifying patients, specific team composition, or type of spatial arrangement). Parameters are a shared and specific vocabulary for acceptable variations.