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.
Email Updates
