Literature Collection

OBJECTIVES: This study aims to compare primary care providers and medical assistants in degrees of comfort, confidence, and consistency when addressing behavioral health concerns with patients before and after the implementation of a model of integrated behavioral health in primary care (IBHPC), and evaluate whether these perceptions differ based on increased access to behavioral health clinicians. METHODS: This longitudinal study was conducted at 2 primary care clinics in Northern California while implementing an IBHPC model. The Integrated Behavioral Health Staff Perceptions Survey was administered to assess the comfort, confidence, and consistency of behavioral health practices. Confidential online surveys were distributed to primary care faculty and staff members before and post-implementation. Responses from providers and medical assistants were compared between pre- and post-implementation with linear regression analyses. The relationships between accessibility to behavioral health clinicians and a change in comfort, confidence, and consistency of behavioral health practices were explored using a linear mixed-effects model. RESULTS: A total of 35 providers and medical assistants completed the survey both before and post-implementation of IBHPC. Over time, there were increasingly positive perceptions about the consistency of behavioral health screening (P = .03) and overall confidence in addressing behavioral health concerns (P = .005). Comfort in addressing behavioral health concerns did not significantly change for either providers or staff over time. Medical assistants were initially more confident and comfortable addressing behavioral health concerns than providers, but providers' attitudes increased post-IBHPC implementation. Improved access to behavioral health clinicians was associated with greater consistency of screening and referral to specialty mental health care (P < .001). CONCLUSION: The present study is the first to explore differences in provider and medical assistant perceptions during the course of an IBHPC implementation. Findings underscore the importance of integrating medical assistants, along with providers, into all phases of the implementation process.

This paper introduces an evaluation of community-based, integrated health and social care multi-disciplinary teams (MDTs), primarily serving older people with long-term conditions, undertaken as part of the wider evaluation (2015-2022) of the Integrated Care and Support Pioneer Programme in England (2013-2018). To explain the context within which the MDT evaluation was undertaken, we first outline a brief history of health and social care integration policy in England, describe the Pioneer Programme and the requirements of the national 'longer-term' evaluation of the Pioneers. We then explain our rationale for focusing on MDTs, describe our conceptual framework of MDT functioning and provide a brief description of the evaluation design and methods, highlighting four overarching challenges we faced in undertaking it. We then briefly describe the individual papers that constitute the current supplement.

ObjectivesThis paper synthesises the findings of an evaluation of community-based multi-disciplinary teams (MDTs), primarily serving older people with long-term conditions, undertaken as part of a wider evaluation (2015-2022) of the Integrated Care and Support Pioneer Programme (2013-2018) in England. The MDT evaluation was undertaken in two contrasting Pioneers with 11 MDTs covering four models of MDT functioning.MethodsThe synthesis, set against our conceptual framework of MDT functioning, draws principally on the findings of semi-structured interviews with local strategic level health and care leaders, frontline MDT staff, and patients and their informal carers, observations of MDT meetings, and an online survey of MDT staff.ResultsMDTs were seen as an essential means of working towards local health and care integration. While local contexts shaped the precise aims, structure, composition and ways of working of the different MDT models studied, there were strong similarities across the teams in how staff viewed the nature and benefits of MDT working. MDTs were perceived as having the potential to provide more holistic care to patients, speed up access to care, improve access to a wider range of services and enhance care at home. Benefits to staff included better information sharing; reduced duplication of tasks; enhanced collective responsibility and problem-solving, which enriched decision-making; opportunities to learn from, and about, the remits of other professional groups and services; and the erosion of traditional professional hierarchies. However, barriers to MDT working, including the absence of shared patient records, inadequate infrastructure and resources, and concerns about the ability to measure and demonstrate the value of MDT working, were also identified. Patients and their informal carers reported valuing good communication with their health and care providers but often appeared unaware of an MDT's involvement in planning their care. This suggests there is some distance to travel in terms of how MDTs communicate their roles to those they serve.ConclusionsAt the service delivery level, our findings' implications for policy and practice include the need for greater integration across patient records and data systems, and greater investment in specialist services (e.g., housing) currently absent from MDTs. However, our research also highlighted challenges to evaluating the outcomes of 'integration' both as a concept and at the service delivery level. Changes to both the research environment and the approach to evaluation are also warranted.

BACKGROUND: Trauma-informed care (TIC) is a framework designed to understand and address the impacts of trauma, ensuring physical, psychological, and emotional safety for all involved. It seeks to prevent retraumatization and promote a sense of control and empowerment across diverse populations. METHOD: This Trauma Prevention Coalition survey study assessed TIC implementation among members from 13 of the 16 participating organizations, focusing on prevalence, awareness, and training gaps. RESULTS: Out of 948 participants, 91% (n = 861) were affiliated with trauma centers. In adult trauma centers: 19.3% were from Level I, 9.4% from Level II, 5.4% from Level III, 3.1% from Level IV, and 1.2% from Level V. In addition, 1.2% were from nonadult trauma centers, and 2.5% worked in centers serving both adult and pediatric patients. In pediatric centers: 18.6% were from Level I, 13.0% from Level II, 1% from Level III, and 67.0% from nonpediatric centers. Trauma-informed care principles were integrated into the core values of 35.5% of trauma centers, while 64.5% had not adopted them. Only 17.0% had TIC training plans, with 57.7% lacking or unaware of such plans. Bivariate regression analysis indicated that TIC integration decreased for Level II, Level IV, and nontrauma centers compared with Level I adult trauma centers, but increased for Level III. In pediatric centers, TIC integration decreased for Level II, Level III, Level IV, and nontrauma centers compared with Level I. Pediatric trauma centers showed a higher TIC integration rate (71.6%) compared with adult centers (39.4%, p < 0.01). CONCLUSION: TIC adoption varies significantly across trauma center levels, with higher prevalence in pediatric and Level I centers. The study underscores the need for comprehensive TIC training within trauma care systems. LEVEL OF EVIDENCE: Therapeutic/care management; Level IV.