What Not to Do

As you work toward integration, it is important to keep in mind paths and obstacles to avoid. Awareness of what not to do will help your organization succeed in integrating behavioral health and ultimately enhance patient care and health outcomes. Here is a list of things not to do while integrating behavioral health in your setting organized by section of the Playbook:

Planning for Integrating Behavioral Health in Your Ambulatory Care Setting

  • Don’t bypass creating a vision.
  • Don’t create a vision that providers and staff cannot relate to.
  • Avoid ambiguity in your vision.
  • Don’t assume leadership will support plans for integration without a clear case.
  • Don’t delay efforts to engage providers.

Prepare Infrastructure

  • Don't approach integration as a “project.” Projects end. Instead, approach integration as a change in the way that care will be provided in your setting.
  • Don’t get stuck in the planning stages. Some things can only be figured out by trying something and adjusting as needed.
  • Don’t expect a single “one-size-fits-all” workflow to work for all patients. Different population segments are likely to need different workflows.
  • Avoid a workflow that relies only on provider memory during a busy office visit.
  • Don’t dive into integration without a plan for financing its functions.
  • Don’t limit your financial approach to only fee-for-services billing. Payers are testing alternative reimbursement methods, and there may be creative approaches such as subsidies from other parts of the system to help achieve financial sustainability.
  • Don’t maximize billing at the expense of medical and behavioral health outcomes. Even on a tight budget, don’t hire an inexpensive behavioral health professional without defined outcome goals.
  • Don’t jump into data collection without first determining what is important to measure and how to best collect the data.
  • Don’t collect data in a random or inconsistent manner. Plan to collect data on an ongoing basis.
  • Don’t adopt a data collection strategy without considering how the data will be used for quality improvement.
  • Don’t add data collection plans that are separate from your practice’s workflows.
  • Don’t assume patients know or understand the benefits of receiving integrated care.
  • Don’t assume patients understand how integration functions in your setting.
  • Don’t lecture or talk down to patients while trying to convince them to embrace integrated care. Instead, make it easier for them to recognize the benefits and engage them in these changes in the practice.
  • Don’t use a script that sounds hollow and staged for educating patients on integration. Instead, help each provider and staff member find his or her own words for informing patients during visits about the benefits of integrated care.
  • Don’t assume that every behavioral health provider can adapt his or her style to work in an ambulatory medical setting.
  • Don’t just “plunk” a behavioral health provider into a practice. It takes planning and preparation to add team members and implement a new service. Ongoing implementation support is needed over a period of months or even years.

Establish Protocols

  • Don’t rely on provider referral as your only method for identifying patients who could benefit from integrated care.
  • Don’t screen all patients for depression and other behavioral health conditions at every visit. Annual screening is less of a burden on patients and providers.
  • Don’t forget to monitor the process of linking target populations to integrated behavioral health care. It is important to assess how well you are doing and whether any changes are needed.
  • Don’t assume that placing a behavioral health provider in the practice is all you need to do for success. Busy clinical teams do not always think to include the behavioral health provider in the care of appropriate patients.
  • Don’t rely solely on providers to make decisions about involving a behavioral health provider in patient care. Go beyond provider initiative by using protocols that identify target populations.
  • Don’t develop a care plan and consider the process complete. The shared care plan should function as a living document that members of the care team refer to and update on an ongoing basis.
  • Don’t assume that “no news” is good news for people with common behavioral health conditions such as depression and anxiety. Checking in with the patient during and after treatment helps with identifying and addressing any setbacks.
  • Don’t stop communicating with patients after their behavioral health symptoms have started to improve.
  • Don’t set too high an expectation for the treatment timeline. Make patients aware that setbacks can occur, and make patients feel comfortable about alerting you regarding potential setbacks.

Track and Monitor Patients

  • Don’t assume that non-adherence is the reason for lack of improvement.
  • Don’t blame the patient for non-adherence.
  • Don’t ignore the patient when developing the maintenance plan. Find out if the plan is feasible for the patient and fits his or her preferences and values, and be aware of potential distractions or roadblocks.