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Adiba A, Sidhu SS, Shaligram D, Khan M, Qayyum Z. Advances in Child Psychiatry Education and Training. ADVANCES IN PSYCHIATRY AND BEHAVIORAL HEALTH 2023; 3:S2667-3827(23)00006-6. [PMID: 38620094 PMCID: PMC10132457 DOI: 10.1016/j.ypsc.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The article provides a comprehensive overview of the current state of child and adolescent psychiatry, including historical background and the impact of the COVID-19 pandemic. It discusses recent advances in theoretical frameworks related to physician burnout, prevention, access to care, diversity, equity, and inclusion, and trauma-informed care. The authors conclude by emphasizing the importance of education and training in improving the lives of youth and families and encourage their colleagues to push the boundaries of education and training for a better today and brighter tomorrow, while honoring and doing justice to those they serve.
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Affiliation(s)
- Afifa Adiba
- Sheppard Pratt Health System, Towson, MD, USA
- University of Maryland, 6501 North Charles Street, Baltimore, MD 21204, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Shawn Singh Sidhu
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California San Diego Medical Center, UCSD Medical Center, Rady Children's Hospital of San Diego, 2125 Citracado Parkwy, Escondido, CA 92029, USA
| | - Deepika Shaligram
- Boston Children's Hospital, Harvard Medical School, 9 Hope Avenue, Waltham, MA 02453, USA
| | - Manal Khan
- University of California, 300 Medical Plaza Driveway, Los Angeles, CL 90095, USA
| | - Zheala Qayyum
- Harvard Medical School, Yale School of Medicine, 300 Longwood Avenue, Boston, MA 02115, USA
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Shiner B, Gottlieb D, Rice K, Forehand JA, Snitkin M, Watts BV. Evaluating policies to improve access to mental health services in rural areas. J Rural Health 2022; 38:805-816. [PMID: 35538395 DOI: 10.1111/jrh.12674] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The United States Department of Veterans Affairs (VA) has gradually implemented policies to increase access to mental health care outside of VA medical centers. Most notably, this included requirements to offer mental health services at VA-administered community-based clinics in 2008 and increased access to VA-paid care in the community beginning in 2014. Our objective was to understand how mental health service use patterns changed for rural VA patients during this time. METHODS We developed a longitudinal cohort of all rural patients who used VA services between 2002 and 2019 (N = 3,345,862). We examined individual, health care, and contextual predictors of mental health service use as well as modalities of mental health service use during policy-relevant time periods using descriptive statistics. FINDINGS Access to mental health services increased with each policy change. The annual percentage of rural VA patients accessing mental health services increased from 11.4% in the earliest years (2002-2004) to 19.8% in the latest years (2017-2019). The most rapid period of increase followed a requirement for availability of mental health services at VA-administered community clinics. Increasing access to VA-paid care in the community had less effect. By the end of the evaluation, gaps remained in the delivery of care to elderly patients over the age of 75. CONCLUSIONS Rural patients use mental health services when they become available. Access was the highest with a combination of changes to both delivery modalities and payment methods. Continued, and perhaps different efforts are required to address a persistent disparity for older patients.
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Affiliation(s)
- Brian Shiner
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Daniel Gottlieb
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Korie Rice
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Jenna A Forehand
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Meghan Snitkin
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Bradley V Watts
- Behavioral Health Services, Veterans Affairs Medical Center, White River Junction, Vermont, USA.,Department of Psychiatry, Geisel School of Medicine, Hanover, New Hampshire, USA.,Veterans Rural Health Resource Center, White River Junction, Vermont, USA
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Vergès Y, Driot D, Mesthé P, Rougé Bugat MÈ, Dupouy J, Poutrain JC. Activité des psychologues libéraux : modalités d’exercice, orientations et outils psychothérapeutiques. ANNALES MEDICO-PSYCHOLOGIQUES 2022. [DOI: 10.1016/j.amp.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Monaghan K, Cos T. Integrating physical and mental healthcare: Facilitators and barriers to success. MEDICINE ACCESS @ POINT OF CARE 2021; 5:23992026211050615. [PMID: 36204502 PMCID: PMC9413608 DOI: 10.1177/23992026211050615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Effective and appropriate provision of mental healthcare has long been a
struggle globally, resulting in significant disparity between prevalence of
mental illness and access to care. One attempt to address such disparity was
the Patient Protection and Affordable Care Act (PPACA), 2010, mandate in the
United States to integrate physical and mental healthcare in Federally
Qualified Health Centers (FQHCs). The notion of integration is attractive,
as it has demonstrated the potential to improve both access to mental
healthcare and healthcare outcomes. However, while the PPACA mandate set
this requirement for FQHCs, no clear process as to how these centers should
achieve successful integration was identified. Methods: This research employed case study methods to examine the implementation of
this policy in two FQHCs in New England. Data were obtained from in-depth
interviews with leadership, management, and frontline staff at two case
study sites. Results: Study findings include multiple definitions of and approaches for integrating
physical and mental healthcare, mental healthcare being subsumed into,
rather than integrated with, the medical model and multiple facilitators of
and barriers to integration. Conclusion: This study asked questions about what integration means, how it occurs, and
what factors facilitate or pose barriers to integration. Integration is
facilitated by co-location of providers within the same department, a warm
hand-off, collaborative collegial relationships, strong leadership support,
and a shared electronic health record. However, interdisciplinary conflict,
power differentials, job insecurity, communication challenges, and the
subsumption of mental health into the medical model pose barriers to
successful integration.
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Affiliation(s)
| | - Travis Cos
- School of Arts and Sciences, La Salle University, Philadelphia, PA, USA
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Rogers R, Hartigan SE, Sanders CE. Identifying Mental Disorders in Primary Care: Diagnostic Accuracy of the Connected Mind Fast Check (CMFC) Electronic Screen. J Clin Psychol Med Settings 2021; 28:882-896. [PMID: 34609692 PMCID: PMC8491449 DOI: 10.1007/s10880-021-09820-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/27/2022]
Abstract
Primary care physicians (PCPs) often daily address diagnoses and treatment of mental disorders in their practices. The current study examined the Connected Mind Fast Check (CMFC), a two-tiered electronic screen, assessing six common mental disorders. The eight-item Initial Screen assesses possible symptoms, whereas SAM modules establish provisional diagnoses and areas of clinical concern. With 234 patients from five independent PCP offices, diagnostic accuracy was tested with the SCID-5-RV as the external criterion. Concerningly, many patients were unaware of their current mental disorders and comorbidities. The CMFC Initial Screen evidenced strong sensitivity, identifying with very few missing diagnoses. About two-thirds of provisional SAM diagnoses were confirmed with high specificities. Bipolar Disorder posed the most challenges at both tiers. Importantly, the suicide screen identified all patients with suicide plans and three-fourths with ideation. In general, the CMFC effectively identified provisional diagnoses, impairment, and potential suicidality.
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Affiliation(s)
- Richard Rogers
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, 311280, USA.
| | - Sara E Hartigan
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, 311280, USA
| | - Courtney E Sanders
- Department of Psychology, University of North Texas, 1155 Union Circle, Denton, 311280, USA
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Vergès Y, Vernhes S, Vanneste P, Braun É, Poutrain JC, Dupouy J, Bouchard JP. Collaboration entre médecins généralistes et psychologues en libéral. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vergès Y, Driot D, Mesthé P, Rougé Bugat ME, Dupouy J, Poutrain JC. Collaboration Between GPs and Psychologists: Dissatisfaction from the Psychologists' Perspective-A Cross-Sectional Study. J Clin Psychol Med Settings 2019; 27:331-342. [PMID: 31552521 DOI: 10.1007/s10880-019-09663-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Collaborative mental health practices in primary care significantly enhances patients' health. Collaboration between general practitioners (GPs) and psychologists could improve non-drug mental care. Little is known of psychologists' perception of GPs and their collaboration. This study aimed to assess the quality of collaboration between GPs and psychologists from the psychologists' perspective and to identify factors associated with satisfactory collaboration. A questionnaire was sent by post to all private psychologists in a region of France in February, 2017. We carried out descriptive and multivariate analysis of factors associated with satisfactory collaboration. The response rate was 38% (n = 434 out of 1128). Collaboration between GPs and psychologists was considered unsatisfactory by 64% (n = 278) of psychologists. The main barriers reported were lack of time, lack of understanding and poor interactions/communication. Sixty-nine percent of psychologists felt that GPs knew little about their work. Psychologists had professional exchanges with an average of three local GPs and received referral information for 12% of new patients. Out of 10 new patients, 2 were referred by a GP. In a multivariate analysis, satisfactory collaboration was significantly associated with the number of GPs psychologists exchanged with (OR 1.29), receipt of referral information (OR 2.18) and a positive assessment of GPs' understanding of psychologists' activity (OR 3.35). Psychologists considered the collaboration between GPs and psychologists as substandard, as well as GPs' knowledge of psychologists' activity. More interactions and better understanding would improve their collaboration.
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Affiliation(s)
- Yohann Vergès
- General Practice Department, Toulouse III University, 133 Route de Narbonne, 31062, Toulouse, France.
| | - Damien Driot
- General Practice Department, Toulouse III University, 133 Route de Narbonne, 31062, Toulouse, France
- UMR1027 Inserm - Toulouse III University, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Pierre Mesthé
- General Practice Department, Toulouse III University, 133 Route de Narbonne, 31062, Toulouse, France
| | - Marie-Eve Rougé Bugat
- General Practice Department, Toulouse III University, 133 Route de Narbonne, 31062, Toulouse, France
- UMR1027 Inserm - Toulouse III University, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Julie Dupouy
- General Practice Department, Toulouse III University, 133 Route de Narbonne, 31062, Toulouse, France
- UMR1027 Inserm - Toulouse III University, 37 Allées Jules Guesde, 31000, Toulouse, France
| | - Jean-Christophe Poutrain
- General Practice Department, Toulouse III University, 133 Route de Narbonne, 31062, Toulouse, France
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Hassiotis A, Poppe M, Strydom A, Vickerstaff V, Hall I, Crabtree J, Omar R, King M, Hunter R, Bosco A, Biswas A, Ratti V, Blickwedel J, Cooper V, Howie W, Crawford M. Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT. Health Technol Assess 2019; 22:1-110. [PMID: 29596045 DOI: 10.3310/hta22150] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preliminary studies have indicated that training staff in Positive Behaviour Support (PBS) may help to reduce challenging behaviour among people with intellectual disability (ID). OBJECTIVE To evaluate whether or not such training is clinically effective in reducing challenging behaviour in routine care. The study also included longer-term follow-up (approximately 36 months). DESIGN A multicentre, single-blind, two-arm, parallel-cluster randomised controlled trial. The unit of randomisation was the community ID service using an independent web-based randomisation system and random permuted blocks on a 1 : 1 allocation stratified by a staff-to-patient ratio for each cluster. SETTING Community ID services in England. PARTICIPANTS Adults (aged > 18 years) across the range of ID with challenging behaviour [≥ 15 Aberrant Behaviour Checklist - Community total score (ABC-CT)]. INTERVENTIONS Manual-assisted face-to-face PBS training to therapists and treatment as usual (TAU) compared with TAU only in the control arm. MAIN OUTCOME MEASURES Carer-reported changes in challenging behaviour as measured by the ABC-CT over 12 months. Secondary outcomes included psychopathology, community participation, family and paid carer burden, family carer psychopathology, costs of care and quality-adjusted life-years (QALYs). Data on main outcome, service use and health-related quality of life were collected for the 36-month follow-up. RESULTS A total of 246 participants were recruited from 23 teams, of whom 109 were in the intervention arm (11 teams) and 137 were in the control arm (12 teams). The difference in ABC-CT between the intervention and control arms [mean difference -2.14, 95% confidence interval (CI) -8.79 to 4.51; p = 0.528] was not statistically significant. No treatment effects were found for any of the secondary outcomes. The mean cost per participant in the intervention arm was £1201. Over 12 months, there was a difference in QALYs of 0.076 in favour of the intervention (95% CI 0.011 to 0.140 QALYs) and a 60% chance that the intervention is cost-effective compared with TAU from a health and social care cost perspective at the threshold of £20,000 per QALY gained. Twenty-nine participants experienced 45 serious adverse events (intervention arm, n = 19; control arm, n = 26). PBS plans were available for 33 participants. An independent assessment of the quality of these plans found that all were less than optimal. Forty-six qualitative interviews were conducted with service users, family carers, paid carers and service managers as part of the process evaluation. Service users reported that they had learned to manage difficult situations and had gained new skills, and carers reported a positive relationship with therapists. At 36 months' follow-up (n = 184), the mean ABC-CT difference between arms was not significant (-3.70, 95% CI -9.25 to 1.85; p = 0.191). The initial cost-effectiveness of the intervention dissipated over time. LIMITATIONS The main limitations were low treatment fidelity and reach of the intervention. CONCLUSIONS Findings from the main study and the naturalistic follow-up suggest that staff training in PBS as delivered in this study is insufficient to achieve significant clinical gains beyond TAU in community ID services. Although there is an indication that training in PBS is potentially cost-effective, this is not maintained in the longer term. There is increased scope to develop new approaches to challenging behaviour as well as optimising the delivery of PBS in routine clinical practice. TRIAL REGISTRATION This study is registered as NCT01680276. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Michaela Poppe
- Division of Psychiatry, University College London, London, UK
| | - Andre Strydom
- Division of Psychiatry, University College London, London, UK
| | | | - Ian Hall
- Tower Hamlets Community Learning Disability Service, Mile End Hospital, London, UK
| | - Jason Crabtree
- Tower Hamlets Community Learning Disability Service, Mile End Hospital, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Rachael Hunter
- University College London PRIMENT Clinical Trials Unit, London, UK
| | - Alessandro Bosco
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Asit Biswas
- Leicestershire Partnership NHS Trust, Directorate of Learning Disabilities, Frith Hospital, Leicester, UK
| | - Victoria Ratti
- Division of Psychiatry, University College London, London, UK
| | | | | | - William Howie
- South West London and St George's Mental Health Trust, Wandsworth Community Mental Health Learning Disabilities Team, Springfield University Hospital, London, UK
| | - Mike Crawford
- Centre for Mental Health, Department of Medicine, Imperial College London, London, UK
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9
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Moye J, Harris G, Kube E, Hicken B, Adjognon O, Shay K, Sullivan JL. Mental Health Integration in Geriatric Patient-Aligned Care Teams in the Department of Veterans Affairs. Am J Geriatr Psychiatry 2019; 27:100-108. [PMID: 30409549 PMCID: PMC6676903 DOI: 10.1016/j.jagp.2018.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/22/2018] [Accepted: 09/06/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To inform geriatric mental health policy by describing the role of behavioral healthcare providers within a geriatric patient-aligned care team (GeriPACT), a patient-centered medical home model of care within the Veterans Health Administration (VHA), serving older veterans with chronic disease, functional dependency, cognitive decline, and psychosocial challenges, and/or those who have elder abuse, risk of long-term care placement, or impending disability. METHODS The authors used mixed methods, consisting of a national survey and site visits between July 2016 and February 2017, at VHA outpatient clinics. The participants, 101 GeriPACTs at 44 sites, completed surveys, and 24 medical providers were interviewed. A standardized survey and semi-structured interview guide were developed based on the program handbook, with input from experts in the VHA Office of Geriatrics and Extended Care Services, guided by the Consolidated Framework for Implementation Science Research. RESULTS Of surveyed GeriPACTs, 42.6% had a mental health provider on the team-a psychiatrist (28.7%) and/or psychologist (23.8%). Of these, the mean was 0.27 full-time equivalent psychiatrists and 0.44 full-time equivalent psychologists per team (suggested panel = 800 patients). In surveys, teams with behavioral health providers were more likely to manage psychosocial χ2 = 8.87, cognitive χ2 = 8.68, and depressive χ2 = 11.85 conditions in their panel than those without behavioral health providers. CONCLUSION GeriPACT mental health integration is less than 50%. Population differences between general primary care and geriatric primary care may require different care approaches and provider competencies and need further study.
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Affiliation(s)
- Jennifer Moye
- VA New England Geriatric Research Education and Clinical Center (JM), VA Boston Healthcare System, Jamaica Plain, MA; Department of Psychiatry (JM), Harvard Medical School, Boston, MA.
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Davis MM, Gunn R, Gowen LK, Miller BF, Green LA, Cohen DJ. A qualitative study of patient experiences of care in integrated behavioral health and primary care settings: more similar than different. Transl Behav Med 2018; 8:649-659. [DOI: 10.1093/tbm/ibx001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Melinda M Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Rural Practice-based Research Network, Portland, OR, USA
| | - Rose Gunn
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - L Kris Gowen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Benjamin F Miller
- Eugene S. Farley, Jr. Health Policy Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Larry A Green
- Eugene S. Farley, Jr. Health Policy Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
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Staab EM, Terras M, Dave P, Beckman N, Shah S, Vinci LM, Yohanna D, Laiteerapong N. Measuring Perceived Level of Integration During the Process of Primary Care Behavioral Health Implementation. Am J Med Qual 2017; 33:253-261. [PMID: 29072487 DOI: 10.1177/1062860617736607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Provider- and staff-perceived levels of integration were measured during implementation of a primary care behavioral health clinic; these data were used to tailor and evaluate quality improvement strategies. Providers and staff at an urban, academic, adult primary care clinic completed the 32-item Level of Integration Measure (LIM) at baseline and 7 months. The LIM assesses 6 domains of integrated care. Overall and domain scores were calibrated from 0 to 100, with ≥80 representing a highly integrated clinic. Response rate was 79% (N = 46/58) at baseline and 83% (N = 52/63) at follow-up. Overall, LIM score increased from 64.5 to 70.1, P = .001. The lowest scoring domains at baseline were targeted for quality improvement and increased significantly: integrated clinical practice, 60.0 versus 68.4, P < .001; systems integration, 57.0 versus 63.8, P = .001; and training, 56.7 versus 65.3, P = .001. Ongoing quality improvement, including organizational and financial strategies, is needed to achieve higher levels of integration.
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Harnagea H, Couturier Y, Shrivastava R, Girard F, Lamothe L, Bedos CP, Emami E. Barriers and facilitators in the integration of oral health into primary care: a scoping review. BMJ Open 2017; 7:e016078. [PMID: 28951405 PMCID: PMC5623507 DOI: 10.1136/bmjopen-2017-016078] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This scoping study has been conducted to map the literature and provide a descriptive synthesis on the barriers and facilitators of the integration of oral health into primary care. METHODS Grounded in the Rainbow conceptual model and using the Levac et al six-stage framework, we performed a systematic search of electronic databases, organisational websites and grey literature from 1978 to April 2016. All publications with a focus on the integration of oral health into primary care were included except commentaries and editorials. Thematic analyses were performed to synthesise the results. RESULTS From a total of 1619 citations, 58 publications were included in the review. Barrier-related themes included: lack of political leadership and healthcare policies; implementation challenges; discipline-oriented education; lack of continuity of care and services and patients' oral healthcare needs. The facilitators of integration were supportive policies and resources allocation, interdisciplinary education, collaborative practices between dental and other healthcare professionals, presence of local strategic leaders and geographical proximity. DISCUSSION AND PUBLIC HEALTH IMPLICATIONS This work has advanced the knowledge on the barriers and facilitators at each integration domain and level, which may be helpful if the healthcare organisations decide to integrate oral health and dental services into primary care. The scoping review findings could be useful for both dental and medical workforce and allied primary healthcare providers. They could also guide the development of healthcare policies that support collaborative practices and patient-centred care in the field of primary care.
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Affiliation(s)
- Hermina Harnagea
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Richa Shrivastava
- Faculty of Dental Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Felix Girard
- Faculty of Dental Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Lise Lamothe
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Public Health Research Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Elham Emami
- School of Public Health, Université de Montréal, Montréal, Québec, Canada
- Faculty of Dental Medicine, Université de Montréal, Montréal, Québec, Canada
- Public Health Research Institute, Université de Montréal, Montréal, Québec, Canada
- Faculty of Dentistry, McGill University, Montréal, Québec, Canada
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Rothenberg LS, Ganz DA, Wenger NS. Possible Legal Barriers for PCP Access to Mental Health Treatment Records. J Behav Health Serv Res 2017; 43:319-29. [PMID: 25870028 DOI: 10.1007/s11414-015-9458-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Provider and payer groups have endorsed the goal of improving the integration of primary care and behavioral health across a variety of programs and settings. There is an interest in sharing patients' medical information, a goal that is permissible within HIPAA, but there are concerns about more restrictive state medical privacy laws. This article assesses whether a substantial number of state medical privacy laws are, or could be interpreted to be, more restrictive than HIPAA. Preliminary investigation found that in almost one third of the states (including large-population states such as Florida, Georgia, Massachusetts, New York, and Texas), primary care physicians (PCPs) may have difficulty accessing mental health treatment records without the patient's (or his/her guardian/conservator's) written consent. If a comprehensive legal analysis supports this conclusion, then those advocating integration of behavioral and primary care may need to consider seeking appropriate state legislative solutions.
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Affiliation(s)
- Leslie S Rothenberg
- , 16751 Edgar Street, Pacific Palisades, CA, 90272-3226, USA. .,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. .,The RAND Corporation, Santa Monica, CA, USA.
| | - David A Ganz
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,The RAND Corporation, Santa Monica, CA, USA.,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Neil S Wenger
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,The RAND Corporation, Santa Monica, CA, USA.,UCLA Health Ethics Center, Los Angeles, CA, USA
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Abstract
PURPOSE To identify how organizations prepare clinicians to work together to integrate behavioral health and primary care. METHODS Observational cross-case comparison study of 19 U.S. practices, 11 participating in Advancing Care Together, and 8 from the Integration Workforce Study. Practices varied in size, ownership, geographic location, and experience delivering integrated care. Multidisciplinary teams collected data (field notes from direct practice observations, semistructured interviews, and online diaries as reported by practice leaders) and then analyzed the data using a grounded theory approach. RESULTS Organizations had difficulty finding clinicians possessing the skills and experience necessary for working in an integrated practice. Practices newer to integration underestimated the time and resources needed to train and organizationally socialize (onboard) new clinicians. Through trial and error, practices learned that clinicians needed relevant training to work effectively as integrated care teams. Training efforts exclusively targeting behavioral health clinicians (BHCs) and new employees were incomplete if primary care clinicians (PCCs) and others in the practice also lacked experience working with BHCs and delivering integrated care. Organizations' methods for addressing employees' need for additional preparation included hiring a consultant to provide training, sending employees to external training programs, hosting residency or practicum training programs, or creating their own internal training program. Onboarding new employees through the development of training manuals; extensive shadowing processes; and protecting time for ongoing education, mentoring, and support opportunities for new and established clinicians and staff were featured in these internal training programs. CONCLUSION Insufficient training capacity and practical experience opportunities continue to be major barriers to supplying the workforce needed for effective behavioral health and primary care integration. Until the training capacity grows to meet the demand, practices must put forth considerable effort and resources to train their own employees.
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Bridges AJ, Gregus SJ, Rodriguez JH, Andrews AR, Villalobos BT, Pastrana FA, Cavell TA. Diagnoses, intervention strategies, and rates of functional improvement in integrated behavioral health care patients. J Consult Clin Psychol 2015; 83:590-601. [PMID: 25774786 DOI: 10.1037/a0038941] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Compared with more traditional mental health care, integrated behavioral health care (IBHC) offers greater access to services and earlier identification and intervention of behavioral and mental health difficulties. The current study examined demographic, diagnostic, and intervention factors that predict positive changes for IBHC patients. METHOD Participants were 1,150 consecutive patients (mean age = 30.10 years, 66.6% female, 60.1% Hispanic, 47.9% uninsured) seen for IBHC services at 2 primary care clinics over a 34-month period. Patients presented with depressive (23.2%), anxiety (18.6%), adjustment (11.3%), and childhood externalizing (7.6%) disorders, with 25.7% of patients receiving no diagnosis. RESULTS The most commonly delivered interventions included behavioral activation (26.1%), behavioral medicine-specific consultation (14.6%), relaxation training (10.3%), and parent-management training (8.5%). There was high concordance between diagnoses and evidence-based intervention selection. We used latent growth curve modeling to explore predictors of baseline global assessment of functioning (GAF) and improvements in GAF across sessions, utilizing data from a subset of 117 patients who attended at least 3 behavioral health visits. Hispanic ethnicity and being insured predicted higher baseline GAF, while patients with an anxiety disorder had lower baseline GAF than patients with other diagnoses. Controlling for primary diagnosis, patients receiving behavioral activation or exposure therapy improved at faster rates than patients receiving other interventions. Demographic variables did not relate to rates of improvement. CONCLUSION Results suggest even brief IBHC interventions can be focused, targeting specific patient concerns with evidence-based treatment components. (PsycINFO Database Record
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Affiliation(s)
- Ana J Bridges
- Department of Psychological Science, University of Arkansas
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Davis TS, Guada J, Reno R, Peck A, Evans S, Sigal LM, Swenson S. Integrated and Culturally Relevant Care: A Model to Prepare Social Workers for Primary Care Behavioral Health Practice. SOCIAL WORK IN HEALTH CARE 2015; 54:909-938. [PMID: 26671244 DOI: 10.1080/00981389.2015.1062456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Policymakers and researchers emphasize needs for an integrated, effective, and efficient health care system to address well-documented disparities and inequities in care experienced by diverse populations. The Affordable Care Act, through its support of integrated health care, addresses social determinants of health with a goal of increasing access to care. Social work is poised to assume a central position in health care reform and integrated behavioral health, but must prepare practitioners to work alongside medical providers in health care settings. This article describes a social work field education model developed in partnership with community mental health and health care providers. The model, Integrated and Culturally Relevant Care, prepares social work students to provide behavioral health services in integrated primary care environments.
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Affiliation(s)
- Tamara S Davis
- a College of Social Work , The Ohio State University , Columbus , Ohio , USA
| | - Joe Guada
- a College of Social Work , The Ohio State University , Columbus , Ohio , USA
| | - Rebecca Reno
- a College of Social Work , The Ohio State University , Columbus , Ohio , USA
| | - Adriane Peck
- b Formerly of Mental Health America of Franklin County , Columbus , Ohio , USA
| | - Shannon Evans
- b Formerly of Mental Health America of Franklin County , Columbus , Ohio , USA
| | - Laura Moskow Sigal
- b Formerly of Mental Health America of Franklin County , Columbus , Ohio , USA
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Chang ET, Wells KB, Young AS, Stockdale S, Johnson MD, Fickel JJ, Jou K, Rubenstein LV. The anatomy of primary care and mental health clinician communication: a quality improvement case study. J Gen Intern Med 2014; 29 Suppl 2:S598-606. [PMID: 24715400 PMCID: PMC4070235 DOI: 10.1007/s11606-013-2731-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The high prevalence of comorbid physical and mental illnesses among veterans is well known. Therefore, ensuring effective communication between primary care (PC) and mental health (MH) clinicians in the Veterans Affairs (VA) health care system is essential. The VA's Patient Aligned Care Teams (PACT) initiative has further raised awareness of the need for communication between PC and MH. Improving such communication, however, has proven challenging. OBJECTIVE To qualitatively understand barriers to PC-MH communication in an academic community-based clinic by using continuous quality improvement (CQI) tools and then initiate a change strategy. DESIGN, PARTICIPANTS, AND APPROACH An interdisciplinary quality improvement (QI) work group composed of 11 on-site PC and MH providers, administrators, and researchers identified communication barriers and facilitators using fishbone diagrams and process flow maps. The work group then verified and provided context for the diagram and flow maps through medical record review (32 patients who received both PC and MH care), interviews (6 stakeholders), and reports from four previously completed focus groups. Based on these findings and a previous systematic review of interventions to improve interspecialty communication, the team initiated plans for improvement. KEY RESULTS Key communication barriers included lack of effective standardized communication processes, practice style differences, and inadequate PC training in MH. Clinicians often accessed advice or formal consultation based on pre-existing across-discipline personal relationships. The work group identified collocated collaborative care, joint care planning, and joint case conferences as feasible, evidence-based interventions for improving communication. CONCLUSIONS CQI tools enabled providers to systematically assess local communication barriers and facilitators and engaged stakeholders in developing possible solutions. A locally tailored CQI process focusing on communication helped initiate change strategies and ongoing improvement efforts.
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Affiliation(s)
- Evelyn T Chang
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA,
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Beehler GP, Funderburk JS, Possemato K, Dollar KM. Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ). Transl Behav Med 2013; 3:379-91. [PMID: 24294326 DOI: 10.1007/s13142-013-0216-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Adherence to protocol among behavioral health providers working in co-located, collaborative care or Primary Care Behavioral Health settings has rarely been assessed due to limited measurement options. Development of psychometrically sound measures of provider fidelity may improve the translation of these service delivery models into every day practice. One hundred seventy-three integrated behavioral health providers in VA primary care clinics responded to an online questionnaire to assess the reliability and validity of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ). Psychometric assessment resulted in a reliable 48-item measure with two subscales that specified essential and prohibited provider behaviors. The PPAQ demonstrated strong convergent and divergent validity when compared to another measure of health care integration. Known-group comparisons provided partial support for criterion validity. The PPAQ is a reliable and valid self-report of behavioral health provider fidelity with implications for improving provider training, program monitoring, and clinical research.
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Affiliation(s)
- Gregory P Beehler
- VA Center for Integrated Healthcare, VA WNY Healthcare System, 3495 Bailey Ave, Buffalo, NY 14215 USA ; School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY USA ; School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY USA
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The role of mental and behavioral health in the application of the patient-centered medical home in the Department of Veterans Affairs. Transl Behav Med 2013; 1:624-8. [PMID: 24073086 DOI: 10.1007/s13142-011-0093-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
The patient-centered medical home, which is termed the Patient Aligned Care Team (PACT) in the Department of Veterans Affairs (VA), is a transformational initiative with mental and behavioral health as integral components. Funding has been provided to VA medical facilities to assist with the transformation and process redesign of primary care into interdisciplinary teams focused on increased access, Veteran-centered care, and active incorporation of collaborative expertise from specialists within primary care. Primary care clinics are not simple machines that change by merely replacing parts or colocating additional resources. Rather, they are complex systems with a relationship infrastructure among members of the team that is critically important to the change process. Mental health professionals are integral, mandated members of the PACTs providing needed mental and behavioral health care to Veterans as an integrated component of primary care. They also work to catalyze a quality improvement process that encourages collaboration, innovation, and adoption of best practices that promote transformation based on patient-centered principles of care. The purpose of this article is to describe the evolution of VA primary care settings toward interdisciplinary teams that provide patient-centered care in collaboration with Primary Care-Mental Health Integration providers and Health Promotion Disease Prevention team members.
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20
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Beehler GP, Funderburk JS, Possemato K, Vair CL. Developing a measure of provider adherence to improve the implementation of behavioral health services in primary care: a Delphi study. Implement Sci 2013; 8:19. [PMID: 23406425 PMCID: PMC3640894 DOI: 10.1186/1748-5908-8-19] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 01/31/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The integration of behavioral health services into primary care is increasingly popular, yet fidelity of implementation in this area has been infrequently assessed due to the few measurement tools available. A sentinel indicator of fidelity of implementation is provider adherence, or utilization of prescribed procedures and engagement in model-specific behaviors. This study aimed to develop the first self-report measure of behavioral health provider adherence for co-located, collaborative care, a commonly adopted model of behavioral health service delivery in primary care. METHODS A preliminary 56-item measure was developed by the research team to represent critical components of adherence among behavioral health providers. To ensure the content validity of the measure, a modified Delphi study was conducted using a panel of co-located, collaborative care model experts. During three rounds of emailed surveys, panel members provided qualitative feedback regarding item content while rating each item's relevance for behavioral health provider practice. Items with consensus ratings of 80% or greater were included in the final adherence measure. RESULTS The panel consisted of 25 experts representing the Department of Veterans Affairs, the Department of Defense, and academic and community health centers (total study response rate of 76%). During the Delphi process, two new items were added to the measure, four items were eliminated, and a high level of consensus was achieved on the remaining 54 items. Experts identified 38 items essential for model adherence, six items compatible (although not essential) for model adherence, and 10 items that represented prohibited behaviors. Item content addressed several domains, but primarily focused on behaviors related to employing a time-limited, brief treatment model, the scope of patient concerns addressed, and interventions used by providers. CONCLUSIONS This study yielded the first content valid self-report measure of critical components of collaborative care adherence for use by behavioral health providers in primary care. Although additional psychometric evaluation is necessary, this measure may assist implementation researchers in clarifying how provider behaviors contribute to clinical outcomes. This measure may also assist clinical stakeholders in monitoring implementation and identifying ways to support frontline providers in delivering high quality services.
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Affiliation(s)
- Gregory P Beehler
- VA Center for Integrated Healthcare, VA WNY Healthcare System, Buffalo, NY, USA.
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21
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Bohnert KM, Pfeiffer PN, Szymanski BR, McCarthy JF. Continuation of care following an initial primary care visit with a mental health diagnosis: differences by receipt of VHA Primary Care-Mental Health Integration services. Gen Hosp Psychiatry 2013; 35:66-70. [PMID: 23062728 DOI: 10.1016/j.genhosppsych.2012.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/16/2012] [Accepted: 09/03/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE For patients with an initial primary care (PC) encounter in the Veterans Health Administration (VHA) that included a mental health diagnosis, we evaluate whether same-day receipt of Primary Care-Mental Health Integration (PC-MHI) services is associated with the likelihood of receiving a subsequent mental-health-related encounter in the following 90 days. METHOD Using VHA administrative data, we identified 9046 patients who received VHA care for the first time in fiscal year 2009, received a PC encounter that included a mental health diagnosis on the first day of their VHA services and initiated care at a VHA facility that provided PC-MHI services. Using multivariable generalized estimating equations logistic regression, we examined whether receipt of same-day PC-MHI was associated with receipt of a subsequent encounter with a mental health diagnosis within 90 days. Analyses adjusted for Operation Enduring Freedom/Operation Iraqi Freedom Veteran status, demographic characteristics, service-connected disability, psychiatric and non-psychiatric diagnoses, and psychotropic medication initiation on the index day of service use. RESULTS Receipt of same-day PC-MHI services was positively associated with having a mental-health-related encounter in the following 90 days (adjusted odds ratio=2.05; 95% confidence interval=1.66-2.54). CONCLUSIONS PC-MHI services may enhance mental health continuation of care among PC patients with mental health conditions who initiate VHA services.
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Affiliation(s)
- Kipling M Bohnert
- Department of Veterans Affairs, Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, Michigan, USA.
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Horevitz E, Manoleas P. Professional competencies and training needs of professional social workers in integrated behavioral health in primary care. SOCIAL WORK IN HEALTH CARE 2013; 52:752-787. [PMID: 24028739 DOI: 10.1080/00981389.2013.791362] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The Affordable Care Act has led to a widespread movement to integrate behavioral health services into primary care settings. Integrated behavioral health (IBH) holds promise for treating mild to moderate psychiatric disorders in a manner that more fully addresses the biopsychosocial spectrum of needs of individuals and families in primary care, and for reducing disparities in accessing behavioral health care. For behavioral health practitioners, IBH requires a shift to a brief, outcome-driven, and team-based model of care. Despite the fact that social workers comprise the majority of behavioral health providers in IBH settings, little research has been done to assess the extent to which social workers are prepared for effective practice in fast-paced primary care. We conducted a survey of social workers (N = 84) in IBH settings to assess the following: (1) Key competency areas for social work practice in IBH settings and (2) Self-rated preparedness for effective practice in IBH settings. Online snowball sampling methods were used over a period of 1 month. Results indicate that social workers feel prepared for general practice in IBH settings, but would benefit from additional training in IBH-specific competency areas identified in the survey. Findings can help guide social work training to improve workforce preparedness for practice in IBH settings in the wake of health care reform.
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Affiliation(s)
- Elizabeth Horevitz
- a School of Social Welfare , University of California, Berkeley , Berkeley , California , USA
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Nash JM, McKay KM, Vogel ME, Masters KS. Functional roles and foundational characteristics of psychologists in integrated primary care. J Clin Psychol Med Settings 2012; 19:93-104. [PMID: 22415522 DOI: 10.1007/s10880-011-9290-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Psychologists are presented with unprecedented opportunities to integrate their work in primary care settings. Although some roles of psychologists in primary care overlap with those in traditional psychology practice settings, a number are distinct reflecting the uniqueness of the primary care culture. In this paper, we first describe the integrated primary care setting, with a focus on those settings that have components of patient centered medical home. We then describe functional roles and foundational characteristics of psychologists in integrated primary care. The description of functional roles emphasizes the diversity of roles performed. The foundational characteristics identified are those that we consider the 'primary care ethic,' or core characteristics of psychologists that serve as the basis for the various functional roles in integrated primary care. The 'primary care ethic' includes attitudes, values, knowledge, and abilities that are essential to the psychologist being a valued, effective, and productive primary care team member.
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Affiliation(s)
- Justin M Nash
- Department of Family Medicine, Warren Alpert Medical School of Brown University and Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtucket, RI 02860, USA.
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Fox MA, Hodgson JL, Lamson AL. Integration: Opportunities and Challenges for Family Therapists in Primary Care. CONTEMPORARY FAMILY THERAPY 2012. [DOI: 10.1007/s10591-012-9189-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cubic B, Mance J, Turgesen JN, Lamanna JD. Interprofessional Education: Preparing Psychologists for Success in Integrated Primary Care. J Clin Psychol Med Settings 2012; 19:84-92. [DOI: 10.1007/s10880-011-9291-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McCrae CS, Taylor DJ, Smith MT, Perlis ML. The future of behavioral sleep medicine: a report on the presentations given at the Ponte Vedra Behavioral Sleep Medicine Consensus Conference, March 27-29, 2009. Behav Sleep Med 2010; 8:74-89. [PMID: 20352544 DOI: 10.1080/15402001003622792] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A major goal of the Behavioral Sleep Medicine Consensus Conference held in Ponte Vedra, Florida on March 27 through 29, 2009 was to have 15 key opinion leaders provide the latest information on their areas of expertise. Those leaders represented the breadth of the behavioral sleep medicine field (pediatrics, adults, insomnia, PAP adherence, and circadian rhythm disorders) and included clinicians and researchers from a variety of settings (academia, private practice, the military, and primary care). The presentations highlighted the milestones already achieved by the field (critical mass, solid empirical base, 30+ training programs, certification, dedicated journal, and dedicated textbook), as well as important future directions (more clinical research, public relations campaigns, training, and reimbursement).
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Affiliation(s)
- Christina S McCrae
- Department of Clinical and Health Psychology, University of Florida, 101 S. Newell Drive, Gainesville, FL 32610-0165, USA.
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Kessler R, Stafford D, Messier R. The problem of integrating behavioral health in the medical home and the questions it leads to. J Clin Psychol Med Settings 2009; 16:4-12. [PMID: 19219628 DOI: 10.1007/s10880-009-9146-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 01/07/2009] [Indexed: 10/21/2022]
Abstract
Psychology and other behavioral health professions have amassed a broad empirical and clinical literature suggesting many medical presentations are best responded to with the addition of evidence based behavioral interventions. Despite this, psychology has not achieved a regular presence as part of medical practice. We suggest specific reasons for the current state of affairs including clinical, operational, societal labels, financial and training dimensions. Medical, psychological, administrative, and financial perspectives are reviewed. If the goals of health care system reform are to be reached then we must identify and challenge the current limitations of health care. This paper will identify the elements that need to be changed in order for psychology to be integrated into medicine rather than excluded from its policy, planning and operations.
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Affiliation(s)
- Rodger Kessler
- Department of Family Medicine and Center for Translational Science, University of Vermont College of Medicine, Berlin Family Health, Fletcher Allen Health Care, Burlington, VT 05401, USA.
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