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Ogbeide SA, Knight C, Young A, George D, Houston B, Wicoff M, Johnson-Esparza Y, Gibson-Lopez G. Current Practices in Clinical Supervision in Primary Care. J Clin Psychol Med Settings 2024; 31:316-328. [PMID: 38347384 DOI: 10.1007/s10880-023-10001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 05/20/2024]
Abstract
The purpose of this study was to examine current clinical supervision practices within primary care settings. We used a descriptive survey design, which blends quantitative and qualitative data, and examined the current state of clinical supervision practices and approaches in primary care and the type of training the behavioral health consultants received to provide supervision to pre-licensure level behavioral health trainees. Ninety-four participants completed the survey in 2022. Seventy-one percent of respondents felt they had adequate training to be an effective integrated behavioral health (IBH) supervisor; however, most training came from sources, such as workshops, continuing education, or supervision of supervision. Further efforts to establish universal competencies and formal training programs are needed to meet the growing need for IBH services in primary care.
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Affiliation(s)
| | - Cory Knight
- University of Houston - Clearlake, Houston, TX, USA
| | | | - Deepu George
- UT Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | | | - Maribeth Wicoff
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
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Cooper ZW, Wolfer TA. Conceptualizing the Biopsychosocial-Spiritual Health Influences of Adverse Childhood Experiences and the Application of Primary Care Behavioral Health for Their Treatment. JOURNAL OF RELIGION AND HEALTH 2024; 63:619-639. [PMID: 37831309 DOI: 10.1007/s10943-023-01928-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/23/2023] [Indexed: 10/14/2023]
Abstract
Adverse Childhood Experiences (ACEs) are common and affect the overall functioning of adults, but there is a need to understand how to better address the health impact of ACEs on adults in primary healthcare settings. A narrative review was utilized to extract data from seminal articles to (1) operationalize the influence of ACEs on health outcomes, (2) assess the primary care behavioral health (PCBH) model as a mechanism to address the influence of ACEs, and (3) identify mechanisms to expand the PCBH model to explicitly address spiritual determinants of health. The extracted data revealed that ACEs influence the biological, psychological, social, and spiritual health of patients providing a rationale for integrating psychosocial and spiritual treatment within primary healthcare settings. Simultaneously, the PCBH model integrates psychosocial interventions into existing primary care services but does not explicitly address spiritual determinants. Recommendations for expansion include (1) training for clinicians on evidence-based interventions to address spirituality, (2) spiritual screening tools in PCBH settings, and (3) consultation with chaplains as needed.
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Affiliation(s)
- Zachary W Cooper
- School of Social Work, University of Georgia, 279 Williams St, Athens, GA, 30602, USA.
| | - Terry A Wolfer
- College of Social Work, University of South Carolina, Columbia, SC, USA
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3
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Ogbeide SA, Ingram M, Lloyd-Hazlett J. Primary Care Supervision: A Community of Practice. CLINICAL TEACHER 2023:e13704. [PMID: 37994386 DOI: 10.1111/tct.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/27/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND The goal of this project was to determine the feasibility of a Community of Practice (CoP) model to support behavioural health (BH) clinical supervisor professional development. APPROACH Fourteen supervisors participated in 13 CoP-focused workshops focused on supervision within the Primary Care Behavioural Health (PCBH) model over a 4-year period. These workshops occurred twice a semester (in person and virtually) for supervisors hosting students participating in a Health Resources and Services Administration (HRSA) Behavioural Health Workforce Education Training (BHWET) grant. The program focused on preparing masters-level clinical mental health counselling students to function as Behavioural Health Consultants (BHCs) in primary care settings in rural and urban areas. Supervisors completed post-workshop surveys on their satisfaction with the content and the impact of the workshop content on building their PCBH supervision skills. EVALUATION Supervisors were satisfied with the content presented during the CoP workshops as well as indicated improvements in their confidence with providing supervision within the PCBH model. Areas of improved confidence and competence included supervision in integrated health care settings, topics discussed in primary care, and telehealth visits. IMPLICATIONS Overall, this demonstrates an approach to building supervisor confidence in working with pre-licensure trainees within the PCBH model. CoP workshops show promise as an approach that institutions of higher education and health care organisation can adopt to improve clinical teaching and supervision in primary care as well as support supervisors in the community who work with trainees in primary care.
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Farnsworth von Cederwald A, Lilja JL, Hentati Isacsson N, Kaldo V. Primary Care Behavioral Health in Sweden - a protocol of a cluster randomized trial evaluating outcomes related to implementation, organization, and patients (KAIROS). BMC Health Serv Res 2023; 23:1188. [PMID: 37907899 PMCID: PMC10619326 DOI: 10.1186/s12913-023-10180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Providing comprehensive and continuous care for patients whose conditions have mental or behavioral components is a central challenge in primary care and an important part of improving universal health coverage. There is a great need for high and routine availability of psychological interventions, but traditional methods for delivering psychotherapy often result in low reach and long wait times. Primary Care Behavioral Health (PCBH) is a method for organizing primary care in which behavioral health staff provide brief, flexible interventions to a large part of the population in active collaboration with other providers. While PCBH holds promise in addressing important challenges, it has not yet been thoroughly evaluated. METHODS This cluster randomized trial will assess 17 primary care centers (PCCs) that are starting a PCBH implementation process. The PCCs will be divided into two groups, with one starting immediate implementation and the other acting as a control, implementing six months later. The purpose of the study is to strengthen the evidence base for PCBH regarding implementation-, organization-, and patient-level outcomes, taking into consideration that there is a partially dependent relationship between the three levels. Patient outcomes (such as increased daily functioning and reduction of symptoms) may be dependent on organizational changes (such as availability of treatment, waiting times and interprofessional teamwork), which in turn requires change in implementation outcomes (most notably, model fidelity). In addition to the main analysis, five secondary analyses will compare groups based on different combinations of randomization and time periods, specifically before and after each center achieves sufficient PCBH fidelity. DISCUSSION A randomized comparison of PCBH and traditional primary care has, to our knowledge, not been made before. While the naturalistic setting and the intricacies of implementation pose certain challenges, we have designed this study in an effort to evaluate the causal effects of PCBH despite these complex aspects. The results of this project will be helpful in guiding decisions on how to organize the delivery of behavioral interventions and psychological treatment within the context of primary care in Sweden and elsewhere. TRIAL REGISTRATION ClinicalTrials.gov: NCT05335382. Retrospectively registered on March 13th, 2022.
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Affiliation(s)
| | - Josefine L Lilja
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Nils Hentati Isacsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Martin MP, Bridges AJ, Cos T. Measuring Productivity in Primary Care Behavioral Health: A Delphi Study. J Clin Psychol Med Settings 2022; 29:616-623. [PMID: 34420120 DOI: 10.1007/s10880-021-09814-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
High productivity by behavioral health consultants (BHC) is a defining aspect of the primary care behavioral health (PCBH) model to maximize access to care and is often measured by patient volume. Studies of productivity in health care settings suggest a single productivity target may not be optimal. We used a Delphi method to obtain expert consensus on an operational definition of high productivity by BHCs in the PCBH model. Clinicians, managers, and researchers in PCBH were recruited to participate in a multi-round survey using a modified Delphi technique and develop consensus on PCBH productivity metrics. Ten participants completed all three survey rounds and rated 28 metrics. After three rounds, two direct metrics (average number of billable BHC visits each day; number of patients seen per day) received at least 80% consensus as "Essential", two received at least 50%, and five received less than 50%. One influencer (level of integration at the practice) received at least 80% consensus as "Very Much" influential, 19 received at least 50%, and eight items received less than 50%. Several themes arose from participant comments. PCBH productivity can be interpreted as being high volume. Numerous practice factors influence how productive a BHC may be. Future studies should determine the feasibility of our metrics in clinical practice, establish productivity expectations based on patient needs and clinic resources, and identify patient-, clinician-, or practice-level moderators of productivity.
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Affiliation(s)
- Matthew P Martin
- College of Health Solutions, Arizona State University, 550 N. 3rd St Phoenix, Phoenix, AZ, 85004, USA.
| | - Ana J Bridges
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Travis Cos
- Health Federation of Philadelphia, Philadelphia, PA, USA
- Department of Psychology, La Salle University, Philadelphia, PA, USA
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Wilfong KM, Goodie JL, Curry JC, Hunter CL, Kroke PC. The Impact of Brief Interventions on Functioning Among those Demonstrating Anxiety, Depressive, and Adjustment Disorder Symptoms in Primary Care: The Effectiveness of the Primary Care Behavioral Health (PCBH) Model. J Clin Psychol Med Settings 2021; 29:318-331. [PMID: 34626278 DOI: 10.1007/s10880-021-09826-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Limited scalability combined with limited opportunities for patients to receive evidence-based interventions in traditional behavioral health treatment models for anxiety and depression creates a gap in access to adequate care. Primary Care Behavioral Health (PCBH) is one model of treatment in which behavioral health consultants (BHC) work directly within primary care settings, but there is limited evidence regarding the effectiveness of this model of care. The functional outcomes and appointment characteristics of Beneficiaries (N = 5402) within the military healthcare system were assessed. The study sample was predominately Caucasian, female, military dependents seen for 2 to 4 appointments. A reliable change index revealed that 17.2% showed reliable improvement and 2.4% showed reliable deterioration (p < .05). Of individuals with a severe Behavioral Health Measure-20 score at baseline, 81.5% showed some improvement at their final appointment, with 33% demonstrating reliable improvement. A mixed model analysis was used to determine the predictive value of appointment characteristics. All relations were significant (p < .001), except the between-subjects effect of appointment duration. Appointment duration revealed individuals reported worse functioning at the start of atypically long appointments. Individuals with generally longer intervals between appointments reported worse functioning, but an atypically long interval predicted better functioning at the following appointment. As it relates to number of appointments, individuals with more total appointments reported worse functioning outcomes, with generally better functioning across appointments. Overall, these data support the effectiveness of time-limited care provided through the PCBH model.
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Affiliation(s)
- Kevin M Wilfong
- Uniformed Service University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
| | - Jeffrey L Goodie
- Uniformed Service University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Justin C Curry
- Defense Health Agency, Clinical Support Division, Patient Centered Medical Home Branch, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA, 22042, USA
| | - Christopher L Hunter
- Defense Health Agency, Clinical Support Division, Patient Centered Medical Home Branch, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA, 22042, USA
| | - Phillip C Kroke
- Uniformed Service University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
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Caldwell BA, Alessi EJ, DiGiulio M, Findley P, Oursler J, Wagner M. Integrating Behavioral Health into Primary Care: The Role of Psychiatric Nursing in the Development of the Interprofessional Team. Issues Ment Health Nurs 2021; 42:758-767. [PMID: 33539194 DOI: 10.1080/01612840.2020.1867676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Integrated behavioral health in a primary care setting is a paradigm shift that requires academic reconfiguration on how health care professionals are educated and trained in the clinical arena. METHOD An academic university was able to create interprofessional didactic and clinical learning experiences for students within the Schools of Nursing, Social Work, Health Professions-Rehabilitation Counseling Department and Pharmacy resulting in improved models for patient care delivery. RESULTS Interdisciplinary faculty developed the didactic, clinical and evaluative areas based on the HRSA grant work plan. Deliverables included 18 modules, case studies focused on population health, and team-focused standardized patient experiences to test their behavioral health and psychiatric skills in a primary care setting. CONCLUSIONS Faculty from the different disciplines were able to collaborate on the deliverables, take the opportunities to engage students and collaborate on scholarly presentations at a national, state and local professional organizations. Academic course for interprofessional practice has been developed and implemented as an outcome of this grant.
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Affiliation(s)
| | - Edward J Alessi
- School of Social Work, Graduate Department, Rutgers University, New Brunswick, New Jersey, USA
| | - Mary DiGiulio
- School of Nursing, Rutgers University, Newark, New Jersey, USA
| | - Patricia Findley
- School of Social Work, Graduate Department, Rutgers University, New Brunswick, New Jersey, USA
| | - Janice Oursler
- School of Health Professions, Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Piscataway, New Jersey, USA
| | - Mary Wagner
- Department of Pharmacy Practice and Administration Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
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Training Psychologists in Integrated Primary Care and Child Maltreatment: Trainee and Supervisor Perspectives on Lessons Learned. J Clin Psychol Med Settings 2021; 27:541-552. [PMID: 31388847 DOI: 10.1007/s10880-019-09648-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Psychologists are key team members in the delivery of integrated behavioral healthcare. Healthcare reform has supported a shift toward a team-based, interdisciplinary model of service delivery, with increasing emphasis on primary care services, prevention, and health promotion. In conjunction with this shift has been a greater focus on psychosocial problems and social determinants of health, particularly childhood adversity. Psychologists in primary care are uniquely positioned to advance efforts to prevent and ameliorate childhood adversity, which are essential to improving care for underserved populations and reducing health disparities. Targeted training efforts are needed to increase the number of psychologists equipped to work in primary care settings with underserved populations. This paper provides an overview of a training program designed to provide psychology trainees with specialized training in both integrated primary care and child maltreatment. The overarching goal of the program is to provide trainees with the skillset to work within integrated primary care settings and the expertise needed to further efforts to address and prevent child maltreatment, as well as childhood adversity more broadly, to improve outcomes for underserved populations. The paper reviews strengths, challenges, and lessons learned from this program.
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Yin I, Staab EM, Beckman N, Vinci LM, Ari M, Araújo FS, Yohanna D, Laiteerapong N. Improving Primary Care Behavioral Health Integration in an Academic Internal Medicine Practice: 2-Year Follow-Up. Am J Med Qual 2021; 36:379-386. [PMID: 33967190 DOI: 10.1097/01.jmq.0000735472.47097.a1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This report details ongoing efforts to improve integration in the 2 years following implementation of the Primary Care Behavioral Health model at a general internal medicine clinic of an urban academic medical center. Efforts were informed by a modified version of the validated Level of Integration Measure, sent to all faculty and staff annually. At baseline, results indicated that the domains of systems integration, training, and integrated clinical practices had the greatest need for improvement. Over the 2 years, the authors increased availability of behavioral medicine appointments, improved depression screening processes, offered behavioral health training for providers, disseminated clinical decision support tools, and provided updates about integration progress during clinic meetings. Follow-up survey results demonstrated that physicians and staff perceived improvements in integration overall and in targeted domains. However, the main ongoing barrier to integration was insufficient behavioral health staff to meet patient demand for behavioral health services.
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Affiliation(s)
- Isabel Yin
- Pritzker School of Medicine, University of Chicago, Chicago, IL Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL
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10
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Clark-Sienkiewicz SM, Caño A, Zeman LL, Lumley MA, Gothe N. Development of a Multicomponent Intervention to Initiate Health Behavior Change in Primary Care: The Kickstart Health Program. J Clin Psychol Med Settings 2021; 28:694-705. [PMID: 33398641 DOI: 10.1007/s10880-020-09755-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
There is a growing movement to integrate behavioral health specialists into primary care settings in order to better manage patients' health behaviors. Group interventions in healthcare settings can provide services to multiple individuals simultaneously; however, the participants' experiences taking part in these activities and the logistics of integrating them into clinical settings are largely under-studied. This article describes the development and implementation of a novel group intervention for health behavior change, The Kickstart Health Program, which integrates components of cognitive, behavioral, acceptance, and experiential therapies. Participant feasibility, acceptability, experiences, and treatment course were assessed. Acceptability among a small sample of attendees was high, and initial data on behavior change suggest there were benefits to patients who attended the program. Increases in mindfulness practice and decreases in exercise barriers from baseline to 10-week follow-up were detected as were improvements in overall perceived health and well-being. Participants expressed that the program was acceptable and successful at helping them reach their individual health goals; however, enrollment barriers negatively impacted the feasibility of the program in regard to attendance. Modification to the enrollment process such as embedding referrals into the electronic medical record, encouraging spouse or family co-enrollment, and peer coaching may address these barriers. The Kickstart Health Program has the potential to improve health behaviors and paves the way for unique studies of dissemination and implementation of efficacious behavioral health interventions into real-world healthcare settings.
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Affiliation(s)
- Shannon M Clark-Sienkiewicz
- Department of Psychology, Wayne State University, Detroit, MI, USA. .,Beaumont Health, Sterling Heights, MI, USA. .,Huntsman Cancer Institute, University of Utah, 2000 Cir of Hope Dr, #1950, Salt Lake City, UT, 84112, USA.
| | - Annmarie Caño
- Department of Psychology, Wayne State University, Detroit, MI, USA.,College of Arts and Sciences, Gonzaga University, Spokane, WA, USA
| | | | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Neha Gothe
- Department of Kinesiology & Community Health, University of Illinois At Urbana-Champaign, Champaign, IL, USA
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Bütz MR, Tynan WD. Integrating Behavioral Healthcare and Primary Care, Appropriate Balance on What Model is Driving Care, and, the Whole Spectrum of Individuals are Coming Through the Door…. J Clin Psychol Med Settings 2019; 27:553-559. [PMID: 31732896 DOI: 10.1007/s10880-019-09679-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
With the integration of behavioral health services into primary care and other medical specialties, the community of providers and the public must address a number of questions, including: What models of care are there for these services? What kinds of providers supply these services? Are these providers trained behavioral health providers or extenders in some form? And, as these systems of care are constructed, who makes use of them? The purpose of this study is to address these questions as well as to consider some of the challenges of attending to the spectrum of needs that will arise as integrated healthcare services expand. Consideration of these questions may serve to clarify the impact that these models of healthcare will have in ways that may be readily apparent and, at the same time, in ways that may be subtler and less comprehensible. Addressing these questions is also intended to facilitate discussions within healthcare systems and among providers concerning which models of care best respond to specific populations. In turn, proactively answering these questions will, for the foreseeable future, shape not only behavioral healthcare, in perhaps small or large ways, but also healthcare in general.
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Affiliation(s)
- Michael R Bütz
- Aspen Practice, P.C., and St. Vincent Healthcare, 2900 12th Avenue North, Suite 280 W, Billings, MT, 59101, USA.
| | - W Douglas Tynan
- Office of Integrated Health Care, American Psychological Association Center for Psychology and Health, Washington, DC, USA
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Russon J, Mensinger J, Herres J, Shearer A, Vaughan K, Wang SB, Diamond GS. Identifying Risk Factors for Disordered Eating among Female Youth in Primary Care. Child Psychiatry Hum Dev 2019; 50:727-737. [PMID: 30847634 DOI: 10.1007/s10578-019-00875-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Eating disorders are a serious, life-threating condition impacting adolescents and young adults. Providers in primary care settings have an important role in identifying disordered eating (DE) symptoms. Unfortunately, symptoms go undetected in 50% of patients in medical settings. Using the behavioral health screen, this study identified DE risk profiles in a sample of 3620 female adolescents and young adults (ages 14-24), presenting in primary care. A latent class analysis with twenty psychosocial factors identified three DE risk groups. The group at highest risk for DE was characterized by endorsement of internalizing symptoms and a history of trauma. The next risk group consisted of those with externalizing symptoms, particularly substance use. The group at lowest risk for DE reported more time spent with friends compared to their peers. Primary care providers and psychiatric teams can benefit from knowing the psychosocial risk patterns affiliated with DE, and using brief, comprehensive screening tools to identify these symptoms.
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Affiliation(s)
- Jody Russon
- Department of Human Development and Family Science, Virginia Tech, Blacksburg, USA.
| | - Janell Mensinger
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
| | - Joanna Herres
- Psychology Department, The College of New Jersey, Jersey City, NJ, USA
| | - Annie Shearer
- School of Medicine, University of Pittsburgh, Pittsburg, PA, USA
| | - Katherine Vaughan
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
| | - Shirley B Wang
- Psychology Department, The College of New Jersey, Jersey City, NJ, USA
| | - Guy S Diamond
- Center for Family Intervention Science, Drexel University, Philadelphia, PA, USA
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Reiter JT, Dobmeyer AC, Hunter CL. The Primary Care Behavioral Health (PCBH) Model: An Overview and Operational Definition. J Clin Psychol Med Settings 2019; 25:109-126. [PMID: 29480434 DOI: 10.1007/s10880-017-9531-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The Primary Care Behavioral Health (PCBH) model is a prominent approach to the integration of behavioral health services into primary care settings. Implementation of the PCBH model has grown over the past two decades, yet research and training efforts have been slowed by inconsistent terminology and lack of a concise, operationalized definition of the model and its key components. This article provides the first concise operationalized definition of the PCBH model, developed from examination of multiple published resources and consultation with nationally recognized PCBH model experts. The definition frames the model as a team-based approach to managing biopsychosocial issues that present in primary care, with the over-arching goal of improving primary care in general. The article provides a description of the key components and strategies used in the model, the rationale for those strategies, a brief comparison of this model to other integration approaches, a focused summary of PCBH model outcomes, and an overview of common challenges to implementing the model.
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Affiliation(s)
- Jeffrey T Reiter
- Doctor of Behavioral Health (DBH) Program, College of Health Solutions, Arizona State University, Phoenix, AZ, USA. .,, Seattle, WA, USA.
| | - Anne C Dobmeyer
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Christopher L Hunter
- Patient-Centered Medical Home Branch, Defense Health Agency, Falls Church, VA, USA
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Porcerelli JH, Jones JR, Grabowski JE, Murdoch W. Behavioral Health Assessments and Interventions of Psychology Trainees and Residents During Dual Interviewing: Replication and Extension. J Clin Psychol Med Settings 2018; 26:228-234. [PMID: 30209674 DOI: 10.1007/s10880-018-9581-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The integration of psychologists and other behavioral health providers in primary care practice continues to evolve and reshape approaches to patient care. This study is a replication and extension of a 2013 study describing dual interviewing encounters involving psychology trainees and family medicine residents within an integrated primary care clinic as it relates to behavioral health assessments and interventions. Psychology trainees provided descriptions of 400 collaborative patient encounters involving 337 single and 63 repeat encounters. Psychology trainees coded the frequency of behavioral health assessments and interventions by the psychology trainee, family medicine resident, or both. Seventy-eight percent of encounters contained an assessment, and 20% contained interventions. Compared to the 2013 study, there were significantly fewer behavioral health interventions offered and a significantly greater number of psychoeducation/supportive interventions offered collaboratively. It was discovered that discussions between psychology trainees and family medicine residents immediately after patient encounters occurred 50% of the time and involved issues of case conceptualization. These informal discussions may be an important source of behavioral health education for family medicine residents. This study adds to efforts to better understand what occurs during these encounters.
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Affiliation(s)
- John H Porcerelli
- Department of Psychology, University of Detroit Mercy, 4001 W. McNichols Road, 142 Reno Hall, Detroit, MI, 48221, USA.
| | - John R Jones
- United States Air Force, 1538 Cable Ranch Road, Apt. 6203, San Antonio, TX, 78245, USA
| | - Jillian E Grabowski
- Department of Psychology, University of Detroit Mercy, 4001 W. McNichols Road, 142 Reno Hall, Detroit, MI, 48221, USA
| | - William Murdoch
- Family Medicine Residency Program, ProMedica Monroe Regional Hospital, 718 N. Macomb Street, Monroe, MI, 48162, USA
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Integrating Behavioral Health Services into Primary Care: Spotlight on the Primary Care Behavioral Health (PCBH) Model of Service Delivery. J Clin Psychol Med Settings 2018; 25:105-108. [DOI: 10.1007/s10880-017-9534-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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