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Kim JS, Prins A, Hirschhorn EW, Legrand AC, Macia KS, Yam SS, Cloitre M. Preliminary Investigation Into the Effectiveness of Group webSTAIR for Trauma-exposed Veterans in Primary Care. Mil Med 2024; 189:e1403-e1408. [PMID: 38442368 DOI: 10.1093/milmed/usae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION A substantial number of trauma-exposed veterans seen in primary care report significant symptoms of PTSD and depression. While primary care mental health integration (PCMHI) providers have been successful in delivering brief mental health treatments in primary care, few studies have evaluated interventions that combine mobile health resources with PCMHI groups. This pilot study assessed the potential benefits of webSTAIR, a 10-module transdiagnostic treatment for trauma-exposed individuals, supported by 5 biweekly group sessions delivered via telehealth. The transdiagnostic and mobile health nature of the treatment, as well as the therapist and peer support provided through group sessions, may offer an innovative approach to increasing access to patient-centered and trauma-informed treatment in primary care settings. MATERIALS AND METHODS Thirty-nine male and female veterans with trauma-related symptoms (i.e., PTSD and/or depression) participated in group webSTAIR. Mixed effects analyses were conducted to assess changes in PTSD and depression at pre-, mid-, and post-treatment. Baseline symptom severity was assessed as a predictor of module completion and group attendance. The project was part of a VHA quality improvement project, and IRB approval was waived by the affiliated university. RESULTS Analyses revealed significant pre-to-post improvement in both PTSD and depression outcomes with a large effect size for PTSD (Hedges' gav = 0.88) and medium to large for depression (Hedges' gav = 0.73). Of participants who completed the baseline assessment, 90% began webSTAIR; of those, 71% completed the program. Baseline symptoms of PTSD and depression did not predict group attendance or module completion. CONCLUSIONS Good outcomes and a satisfactory retention rate suggest that group webSTAIR may provide easily accessible, high-quality, and effective treatment for patients presenting with trauma-related problems without increasing therapist or system burdens. The results suggest the value of conducting a randomized controlled trial to test the effectiveness of group webSTAIR relative to PCMHI usual care or other evidence-based, disorder-specific (e.g., PTSD) treatments for trauma-exposed individuals in PCMHI.
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Affiliation(s)
- Jamie S Kim
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
| | - Annabel Prins
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
- American Lake Division, VA Puget Sound Health Care System, 9600 Veterans Drive Southwest, Tacoma, WA 98493-0003, USA 900-329-8387
| | - Elizabeth W Hirschhorn
- American Lake Division, VA Puget Sound Health Care System, 9600 Veterans Drive Southwest, Tacoma, WA 98493-0003, USA 900-329-8387
| | - Alison C Legrand
- American Lake Division, VA Puget Sound Health Care System, 9600 Veterans Drive Southwest, Tacoma, WA 98493-0003, USA 900-329-8387
| | - Kathryn S Macia
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
| | - Sherry S Yam
- General Mental Health, VA Northern California Health Care System, 150 Muir Road, Martinez, CA 94553-4668, USA
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA
- Department of Psychiatry and Behavioral Health Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305-5717, USA
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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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Peer Y, Koren A, DiNapoli P, Gautam R. Factors Associated with Implementing the Integrated Behavioral Health Care Model and Iraqi Refugees in the USA. Community Ment Health J 2023; 59:1251-1260. [PMID: 36917297 PMCID: PMC10011859 DOI: 10.1007/s10597-023-01107-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
The aim was to identify which factors facilitate providing integrated behavioral health care for Iraqi refugees in nationally recognized community health center in Northern USA. The social-ecological model (SEM) framework guided this qualitative case study exploring the experience of 11 professional staff. Data were collected from June through August 2021 through individual interviews. Eight themes emerged based on the SEM levels: Intrapersonal-gender-driven engagement; interpersonal-the need for discretion and trusting relationship; community-collaboration with community resources and integrator from the community; organizational-holistic care, and long-term care; and policy-insufficient educational preparation. The results highlight components for clinical practice and policymakers regarding a population that is a big consumer of mental health care. Future research should explore other vulnerable populations, the effect of social groups, and the incorporation of community resources as part of the integrated care team.
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Affiliation(s)
- Yifat Peer
- Susan and Alan Solomont School of Nursing, University of Massachusetts, Lowell 113 Wilder Street, Suite 200, Lowell, MA 01854-3058 USA
| | - Ainat Koren
- Susan and Alan Solomont School of Nursing, University of Massachusetts, Lowell 113 Wilder Street, Suite 200, Lowell, MA 01854-3058 USA
| | - Pamela DiNapoli
- Department of Nursing, University of New Hampshire, Hewitt Hall, 4 Library Way, Durham, NH 03824 USA
| | - Ramraj Gautam
- Susan and Alan Solomont School of Nursing, University of Massachusetts, Lowell 113 Wilder Street, Suite 200, Lowell, MA 01854-3058 USA
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Predictors of Full Recovery in Individuals with Emotional Disorders: One-Year Follow-Up Secondary Analysis of the PsicAP Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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5
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Roche AI, Savitz ST, Kelpin SS, Lebow J, Lombardi N, Bogucki OE, Kurtzhals AA, Drews MS, Trane ST, Allen JS, Williams MD, Sawchuk CN. Study What You Do: Developing a Psychotherapy Tracking Database in a Large-Scale Integrated Behavioral Health Service. Ann Fam Med 2023; 21:S49-S55. [PMID: 36849471 PMCID: PMC9970678 DOI: 10.1370/afm.2927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/12/2022] [Accepted: 10/27/2022] [Indexed: 03/01/2023] Open
Abstract
PURPOSE Many individuals with behavioral health challenges receive services in primary care, and integrated behavioral health (IBH) programs can help increase access to evidence-based interventions. IBH programs can benefit substantially from integrating standardized tracking databases that allow for the implementation of measurement-based care to evaluate patient-, clinician-, and practice-level outcomes. We describe the development and integration of Mayo Clinic's pediatric and adult primary care psychotherapy tracking database. METHODS IBH practice leaders directed the development of a large psychotherapy tracking database that continuously populates from Mayo Clinic's electronic health record system. The database captures numerous patient variables including demographics, behavioral health and substance use issues, psychotherapy principles used, and self-reported symptoms. We retrieved current data for patients empaneled in Mayo Clinic's pediatric and adult primary care psychotherapy programs from June 2014 to June 2022. RESULTS The tracking database contained data for 16,923 adult patients and 6,298 pediatric patients. The mean age of adult patients was 43.2 years (SD 18.3), 88.1% were non-Latine White, and 66.7% identified as female. The mean age of pediatric patients was 11.6 years (SD 4.2), 82.5% were non-Latine White, and 56.9% identified as female. We provide examples of practical applications of the database across clinical, educational, research, and administrative domains. CONCLUSIONS The development and integration of a psychotherapy tracking database supports clinician communication, examination of patient outcomes, practice quality improvement efforts, and clinically relevant research. Our description of Mayo Clinic's IBH database may serve as a model for other IBH practices.
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Affiliation(s)
- Anne I Roche
- Division of Integrated Behavioral Health, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Samuel T Savitz
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
| | - Sydney S Kelpin
- Division of Integrated Behavioral Health, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Jocelyn Lebow
- Division of Integrated Behavioral Health, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.,Department of Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Nathaniel Lombardi
- Division of Integrated Behavioral Health, Mayo Clinic Health System, Albert Lea, Minnesota
| | - Olivia E Bogucki
- Division of Integrated Behavioral Health, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Maureen S Drews
- Research Application Solutions, Mayo Clinic, Rochester, Minnesota
| | - Sarah T Trane
- Division of Integrated Behavioral Health, Mayo Clinic Health System, La Crosse, Wisconsin
| | - Jay-Sheree Allen
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mark D Williams
- Division of Integrated Behavioral Health, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Craig N Sawchuk
- Division of Integrated Behavioral Health, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
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Nederveld A, Wiggins K, Dickinson LM, Dickinson PW, Tolle LW, Holtrop JS. Integrated Primary Care and Health Behavior Support: A Survey of Behavioral Health Providers. J Prim Care Community Health 2023; 14:21501319231172039. [PMID: 37119040 PMCID: PMC10155017 DOI: 10.1177/21501319231172039] [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: 01/25/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES Many behavioral health providers (BHPs) in primary care practices spend a majority of their time addressing mental health rather than behavior change. We wanted to better understand the practice of BHPs in integrated primary care. METHODS Survey of BHPs from practices participating in the Colorado State Innovation Model (SIM) initiative. The survey measured what diagnoses BHPs receive referrals to treat, what they treat regardless of referral reason, which techniques they use, and think are most effective for mental health diagnoses and behavior change/weight management support, and their interest in providing support for weight management. Results were analyzed using descriptive statistics and Spearman correlations. RESULTS We received 79 surveys representing 64 out of 248 SIM practices (practice response rate of 26%). BHPs reported addressing health-related behaviors with patients referred to them for mental health diagnoses. They expressed interest in health behavior and believed the techniques they use for traditional mental health diagnoses also support behavior change. Most reported using cognitive behavioral therapy (89%), mindfulness (94%), and relaxation/stress management (94%). Time in practice was associated with receiving more referrals for weight management (rho(76) = .271, P = .018) and with addressing diet (rho(75) = .339, P = .003) and weight management (rho(75) = .323, P = .005). BHPs in practices that had care managers were more likely to report receiving referrals for weight management than BHPs in practices that did not employ a case manager (r τ (76) = .222, P = .038); practices employing a health coach were more likely to receive referrals for physical activity than practices without a health coach (r τ (76) = .257, P = .015). CONCLUSIONS BHPs are interested in and frequently address health related behavior. Formalizing health behavior services from BHPs in primary care may provide opportunities to better support patients with behavior change and subsequently improve health outcomes.
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Affiliation(s)
| | | | - Linda Miriam Dickinson
- University of Colorado, Aurora, CO,
USA
- Adult and Child Center for Outcomes
Research and Delivery Science (ACCORDS), Aurora, CO, USA
| | - Perry W Dickinson
- University of Colorado, Aurora, CO,
USA
- Adult and Child Center for Outcomes
Research and Delivery Science (ACCORDS), Aurora, CO, USA
| | | | - Jodi Summers Holtrop
- University of Colorado, Aurora, CO,
USA
- Adult and Child Center for Outcomes
Research and Delivery Science (ACCORDS), Aurora, CO, USA
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Peer Y, Koren A. Facilitators and barriers for implementing the integrated behavioural health care model in the USA: An integrative review. Int J Ment Health Nurs 2022; 31:1300-1314. [PMID: 35637556 DOI: 10.1111/inm.13027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
The integrated behavioural health care (IBHC) model incorporates mental health services with primary care. This service model is widely advocated due to its increasing access to health care and cost-saving. By connecting individuals with mental illnesses with a primary care provider, this model of care promotes collaboration between interdisciplinary teams, and therefore, increases health equity, decreases stigma, and increases patient satisfaction. This integrative review aimed to examine and synthesize available literature on facilitators and barriers related to the IBHC model implementation in the United States. An integrative review methodology by Whittemore and Knafl was utilized, and data evaluation was based on the JBI Critical Appraisal Checklist. The social-ecological model guided the review. Twenty-two articles were analysed, and nine themes were identified, which were further organized according to the five levels of the social-ecological model and consisted of intrapersonal level - patient-centered care; interpersonal level - relationships; community level - physical accessibility; organizational level - operation and infrastructure, team approach, training in behavioural health, electronic medical record, and staffing; and policy level - funds and health insurance. Most facilitating factors were on the organizational level and related to infrastructure, team approach, patient-centered care, and the most noted barrier was poor relationships. Nurses can increase engagement in integrated care by assuming roles that oversee patient care, foster professional collaborations, and improve relationships. Future research should focus on vulnerable populations this model serves, patients' perspectives, and the effect of telehealth.
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Affiliation(s)
- Yifat Peer
- Susan and Alan Solomont School of Nursing, University of Massachusetts - Lowell, Lowell, Massachusetts, USA
| | - Ainat Koren
- Susan and Alan Solomont School of Nursing, University of Massachusetts - Lowell, Lowell, Massachusetts, USA
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8
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Brown CC, Durtschi JA, Rosenkranz S, Yorgason J, Topham G, McPhee D. Attachment, Depression, and Health: A Longitudinal Analysis of Those with A Chronic Disease. CONTEMPORARY FAMILY THERAPY 2022. [DOI: 10.1007/s10591-022-09647-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Pugh M, Perrin PB, Rybarczyk B, Tan J. Racism, Mental Health, Healthcare Provider Trust, and Medication Adherence Among Black Patients in Safety-Net Primary Care. J Clin Psychol Med Settings 2021; 28:181-190. [PMID: 32008136 DOI: 10.1007/s10880-020-09702-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There has been a growing research focus on social determinants to health disparities in general and medication adherence more specifically in low-income Black populations. The purpose of this study was to examine whether prior experiences of racism among Black patients in safety-net primary care indirectly predicts poor medication adherence through increased mental health symptoms and low healthcare provider trust. Two competing models were run whereby mental health leads to provider trust or provider trust leads to mental health in this multiple mediational chain. A group of 134 Black patients (76 men, average age 45.39 years) in a safety-net primary care clinic completed measures of these constructs. Results revealed that in the first model, mental health mediated the relationship between racism and provider trust, and provider trust mediated the relationship between mental health and medication adherence. All paths within this model were statistically significant, except the path between provider trust and medication adherence which approached significance. In the second model, provider trust and mental health significantly mediated the relationship between racism and medication adherence, and all direct and indirect paths were statistically significant, though the path between provider trust and medication adherence was omitted. These results may serve as catalysts to assess and attempt to mitigate specific minority-based stressors and associated outcomes within safety-net primary care settings.
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Affiliation(s)
- Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
- Departments of Psychology, Physical Medicine and Rehabilitation, Virginia Commonwealth University, 800 West Franklin St., Room 201, Box 842018, Richmond, VA, 23284-2018, USA.
| | - Bruce Rybarczyk
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Joseph Tan
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
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White K, Stetson L, Hussain K. Integrated Behavioral Health Role in Helping Pediatricians Find Long Term Mental Health Interventions with the Use of Assessments. Pediatr Clin North Am 2021; 68:685-705. [PMID: 34044994 DOI: 10.1016/j.pcl.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article explores the role of assessments in integrated behavioral health within a pediatric primary care setting, specifically exploring what valid and reliable standardized assessments may be used and for what concerns the assessment be of most use. The article also considers how assessments used by integrated behavioral health may inform the type of evidenced-based intervention that would be most appropriate and efficacious for the patient, as well as assist in determining if longer term or more formal mental health treatment may be required.
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Affiliation(s)
- Katie White
- Division of Pediatric Psychology, Western Michigan University School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA.
| | - Lydia Stetson
- Division of Pediatric Psychology, Western Michigan University School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
| | - Khadijah Hussain
- MD Candidate Class of 2022, Western Michigan University Homer Stryker, MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
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Petts RA, Gaynor ST. Behavioral Health in Primary Care: Brief Screening and Intervention Strategies for Pediatric Clinicians. Pediatr Clin North Am 2021; 68:583-606. [PMID: 34044987 DOI: 10.1016/j.pcl.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Despite the high prevalence of behavioral health concerns presenting in pediatric primary care and the growing support for integrating behavioral health services into this setting, a majority of primary care providers do not have access to on-site behavioral health specialists. Fortunately, primary care providers can implement some services typically provided by behavioral health clinicians. This article outlines screening, brief intervention, and referral guidelines for prominent behavioral health problems seen in primary care. The evidence-based approaches have the potential to supplement typical management of behavioral health problems in primary care and provide a foundation for future integrated behavioral health practice.
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Affiliation(s)
- Rachel A Petts
- Department of Psychology, Wichita State University, 1845 Fairmount Street, Wichita, KS 67260, USA.
| | - Scott T Gaynor
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008, USA
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Gibb TS, Crutchfield P, Redinger MJ, Minser J. Ethical and Professional Considerations in Integrated Behavioral Health. Pediatr Clin North Am 2021; 68:607-619. [PMID: 34044988 DOI: 10.1016/j.pcl.2021.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Integrated behavioral health models of care offer many benefits for patient experience and outcomes. However, multidisciplinary teams are comprised of professionals who each may have different professional norms and ethical obligations, which may at times be in conflict. This article offers a framework for negotiating potential conflicts between professional norms and expectations across disciplines involved in integrated behavioral health teams.
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Affiliation(s)
- Tyler S Gibb
- Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8010, USA.
| | - Parker Crutchfield
- Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8010, USA
| | - Michael J Redinger
- Department of Psychiatry, Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8010, USA. https://twitter.com/MikeRedingerMD
| | - John Minser
- Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8010, USA
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14
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Funderburk JS, Pigeon WR, Shepardson RL, Wade M, Acker J, Fivecoat H, Wray LO, Maisto SA. Treating depressive symptoms among veterans in primary care: A multi-site RCT of brief behavioral activation. J Affect Disord 2021; 283:11-19. [PMID: 33516082 DOI: 10.1016/j.jad.2021.01.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/30/2020] [Accepted: 01/10/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Behavioral activation is ideal for embedded behavioral health providers (BHPs) working in primary care settings treating patients reporting a range of depressive symptoms. The current study tested whether a brief version of Behavioral Activation (two 30-minute appointments, 2 boosters) designed for primary care (BA-PC) was more effective than primary care behavioral health treatment-as-usual (TAU) in reducing depressive symptoms and improving quality of life and functioning. METHODS Parallel-arm, multi-site randomized controlled trial. 140 Veterans were randomized to BA-PC or TAU and completed assessments at baseline, 6 weeks, 12 weeks, and 24 weeks. RESULTS Reductions in depressive symptoms were observed in both groups between baseline and 3-weeks prior to any treatment, with continued reductions among those in the BA-PC condition through 12-weeks. However, there was no significant condition X time interaction at 12-weeks. Quality of life and mental health functioning were significantly improved for those in the BA-PC condition, compared to TAU, at 12 weeks. LIMITATIONS Generalizability to a broader population may be limited as this sample consisted of veterans. Although engagement in TAU matched other prior work, it was lower than engagement in BA-PC, which also may compromise results. CONCLUSIONS Although this study found that both TAU and BA-PC participants showed a decline in depressive symptoms, improvements in functioning and quality of life within those assigned to BA-PC, strong treatment retention and feasibility of BA-PC, and significant reductions in depressive symptoms among those with more severe baseline depressive symptoms are encouraging and support continued research on BA-PC. This trial was registered in clinicaltrials.gov as Improving Mood in Veterans in Primary Care (NCT02276807).
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Affiliation(s)
- Jennifer S Funderburk
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA; VA VISN 2 Center of Excellence for Suicide Prevention, Finger Lakes VA Medical Center, Canandaigua, NY, USA
| | - Robyn L Shepardson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Michael Wade
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - John Acker
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Hayley Fivecoat
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura O Wray
- VA Center for Integrated Healthcare, Western New York VA Medical Center, Buffalo, NY, USA; Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA
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15
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White EJ, Wray JM, Shepardson RL. Clinical considerations in designing brief exposure interventions for primary care behavioral health settings. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2020; 38:439-449. [PMID: 33119371 PMCID: PMC7928230 DOI: 10.1037/fsh0000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Prevalence rates of anxiety disorders and symptoms in primary care (PC) settings are very high. Behavioral health consultants in primary care behavioral health (PCBH) settings enable increased access to evidence-based anxiety treatment. Despite strong extant support for exposure-based therapy for anxiety disorders, the use of exposure to treat anxiety in PC settings is low. Although barriers to exposure therapy (ET) may be exacerbated in PC settings, many anxiety presentations in PC warrant an exposure-based approach to treatment. Thus, exploration of feasibility and efficacy of ET in PC represents a critical area for advancing evidence-based treatment of anxiety symptoms. METHODS The current article addresses this gap through the presentation of two case examples of ET conducted in PCBH. Theoretical and practical information regarding the implementation of exposure using a brief (≤ 30 min), time-limited (4-6 visit) approached are presented. RESULTS Results from the case examples demonstrate feasibility of conducting exposure in a brief format consistent with a PCBH approach. Additionally, patient outcomes presented suggest that ET conducted in PCBH reduces anxiety symptoms and may facilitate referral to specialty care settings. DISCUSSION Exposure may offer promise in improving the quality of anxiety treatment in PC. Future work documenting both effectiveness and implementation outcomes of exposure in PC in clinical work and research trials is needed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Jennifer M. Wray
- Ralph H. Johnson VA Medical Center, Charleston, SC
- Medical University of South Carolina, Department of Psychiatry, Charleston, SC
| | - Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY
- Department of Psychology, Syracuse University, Syracuse, NY
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Hopko DR, Lejuez CW, Ryba MM, Shorter RL, Bell JL. Support for the efficacy of behavioural activation in treating anxiety in breast cancer patients. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Derek R. Hopko
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee, USA,
| | - Carl W. Lejuez
- Department of Psychology, The University of Maryland, College Park, Maryland, USA,
| | - Marlena M. Ryba
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee, USA,
| | - Rebecca L. Shorter
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee, USA,
| | - John L. Bell
- Cancer Institute, The University of Tennessee Medical Center, Knoxville, Tennessee, USA,
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Treating Post-traumatic Stress Disorder with a Prolonged Exposure Protocol Within Primary Care Behavioral Health: A Case Example. J Clin Psychol Med Settings 2020; 28:575-583. [PMID: 33090302 DOI: 10.1007/s10880-020-09747-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: 10/12/2020] [Indexed: 10/23/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a debilitating condition that impacts anywhere from 2 to 39% of primary care patients. Research suggests overall health, instances of hospitalizations, emergency room visits, and utilization of primary care services are impacted by a diagnosis of PTSD. Evidenced based treatments such as cognitive process therapy and prolonged exposure (PE) are available in specialty mental health but pose many barriers to treatment and implementation into primary care. This case study serves as the first known case example with an ethnic minority civilian, examining the treatment of PTSD within the Primary Care Behavioral Health Model using the brief (5 visits), PE protocol for primary care (PE-PC). PTSD was assessed using the PCL-5. Additional variables were assessed and tracked with the following tools: PHQ-9 (depressive symptoms), GAD-7 (anxiety symptoms), QLES-SF (quality of life), and the AAQ-2 (psychological flexibility) pre/post treatment, 6 months post-treatment and 9 months post-treatment. The patient reported clinically significant decreases in symptoms of PTSD, depression, and anxiety symptoms. Additionally, the patient's scores on quality of life and psychological flexibility improved. Brief, exposure-based treatment for PTSD can be delivered within the PCBH model. This treatment may result in improved quality of life and has the potential to reduce health care costs. This case encourages the treatment of PTSD within primary care, increasing access to care for patients. Future research is needed to further investigate this protocol in primary care with underserved, civilian populations and to explore patient attitudes toward brief treatment for PTSD in a primary care setting.
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18
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Kanzler KE, Ogbeide S. Addressing trauma and stress in the COVID-19 pandemic: Challenges and the promise of integrated primary care. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2020; 12:S177-S179. [PMID: 32584101 DOI: 10.1037/tra0000761] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Integrated primary care settings are ideal locations for treatment of posttraumatic stress concerns as primary care is the principal access point for mental health treatment in the United States. The COVID-19 global pandemic will increase the necessity of posttraumatic stress-related psychological care for vulnerable populations and frontline providers through traditional and virtual methods; integrated primary care settings are rapidly adapting to meet this need. Integrating more behavioral health clinicians into primary care clinics will provide better access to whole-person care when it is needed most. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Shepardson RL, Minnick MR, Funderburk JS. Anxiety interventions delivered in primary care behavioral health routine clinical practice. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2020; 38:193-199. [PMID: 32525354 PMCID: PMC8314503 DOI: 10.1037/fsh0000493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Although anxiety is highly prevalent in primary care and a top reason for referral to primary care behavioral health (PCBH) services, there are limited data on which anxiety interventions are used in routine PCBH practice. The objective of this study was to identify interventions delivered when treating anxiety in PCBH practice. METHOD We conducted an online survey of PCBH providers regarding their clinical practice with patients who present for treatment of anxiety symptoms. The final sample comprised 209 PCBH providers recruited from e-mail listservs of national professional organizations (59.3% psychologists, 23.4% social workers, 12.4% counselors, 4.8% other). Providers reported on use (yes/no) of 17 interventions in their most recent session with their most recent adult patient presenting with a primary concern of non-trauma-related anxiety. RESULTS On average, patients were reported to be 42.2 (14.73) years old, White (73.7%), and male (56.5%) with anxiety symptoms of moderate severity (65.6%). Most reportedly had comorbid sleep difficulties (63.6%), depressive symptoms (58.4%), and/or stress/adjustment (56.0%). Providers reported delivering an average of 5.77 (2.05, range: 1-15) interventions, with psychoeducation (94.7%), relaxation training (64.1%), and supportive therapy (60.8%) being most common. Several highly efficacious evidence-based interventions for anxiety, including cognitive therapy (45.0%) and exposure (21.1%), were less common. DISCUSSION While PCBH providers delivered numerous brief interventions for anxiety, cognitive therapy and exposure were underutilized. Furthermore, PCBH patients with anxiety symptoms were complex, with significant severity and comorbidity. These results suggest implications for research, clinical training, intervention design, and future implementation efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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20
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Carroll AJ, Jaffe AE, Stanton K, Guille C, Lazenby GB, Soper DE, Gilmore AK, Holland-Carter L. Program Evaluation of an Integrated Behavioral Health Clinic in an Outpatient Women's Health Clinic: Challenges and Considerations. J Clin Psychol Med Settings 2019; 27:207-216. [PMID: 31858362 DOI: 10.1007/s10880-019-09684-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many women receive their regular check-ups and preventive care through a women's health clinic, including their behavioral health needs. Most of these clinics have not yet developed the capacity to adequately manage behavioral health concerns. We describe our clinical experience integrating behavioral health services into a women's health clinic. In one year, 108 women (54% White, Mage= 35) were referred for behavioral health treatment 47% were identified using a screening questionnaire, 51% were referred by their women's health provider and 2% were self-referred. The most common presenting concerns were anxiety (52%) and depressive symptoms (48%). Sixty-one (56%) patients completed an intake assessment, of whom 33 (54%) engaged in follow-up treatment (M = 3.7 treatment sessions, SD = 3.0). Behavioral health screening and treatment appears to be feasible and effective within a women's health setting. Further research is needed to overcome barriers to referrals and treatment engagement in this population.
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Affiliation(s)
- Allison J Carroll
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.,Bluhm Cardiovascular Institute of Northwestern, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anna E Jaffe
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kimberley Stanton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.,Psychology Houston, PC, Houston, TX, USA
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.,Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Gweneth B Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - David E Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda K Gilmore
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA. .,College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, MSC 160, Charleston, SC, 29425, USA. .,Department of Health Policy and Behavioral Sciences and Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State University, P. O. Box 3995, Atlanta, GA, 30303, USA.
| | - Lauren Holland-Carter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA.
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Trafalis S, Friedberg RD. Better Together: Integrated Behavioral Health Care Services. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/266608221502190906094707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sandra Trafalis
- Center for the Study and Treatment of Anxious Youth at Palo Alto University, Palo Alto, CA 94304, United States
| | - Robert D. Friedberg
- Center for the Study and Treatment of Anxious Youth at Palo Alto University, Palo Alto, CA 94304, United States
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22
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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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23
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Bell Scott B, Doss S, Myers D, Hess B. Addressing externalized behavioral concerns in primary care: Listening to the voices of parents. SOCIAL WORK IN HEALTH CARE 2019; 58:14-31. [PMID: 30130473 DOI: 10.1080/00981389.2018.1508114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
This article presents the perceptions parents have of the causative and curative factors for their child's externalized behaviors and what treatment they prefer to receive from their primary care integrated behavioral health team. This is a qualitative study, using interpretative phenomenological analysis. Semi-structured interviews were conducted with a purposive sample of 12 parents representing 14 patients with a disruptive behavior disorder (DBD) who sought care from their primary care physician for treatment of the DBD. Participants spoke of uncertainty of the cause of the DBD and the desire to find parenting approaches that augment the effectiveness of pharmacological intervention provided by the primary care team. Parents' responses suggest that they are eager for more education about their child's DBD and how to engage at-home management of the symptoms. Discussion focused on the import of considering the voices of these parents when implementing brief parent management training programs in integrated behavioral health primary care programs.
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Affiliation(s)
- Becky Bell Scott
- a Garland School of Social Work , Baylor University , Waco , Texas
| | - Susanna Doss
- a Garland School of Social Work , Baylor University , Waco , Texas
| | - Dennis Myers
- a Garland School of Social Work , Baylor University , Waco , Texas
| | - Burrit Hess
- b Waco Family Medicine Residency Program , Waco , Texas
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24
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Sanchez Gonzalez ML, McCord CE, Dopp AR, Tarlow KR, Dickey NJ, McMaughan DK, Elliott TR. Telemental health training and delivery in primary care: A case report of interdisciplinary treatment. J Clin Psychol 2018; 75:260-270. [PMID: 30589440 DOI: 10.1002/jclp.22719] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Telehealth can overcome access and availability barriers that often impede receiving needed mental health services. This case report describes an interdisciplinary approach to treatment for an individual with chronic physical health conditions and comorbid mental health concerns, which resulted in high utilization (and associated costs) of preventable emergency services. The report describes clinical case progression on anxiety symptoms and emergency service utilization while concurrently highlighting telehealth-specific practice implications, especially as they pertain to training settings.
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Affiliation(s)
| | - Carly E McCord
- Department of Psychiatry and Department of Educational Psychology, Texas A&M University, Texas
| | - Alex R Dopp
- Department of Psychological Sciences, University of Arkansas, Arkansas
| | | | - Nancy J Dickey
- Department of Family & Community Medicine, Texas A&M University, Texas
| | - Darcy K McMaughan
- Health Policy and Management Department, Texas A&M University, Texas
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25
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Reppeto H, Tuning C, Olsen DH, Mullane A, Smith C. Triple Aim: Benefits of behavioral health providers in primary care. J Health Psychol 2018; 26:205-213. [PMID: 30318920 DOI: 10.1177/1359105318802949] [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: 11/16/2022] Open
Abstract
There is little research on behavioral health consultants addressing The Triple Aim goals in a community setting. This study examined the behavioral health consultants' effect on (1) reducing overall patient cost and (2) improving population health by examining psychological screening measures, healthcare utilization, and hospital charges. Results revealed changes in patient charges: emergency department encounters reduce by 8 percent, psychological distress significantly decrease (Patient Health Questionnaire-9, 13.9 to 10.9, p < 0.001; Generalized Anxiety Disorder-7, 12.2 to 9.8, p < 0.001), and reduction in suicidal ideation (p < 0.001) following behavioral health consultant contact. Findings suggest that utilization of behavioral health consultants help health care systems meet The Triple Aim goals.
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26
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Possemato K, Johnson EM, Beehler GP, Shepardson RL, King P, Vair CL, Funderburk JS, Maisto SA, Wray LO. Patient outcomes associated with primary care behavioral health services: A systematic review. Gen Hosp Psychiatry 2018; 53:1-11. [PMID: 29698902 DOI: 10.1016/j.genhosppsych.2018.04.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/13/2018] [Accepted: 04/15/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE This systematic review focused on Primary Care Behavioral Health (PCBH) services delivered under normal clinic conditions that included the patient outcomes of: 1) access/utilization of behavioral health services, 2) health status, and 3) satisfaction. METHOD Following PRISMA guidelines, comprehensive database searches and rigorous coding procedures rendered 36 articles meeting inclusion criteria. The principle summary measures of odd ratios or Cohen's d effect sizes were reported. RESULTS Due to significant limitations in the methodological rigor of reviewed studies, robust findings only emerged for healthcare utilization: PCBH is associated with shorter wait-times for treatment, higher likelihood of engaging in care, and attending a greater number of visits. Several small, uncontrolled studies report emerging evidence that functioning, depression, and anxiety improve overtime. There was no evidence of greater improvement in patient health status when PCBH was compared to other active treatments. The limited available evidence supports that patient satisfaction with PCBH services is high. CONCLUSIONS The implementation of PCBH services is ahead of the science supporting the usefulness of these services. Patient outcomes for PCBH are weaker than outcomes for Collaborative Care. More rigorous investigations of patient outcomes associated with PCBH are needed to allow for optimization of services.
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Affiliation(s)
- Kyle Possemato
- VA Center for Integrated Healthcare, New York/New Jersey VA Healthcare System, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States.
| | - Emily M Johnson
- VA Center for Integrated Healthcare, New York/New Jersey VA Healthcare System, United States
| | - Gregory P Beehler
- VA Center for Integrated Healthcare, New York/New Jersey VA Healthcare System, United States; Community Health and Health Behavior, University at Buffalo, Buffalo, NY, United States
| | - Robyn L Shepardson
- VA Center for Integrated Healthcare, New York/New Jersey VA Healthcare System, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Paul King
- VA Center for Integrated Healthcare, New York/New Jersey VA Healthcare System, United States; Department of Counseling, School, and Educational Psychology, University at Buffalo, Buffalo, NY, United States
| | | | - Jennifer S Funderburk
- VA Center for Integrated Healthcare, New York/New Jersey VA Healthcare System, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States; Department of Psychiatry, University of Rochester, Rochester, NY, United States
| | - Stephen A Maisto
- VA Center for Integrated Healthcare, New York/New Jersey VA Healthcare System, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Laura O Wray
- VA Center for Integrated Healthcare, New York/New Jersey VA Healthcare System, United States; Division of Geriatrics/Palliative Care, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, United States
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Amati F, Banks C, Greenfield G, Green J. Predictors of outcomes for patients with common mental health disorders receiving psychological therapies in community settings: a systematic review. J Public Health (Oxf) 2017; 40:e375-e387. [DOI: 10.1093/pubmed/fdx168] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- F Amati
- NIHR CLAHRC NWL, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - C Banks
- WHO Collaborating Centre for Public Health Training and Education, School of Public Health, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - G Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - J Green
- CNWL NHS Foundation Trust, Academic Lead at NIHR CLAHRC NWL, London, UK
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Black DR. Preparing the workforce for integrated healthcare: A systematic review. SOCIAL WORK IN HEALTH CARE 2017; 56:914-942. [PMID: 28862917 DOI: 10.1080/00981389.2017.1371098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Integrated healthcare is recommended to deliver care to individuals with co-occurring medical and mental health conditions. This literature review was conducted to identify the knowledge and skills required for behavioral health consultants in integrated settings. A review from 1999 to 2015 identified 68 articles. Eligible studies examined care to the U.S. adult population at the highest level of integration. The results provide evidence of specific knowledge of medical and mental health diagnoses, screening instruments, and intervention skills in integrated primary care, specialty medical, and specialty mental health. Further research is required to identify methods to develop knowledge/skills in the workforce.
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Affiliation(s)
- Denise R Black
- a College of Social Work , University of Tennessee , Knoxville , TN , USA
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29
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Primary Care Behavioral Health (PCBH) Model Research: Current State of the Science and a Call to Action. J Clin Psychol Med Settings 2017; 25:127-156. [DOI: 10.1007/s10880-017-9512-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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30
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Sadock E, Perrin PB, Grinnell RM, Rybarczyk B, Auerbach SM. Initial and Follow-Up Evaluations of Integrated Psychological Services for Anxiety and Depression in a Safety Net Primary Care Clinic. J Clin Psychol 2017; 73:1462-1481. [PMID: 28152186 DOI: 10.1002/jclp.22459] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Despite the recognized importance of integrated behavioral health, particularly in safety net primary care, its effectiveness in real world settings has not been extensively evaluated. This article presents 2 successive studies examining the effectiveness of integrated behavioral care in a safety net setting. METHOD Study 1 compared the depression and anxiety scores of predominately low-income and minority patients who underwent brief interventions (N = 147) to those of patients from a demographically similar comparison clinic without integrated psychological services, matched on baseline levels of anxiety and depression and length of time between assessments (N = 139). Study 2 did not include a control group but served as a long-term follow-up assessment of anxiety and depression for a subset of 47 patients who finished treatment and could be reached by telephone within 6-18 months of their last session. RESULTS Study 1 found that patients from the clinic with integrated psychology services experienced greater decreases in depression and anxiety scores than patients in the control clinic. These effects did not differ as a function of age, gender, or race. Study 2 found that patients continued to decline in depression and anxiety over time, with lower scores at the last session and even lower scores after longer-term follow-up ranging from 6 to18 months. These improvements remained significant when controlling for other interim mental health treatments. CONCLUSION These results support the short- and long-term treatment effects of brief primary care behavioral interventions, further strengthening the case for integrated behavioral healthcare in safety net settings.
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Andrews AR, Gomez D, Larey A, Pacl H, Burchette D, Rodriguez JH, Pastrana FA, Bridges AJ. Comparison of integrated behavioral health treatment for internalizing psychiatric disorders in patients with and without Type 2 diabetes. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2016; 34:367-377. [PMID: 27669050 PMCID: PMC5266537 DOI: 10.1037/fsh0000224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Type 2 diabetes is often comorbid with internalizing mental health disorders and associated with greater psychiatric treatment resistance. Integrating psychotherapy into primary care can help treat internalizing disorders generally. We explored whether such treatment had comparable effectiveness in patients with and without Type 2 diabetes. METHOD Participants were 468 consecutive adults (23% male; 62% Hispanic, Mage = 41.46 years) referred by medical staff for psychotherapy appointments to address internalizing symptoms (e.g., depression). After each visit, patients completed a self-report measure and clinicians assessed patient symptom severity. These data and demographics extracted from electronic medical records were analyzed using descriptive and multilevel modeling analyses. RESULTS Patients with and without diabetes were similar in types of internalizing disorders experienced and baseline clinician- and self-reported symptomology. Multilevel modeling suggested improvements in self-reported symptomology was comparable across patient groups; however, only patients without diabetes significantly improved according to clinician reports. DISCUSSION Although findings suggested integrated psychotherapy resulted in comparable patient-reported reductions of internalizing symptoms, these effects were not evident in clinician reports of diabetic patients. Possible reasons for this discrepancy (e.g., reporting biases) are discussed. Integrated psychotherapy for internalizing disorders may be effective for Type 2 diabetic patients, though caution is warranted. (PsycINFO Database Record
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Affiliation(s)
- Arthur R. Andrews
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC 29425 USA
| | - Debbie Gomez
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72701 USA
| | - Austin Larey
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72701 USA
| | - Hayden Pacl
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72701 USA
| | - Dennis Burchette
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72701 USA
| | | | - Freddie A. Pastrana
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72701 USA
| | - Ana J. Bridges
- Department of Psychological Science, University of Arkansas, Fayetteville, AR 72701 USA
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Lanoye A, Stewart KE, Rybarczyk BD, Auerbach SM, Sadock E, Aggarwal A, Waller R, Wolver S, Austin K. The Impact of Integrated Psychological Services in a Safety Net Primary Care Clinic on Medical Utilization. J Clin Psychol 2016; 73:681-692. [PMID: 27505218 DOI: 10.1002/jclp.22367] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/13/2016] [Accepted: 06/21/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The integration of psychological and behavioral health services into safety net primary care clinics has been viewed as a step toward reducing disparities in mental health treatment and addressing behavioral factors in chronic diseases. Though it is posited that integrated behavioral health (IBH) reduces preventable medical costs, this premise has yet to be tested in a safety net primary care clinic. METHOD Retrospective pre- and posttreatment analysis with quasi-experimental control group was constructed using propensity score matching. Participants included 1,440 adult patients at a safety net primary care clinic, 720 of whom received IBH services, and 720 of whom received medical treatment only. RESULTS Analysis showed that rates of preventable inpatient utilization decreased significantly among IBH-treated patients compared to no change among control patients. CONCLUSION IBH was associated with decreased rates of preventable inpatient visits. IBH may present opportunities to deliver improved holistic patient care while reducing unnecessary inpatient medical utilization.
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Kear BM, Guck TP, McGaha AL. Timed Up and Go (TUG) Test: Normative Reference Values for Ages 20 to 59 Years and Relationships With Physical and Mental Health Risk Factors. J Prim Care Community Health 2016; 8:9-13. [PMID: 27450179 DOI: 10.1177/2150131916659282] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The Timed Up and Go (TUG) test is a reliable, cost-effective, safe, and time-efficient way to evaluate overall functional mobility. However, the TUG does not have normative reference values (NRV) for individuals younger than 60 years. The purpose of this study was to establish NRV for the TUG for individuals aged between 20 and 59 years and to examine the relationship between the TUG and demographic, physical, and mental health risk factors. METHODS Two hundred participants, 50 per decade (ages 20-29, 30-39, 40-49, 50-59 years) were selected at their primary care visit, and timed as they performed the TUG by standing up out of a chair, walking 3 m, turning around, walking back to the chair, and sitting down. Information regarding the risk factors socioeconomic status, body mass index, an index of multimorbidities, perceptions of overall physical and mental health was obtained and used as predictors of TUG time independent of age. RESULTS TUG times were significantly different among the decades ( F = 6.579, P = .001) with slower times occurring with the 50-year-old decade compared with the 20s ( P = .001), 30s ( P = .001), and 40s ( P = .020). Slower TUG times were associated with lower SES, higher body mass index, more medical comorbidities, and worse perceived physical and mental health. Regression results indicated that perceived physical and mental health accounted for unique variance in the prediction of TUG time beyond age, gender, and socioeconomic status. CONCLUSIONS This study provided TUG NRV for adults in their 20s, 30s, 40s, and 50s. The TUG may have utility for primary care providers as they assess and monitor physical activity in younger adults, especially those with physical and mental health risk factors.
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Affiliation(s)
- Breelan M Kear
- 1 Creighton University School of Medicine, Omaha, NE, USA
| | - Thomas P Guck
- 1 Creighton University School of Medicine, Omaha, NE, USA
| | - Amy L McGaha
- 1 Creighton University School of Medicine, Omaha, NE, USA
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Lilienthal K, Possemato K, Funderburk J, Wade M, Eaker A, Beehler GP. Predisposing Characteristics, Enabling Factors, and Need as Predictors of Integrated Behavioral Health Utilization. J Behav Health Serv Res 2016; 44:263-273. [DOI: 10.1007/s11414-016-9496-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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