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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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Wooten NR, Tavakoli AS, Al-Barwani MB, Thomas NA, Chakraborty H, Scheyett AM, Kaminski KM, Woods AC, Levkoff SE. Comparing behavioral health models for reducing risky drinking among older male veterans. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 43:545-555. [PMID: 28410002 PMCID: PMC5604788 DOI: 10.1080/00952990.2017.1286499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/20/2017] [Accepted: 01/21/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Screening older veterans in Veterans Affairs Medical Center (VAMC) primary care clinics for risky drinking facilitates early identification and referral to treatment. OBJECTIVE This study compared two behavioral health models, integrated care (a standardized brief alcohol intervention co-located in primary care clinics) and enhanced referral care (referral to specialty mental health or substance abuse clinics), for reducing risky drinking among older male VAMC primary care patients. VAMC variation was also examined. METHOD A secondary analysis of longitudinal data from the Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study, a multisite randomized controlled trial, was conducted with a sample of older male veterans (n = 438) who screened positive for risky drinking and were randomly assigned to integrated or enhanced referral care at five VAMCs. RESULTS Generalized estimating equations revealed no differences in either behavioral health model for reducing risky drinking at a 6-month follow-up (AOR: 1.46; 95% CI: 0.42-5.07). Older veterans seen at a VAMC providing geriatric primary care and geriatric evaluation and management teams had lower odds of risky drinking (AOR: 0.24; 95% CI: 0.07-0.81) than those seen at a VAMC without geriatric primary care services. CONCLUSIONS Both integrated and enhanced referral care reduced risky drinking among older male veterans. However, VAMCs providing integrated behavioral health and geriatric specialty care may be more effective in reducing risky drinking than those without these services. Integrating behavioral health into geriatric primary care may be an effective public health approach for reducing risky drinking among older veterans.
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Affiliation(s)
- Nikki R. Wooten
- College of Social Work, University of South Carolina, Columbia, SC, USA
- Lieutenant Colonel, U. S. Army Reserves, Columbia, SC, USA
| | | | | | - Naomi A. Thomas
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | | | | | - Kelly M. Kaminski
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Alyssia C. Woods
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Sue E. Levkoff
- College of Social Work, University of South Carolina, Columbia, SC, USA
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Simioni N, Cottencin O, Rolland B. Interventions for Increasing Subsequent Alcohol Treatment Utilisation Among Patients with Alcohol Use Disorders from Somatic Inpatient Settings: A Systematic Review. Alcohol Alcohol 2015; 50:420-9. [DOI: 10.1093/alcalc/agv017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 02/17/2015] [Indexed: 11/13/2022] Open
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Cucciare MA, Coleman EA, Saitz R, Timko C. Enhancing Transitions from Addiction Treatment to Primary Care. J Addict Dis 2014; 33:340-53. [PMID: 25299380 DOI: 10.1080/10550887.2014.969602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Although the myth that older adults do not use mood-altering substances persists, evidence suggests that substance use among older adults has been underidentified for decades. The baby boom generation is unique in its exposure to, attitudes toward, and prevalence of substance use-causing projected rates of substance use to increase over the next twenty years. Given their unique biological vulnerabilities and life stage, older adults who misuse substances require special attention. Prevalence rates of substance use and misuse among older adults, methods of screening and assessment unique to older adults, and treatment options for older adults are reviewed.
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Affiliation(s)
- Alexis Kuerbis
- Department of Mental Health Services and Policy Research, Research Foundation for Mental Hygiene, Inc, Columbia University Medical Center, 3 Columbus Circle, Suite 1404, New York, NY 10019, USA.
| | - Paul Sacco
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA
| | - Dan G Blazer
- Department of Psychiatry and Behavioral Sciences, Academic Development, Duke University, DUMC 3003, Durham, NC 27710, USA
| | - Alison A Moore
- Department of Medicine, Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 90095, USA
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Abstract
With the "Baby Boom" cohort reaching the age of 65 years, the older adult population is growing and will continue to grow at a rapid rate. There is a substantial and growing number of older adults who misuse alcohol, psychoactive prescription drugs, and/or other substances. The emerging literature on the cohort of aging adults indicates that they are continuing to use alcohol and psychoactive prescription medications at a higher rate than previous generations. The development and refinement of techniques to address these problems and provide early intervention services is going to be crucial to meeting the needs of this growing population. This chapter provides background on the extent of the problem, guidelines for alcohol and psychoactive medication use, and methods for screening and providing early interventions to improve the lives of older adults who misuse alcohol and/or psychoactive medications and drugs.
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Affiliation(s)
- Frederic C Blow
- Department of Psychiatry, North Campus Research Complex, University of Michigan, Building 14, Ann Arbor, MI 49109, USA.
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Implementation of Primary Care-Mental Health Integration Services in the Veterans Health Administration: Program Activity and Associations with Engagement in Specialty Mental Health Services. J Clin Psychol Med Settings 2012; 19:105-16. [DOI: 10.1007/s10880-011-9285-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Age group differences among veterans enrolled in a clinical service for behavioral health issues in primary care. Am J Geriatr Psychiatry 2012; 20:205-14. [PMID: 20808141 DOI: 10.1097/jgp.0b013e3181ec828a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES : To examine age group differences in the identification, engagement, clinical outcomes, and monitoring of older, relative to middle aged and younger, veterans with behavioral health needs enrolled in an integrated care management program DESIGN : Cross-sectional and longitudinal SETTING : Primary care clinics affiliated with two Veterans Affairs Medical Centers PARTICIPANTS : A total of 9,087 veterans were referred to the Behavioral Health Laboratory (BHL) for a behavioral health assessment and 7,251 completed an initial assessment MEASUREMENTS : Data on consult source and reason for the referral, clinical assessment outcomes, and engagement were collected during a 3-year period. Variations in process and patient-level factors were examined as a function of age group. RESULTS : Although all age groups evidenced high rates of engagement in clinical assessment calls, older adults were slightly more likely to complete the assessments than young/middle-aged veterans. Clinical assessment outcomes revealed that although older adults were less likely to meet criteria for more complex, severe conditions, rates of disorder remained clinically significant, and comorbidity was common. Finally, older veterans receiving treatment monitoring for a newly prescribed antide- pressant consistently reported high rates of antidepressant adherence during the course of the monitoring calls and showed significant reductions in depressive symptomatology during the course of monitoring. CONCLUSIONS : Results indicate age-related variability in processes and outcomes among veterans referred to the BHL and suggest that older veterans are just as likely to benefit from a program designed to facilitate the identification, engagement, monitoring, and care management of primary care patients experiencing behavioral health issues.
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McGuire J, Gelberg L, Blue-Howells J, Rosenheck RA. Access to primary care for homeless veterans with serious mental illness or substance abuse: a follow-up evaluation of co-located primary care and homeless social services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2009; 36:255-64. [PMID: 19280333 DOI: 10.1007/s10488-009-0210-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 02/23/2009] [Indexed: 11/29/2022]
Abstract
To examine the hypothesis that a demonstration clinic integrating homeless, primary care, and mental health services for homeless veterans with serious mental illness or substance abuse would improve medical health care access and physical health status. A quasi-experimental design comparing a 'usual VA care' group before the demonstration clinic opened (N = 130) and the 'integrated care' group (N = 130). Regression models indicated that the integrated care group was more rapidly enrolled in primary care, received more prevention services and primary care visits, and fewer emergency department visits, and was not different in inpatient utilization or in physical health status over 18 months. The demonstration clinic improved access to primary care services and reduced emergency services but did not improve perceived physical health status over 18 months. Further research is needed to determine generalizability and longer term effects.
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Affiliation(s)
- James McGuire
- Department of Veterans Affairs Northeast Program Evaluation Center (NEPEC), Los Angeles, CA, USA.
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Banerjea R, Sambamoorthi U, Smelson D, Pogach LM. Expenditures in mental illness and substance use disorders among veteran clinic users with diabetes. J Behav Health Serv Res 2008; 35:290-303. [PMID: 18512155 DOI: 10.1007/s11414-008-9120-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Accepted: 03/21/2008] [Indexed: 11/29/2022]
Abstract
Few studies have looked at the health-care expenditures of diabetes patients based on the type of co-occurring conditions of mental illness (MI) or substance use disorders (SUD). Our study analyzes the health-care expenditures associated with various diagnostic clusters of co-occurring drug, alcohol, tobacco use, and mental illness in veterans with diabetes. We merged Veteran Health Administration and Medicare fee-for-service claims database (fiscal years 1999 and 2000) for analysis (N = 390,253) using generalized linear models; SUD/MI were identified using International Classification of Diseases, 9th edition codes. The total average expenditures (fiscal year 2000) were lowest ($6,185) in the "No MI and No SUD" and highest ($19,801) for individuals with schizophrenia/other psychoses and alcohol/drug use. High expenditures were associated with both SUD and MI conditions in diabetes patients, and veterans with alcohol/drug use had the highest expenditures across all groups of MI. These findings reinforce the need to target groups with multiple comorbidities specifically those with serious mental illnesses and alcohol/drug use for interventions to reduce health-care expenditures.
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Affiliation(s)
- Ranjana Banerjea
- Center for Healthcare Knowledge Management, VA New Jersey Healthcare System, East Orange, NJ, USA.
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Zanjani F, Mavandadi S, TenHave T, Katz I, Durai NB, Krahn D, Llorente M, Kirchner J, Olsen E, Van Stone W, Cooley S, Oslin DW. Longitudinal course of substance treatment benefits in older male veteran at-risk drinkers. J Gerontol A Biol Sci Med Sci 2008; 63:98-106. [PMID: 18245767 DOI: 10.1093/gerona/63.1.98] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This investigation aims to determine the 12-month drinking trajectory of older at-risk drinkers in treatment. Furthermore, the drinking trajectory between at-risk drinkers who had met the threshold suggestive of alcohol dependence (problem at-risk drinkers) and those who did not meet this threshold (nonproblematic at-risk drinkers) were compared. METHODS This investigation is a component of the PRISM-E (Primary Care Research in Substance Abuse and Mental Health for the Elderly) Study, a multisite randomized trial comparing service use, outcomes, and cost between Integrated (IC) versus Enhanced Specialty Referral (ESR) care models for older (65+ years) adults with depression, anxiety, and/or at-risk alcohol consumption. This investigation focuses only on at-risk drinkers, generally defined as exceeding recommended drinking limits, which in the case of older adults has been classified as consuming more than one drink per day. Two hundred fifty-eight randomized older at-risk drinkers were examined, of whom 56% were problem drinkers identified through the Short Michigan Alcohol Screening Test-Geriatric version. RESULTS Over time, all at-risk drinkers showed a significant reduction in drinking. Problem drinkers showed reductions in average weekly consumption and number of occurrences of binge drinking at 3, 6, and 12 months, whereas nonproblematic drinkers showed significant reductions in average weekly consumption at 3, 6, and 12 months and number of occurrences of binge drinking at only 6 months. IC treatment assignment led to higher engagement in treatment, which led to better binge drinking outcomes for problem drinkers. Despite significant reductions in drinking, approximately 29% of participants displayed at-risk drinking at the end of the study. CONCLUSIONS Results suggest that older at-risk drinkers, both problem and nonproblematic, show a considerable decrease in drinking, with slightly greater improvement evidenced in problem drinkers and higher engagement in treatment seen in those assigned to IC.
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Affiliation(s)
- Faika Zanjani
- Graduate Center for Gerontology, University of Kentucky, Lexington, KY 41094, USA.
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Abstract
The relationship between alcohol use and later-life depression is complex. At-risk and problem drinking elevates the risk of depressive symptoms. The co-occurrence of alcohol use disorders and depression increases the potential for poor mental and physical health outcomes in older adults. Many older adults who are experiencing problems related to alcohol use do not meet alcohol abuse/dependence criteria. Depressive symptoms among older adults often are overlooked or misdiagnosed. The role of at-risk and problem alcohol use in depressive symptoms and vice versa may be underestimated. After a review of the literature, clinical recommendations for addressing late-life alcohol misuse and depression are presented.
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Affiliation(s)
- Frederic C Blow
- University of Michigan Department of Psychiatry, 4250 Plymouth Road, Campus Box 5765, Ann Arbor, MI 48109-2700, USA.
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