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Ogbeide SA, Knight C, Young A, George D, Houston B, Wicoff M, Johnson-Esparza Y, Gibson-Lopez G. Current Practices in Clinical Supervision in Primary Care. J Clin Psychol Med Settings 2024; 31:316-328. [PMID: 38347384 DOI: 10.1007/s10880-023-10001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 05/20/2024]
Abstract
The purpose of this study was to examine current clinical supervision practices within primary care settings. We used a descriptive survey design, which blends quantitative and qualitative data, and examined the current state of clinical supervision practices and approaches in primary care and the type of training the behavioral health consultants received to provide supervision to pre-licensure level behavioral health trainees. Ninety-four participants completed the survey in 2022. Seventy-one percent of respondents felt they had adequate training to be an effective integrated behavioral health (IBH) supervisor; however, most training came from sources, such as workshops, continuing education, or supervision of supervision. Further efforts to establish universal competencies and formal training programs are needed to meet the growing need for IBH services in primary care.
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Affiliation(s)
| | - Cory Knight
- University of Houston - Clearlake, Houston, TX, USA
| | | | - Deepu George
- UT Rio Grande Valley School of Medicine, Edinburg, TX, USA
| | | | - Maribeth Wicoff
- Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
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Shepardson RL, Fletcher TL, Funderburk JS, Weisberg RB, Beehler GP, Maisto SA. Barriers to and facilitators of using evidence-based, cognitive-behavioral anxiety interventions in integrated primary care practice. Psychol Serv 2023; 20:709-722. [PMID: 35951391 PMCID: PMC10166237 DOI: 10.1037/ser0000696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cognitive-behavioral treatment for anxiety disorders and symptoms remains underutilized in integrated primary care (IPC), in part because the many treatments developed for specialty care are not readily translated to this unique setting. The objective of this study was to identify barriers and facilitators to behavioral health providers (BHPs) delivering evidence-based cognitive--behavioral anxiety interventions within IPC practice. We conducted semistructured interviews with a national sample of 18 BHPs (50% psychologists, 33% social workers, 17% registered nurses) working in IPC in the Veterans Health Administration. We assessed barriers to and facilitators of using psychoeducation, exposure, cognitive therapy, relaxation training, mindfulness/meditation, Acceptance and Commitment Therapy-based interventions, and problem-solving therapy. Qualitative coding and conventional content analysis revealed barriers and facilitators at three levels: IPC, provider, and patient. Themes suggested key barriers of poor fit with the IPC model, BHP training deficits, and lack of patient buy-in, and key facilitators of good perceived fit of the intervention (e.g., scope, duration) with the IPC model, BHPs feeling well equipped, and utility for patients. BHPs select interventions based on fit for the individual patient. Some results were consistent with prior work from specialty care, but the IPC model itself introduces significant implementation challenges. BHPs would benefit from flexible intervention options and training on IPC treatment goals and how to deliver the essence of evidence-based interventions in small doses. Our findings will help to inform adaptation of behavioral anxiety interventions to better fit IPC practice and development of beneficial training and resources for BHPs to reduce implementation challenges. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
| | - Terri L. Fletcher
- VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
- VA South Central Mental Illness Research, Education, and Clinical Center
| | - Jennifer S. Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
- Department of Psychiatry, University of Rochester
| | - Risa B. Weisberg
- VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
- Department of Family Medicine, Alpert Medical School, Brown University
| | - Gregory P. Beehler
- Center for Integrated Healthcare, VA Western New York Healthcare System
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Stephen A. Maisto
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
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Al-Bedaery R, Rosenthal J, Protheroe J, Reeve J, Ibison J. Primary care in the world of integrated care systems: education and training for general practice. Future Healthc J 2023; 10:253-258. [PMID: 38162216 PMCID: PMC10753223 DOI: 10.7861/fhj.2023-0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Here, we discuss the required education and training for the emergent and evolving roles of GPs and other healthcare professionals within Integrated Care Systems (ICSs). We underscore the importance of collaborative skills for all medical specialties, and the need for interprofessional education and leadership development in undergraduate and postgraduate medical training. We also argue for a paradigm shift in medical education, away from traditional siloed approaches and toward comprehensive training that prepares practitioners to excel in integrated and multidisciplinary healthcare environments, within which expert generalists (GPs) and specialists collaborate in individual patient care and concurrently co-develop innovative system pathways for chronic medical conditions, including complexity and frailty. We highlight the need to align workforce development with evolving healthcare systems and the existing obstacles hindering this alignment.
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Vriesman M, Dhuga J, LaLonde L, Orkopoulou E, Lucy C, Teeple T, Good J, Maragakis A. Clinical Psychologists as T-Shaped Professionals. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:996-1008. [PMID: 36459685 DOI: 10.1177/17456916221135615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The modern world is becoming increasingly integrated, and disciplines are frequently collaborating with each other. Following this trend, clinical psychologists are also often working within multidisciplinary teams and in settings outside of traditional mental health. To be competent and effective in these contexts, clinical psychologists could benefit from skills outside of psychology. The current psychology training model provides depth of training in psychology but could be improved by providing the breadth of training required of modern clinical psychologists working in these contexts. Other disciplines, such as engineering, business, and social work, have improved their breadth of training through the adoption of the T-shaped model. This model of training allows individuals to simultaneously acquire the depth of knowledge required for their discipline and the breadth required to work effectively in multidisciplinary contexts. This article discusses areas in which clinical psychologists could benefit from broad training and recommendations to implement the T-shaped model.
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Affiliation(s)
| | | | - Leah LaLonde
- Psychology Department, Eastern Michigan University
| | | | | | - Tatum Teeple
- Psychology Department, Eastern Michigan University
| | - Jessica Good
- Psychology Department, Eastern Michigan University
| | - Alexandros Maragakis
- Psychology Department, Eastern Michigan University
- Deree, The American College of Greece, School of Graduate and Professional Studies
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Ritchie MJ, Parker LE, Kirchner JE. Facilitating implementation of primary care mental health over time and across organizational contexts: a qualitative study of role and process. BMC Health Serv Res 2023; 23:565. [PMID: 37259064 DOI: 10.1186/s12913-023-09598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Healthcare organizations have increasingly utilized facilitation to improve implementation of evidence-based practices and programs (e.g., primary care mental health integration). Facilitation is both a role, related to the purpose of facilitation, and a process, i.e., how a facilitator operationalizes the role. Scholars continue to call for a better understanding of this implementation strategy. Although facilitation is described as dynamic, activities are often framed within the context of a staged process. We explored two understudied characteristics of implementation facilitation: 1) how facilitation activities change over time and in response to context, and 2) how facilitators operationalize their role when the purpose of facilitation is both task-focused (i.e., to support implementation) and holistic (i.e., to build capacity for future implementation efforts). METHODS We conducted individual monthly debriefings over thirty months with facilitators who were supporting PCMHI implementation in two VA networks. We developed a list of facilitation activities based on a literature review and debriefing notes and conducted a content analysis of debriefing notes by coding what activities occurred and their intensity by quarter. We also coded whether facilitators were "doing" these activities for sites or "enabling" sites to perform them. RESULTS Implementation facilitation activities did not occur according to a defined series of ordered steps but in response to specific organizational contexts through a non-linear and incremental process. Amount and types of activities varied between the networks. Concordant with facilitators' planned role, the focus of some facilitation activities was primarily on doing them for the sites and others on enabling sites to do for themselves; a number of activities did not fit into one category and varied across networks. CONCLUSIONS Findings indicate that facilitation is a dynamic and fluid process, with facilitation activities, as well as their timing and intensity, occurring in response to specific organizational contexts. Understanding this process can help those planning and applying implementation facilitation to make conscious choices about the facilitation role and the activities that facilitators can use to operationalize this role. Additionally, this work provides the foundation from which future studies can identify potential mechanisms of action through which facilitation activities enhance implementation uptake.
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Affiliation(s)
- Mona J Ritchie
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, North Little Rock, AR, 72114, USA.
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
| | - Louise E Parker
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, North Little Rock, AR, 72114, USA
- Department of Management, University of Massachusetts, 100 Morrissey Blvd, Boston, MA, 02125, USA
| | - JoAnn E Kirchner
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, North Little Rock, AR, 72114, USA
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
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Barber S, Otis M, Greenfield G, Razzaq N, Solanki D, Norton J, Richardson S, Hayhoe BWJ. Improving Multidisciplinary Team Working to Support Integrated Care for People with Frailty Amidst the COVID-19 Pandemic. Int J Integr Care 2023; 23:23. [PMID: 37303477 PMCID: PMC10253239 DOI: 10.5334/ijic.7022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 05/18/2023] [Indexed: 06/13/2023] Open
Abstract
Multidisciplinary team (MDT) working is essential to optimise and integrate services for people who are frail. MDTs require collaboration. Many health and social care professionals have not received formal training in collaborative working. This study investigated MDT training designed to help participants deliver integrated care for frail individuals during the Covid-19 pandemic. Researchers utilised a semi-structured analytical framework to support observations of the training sessions and analyse the results of two surveys designed to assess the training process and its impact on participants knowledge and skills. 115 participants from 5 Primary Care Networks in London attended the training. Trainers utilised a video of a patient pathway, encouraged discussion of it, and demonstrated the use of evidence-based tools for patient needs assessment and care planning. Participants were encouraged to critique the patient pathway, reflect on their own experiences of planning and providing patient care. 38% of participants completed a pre-training survey, 47% a post-training survey. Significant improvement in knowledge and skills were reported including understanding roles in contributing to MDT working, confidence to speak in MDT meetings, using a range of evidence-based clinical tools for comprehensive assessment and care planning. Greater levels of autonomy, resilience, and support for MDT working were reported. Training proved effective; it could be scaled up and adopted to other settings.
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Affiliation(s)
- Susan Barber
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
- Chelsea & Westminster Hospital NHS Foundation Trust, UK
| | - Michaela Otis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
- Chelsea & Westminster Hospital NHS Foundation Trust, UK
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
| | - Nasrin Razzaq
- Harrow CCG The Heights, Middlesex 59-65 Lowlands Road Harrow HA1 3AW, UK
| | - Deepa Solanki
- Integrated Care Education, Harrow ICP and Training Hub, UK
| | - John Norton
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
| | - Sonia Richardson
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
| | - Benedict W. J. Hayhoe
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London W6 8RP, UK
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Staab EM, Wan W, Li M, Quinn MT, Campbell A, Gedeon S, Schaefer CT, Laiteerapong N. Integration of primary care and behavioral health services in midwestern community health centers: A mixed methods study. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2022; 40:182-209. [PMID: 34928653 PMCID: PMC9743793 DOI: 10.1037/fsh0000660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Integrating behavioral health (BH) and primary care is an important strategy to improve health behaviors, mental health, and substance misuse, particularly at community health centers (CHCs) where disease burden is high and access to mental health services is low. Components of different integrated BH models are often combined in practice. It is unknown which components distinguish developing versus established integrated BH programs. METHOD A survey was mailed to 128 CHCs in 10 Midwestern states in 2016. Generalized estimating equation models were used to assess associations between program characteristics and stage of integration implementation (precontemplation, contemplation, preparation, action, or maintenance). Content analysis of open-ended responses identified integration barriers. RESULTS Response rate was 60% (N = 77). Most CHCs had colocated BH and primary care services, warm hand-offs from primary care to BH clinicians, shared scheduling and electronic health record (EHR) systems, and depression and substance use disorder screening. Thirty-two CHCs (42%) indicated they had completed integration and were focused on quality improvement (maintenance). Being in the maintenance stage was associated with having a psychologist on staff (odds ratio [OR] = 7.16, 95% confidence interval [CI] [2.76, 18.55]), a system for tracking referrals (OR = 3.42, 95% CI [1.03, 11.36]), a registry (OR = 2.71, 95% CI [1.86, 3.94]), PCMH designation (OR = 2.82, 95% CI [1.48, 5.37]), and a lower proportion of Black/African American patients (OR = .82, 95% CI [.75, .89]). The most common barriers to integration were difficulty recruiting and retaining BH clinicians and inadequate reimbursement. DISCUSSION CHCs have implemented many foundational components of integrated BH. Future work should address barriers to integration and racial disparities in access to integrated BH. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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O'Malley DM, Abraham CM, Lee HS, Rubinstein EB, Howard J, Hudson SV, Kieber-Emmons AM, Crabtree BF. Substance use disorder approaches in US primary care clinics with national reputations as workforce innovators. Fam Pract 2022; 39:282-291. [PMID: 34423366 PMCID: PMC8956130 DOI: 10.1093/fampra/cmab095] [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: 11/13/2022] Open
Abstract
BACKGROUND Over the last decade, primary care clinics in the United States have responded both to national policies encouraging clinics to support substance use disorders (SUD) service expansion and to regulations aiming to curb the opioid epidemic. OBJECTIVE To characterize approaches to SUD service expansion in primary care clinics with national reputations as workforce innovators. METHODS Comparative case studies were conducted to characterize different approaches among 12 primary care clinics purposively and iteratively recruited from a national registry of workforce innovators. Observational field notes and qualitative interviews from site visits were coded and analysed to identify and characterize clinic attributes. RESULTS Codes describing clinic SUD expansion approaches emerged from our analysis. Clinics were characterized as: avoidant (n = 3), contemplative (n = 5) and responsive (n = 4). Avoidant clinics were resistant to planning SUD service expansion; had no or few on-site behavioural health staff; and lacked on-site medication treatment (previously termed medication-assisted therapy) waivered providers. Contemplative clinics were planning or had partially implemented SUD services; members expressed uncertainties about expansion; had co-located behavioural healthcare providers, but no on-site medication treatment waivered and prescribing providers. Responsive clinics had fully implemented SUD; members used non-judgmental language about SUD services; had both co-located SUD behavioural health staff trained in SUD service provision and waivered medication treatment physicians and/or a coordinated referral pathway. CONCLUSIONS Efforts to support SUD service expansion should tailor implementation supports based on specific clinic training and capacity building needs. Future work should inform the adaption of evidence-based practices that are responsive to resource constraints to optimize SUD treatment access.
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Affiliation(s)
- Denalee M O'Malley
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Cilgy M Abraham
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Heather S Lee
- Department of Anthropology, Sociology, Social Work and Criminal Justice, Seton Hall University, South Orange, NJ, USA
| | - Ellen B Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, ND, USA
| | - Jenna Howard
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Shawna V Hudson
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Autumn M Kieber-Emmons
- Lehigh Valley Health Network/University of Southern Florida Morsani School of Medicine, Allentown, PA, USA
| | - Benjamin F Crabtree
- Department of Family Medicine and Community Health, Research Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Belus JM, Regenauer KS, Hutman E, Rose AL, Burnhams W, Andersen LS, Myers B, Joska JA, Magidson JF. Substance use referral, treatment utilization, and patient costs associated with problematic substance use in people living with HIV in Cape Town, South Africa. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 2:100035. [PMID: 36845899 PMCID: PMC9948858 DOI: 10.1016/j.dadr.2022.100035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/15/2021] [Accepted: 02/23/2022] [Indexed: 10/19/2022]
Abstract
Introduction Despite efforts to detect and treat problematic substance use (SU) among people living with HIV (PLWH) in South Africa, integration of HIV and SU services is limited. We sought to understand whether PLWH and problematic SU were: (a) routinely referred to SU treatment, a co-located Matrix clinic, (b) used SU treatment services when referred, and (c) the individual amount spent on SU. Methods Guided by the RE-AIM implementation science framework, we examined patient-level quantitative screening and baseline data from a pilot clinical trial for medication adherence and problematic SU. Qualitative data came from semi-structured interviews with HIV care providers (N = 8), supplemented by patient interviews (N = 15). Results None of the screened patient participants (N = 121) who were seeking HIV care and had problematic SU were engaged in SU treatment, despite the freely available co-located SU treatment program. Only 1.5% of the enrolled patient study sample (N = 66) reported lifetime referral to SU treatment. On average, patients with untreated SU spent 33.3% (SD=34.5%) of their monthly household income on substances. HIV care providers reported a lack of clarity about the SU referral process and a lack of direct communication with patients about patients' needs or interest in receiving an SU referral. Discussion SU treatment referrals and uptake were rare among PLWH reporting problematic SU, despite the high proportion of individual resources allocated to substances and the co-located Matrix site. A standardized referral policy between the HIV and Matrix sites may improve communication and uptake of SU referrals.
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Affiliation(s)
- Jennifer M. Belus
- Swiss Tropical and Public Health Institute, Department of Medicine, Basel, Switzerland,University of Basel, Basel, Switzerland,University of Maryland, Department of Psychology, College Park, MD, USA,Corresponding author at: Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel 4051, Switzerland.
| | | | - Elizabeth Hutman
- University of Maryland, School of Public Health, College Park, MD, USA
| | - Alexandra L. Rose
- University of Maryland, Department of Psychology, College Park, MD, USA
| | - Warren Burnhams
- City of Cape Town, Department of Health, Cape Town, South Africa
| | - Lena S. Andersen
- University of Copenhagen, Global Health Section, Department of Public Health, Copenhagen, Denmark
| | - Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia,South African Medical Research Council, Alcohol, Tobacco, and Other Drug Research Unit, Cape Town, South Africa,University of Cape Town, Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa
| | - John A. Joska
- University of Cape Town, HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, Cape Town, South Africa
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Howland M, Chang D, Ratzliff A, Palm-Cruz K. C-L Case Conference: Chronic Psychosis Managed in Collaborative Care. J Acad Consult Liaison Psychiatry 2021; 63:189-197. [PMID: 34902599 DOI: 10.1016/j.jaclp.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/29/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Molly Howland
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA.
| | - Denise Chang
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Anna Ratzliff
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - Katherine Palm-Cruz
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
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McGinty EE, Presskreischer R, Breslau J, Brown JD, Domino ME, Druss BG, Horvitz-Lennon M, Murphy KA, Pincus HA, Daumit GL. Improving Physical Health Among People With Serious Mental Illness: The Role of the Specialty Mental Health Sector. Psychiatr Serv 2021; 72:1301-1310. [PMID: 34074150 PMCID: PMC8570967 DOI: 10.1176/appi.ps.202000768] [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] [Indexed: 11/30/2022]
Abstract
People with serious mental illness die 10-20 years earlier, compared with the overall population, and the excess mortality is driven by undertreated physical health conditions. In the United States, there is growing interest in models integrating physical health care delivery, management, or coordination into specialty mental health programs, sometimes called "reverse integration." In November 2019, the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness convened a forum of 25 experts to discuss the current state of the evidence on integrated care models based in the specialty mental health system and to identify priorities for future research, policy, and practice. This article summarizes the group's conclusions. Key research priorities include identifying the active ingredients in multicomponent integrated care models and developing and validating integration performance metrics. Key policy and practice recommendations include developing new financing mechanisms and implementing strategies to build workforce and data capacity. Forum participants also highlighted an overarching need to address socioeconomic risks contributing to excess mortality among adults with serious mental illness.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Rachel Presskreischer
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Joshua Breslau
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Jonathan D Brown
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Marisa Elena Domino
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Benjamin G Druss
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Marcela Horvitz-Lennon
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Karly A Murphy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Harold Alan Pincus
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
| | - Gail L Daumit
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (McGinty, Presskreischer); RAND Corporation, Pittsburgh (Breslau) and Boston (Horvitz-Lennon); Mathematica, Washington, D.C. (Brown); Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Domino); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Druss); Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore (Murphy, Daumit); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Pincus)
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12
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McGinty EE, Thompson D, Murphy KA, Stuart EA, Wang NY, Dalcin A, Mace E, Gennusa JV, Daumit GL. Adapting the Comprehensive Unit Safety Program (CUSP) implementation strategy to increase delivery of evidence-based cardiovascular risk factor care in community mental health organizations: protocol for a pilot study. Implement Sci Commun 2021; 2:26. [PMID: 33663620 PMCID: PMC7931551 DOI: 10.1186/s43058-021-00129-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND People with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder experience excess mortality driven in large part by high rates of poorly controlled and under-treated cardiovascular risk factors. In the USA, integrated "behavioral health home" models in which specialty mental health organizations coordinate and manage physical health care for people with SMI are designed to improve guideline-concordant cardiovascular care for this group. Such models have been shown to improve cardiovascular care for clients with SMI in randomized clinical trials, but real-world implementation has fallen short. Key implementation barriers include lack of alignment of specialty mental health program culture and physical health care coordination and management for clients with SMI and lack of structured protocols for conducting effective physical health care coordination and management in the specialty mental health program context. This protocol describes a pilot study of an implementation intervention designed to overcome these barriers. METHODS This pilot study uses a single-group, pre/post-study design to examine the effects of an adapted Comprehensive Unit Safety Program (CUSP) implementation strategy designed to support behavioral health home programs in conducting effective cardiovascular care coordination and management for clients with SMI. The CUSP strategy, which was originally designed to improve inpatient safety, includes provider training, expert facilitation, and implementation of a five-step quality improvement process. We will examine the acceptability, appropriateness, and feasibility of the implementation strategy and how this strategy influences mental health organization culture; specialty mental health providers' self-efficacy to conduct evidence-based cardiovascular care coordination and management; and receipt of guideline-concordant care for hypertension, dyslipidemia, and diabetes mellitus among people with SMI. DISCUSSION While we apply CUSP to the implementation of evidence-based hypertension, dyslipidemia, and diabetes care, this implementation strategy could be used in the future to support the delivery of other types of evidence-based care, such as smoking cessation treatment, in behavioral health home programs. CUSP is designed to be fully integrated into organizations, sustained indefinitely, and used to continually improve evidence-based practice delivery. TRIAL REGISTRATION ClinicalTrials.gov, NCT04696653 . Registered on January 6, 2021.
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Affiliation(s)
- Emma Elizabeth McGinty
- Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205 USA
| | - David Thompson
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Karly A. Murphy
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Elizabeth A. Stuart
- Johns Hopkins University Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205 USA
| | - Nae-Yuh Wang
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Arlene Dalcin
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Elizabeth Mace
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Joseph V. Gennusa
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
| | - Gail L. Daumit
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21202 USA
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13
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Ritchie MJ, Kirchner JE, Townsend JC, Pitcock JA, Dollar KM, Liu CF. Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration. J Gen Intern Med 2020; 35:1001-1010. [PMID: 31792866 PMCID: PMC7174254 DOI: 10.1007/s11606-019-05537-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 07/18/2019] [Accepted: 09/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost. OBJECTIVE To examine the time and organizational cost of facilitating implementation of primary care mental health integration. DESIGN Descriptive analysis. PARTICIPANTS One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics. INTERVENTION Implementation facilitation tailored to the needs and resources of the setting and its stakeholders. MAIN MEASURES We documented facilitators' and stakeholders' time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organizational cost. KEY RESULTS The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders). The organizational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other. CONCLUSIONS Although facilitation can improve implementation of primary care mental health integration, it requires substantial organizational investments that may vary by site and implementation effort. Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.
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Affiliation(s)
- Mona J Ritchie
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, U.S. Department of Veterans Affairs, North Little Rock, AR, USA.
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - JoAnn E Kirchner
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, U.S. Department of Veterans Affairs, North Little Rock, AR, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James C Townsend
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, U.S. Department of Veterans Affairs, North Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Jeffery A Pitcock
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, U.S. Department of Veterans Affairs, North Little Rock, AR, USA
| | | | - Chuan-Fen Liu
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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14
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Aby M. A Case Study of Implementing Grant-Funded Integrated Care in a Community Mental Health Center. J Behav Health Serv Res 2020; 47:293-308. [PMID: 31482468 PMCID: PMC7051885 DOI: 10.1007/s11414-019-09671-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The US government funds integrated care demonstration projects to decrease health disparities for individuals with serious mental illness. Drawing on the Exploration Preparation Implementation Sustainability (EPIS) implementation framework, this case study of a community mental health clinic describes implementation barriers and sustainability challenges with grant-funded integrated care. Findings demonstrate that integrated care practices evolve during implementation and the following factors influenced sustainability: workforce rigidity, intervention clarity, policy and funding congruence between the agency and state/federal regulations, on-going support and training in practice application, and professional institutions. Implementation strategies for primary care integration within CMHCs include creating a flexible workforce, shared definition of integrated care, policy and funding congruence, and on-going support and training.
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Affiliation(s)
- Martha Aby
- University of Washington, 4101 15th Avenue NE, Seattle, WA, 98105, USA.
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15
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Mattingly JR. Medicine, with a focus on physician assistants: Addressing substance use in the 21st century. Subst Abuse 2019; 40:405-411. [PMID: 31774387 DOI: 10.1080/08897077.2019.1686727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jill R Mattingly
- College of Health Professions, Mercer University, Atlanta, Georgia, USA
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16
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Breslau J, Pritam R, Guarasi D, Horvitz-Lennon M, Finnerty M, Yu H, Leckman-Westin E. Predictors of Receipt of Physical Health Services in Mental Health Clinics. Community Ment Health J 2019; 55:1279-1287. [PMID: 30963350 PMCID: PMC7338040 DOI: 10.1007/s10597-019-00399-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 04/04/2019] [Indexed: 10/27/2022]
Abstract
To inform efforts to improve physical health care for adults with serious mental illness, this study examines predictors of provision and receipt of physical health services in freestanding mental health clinics in New York state. The number of services provided over the initial 12-months of implementation varied across clinics from 0 to 1407. Receipt of services was associated with a diagnosis of schizophrenia, frequent mental and physical health visits in the prior year, and prescription of antipsychotic medications. Additional support may also be needed to enable clinics to target patients without established patterns of frequent mental health or medical visits.
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Affiliation(s)
- Joshua Breslau
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA.
| | - Riti Pritam
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY, 12229, USA
| | - Diana Guarasi
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY, 12229, USA
| | | | - Molly Finnerty
- Langone Medical Center, New York University, New York, NY, 10016, USA
| | - Hao Yu
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA
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17
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Shellman AB, Meinert AC, Curtis DF. Physician Utilization of a Universal Psychosocial Screening Protocol in Pediatric Primary Care. Clin Pediatr (Phila) 2019; 58:957-969. [PMID: 31030553 DOI: 10.1177/0009922819845878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study evaluated physicians' utilization of a universal psychosocial screening protocol within a pediatric primary care setting. Pediatricians (n = 20) adopted a multitiered screening algorithm using the Pediatric Symptom Checklist-17 (PSC-17) within well-child checkups (WCC) for children, ages 7 and 11 years. Descriptive analyses were performed to evaluate the initial 3 years of physician screening protocol implementation to: (1) determine frequency and proportion of use and (2) examine patient outcomes associated with accessing behavioral health care. Physicians frequently initiated the protocol, administering the PSC-17 within 3678 WCC encounters, with frequency progressively increasing over the 3-year period. Results highlighted elements of screener utilization, cost-effectiveness, screening algorithm fidelity, and prevalence of psychosocial concerns identified. Secondary implementation challenges were observed after initial screening, specific to implementation of prescribed follow-up procedures. Primary care behavioral health collaborations appear helpful for improving universal screening utilization and cost-effectiveness, and for ensuring children with psychosocial problems are identified early and directed to follow-up care as needed.
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Affiliation(s)
- Alison B Shellman
- 1 The University of Texas Health Science Center at Houston, TX, USA.,2 Texas Children's Hospital, Houston, TX, USA
| | | | - David F Curtis
- 2 Texas Children's Hospital, Houston, TX, USA.,4 The University of Texas at Austin, TX, USA
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18
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Zimbudzi E, Lo C, Robinson T, Ranasinha S, Teede HJ, Usherwood T, Polkinghorne KR, Kerr PG, Fulcher G, Gallagher M, Jan S, Cass A, Walker R, Russell G, Johnson G, Zoungas S. The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study. PLoS One 2019; 14:e0219685. [PMID: 31306453 PMCID: PMC6629146 DOI: 10.1371/journal.pone.0219685] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/30/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To address guideline-practice gaps and improve management of patients with both diabetes and chronic kidney disease (CKD), we involved patients, health professionals and patient advocacy groups in the co-design and implementation of an integrated diabetes-kidney service. OBJECTIVE In this study, we explored the experiences of patients and health-care providers, within this integrated diabetes and kidney service. METHODS 5 focus groups and 2 semi-structured interviews were conducted amongst attending patients, referring primary health professionals, and attending specialist health professionals. Maximal variation sampling was used for both patients and referring primary health professionals to ensure an equal representation of males and females, and patients of different CKD stages. All discussions were audiotaped and transcribed verbatim, before being thematically analysed independently by 2 researchers. RESULTS The mean age (SD) for specialist health professionals, primary care professionals and patients who participated was 45 (11), 44 (15) and 68 (5) years with men being 50%, 80% and 76% of the participants respectively. Key strengths of the diabetes and kidney service were noted to be better integration of care and a perception of improved health and management of health. Whilst some aspects of access such as time between referral and initial appointment and having fewer appointments improved, other aspects such as in-clinic waiting times and parking remained problematic. Specialist health professionals noted that health professional education could be improved. Patient self-management was also noted by to be an issue with some patients requesting more information and some health professionals expressing difficulty in empowering some patients. CONCLUSIONS Health professionals and patients reported that a co-designed integrated diabetes kidney service improved integration of care and improved health and management of health. However, some aspects of the process of care, health professional education and patient self-management remained challenging.
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Affiliation(s)
- Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| | - Tracy Robinson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sanjeeva Ranasinha
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helena J. Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Department of General Practice, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kevan R. Polkinghorne
- Department of Nephrology, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Peter G. Kerr
- Department of Nephrology, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Gregory Fulcher
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, University of Sydney, Sydney, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Alan Cass
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Menzies School of Health Research, Darwin, Australia
| | - Rowan Walker
- Department of Renal Medicine, Alfred Health, Melbourne, Australia
| | - Grant Russell
- School of Primary Health Care, Monash University, Melbourne, Australia
| | | | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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19
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Anastas T, Waddell EN, Howk S, Remiker M, Horton-Dunbar G, Fagnan LJ. Building Behavioral Health Homes: Clinician and Staff Perspectives on Creating Integrated Care Teams. J Behav Health Serv Res 2019; 46:475-486. [PMID: 29790040 PMCID: PMC6250593 DOI: 10.1007/s11414-018-9622-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Adults with serious mental illness and substance use disorders have elevated risk of mortality and higher healthcare costs compared to the general population. As these disparities have been linked to poor management of co-occurring chronic conditions in primary care, the behavioral health setting may be a preferred setting for routine medical screening and treatment. This qualitative study describes early stages of integrating care teams in emerging medical homes based in mental health and addiction treatment settings. Clinicians and staff from ten agencies engaged in the Behavioral Health Home Learning Collaborative participated in qualitative interviews exploring local definitions of "behavioral health home" and initial barriers and facilitators to integration. Facilitators included clear staff roles, flexible scheduling, and interdisciplinary huddles and staff trainings. Challenges included workforce, limited use of electronic health records, and differing professional cultures. Participants advocated for new workflows and payment structures to accommodate scheduling demands and holistic case management.
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Affiliation(s)
- Tracy Anastas
- Oregon Rural Practice-based Research Network (ORPRN), 3181 SW Sam Jackson Park Rd, Mail Code L 222, Portland, OR, 97239, USA
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Elizabeth Needham Waddell
- Oregon Rural Practice-based Research Network (ORPRN), 3181 SW Sam Jackson Park Rd, Mail Code L 222, Portland, OR, 97239, USA.
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
- OHSU-PSU School of Public Health, 184 Parkmill Building, 1633 SW Park Avenue, Portland, OR, 97201, USA.
| | - Sonya Howk
- Oregon Rural Practice-based Research Network (ORPRN), 3181 SW Sam Jackson Park Rd, Mail Code L 222, Portland, OR, 97239, USA
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Mark Remiker
- Oregon Rural Practice-based Research Network (ORPRN), 3181 SW Sam Jackson Park Rd, Mail Code L 222, Portland, OR, 97239, USA
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Gretchen Horton-Dunbar
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
- OHSU-PSU School of Public Health, 184 Parkmill Building, 1633 SW Park Avenue, Portland, OR, 97201, USA
| | - L J Fagnan
- Oregon Rural Practice-based Research Network (ORPRN), 3181 SW Sam Jackson Park Rd, Mail Code L 222, Portland, OR, 97239, USA
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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20
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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: 90] [Impact Index Per Article: 18.0] [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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21
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Beil H, Feinberg RK, Patel SV, Romaire MA. Behavioral Health Integration With Primary Care: Implementation Experience and Impacts From the State Innovation Model Round 1 States. Milbank Q 2019; 97:543-582. [PMID: 30957311 DOI: 10.1111/1468-0009.12379] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Policy Points Individuals with behavioral health (BH) conditions comprise a medically complex population with high costs and high health care needs. Considering national shortages of BH providers, primary care providers serve a critical role in identifying and treating BH conditions and making referrals to BH providers. States are increasingly seeking ways to address BH conditions among their residents. States funded by the Centers for Medicare and Medicaid Services under the first round of the State Innovation Models (SIM) Initiative all invested in BH integration. States found sharing data among providers, bridging professional divides, and overcoming BH provider shortages were key barriers. Nonetheless, states made significant strides in integrating BH care. Beyond payment models, a key catalyst for change was facilitating informal relationships between BH providers and primary care physicians. Infrastructure investments such as promoting data sharing by connecting BH providers to a health information exchange and providing tailored technical assistance for both BH and primary care providers were also important in improving integration of BH care. CONTEXT Increasing numbers of states are looking for ways to address behavioral health (BH) conditions among their residents. The first round of the State Innovation Models (SIM) Initiative provided financial and technical support to six states since 2013 to test the ability of state governments to lead health care system transformation. All six SIM states invested in integration of BH and primary care services. This study summarizes states' progress, challenges, and lessons learned on BH integration. Additionally, the study reports impacts on expenditure, utilization, and quality-of-care outcomes for persons with BH conditions across four SIM states. METHODS We use a mixed-methods design, drawing on focus groups and key informant interviews to reach conclusions on implementation and quantitative analysis using Medicaid claims data to assess impact. For three Medicaid accountable care organization (ACO) models funded under SIM, we used a difference-in-differences regression model to compare outcomes for model participants with BH conditions and an in-state comparison group before-and-after model implementation. For the behavioral health home (BHH) model in Maine, we used a pre-post design to assess how outcomes for model participants changed over time. FINDINGS Informal relationship building, tailored technical assistance, and the promotion of data sharing were key factors in making progress. After three years of implementation, the growth in total expenditures was less than the comparison group by $128 (-$253, -$3; p < 0.10) and $62 (-$87, -$36; p < 0.001) per beneficiary per month for beneficiaries with BH conditions attributed to an ACO in Minnesota and Vermont, respectively. Likewise, there were reductions in emergency department use for ACO participants in all three states after two to four years of implementation. However, there was no improvement in BH-related quality metrics for ACO beneficiaries in all three states. Although participants in the BHH model had increased expenditures after two years of implementation, use of primary care and specialty care services increased by 3% and 8%, respectively, and antidepressant medication adherence also improved. CONCLUSIONS The SIM Round 1 states made considerable progress in integrating BH and primary care services, and there were promising findings for all models. Taken together, there is some evidence that Medicaid payment models can improve patterns of care for beneficiaries with BH conditions.
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Kolko DJ, Torres E, Rumbarger K, James E, Turchi R, Bumgardner C, O'Brien C. Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers. Clin Pediatr (Phila) 2019; 58:213-225. [PMID: 30450951 DOI: 10.1177/0009922818810881] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study reports on a statewide survey of medical and behavioral health professionals to advance the knowledge base on the benefits and obstacles to delivering integrated pediatric health care. Surveys distributed in 3 statewide provider networks were completed by 110 behavioral health specialists (BHSs) and 111 primary care physicians (PCPs). Survey content documented their perceptions about key services, benefits, barriers, and needed opportunities related to integrated care. Factor analyses identified 8 factors, and other items were examined individually. We compared responses by specialty group (BHS vs PCP) and integrated care experience (no vs yes). The findings revealed differences across domains by specialty subgroup. In several cases, BHS (vs PCP) respondents, especially those with integrated care experience, reported lower benefits, higher barriers, and fewer resource requests. The implications of these results for enhancing care integration development, delivery, training, and research are discussed along with the study's limitations and empirical literature.
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Affiliation(s)
- David J Kolko
- 1 University of Pittsburgh School of Medicine, Psychiatry, Pittsburgh, PA, USA.,2 UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Eunice Torres
- 2 UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
| | | | - Everette James
- 3 University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Renee Turchi
- 4 Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.,5 Drexel University College of Medicine, Philadelphia, PA, USA.,6 St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Cheryl Bumgardner
- 7 Pennsylvania Association of Community Health Centers, Wormleysburg, PA, USA
| | - Connell O'Brien
- 8 Rehabilitation and Community Providers Association, Harrisburg, PA, USA
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Griffin A, Knight L, McKeown A, Cliffe C, Arora A, Crampton P. A postgraduate curriculum for integrated care: a qualitative exploration of trainee paediatricians and general practitioners' experiences. BMC MEDICAL EDUCATION 2019; 19:8. [PMID: 30612565 PMCID: PMC6322273 DOI: 10.1186/s12909-018-1420-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 12/05/2018] [Indexed: 05/09/2023]
Abstract
BACKGROUND Integrated care unites funding, administrative, organisational, service delivery and clinical levels to create connectivity, alignment and collaboration within and between care delivery and prevention sectors. It aims to improve efficiency by avoiding unnecessary duplication of resources. Consequently, implementing integrated care is increasingly important; however, there are many barriers and how we teach healthcare practitioners to work across systems is under-researched. This paper explores an innovative educational curriculum, the Programme for Integrated Child Health (PICH). METHODS The PICH involved an experiential learning approach supported by taught sessions on specific issues relevant to integrated care. A qualitative study was conducted by interviewing 23 participants using semi-structured one-to-one interviews. Participants included trainees (general practice, paediatrics) and programme mentors. Data was thematically analysed. RESULTS Results are coded under three main themes: integrated care curriculum components, perceptions of a curriculum addressing integrated care and organisational change, and personal and professional learning. The data highlights the importance of real-world projects, utilising healthcare data, and considering patient perspectives to understand and develop integrated practices. Trainees received guidance from mentors but, more crucially learnt from, with, and about one another. They learnt about the context in which GPs and paediatricians work and developed a deeper understanding through which integrated services could be meaningfully developed. CONCLUSIONS This study explored participants' experiences and can be taken forward by educationalists to design curricula to better prepare healthcare practitioners to work collaboratively. The emergence of integrated care brings about challenges for traditional pedagogical approaches as learners have to re-align their discipline-specific approaches with evolving healthcare structures. PICH demonstrated that trainees acquired knowledge through real-word projects and experiential learning; and that this facilitated integration, empowering doctors to become leaders of organisational change. However, there are also many challenges of implementing integrated curricula which need to be addressed, including breaking down professional silos and integrating resourceful healthcare. This study begins to demonstrate the ability of an integrated curriculum to support trainees to work collaboratively, but further work is needed to develop the wider efficacy of the programme incorporating other professional groups, and to assess its longer term impact.
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Affiliation(s)
- Ann Griffin
- Research Department of Medical Education, UCL Medical School, The Directorate, 74 Huntley Street, London, WC1E 6AU UK
| | - Laura Knight
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, Room GF/664, London, NW3 2PF UK
| | - Alex McKeown
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX UK
| | - Charlotte Cliffe
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, Room GF/664, London, NW3 2PF UK
| | - Arun Arora
- Manchester University, Oxford Rd, Manchester, M13 9PL UK
| | - Paul Crampton
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, Room GF/664, London, NW3 2PF UK
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Clinical Workflows and the Associated Tasks and Behaviors to Support Delivery of Integrated Behavioral Health and Primary Care. J Ambul Care Manage 2018; 42:51-65. [PMID: 30499901 DOI: 10.1097/jac.0000000000000257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Integrating primary care and behavioral health is an important focus of health system transformation. Cross-case comparative analysis of 19 practices in the United States describing integrated care clinical workflows. Surveys, observation visits, and key informant interviews analyzed using immersion-crystallization. Staff performed tasks and behaviors-guided by protocols or scripts-to support 4 workflow phases: (1) identifying; (2) engaging/transitioning; (3) providing treatment; and (4) monitoring/adjusting care. Shared electronic health records and accessible staffing/scheduling facilitated workflows. Stakeholders should consider these workflow phases, address structural features, and utilize a developmental approach as they operationalize integrated care delivery.
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Rosenberg T, Mullin D. Building the plane in the air…but also before and after it takes flight: considerations for training and workforce preparedness in integrated behavioural health. Int Rev Psychiatry 2018; 30:199-209. [PMID: 30862259 DOI: 10.1080/09540261.2019.1566117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Collaborative approaches to healthcare that integrate behavioural and biomedical interventions are more likely to enhance patient outcomes as well as provider satisfaction with care delivery than siloed approaches to care. The recognition for specific and targeted training for these models is growing among all health professions, although many in the field have not received systematized, interprofessional, and competency-based training that adequately prepared them for the work of integration. This article reviews some of the fundamental principles of biopsychosocially-oriented, team-based approaches to care that integrate behavioural and biomedical perspectives and delineates the need for targeted training efforts. It describes which specific elements must be addressed within it in order to promote effective integration, and highlights the array of options for training currently in existence. This review provides an overview of current models of training offered in the US, and concludes with a discussion of the challenges and barriers that may render training either ineffective or difficult to achieve.
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Affiliation(s)
- Tziporah Rosenberg
- a Departments of Psychiatry & Family Medicine , University of Rochester School of Medicine & Dentistry , Rochester , NY , USA
| | - Daniel Mullin
- b Department of Family Medicine and Community Health , University of Massachusetts School of Medicine , North Worcester , MA , USA
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Simelane ML, Georgeu-Pepper D, Ras CJ, Anderson L, Pascoe M, Faris G, Fairall L, Cornick R. The Practical Approach to Care Kit (PACK) training programme: scaling up and sustaining support for health workers to improve primary care. BMJ Glob Health 2018; 3:e001124. [PMID: 30498597 PMCID: PMC6242020 DOI: 10.1136/bmjgh-2018-001124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/12/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022] Open
Abstract
There is an urgent need to depart from in-service training that relies on distance and/or intensive off-site training leading to limited staff coverage at clinical sites. This traditional approach fails to meet the challenge of improving clinical practice, especially in low-income and middle-income countries where resources are limited and disease burden high. South Africa's University of Cape Town Lung Institute Knowledge Translation Unit has developed a facility-based training strategy for implementation of its Practical Approach to Care Kit (PACK) primary care programme. The training has been taken to scale in primary care facilities throughout South Africa and has shown improvements in quality of care indicators and health outcomes along with end-user satisfaction. PACK training uses a unique approach to address the needs of frontline health workers and the health system by embedding a health intervention into everyday clinical practice at facility level. This paper describes the features of the PACK training strategy: PACK training is scaled up using a cascade model of training using educational outreach to deliver PACK to clinical teams in their health facilities in short, regular sessions. Drawing on adult education principles, PACK training empowers clinicians by using experiential and interactive learning methodologies to draw on existing clinical knowledge and experience. Learning is alternated with practice to improve the likelihood of embedding the programme into everyday clinical care delivery.
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Affiliation(s)
| | | | - Christy-Joy Ras
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Lauren Anderson
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Michelle Pascoe
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Gill Faris
- Purposeful People Development, Cape Town, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Ruth Cornick
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
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Shen N, Sockalingam S, Charow R, Bailey S, Bernier T, Freeland A, Hawa A, Sur D, Wiljer D. Education programs for medical psychiatry collaborative care: A scoping review. Gen Hosp Psychiatry 2018; 55:51-59. [PMID: 30384004 DOI: 10.1016/j.genhosppsych.2018.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand the current state of collaborative care education programs reported in the literature. METHODS Following Arksey and O'Malley methodology for scoping reviews, data was abstracted in following domains: article details, program details, program outcomes, and implementation factors. Numerical summaries were calculated where necessary. Implementation factors underwent a qualitative thematic analysis. RESULTS This review identified 40 unique collaborative care education programs. Most programs (n = 25; 62.5%) were delivered to a multi-disciplinary group of learners through didactic (n = 34; 85.0%) and/or in vivo (n = 32; 80.0%) training methods. The majority of programs focused on clinical knowledge/skill acquisition (n = 38; 95.0%) as opposed to attitudes towards mental health and collaboration (n = 27; 67.5%). Implementation factors fell within four themes: program development, supportive environment, necessary resources, and clinical change agents/leaders. CONCLUSION Despite the growing evidence for collaborative care, few collaborative care education programs are reported in the literature. Key elements of collaborative care education programs include: routine multi-disciplinary interaction, curriculum focus on attitudes; clinical change agents and leaders to accelerate implementation; and a user-centred design development process. Future implementations can learn from these experiences to avoid potential barriers and focus on enabling successful programs to enhance care.
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Affiliation(s)
- Nelson Shen
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; University Health Network, 200 Elizabeth Street, 8 Eaton South, Toronto, Ontario M5G 2C4, Canada; Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
| | - Rebecca Charow
- University Health Network, 200 Elizabeth Street, 8 Eaton South, Toronto, Ontario M5G 2C4, Canada.
| | - Sharon Bailey
- Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
| | - Thérèse Bernier
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada.
| | - Alison Freeland
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Trillium Health Partners, 100 Queensway W, Mississauga, Ontario L5B 1B8, Canada.
| | - Aceel Hawa
- Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada
| | - Deepy Sur
- Trillium Health Partners, 100 Queensway W, Mississauga, Ontario L5B 1B8, Canada.
| | - David Wiljer
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; University Health Network, 200 Elizabeth Street, 8 Eaton South, Toronto, Ontario M5G 2C4, Canada; Education, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
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Landoll RR, Maggio LA, Cervero RM, Quinlan JD. Training the Doctors: A Scoping Review of Interprofessional Education in Primary Care Behavioral Health (PCBH). J Clin Psychol Med Settings 2018; 26:243-258. [PMID: 30255408 DOI: 10.1007/s10880-018-9582-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary care behavioral health (PCBH) is a model of integrated healthcare service delivery that has been well established in the field of psychology and continues to grow. PCBH has been associated with positive patient satisfaction and health outcomes, reduced healthcare expenditures, and improved population health. However, much of the education and training on PCBH has focused on developing behavioral health providers to practice in this medical setting. Less attention has been paid to physician team members to support and practice within an integrated environment. This is problematic as underdeveloped physician team members may contribute to low utilization and attrition of behavioral health consultants. A scoping review was conducted to examine the training of physicians in this domain since 2006. Twenty-one studies were identified, predominantly in Family Medicine training programs. Although PCBH training was generally well received, more program evaluation, formalized curriculum, and faculty development are needed to establish best practices.
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Landoll RR, Nielsen MK, Waggoner KK. Factors affecting behavioral health provider turnover in US Air Force primary care behavioral health services. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1478549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ryan R. Landoll
- Family Medicine, Uniformed Services University, Bethesda, Maryland
| | - Matthew K. Nielsen
- Mental Health, Uniformed Services University, Nellis Air Force Base, Nevada
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A Qualitative Study on Primary Care Integration into an Asian Immigrant-specific Behavioural Health Setting in the United States. Int J Integr Care 2018; 18:2. [PMID: 30214389 PMCID: PMC6133215 DOI: 10.5334/ijic.3719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Integrating primary care and behavioural health services improves access to services and health outcomes among individuals with serious mental illness. Integrated care is particularly promising for racial and ethnic minority individuals given higher rates of chronic illnesses and poorer access to and quality of care compared to Whites. However, little is known about integrated care implementation in non-White populations. The aim of this study is to identify facilitators and barriers to successful implementation of primary care-behavioural health integration in a multilingual behavioural healthcare setting. Methods Seven focus groups and five semi-structured interviews were conducted with 41 patients and 5 providers participating in integrated care in a community mental health clinic in California serving Asian immigrants. Results Themes generated from constant comparative analysis suggest limited system-level preconditions and cross-organisational dynamics challenged integrated care. At the same time, changing organisational culture and practice, improving patient-provider and provider-provider communication, and increasing patient involvement enhanced clinical outcomes and facilitated successful implementation. Discussion and conclusions Findings highlight the importance of patient involvement, peer services and interdisciplinary communication to successfully implement integrated care in the face of linguistic and operational challenges in settings serving multilingual and multicultural patients.
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Ross KM, Gilchrist EC, Melek SP, Gordon PD, Ruland SL, Miller BF. Cost savings associated with an alternative payment model for integrating behavioral health in primary care. Transl Behav Med 2018; 9:274-281. [DOI: 10.1093/tbm/iby054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Kaile M Ross
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado School of Medicine, Aurora, CO, USA
- Psychology Department, University of Colorado Denver, Denver, CO, USA
| | - Emma C Gilchrist
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | - Sandra L Ruland
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Benjamin F Miller
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado School of Medicine, Aurora, CO, USA
- Well Being Trust, Oakland, CA, USA
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Freeman DS, Hudgins C, Hornberger J. Legislative and Policy Developments and Imperatives for Advancing the Primary Care Behavioral Health (PCBH) Model. J Clin Psychol Med Settings 2018; 25:210-223. [PMID: 29508113 DOI: 10.1007/s10880-018-9557-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Primary Care Behavioral Health (PCBH) practice model continues to gain converts among primary care and behavioral health professionals as the evidence supporting its effectiveness continues to accumulate. Despite a growing number of practices and organizations using the model effectively, widespread implementation has been hampered by outmoded policies and regulatory barriers. As policymakers and legislators begin to recognize the contributions that PCBH model services make to the care of complex patients and the expansion of access to those in need of behavioral health interventions, some encouraging policy initiatives are emerging and the policy environment is becoming more favorable to implementation of the PCBH model. This article outlines the necessity for policy change, exposing the policy issues and barriers that serve to limit the practice of the PCBH model; highlights innovative approaches some states are taking to foster integrated practice; and discusses the compatibility of the PCBH model with the nation's health care reform agenda. Psychologists have emerged as leaders in the design and implementation of PCBH model integration and are encouraged to continue to advance the model through the demonstration of efficient and effective clinical practice, participation in the expansion of an appropriately trained workforce, and advocacy for the inclusion of this practice model in emerging healthcare systems and value-based payment methodologies.
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Affiliation(s)
- Dennis S Freeman
- Cherokee Health Systems, 2018 Western Avenue, Knoxville, TN, 37921, USA.
| | - Cathy Hudgins
- Southwest Virginia Area Health Education Center, Blacksburg, VA, USA
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Davis MM, Gunn R, Gowen LK, Miller BF, Green LA, Cohen DJ. A qualitative study of patient experiences of care in integrated behavioral health and primary care settings: more similar than different. Transl Behav Med 2018; 8:649-659. [DOI: 10.1093/tbm/ibx001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Melinda M Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- Oregon Rural Practice-based Research Network, Portland, OR, USA
| | - Rose Gunn
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - L Kris Gowen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Benjamin F Miller
- Eugene S. Farley, Jr. Health Policy Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Larry A Green
- Eugene S. Farley, Jr. Health Policy Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
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Gmelin T, Raible CA, Dick R, Kukke S, Miller E. Integrating Reproductive Health Services Into Intimate Partner and Sexual Violence Victim Service Programs. Violence Against Women 2017; 24:1557-1569. [DOI: 10.1177/1077801217741992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study assessed the feasibility of integrating reproductive health services into intimate partner violence/sexual violence (IPV/SV) programs. After a training for victim service agencies on integration of health services, we conducted semistructured interviews with IPV/SV program leadership. Leadership reported advocates were more likely to recognize the need to refer clients to health services, and revealed challenges operationalizing partnerships with health care centers. Training to integrate basic health assessment into victim services may be one way to address women’s urgent health needs. Formal partnership agreements, protocols to facilitate referrals, and opportunities to cross-train are needed to nurture these cross-sector collaborations.
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Affiliation(s)
- Theresa Gmelin
- Children’s Hospital of Pittsburgh of UPMC, PA, USA
- Department of Epidemiology, University of Pittsburgh, PA, USA
| | | | - Rebecca Dick
- Children’s Hospital of Pittsburgh of UPMC, PA, USA
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Shen N, Sockalingam S, Abi Jaoude A, Bailey SM, Bernier T, Freeland A, Hawa A, Hollenberg E, Woldemichael B, Wiljer D. Scoping review protocol: education initiatives for medical psychiatry collaborative care. BMJ Open 2017; 7:e015886. [PMID: 28871017 PMCID: PMC5588937 DOI: 10.1136/bmjopen-2017-015886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION The collaborative care model is an approach providing care to those with mental health and addictions disorders in the primary care setting. There is a robust evidence base demonstrating its clinical and cost-effectiveness in comparison with usual care; however, the transitioning to this new paradigm of care has been difficult. While there are efforts to train and prepare healthcare professionals, not much is known about the current state of collaborative care training programmes. The objective of this scoping review is to understand how widespread these collaborative care education initiatives are, how they are implemented and their impacts. METHODS AND ANALYSIS The scoping review methodology uses the established review methodology by Arksey and O'Malley. The search strategy was developed by a medical librarian and will be applied in eight different databases spanning multiple disciplines. A two-stage screening process consisting of a title and abstract scan and a full-text review will be used to determine the eligibility of articles. To be included, articles must report on an existing collaborative care education initiative for healthcare providers. All articles will be independently assessed for eligibility by pairs of reviewers, and all eligible articles will be abstracted and charted in duplicate using a standardised form. The extracted data will undergo a 'narrative review' or a descriptive analysis of the contextual or process-oriented data and simple quantitative analysis using descriptive statistics. ETHICS AND DISSEMINATION Research ethics approval is not required for this scoping review. The results of this scoping review will inform the development of a collaborative care training initiative emerging from the Medical Psychiatry Alliance, a four-institution philanthropic partnership in Ontario, Canada. The results will also be presented at relevant national and international conferences and published in a peer-reviewed journal.
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Affiliation(s)
- Nelson Shen
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Alexxa Abi Jaoude
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sharon M Bailey
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Thérèse Bernier
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alison Freeland
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Aceel Hawa
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elisa Hollenberg
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Bethel Woldemichael
- Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - David Wiljer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, University Health Network, Toronto, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
- UHN Digital, University Health Network, Toronto, Ontario, Canada
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Serrano N, Cordes C, Cubic B, Daub S. The State and Future of the Primary Care Behavioral Health Model of Service Delivery Workforce. J Clin Psychol Med Settings 2017; 25:157-168. [DOI: 10.1007/s10880-017-9491-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miller BF, Ross KM, Davis MM, Melek SP, Kathol R, Gordon P. Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care. ACTA ACUST UNITED AC 2017; 72:55-68. [PMID: 28068138 DOI: 10.1037/a0040448] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy. (PsycINFO Database Record
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Affiliation(s)
- Benjamin F Miller
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado School of Medicine
| | - Kaile M Ross
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado School of Medicine
| | - Melinda M Davis
- Department of Family Medicine, Oregon Health and Sciences University
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Clark KD, Miller BF, Green LA, de Gruy FV, Davis M, Cohen DJ. Implementation of behavioral health interventions in real world scenarios: Managing complex change. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2017; 35:36-45. [PMID: 27893261 PMCID: PMC7315783 DOI: 10.1037/fsh0000239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION A practice embarks on a radical reformulation of how care is designed and delivered when it decides to integrate medical and behavioral health care for its patients and success depends on managing complex change in a complex system. We examined the ways change is managed when integrating behavioral health and medical care. METHOD Observational cross-case comparative study of 19 primary care and community mental health practices. We collected mixed methods data through practice surveys, observation, and semistructured interviews. We analyzed data using a data-driven, emergent approach. RESULTS The change management strategies that leadership employed to manage the changes of integrating behavioral health and medical care included: (a) advocating for a mission and vision focused on integrated care; (b) fostering collaboration, with a focus on population care and a team-based approaches; (c) attending to learning, which includes viewing the change process as continuous, and creating a culture that promoted reflection and continual improvement; (d) using data to manage change, and (e) developing approaches to finance integration. DISCUSSION This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. We offer an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care. (PsycINFO Database Record
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Affiliation(s)
- Khaya D Clark
- Department of Family Medicine, Oregon Health & Science University
| | - Benjamin F Miller
- Eugene S. Farley, Jr. Health Policy Center, Department of Family Medicine, University of Colorado School of Medicine
| | - Larry A Green
- Department of Family Medicine, University of Colorado School of Medicine
| | - Frank V de Gruy
- Department of Family Medicine, University of Colorado School of Medicine
| | - Melinda Davis
- Department of Family Medicine, Oregon Health & Science University
| | - Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University
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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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Tovian SM. Interprofessionalism and the Practice of Health Psychology in Hospital and Community: Walking the Bridge Between Here and There. J Clin Psychol Med Settings 2016; 23:345-357. [PMID: 27837292 DOI: 10.1007/s10880-016-9479-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Interprofessionalism is a cornerstone for health care reform and is an important dimension for success for the practice of professional psychology in integrated care settings, whether in academic health centers, ambulatory clinics, or in independent practice. This article examines salient skills that have allowed the author to practice in both primary and tertiary health care settings, as well as in academic health centers and independent community practice. The scientist practitioner model of professional psychology has served to guide the author as a "roadmap" for successful collaborative, integrated care in the changing health care environment. The author emphasizes that marketing of health services in professional psychology is crucial for achieving the goals of interprofessionalism, and to secure a role for professional psychology in health care reform. Future challenges to psychology in health care are discussed with implications for training and practice.
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Affiliation(s)
- Steven M Tovian
- , 480 Elm Place Suite #208, Highland Park, IL, 60035, USA.
- The Feinberg School of Medicine at Northwestern University, Chicago, IL, USA.
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Vogel ME, Kanzler KE, Aikens JE, Goodie JL. Integration of behavioral health and primary care: current knowledge and future directions. J Behav Med 2016; 40:69-84. [DOI: 10.1007/s10865-016-9798-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/22/2016] [Indexed: 01/17/2023]
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Abstract
Mounting evidence supports the value of integrated healthcare and the need for interprofessional practice within patient-centered medical homes (PCMH). Incorporating behavioral health services is key to fully implementing the PCMH concept. Unfortunately, psychologists have not been front and center in this integrative and interprofessional care movement nor have they typically received adequate training or experience to work effectively in these integrated care programs. This article builds the case for the value of PCMHs, particularly those that incorporate behavioral health services. Attention is paid to the diverse roles psychologists play in these settings, including as direct service providers, consultants, teachers/supervisors, scholars/program evaluators, and leaders. There is a discussion of the competencies psychologists must possess to play these roles effectively. Future directions are discussed, with a focus on ways psychologists can bolster the PCMH model by engaging in interprofessional partnerships related to education and training, practice, research, and leadership.
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McCue Horwitz S, Storfer-Isser A, Kerker BD, Szilagyi M, Garner AS, O'Connor KG, Hoagwood KE, Green CM, Foy JM, Stein REK. Do On-Site Mental Health Professionals Change Pediatricians' Responses to Children's Mental Health Problems? Acad Pediatr 2016; 16:676-83. [PMID: 27064141 PMCID: PMC5012962 DOI: 10.1016/j.acap.2016.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/22/2016] [Accepted: 03/28/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the availability of on-site mental health professionals (MHPs) in primary care; to examine practice/pediatrician characteristics associated with on-site MHPs; and to determine whether the presence of on-site MHPs is related to pediatricians' comanaging or more frequently identifying, treating/managing, or referring mental health (MH) problems. METHODS Analyses included American Academy of Pediatrics (AAP) members who participated in an AAP Periodic Survey in 2013 and who practiced general pediatrics (n = 321). Measures included sociodemographics, practice characteristics, questions about on-site MHPs, comanagement of MH problems, and pediatricians' behaviors in response to 5 prevalent MH problems. Weighted univariate, bivariate, and multivariable analyses were performed. RESULTS Thirty-five percent reported on-site MHPs. Practice characteristics (medical schools, universities, health maintenance organizations, <100 visits per week, <80% of patients privately insured) and interactions of practice location (urban) with visits and patient insurance were associated with on-site MHPs. There was no overall association between colocation and comanagement, or whether pediatricians usually identified, treated/managed, or referred 5 common child MH problems. Among the subset of pediatricians who reported comanaging, there was an association with comanagement when the on-site MHP was a child psychiatrist, substance abuse counselor, or social worker. CONCLUSIONS On-site MHPs are more frequent in settings where low-income children are served and where pediatricians train. Pediatricians who comanage MH problems are more likely to do so when the on-site MHP is a child psychiatrist, substance abuse counselor, or social worker. Overall, on-site MHPs were not associated with comanagement or increased likelihood of pediatricians identifying, treating/managing, or referring children with 5 common child MH problems.
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Affiliation(s)
- Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY.
| | | | - Bonnie D Kerker
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY; Nathan Kline Institute of Psychiatric Research, Orangeburg, NY
| | - Moira Szilagyi
- University of California at Los Angeles, Los Angeles, Calif
| | - Andrew S Garner
- Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | | | - Kimberly E Hoagwood
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY
| | - Cori M Green
- New York-Presbyterian Hospital-Weill Cornell Medical College, New York, NY
| | - Jane M Foy
- Wake Forest University School of Medicine, Winston Salem, NC
| | - Ruth E K Stein
- Albert Einstein College of Medicine/Children's Hospital at Montefiore, New York, NY
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Hoffses KW, Ramirez LY, Berdan L, Tunick R, Honaker SM, Meadows TJ, Shaffer L, Robins PM, Sturm L, Stancin T. Topical Review: Building Competency: Professional Skills for Pediatric Psychologists in Integrated Primary Care Settings. J Pediatr Psychol 2016; 41:1144-1160. [PMID: 27567023 DOI: 10.1093/jpepsy/jsw066] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 06/25/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES : In the midst of large-scale changes across our nation's health care system, including the Affordable Care Act and Patient-Centered Medical Home initiatives, integrated primary care models afford important opportunities for those in the field of pediatric psychology. Despite the extensive and growing attention, this subspecialty has received in recent years, a comprehensive set of core professional competencies has not been established. METHODS : A subset of an Integrated Primary Care Special Interest Group used two well-established sets of core competencies in integrated primary care and pediatric psychology as a basis to develop a set of integrated pediatric primary care-specific behavioral anchors. CONCLUSIONS : The current manuscript describes these behavioral anchors and their development in the context of professional training as well as with regard to Triple Aim goals and securing psychology's role in integrated pediatric primary care settings.
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Affiliation(s)
- Kathryn W Hoffses
- Nemours/Alfred I. duPont Hospital for Children Department of Pediatrics, Thomas Jefferson University
| | - Lisa Y Ramirez
- Child & Adolescent Psychiatry & Psychology, MetroHealth Medical Center Department of Psychiatry, Case Western Reserve University School of Medicine
| | | | - Rachel Tunick
- Boston Children's Hospital and Harvard Medical School
| | | | | | - Laura Shaffer
- University of Virginia School of Medicine Department of Pediatrics
| | - Paul M Robins
- The Children's Hospital of Philadelphia, and Perelman School of Medicine, University of Pennsylvania
| | - Lynne Sturm
- Department of Pediatrics, Indiana University School of Medicine
| | - Terry Stancin
- Child & Adolescent Psychiatry & Psychology, MetroHealth Medical Center Department of Psychiatry, Case Western Reserve University School of Medicine
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Dobmeyer AC, Hunter CL, Corso ML, Nielsen MK, Corso KA, Polizzi NC, Earles JE. Primary Care Behavioral Health Provider Training: Systematic Development and Implementation in a Large Medical System. J Clin Psychol Med Settings 2016; 23:207-24. [DOI: 10.1007/s10880-016-9464-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care. J Am Board Fam Med 2015; 28 Suppl 1:S32-40. [PMID: 26359470 PMCID: PMC7304943 DOI: 10.3122/jabfm.2015.s1.150087] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To examine the interrelationship among behavioral health clinician (BHC) staffing, scheduling, and a primary care practice's approach to delivering integrated care. METHODS Observational cross-case comparative analysis of 17 primary care practices in the United States focused on implementation of integrated care. Practices varied in size, ownership, geographic location, and integrated care experience. A multidisciplinary team analyzed documents, practice surveys, field notes from observation visits, implementation diaries, and semistructured interviews using a grounded theory approach. RESULTS Across the 17 practices, staffing ratios ranged from 1 BHC covering 0.3 to 36.5 primary care clinicians (PCCs). BHC scheduling varied from 50-minute prescheduled appointments to open, flexible schedules slotted in 15-minute increments. However, staffing and scheduling patterns generally clustered in 2 ways and enabled BHCs to be engaged by referral or warm handoff. Five practices predominantly used warm handoffs to engage BHCs and had higher BHC-to-PCC staffing ratios; multiple BHCs on staff; and shorter, more flexible BHC appointment schedules. Staffing and scheduling structures that enabled warm handoffs supported BHC engagement with patients concurrent with the identification of behavioral health needs. Twelve practices primarily used referrals to engage BHCs and had lower BHC-to-PCC staffing ratios and BHC schedules prefilled with visits. This enabled some BHCs to bill for services, but also made them less accessible to PCCs in when patients presented with behavioral health needs during a clinical encounter. Three of these practices were experimenting with open scheduling and briefer BHC visits to enable real-time access while managing resources. CONCLUSION Practices' approaches to PCC-BHC staffing, scheduling, and delivery of integrated care mutually influenced each other and were shaped by the local context. Practice leaders, educators, clinicians, funders, researchers, and policy makers must consider these factors as they seek to optimize integrated systems of care.
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