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Integrated behavioral health primary care

Wanjiku F M Njoroge, Cody A Hostutler, Billie S Schwartz, Jennifer A Mautone
There are multiple barriers to accessing high quality, evidence-based behavioral health care for children and adolescents, including stigma, family beliefs, and the significant paucity of child and adolescent psychiatrists. Although equal access continues to be an unmet need in the USA, there is growing recognition that integrated behavioral health services in pediatric primary care have the potential to reduce health disparities and improve service utilization. In a joint position paper, the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) highlighted the multiple benefits of children receiving initial behavioral health screening, assessment, and evidence-based behavioral health treatments in the medical home...
December 2016: Current Psychiatry Reports
Curtis Bone, Lilian Gelberg, Mani Vahidi, Barbara Leake, Julia Yacenda-Murphy, Ronald M Andersen
OBJECTIVE: The Affordable Care Act encourages integration of behavioral health into primary care. We aim to estimate the level of under-reporting of drug use in federally qualified health centers (FQHCs) among self-reported risky drug users. METHODS: Adult patients in the waiting rooms of 4 FQHCs who self-reported risky drug use on the screening instrument World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (score 4-26), who participated in the "Quit Using Drugs Intervention Trial," submitted urine samples for drug testing...
October 6, 2016: Journal of Addiction Medicine
Chun Chao, Michael J Silverberg, Tracy A Becerra, Douglas A Corley, Christopher D Jensen, Qiaoling Chen, Virginia P Quinn
BACKGROUND: Human papillomavirus vaccination may result in lowered intention to be screened for cervical cancer, potentially leading to gaps in screening coverage and avoidable cervical cancer diagnoses. OBJECTIVE: To examine the association between human papillomavirus vaccination and subsequent cervical cancer screening initiation and adherence to recommended screening intervals to detect gaps in screening coverage and inform future prevention efforts. STUDY DESIGN: A retrospective cohort study was conducted in two distinct cohorts of female members of Kaiser Permanente Southern California, a large integrated healthcare delivery system...
October 13, 2016: American Journal of Obstetrics and Gynecology
C R Macchi, Rodger Kessler, Andrea Auxier, Juvena R Hitt, Daniel Mullin, Constance van Eeghen, Benjamin Littenberg
Insufficient knowledge exists regarding how to measure the presence and degree of integrated care. Prior estimates of integration levels are neither grounded in theory nor psychometrically validated. They provide scant guidance to inform improvement activities, compare integration efforts, discriminate among practices by degree of integration, measure the effect of integration on quadruple aim outcomes, or address the needs of clinicians, regulators, and policymakers seeking new models of health care delivery and funding...
October 13, 2016: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Rodger S Kessler, Andrea Auxier, Juvena R Hitt, C R Macchi, Daniel Mullin, Constance van Eeghen, Benjamin Littenberg
Introduction: We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health integration in clinical practices with a focus on primary care (PC). Its 30 items, completed by providers, managers, and staff, provide an overall score and 6 domain scores derived from the Lexicon of Collaborative Care. We describe its history and psychometric properties. Method: The PIP was tested in a convenience sample of practices. Linear regression compared scores across integration exemplars, PC with behavioral services, PC without behavioral services, and community mental health centers without PC...
October 13, 2016: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Catharina A Nordin, Peter Michaelson, Gunvor Gard, Margareta K Eriksson
BACKGROUND: Web-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR). OBJECTIVE: The objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data...
October 5, 2016: Journal of Medical Internet Research
James C Rajotte, Deborah Garneau, Nancy Sutton, Ailis Clyne
"The goal of community health teams is to develop and implement care models that integrate clinical and community health promotion and preventive services for patients." -Association of State and Territorial Health Officials (ASTHO)1 Eleven community health teams (CHTs) operate in various geographies within Rhode Island. Physicians and payers refer their highest-risk patients to CHTs that serve as community extenders. Community health workers and others work to link referred individuals to primary care and work to address the other determinants affecting their health, such as safe housing...
October 4, 2016: Rhode Island Medical Journal
B Josea Kramer, Beth Creekmur, Judith L Howe, Scott Trudeau, Joseph R Douglas, Kimberly Garner, Connie Bales, Carol Callaway-Lane, Steven Barczi
The Veterans Affairs Geriatric Scholars Program (GSP) is a continuing professional development program to integrate geriatrics into the clinical practices of primary care providers and select associated health professions that support primary care teams. GSP uses a blended program educational format, and the minimal requirements are to attend an intensive course in geriatrics, participate in an interactive workshop on quality improvement (QI), and initiate a local QI project to demonstrate application of new knowledge to benefit older veterans...
October 3, 2016: Journal of the American Geriatrics Society
Mark E Vogel, Kathryn E Kanzler, James E Aikens, Jeffrey L Goodie
Integrated behavioral health in primary care has spread rapidly over the past three decades, although significant questions remain unanswered regarding best practices in clinical, financial and operational worlds. Two key models have emerged over time: care management and Primary Care Behavioral Health. Research to date has been promising; however, there is a significant need for more sophisticated multi-level scientific methodologies to fill in the gaps in current knowledge of integrated primary care. In this paper, we summarize current scientific knowledge about integrated primary care and critically evaluate the strengths and weaknesses of this knowledge base, focusing on clinical, financial and operational factors...
September 30, 2016: Journal of Behavioral Medicine
Nooshin Razani, Michael A Kohn, Nancy M Wells, Doug Thompson, Hanna Hamilton Flores, George W Rutherford
BACKGROUND: Contact with nature improves human health; stress reduction is a mediating pathway. Stay Healthy in Nature Everyday (SHINE) is a stress reduction and health promotion intervention for low-income families at an urban Federally Qualified Health Center. We plan to evaluate two service-delivery models for SHINE and present here the intervention design and evaluation protocol. METHODS: Behavioral change theory and environmental education literature informed the intervention...
September 29, 2016: Contemporary Clinical Trials
Lisa Zubkoff, Brian Shiner, Bradley V Watts
INTRODUCTION: Guidelines recommend that substance use disorder (SUD) treatment be available in primary care-mental health integrated clinics, which offer mental and behavioral health assessment and treatment in the primary care setting. Despite this recommendation it is unclear what barriers and facilitators exist to SUD treatment being provided in that setting. This work sought to understand current SUD services in such integrated clinics, explore other services may that be appropriate, and identify barriers to such services...
November 2016: Journal of Substance Abuse Treatment
Prerna G Arora, Elizabeth H Connors, Angela Blizzard, Kelly Coble, Nicole Gloff, David Pruitt
Increased attention has been placed on evaluating the extent to which clinical programs that support the behavioral health needs of youth have effective processes and result in improved patient outcomes. Several theoretical frameworks from dissemination and implementation (D&I) science have been put forth to guide the evaluation of behavioral health program implemented in the context of real-world settings. Although a strong rationale for the integration of D&I science in program evaluation exists, few examples exist available to guide the evaluator in integrating D&I science in the planning and execution of evaluation activities...
September 20, 2016: Evaluation and Program Planning
Stephen M Sergay
Medical care delivery has adapted to scientific and societal change in the past. However, today's advancing scientific accomplishments and care capabilities, in the context of current societal and economic developments and our emerging digital age, are challenging physician resilience and endurance and trust in the medical profession. Why has this happened and can these characteristics and perceptions of physicians be reversed? The Charter on Physician Professional Flourishing is a method designed to restore the promise of the medical profession and trust in it...
September 28, 2016: Neurology
Arthur R Andrews, Debbie Gomez, Austin Larey, Hayden Pacl, Dennis Burchette, Juventino Hernandez Rodriguez, Freddie A Pastrana, Ana J Bridges
Introduction: Type 2 diabetes is often comorbid with internalizing mental health disorders and associated with greater psychiatric treatment resistance. Integrating psychotherapy into primary care can help treat internalizing disorders generally. We explored whether such treatment had comparable effectiveness in patients with and without Type 2 diabetes. Method: Participants were 468 consecutive adults (23% male; 62% Hispanic, Mage = 41.46 years) referred by medical staff for psychotherapy appointments to address internalizing symptoms (e...
September 26, 2016: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Jeffrey F Hine, Allison Q Grennan, Kathryn M Menousek, Gail Robertson, Rachel J Valleley, Joseph H Evans
As the benefits of integrated behavioral health care services are becoming more widely recognized, this study investigated physician satisfaction with ongoing integrated psychology services in pediatric primary care clinics. Data were collected across 5 urban and 6 rural clinics and demonstrated the specific factors that physicians view as assets to having efficient access to a pediatric behavioral health practitioner. Results indicated significant satisfaction related to quality and continuity of care and improved access to services...
September 15, 2016: Journal of Primary Care & Community Health
Erin L Olufs, Rachel J Valleley, Kristen C Hembree, Joseph H Evans
INTRODUCTION: As behavioral health providers integrate into primary health care clinics, it is important to examine methods used to increase primary care providers' (PCPs) knowledge of behavioral health providers' areas of expertise and service provision. Attention-deficit/hyperactivity disorder (ADHD) has been identified as one of the most common behavioral health disorders PCPs diagnose and treat in children. METHOD: This study examined whether 2 brief educational "curbside consults," during which a psychologist provided information regarding the assessment and treatment of ADHD, had an impact on PCPs' referral practices...
September 2016: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Benjamin G Druss, Silke A von Esenwein, Gretl E Glick, Emily Deubler, Cathy Lally, Martha C Ward, Kimberly J Rask
OBJECTIVE: Behavioral health homes provide primary care health services to patients with serious mental illness treated in community mental health settings. The objective of this study was to compare quality and outcomes of care between an integrated behavioral health home and usual care. METHOD: The study was a randomized trial of a behavioral health home developed as a partnership between a community mental health center and a Federally Qualified Health Center...
September 15, 2016: American Journal of Psychiatry
David Satcher, Sharon A Rachel
People suffering from mental illness experience poor physical health outcomes, including an average life expectancy of 25 years less than the rest of the population. Stigma is a frequent barrier to accessing behavioral health services. Health equity refers to the opportunity for all people to experience optimal health; the social determinants of health can enable or impede health equity. Recommendations from the U.S. government and the World Health Organization support mental health promotion while recognizing barriers that preclude health equity...
September 14, 2016: Journal of Clinical Psychology in Medical Settings
Maxine Stitzer, Donald Calsyn, Timothy Matheson, James Sorensen, Lauren Gooden, Lisa Metsch
Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN+CM) or without (PN only) the CM program...
August 28, 2016: Journal of Substance Abuse Treatment
Brian DeSantis, Miranda J Jackson, Barry L Duncan, Robert J Reese
: Introduction The integration of behavioral health services into primary care has led to enhanced use of brief screening measures to identify mental health problems. Although useful, such instruments are largely symptom based and diagnosis specific. This narrow focus can potentially limit the identification of broader social or relational distress in patients that affect medical outcomes, as well as present feasibility challenges using a multi-measure approach in identifying mental health comorbidities...
September 9, 2016: Primary Health Care Research & Development
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