Mental Health Care Treatment Initiation When Mental Health Services Are Incorporated Into Primary Care Practice

Article Figures & Data

Table 1. Fletcher Allen Health Care Collaborative Care Model

Clinical	Full-time primary care behavioral health clinician with clinical and care management responsibilities Clinician availability for warm handoff and consultation Brief evidence-supported treatment Intensive training of behavioral health collaborative care clinician in the model, including treatment protocols for a broad range of psychological and medical problems amenable to behavioral health treatment Population (panel)-based care using measurement-based stepped treatment and other resource availability
Operational	Practice re-engineering of operational processes, including “warm handoffs” (personal introductions of behavioral clinician to patient by primary care physician) Automated referral and patient scheduling Training physicians and staff in behavioral care procedures Appointment frequency and interval consistent with primary care Shared electronic health record with mental health note availability Care management coordinates referrals and information out to specialty care if greater intensity of care is needed; management of external information
Financial	Brief interventions during brief time frames Coordination of services and finances to optimize sustainability Regular reports of performance, relative value unit, and financial data

Table 2. Sample Characteristics and Treatment Initiation Results

Sample Characteristics	Site A	Site B
N	93	256
Median age, years (range)	50.4 (18–97)	48 (20–86)
Women (%)	58	78
Non-Hispanic white (%)	100	98.4
Proportion of those who were referred and scheduled an appointment	—	84% (CI = 79.5–88.5)
Proportion of those who scheduled and kept appointment	95.5% (CI = 93.3–97.7)	81.9% (CI = 76.7–87.0)
Overall referral success		68.8% (CI = 64–73.5)