Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals

Deborah J. Cohen; Melinda Davis; Bijal A. Balasubramanian; Rose Gunn; Jennifer Hall; Frank V. deGruy; C. J. Peek; Larry A. Green; Kurt C. Stange; Carla Pallares; Sheldon Levy; David Pollack; Benjamin F. Miller

doi:10.3122/jabfm.2015.S1.150042

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Table 1. Contextual Factors that Shape Coordinating, Collaborating and Consulting

Factors	Consulting: Advice Seeking/Giving	Coordinating: Separate, but Aligned Care Delivery	Collaborating: Shared Sense Making, Decision Making
Patient	Problem/situation definable		Problem/situation is complicated
Patient	Identified as needing expertise of another provider		Identified as needing professionals from different backgrounds to make sense of problem/treatment
Clinician	Clinician with expertise to answer patient care question	Clinician with expertise carries out next steps/treatment	Clinicians work together to clarify patients' needs
	Clinicians from different disciplines work as a team, conduct care team huddles and meet to discuss clinical care, close proximity of team, flexible schedule/time for warm handoffs.
Practice	Clinicians from different disciplines (often colocated) are rapidly and reliably accessible to answer questions
System	Support for communication between separate behavioral and medical practices	Support for synchronizing (behavioral and medical) care over time	Support for shared learning about and with the patient.
Problem	Discrete problem	Definable, discrete problem	Complex, hard-to-define problem that seems intractable to treatment and/or linked to medical or social problem
	Little uncertainty	Moderate uncertainty or routine care need	Professionals need longer dialogue to clarify best strategy to deliver and engage patient in treatment
	Information, when provided, allows advice seeker to act independently	Professional has expertise to address care need
		Quick discussion positions professionals to act in loosely connected way
		Engages patient in treatment

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Table 2. Organization and Operating Level Models and Frameworks Addressing Collaboration

Name and Reference	Description
Coordinated, colocated, integrated^61–63	A typology for design of integrated behavioral health in clinics featuring organizational arrangements along with some corresponding descriptions for how clinicians would interact in these arrangements.
Five levels of collaboration⁶⁴	A typology of escalating levels combining levels of organizational integration with levels of clinical integration and patterns of clinician interaction characterizing each level, or that are hallmarks of those levels (minimal collaboration, basic collaboration at a distance, basic collaboration on site, close collaboration in a partly integrated system, close collaboration in a fully integrated system).
Standard framework for integrated healthcare⁶⁵	Can be considered an elaboration and extension of the “five levels of collaboration” with more contextual information drawn in that in effect create alternative operating models for behavioral health integration, from less to more integration.
Lexicon for integration of behavioral health and primary Care⁶⁶	A national consensus functional definition of behavioral health integration: what functions are required, not an operating model or set of levels featuring both “types” and “levels” of practice spatial arrangements and collaborative relationships.
Collaborative care model^67,68	An approach for organizing integrated care that involves an arrangement between a care manager and psychiatrist working in tandem with a primary care team.