Article Figures & Data
Tables
- Table 1. Observed Differences between Traditional Mental Health and Integrated Primary Care
Traditional Mental Health Integrated Behavioral Health and Primary Care 50-min appointments Brief, targeted interventions (5 to 30 min) Asynchronous communication with other healthcare stakeholders (eg, fax a note, voice message) Immediate communication with other members of the team: directly or within the shared EHR Interventions often focused on mental health Interventions focused on behavioral health: mental health, substance use, life stressors, health behaviors, and adherence to medical regimens Clinical involvement often long term, likely to take a reflective approach Clinical involvement focused on the moment (eg, problem and/or solution), likely to take a more active and teaching approach Patients discharged following completion of care Patients retained in the EHR as long as they are receiving primary care Documentation often in narrative form: focused on telling the person's history and story Documentation often brief, focused on problem, intervention, and plan, and located either in separate note or imbedded in physicians' notes Must document development of thorough knowledge of client Knowledge of patient developed by PCP in previous relationship Assign clinical diagnosis to bill Diagnosis often resisted or delayed to try to help the patient without a label Individuals referred to as “clients,” “consumers,” or other term designed to reduce stigma Individuals referred to as “patients” or “consumers” EHR, electronic health record.
PCC BHC Consulting Psychiatrist Open to sharing care with others: recognizes that other professionals bring specialized expertise May proactively review patients to identify potential needs/opportunities for BHC services to PCC Views role as adjunct to PCC and BHC, not as the replacement Participates in briefing by listening and asking for clarification when needed Reviews screenings, uses clinical discretion, or considers suggestions to identify patients needing BHC services Introduces self as a member of the care team: normalizes behavioral health care delivery as part of “routine” practice Introduces self as a member of the care team Provides brief assessment of patient's behavioral health needs and establishes foundation for BHC handoff: describing expertise, importance of whole person care, expectations (“selling” resource to patient) Conducts rapid, targeted assessments of patient needs; identifies “feasible” targets for brief intervention Provides psychiatric consultation to the primary care team as needed Briefs BHC on perceived patient condition/needs: assessment of situation, depression intervention Sets agenda balancing patient/PCC priorities, or negotiates focus of these two stakeholders Assists PCC: diagnosis, treatment planning, and recommendations Available to debrief with BHC during encounter or post-encounter to develop care plan Apply brief interventions using abbreviated evidence-based treatment strategies: solution-focused therapy, behavioral activation, cognitive behavioral therapy, motivational interview Willing to treat/consult on some patients without seeing them Reinforces care plan and/or BHC intervention during next encounter Clinical capacity to address full spectrum of behavioral health needs: common mental health conditions (depression, anxiety), lifestyle behaviors (self-care, social engagement, relaxation, sleep hygiene, diet, exercise) Makes a treatment plan in a short amount of time with limited information May develop specialization areas: substance use counseling, biofeedback Focuses on complex patients who cannot be managed alone by PCP and BHC Links efforts to overall patient care: reinforce care plan with PCC and summarize goals/next steps with patient Leads group sessions for patients: pain groups, diabetes management Engages other professionals in patient care plan: BHC, social worker, pharmacist Determines care level needed: additional followup with BHC, transition to specialty mental health care Coaches PCCs to manage complex patients; transitions patients back to primary care Assists with specialty mental health/other treatment resource transitions (case management) Concisely communicates information to the primary care team: verbally, EHR notes Concisely communicates information to the primary care team verbally, EHR notes BHC, behavioral health clinician; EHR, electronic health record; PCC, primary care clinician.
Component Organizational background Organizational history Organization mission and vision Information on the integration model (current and ideal) Description of roles and responsibilities Information for all clinicians Sample script and handouts for introducing the model and BHCs to patients Team meeting descriptions and types Smart phrases for the EHR Screener forms Coding and billing procedures Information scheduling, appointment types, and duration Health system (internal) and community (external) resources Workflow descriptions Recommended references (articles, books, and websites) Information for BHCs Behavioral health interventions and treatment modalities Descriptions of the differences between integrated care provided by a BHC and specialty mental health Documentation requirements and examples Medical vocabulary EHR, electronic health record.
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