Abstract
This article provides an overview of 20 years of professional experiences with developing and implementing a model for integrating behavioral health services into primary care. The Primary Care Behavioral Health (PCBH) model is designed to provide immediate access to behavioral care for a large number of primary care patients by positioning a behavioral health consultant in the exam room area to function as a core member of the primary care team. In an initial era of discovery, the authors were directly involved in developing and testing a variety of new approaches to providing behavioral health services in general medicine. In a second era focused on feasibility, the authors worked with Kaiser Permanente, the United States Air Force and Navy, the Veteran’s Administration, and the Bureau of Primary Care to system test this innovative model of integrated care. Now in an era devoted to dissemination, the authors review the various roles formal research, system level quality improvement initiatives and stakeholder analysis play in promoting integrated care. The authors also describe current efforts to (1) create a tool that helps systems develop integration targets and (2) use the PCBH model as a platform for teaching medical residents and behavioral health providers to work together in a redesigned primary care team model.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bryan, C., Morrow, C., & Appolonio, K. (in press). Impact of behavioral health consulting interventions on patient symptoms and functioning in an integrated family medicine clinic. Journal of Clinical Psychology.
Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Singer, M. (2007). The diabetes lifestyle book: Facing your fears and making changes for a long and healthy life. Oakland: New Harbinger.
Hayes, S., Wilson, K., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Clinical Psychology, 6, 1152–1168.
Katon, W., Robinson, P., Von Korff, M., Lin, E., Bush, T., Ludman, E., et al. (1996). A multifaceted intervention to improve treatment of depression in primary care. Archives of General Psychiatry, 53, 924–932.
Katon, W., Von Korff, M., Lin, E., Limpscomb, P., Russo, J., Wagner, E., et al. (1990). Distressed high utilizers of medical care. DSM-III-R diagnoses and treatment needs. General Hospital Psychiatry, 12, 355–362. doi:10.1016/0163-8343(90)90002-T.
Katon, K. J., Von Korff, M., Lin, E. H. B., Simon, G., Ludman, E., Russo, J., et al. (2004). The pathways study: A randomized trial of collaborative care patients with diabetes and depression. Archives of General Psychiatry, 61, 1042–1049. doi:10.1001/archpsyc.61.10.1042.
Katon, W., Von Korff, M., Lin, E., Walker, E., Simon, G. E., Bush, T., et al. (1995). Collaborative management to achieve treatment guidelines: Impact on depression in primary care. Journal of the American Medical Association, 273, 1026–1031. doi:10.1001/jama.273.13.1026.
Lin, E. H. B., Von Korff, M., Katon, W., Bush, T., Simon, G. E., Walker, E., et al. (1995). The role of primary care physicians in adherence to antidepressant therapy. Medical Care, 33, 66–74. doi:10.1097/00005650-199501000-00006.
Meresman, J. F., Hunkeler, E. M., Hargreaves, W. A., Kirsch, A. J., Robinson, P., Green, A., et al. (2003). A case report: Implementing a nurse telecare program for treating depression in primary care. The Psychiatric Quarterly, 74, 61–73. doi:10.1023/A:1021145722959.
Milliken, C. S., Auchterlonie, J. L., & Hoge, C. W. (2007). Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq War. Journal of the American Medical Association, 298, 2141–2148. doi:10.1001/jama.298.18.2141.
Molinari, V., Karel, M., Jones, S., Zeiss, A., Cooley, S. G., Wray, L., et al. (2003). Recommendations about the knowledge and skills required of psychologists working with older adults. Professional Psychology, Research and Practice, 34, 435–443. doi:10.1037/0735-7028.34.4.435.
Pallak, M. S., Cummings, N. A., Dorken, H., & Henke, C. J. (1994). Medical costs, Medicaid, and managed mental health treatment: The Hawaii study. Managed Care Quarterly, 2, 64–70.
Parkerson, G. (1996). User’s guide for the Duke Health Profile (Duke). Manual available from author at Department of Community and Family Medicine, Box 3886, Duke University Medical Center, Durham, North Carolina, 27710.
Patrick, D. L., Grembowski, D., Durham, M., Beresford, S. A., Diehr, P., Ehreth, J., et al. (1999). Cost and outcomes of medicare reimbursement for HMO preventive services. Health Care Financing Review, 20, 25–43.
Robinson, P. (1996). Living life well: New strategies for hard times. Reno, Nevada: Context Press.
Robinson, P., Afari, N. & Ludman, E. (1995). Diagnostic and treatment issues in working with the depressed male patient in primary care: A pilot study. Group Health Forum, Summer, 22–24.
Robinson, P., & Brockey, A. (2000). Conducting research on chronic pain in a managed care setting: A trail guide. In S. D. Lande & R. J. Kulich (Eds.), Managed care and pain (pp. 87–104). Glenview, IL: American Pain Society.
Robinson, P., Bush, T., Von Korff, M., Katon, W., Lin, E., Simon, G. E., et al. (1995). Primary care physician use of cognitive behavioral techniques with depressed patients. The Journal of Family Practice, 40, 352–357.
Robinson, P., Bush, T., Von Korff, M., Katon, W., Lin, E., Simon, G. E., et al. (1997). The education of depressed primary care patients: What do patients think of interactive booklets and a video? The Journal of Family Practice, 44, 562–571.
Robinson, P., Del Vento, A., & Wischman, C. (1998). Integrated treatment of the frail elderly: The group care clinic. In S. Blount (Ed.), Integrated care: The future of medical and mental health collaboration. New York: Norton.
Robinson, P., & Hayes, S. (1997). Psychological acceptance strategies for the primary care setting. In J. Cummings, N. Cummings, & J. Johnson (Eds.), Behavioral health in primary care: A guide for clinical integration. Madison, CT: Psychosocial Press.
Robinson, P., Wischman, C., & Del Vento, A. (1996). Treating depression in primary care: A manual for primary care and mental health providers. Reno, Nevada: Context Press.
Roy-Byrne, P. P., Craske, M. G., Stein, M. B., Sullivan, G., Bystritsky, A., Katon, W., et al. (2005). A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Archives of General Psychiatry, 62, 290–298. doi:10.1001/archpsyc.62.3.290.
Seal, K. H., Bertenthal, D., Miner, C. R., Sen, S., & Marmar, C. (2007). Bringing the war back home: Mental health disorders among 103, 788 US Veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Archives of Internal Medicine, 167, 467–482. doi:10.1001/archinte.167.5.476.
Simon, G., Katon, W., Rutter, C., Von Korff, M., Lin, E., Robinson, P., et al. (1998). Impact of improved depression treatment in primary care on daily functioning and disability. Psychological Medicine, 28, 693–701. doi:10.1017/S0033291798006588.
Simon, G. E., Lin, E., Katon, W., Saunders, K., Von Korff, M., Walker, E., et al. (1996). Outcomes of “inadequate” antidepressant treatment in primary care. Journal of General Internal Medicine, 10, 663–670. doi:10.1007/BF02602759.
Strosahl, K. D., Hayes, S. C., Bergan, J., & Romano, P. (1998). Assessing the field effectiveness of acceptance and commitment therapy: An example of the manipulated training research method. Behavior Therapy, 29, 35–63. doi:10.1016/S0005-7894(98)80017-8.
Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Jr, Hunkeler, E., Harpole, L., et al. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. Journal of the American Medical Association, 288, 2836–2845. doi:10.1001/jama.288.22.2836.
Von Korff, M., Katon, W., Bush, T., Lin, E. H., Simon, G. E., Saunders, K., et al. (1998). Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression. Psychosomatic Medicine, 60, 143–149.
Wang, P. S., Simon, G. E., Avorn, J., Azocar, F., Ludman, E. J., McCulloch, J., et al. (2007). Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: A randomized controlled trial. Journal of the American Medical Association, 298, 1401–1411. doi:10.1001/jama.298.12.1401.
Wulfert, E., & Hayes, S. C. (1988). Transfer of a conditional ordering response through conditional equivalence classes. Journal of the Experimental Analysis of Behavior, 50, 125–144. doi:10.1901/jeab.1988.50-125.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Robinson, P.J., Strosahl, K.D. Behavioral Health Consultation and Primary Care: Lessons Learned. J Clin Psychol Med Settings 16, 58–71 (2009). https://doi.org/10.1007/s10880-009-9145-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-009-9145-z