Primary Care Practice Redesign: Challenges in Improving Behavioral Health Care for a Vulnerable Patient Population

This study examined a program focused on integrating mental health in a family medicine practice in an economically challenged urban setting. The program included using a behavioral health technology platform, a behavioral health collaborative composed of community mental health agencies, and a community health worker (CHW). Of the 202 patients screened, 196 were used for analysis; 56% were positive for anxiety, 38% had scores consistent with moderate to severe depression, and 34% were positive for post-traumatic stress disorder. There was a statistically significant difference in the diagnosis of depression when comparing the screened group to a control group. Only 27% of patients followed through with behavioral health referrals despite navigational assistance provided by a CHW and assured access to care through a community agency engaged with the Behavioral Health Alliance. Further qualitative analysis revealed that there were complex patient factors that affected patient decision making regarding follow-up with behavioral health care.

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Integrated Behavioral Health Care in Family Medicine Residencies

Family Medicine ◽

10.22454/fammed.2018.639260 ◽

2018 ◽

Vol 50 (5) ◽

pp. 380-384 ◽

Cited By ~ 7

Author(s):

Christine Jacobs ◽

Jay A. Brieler ◽

Joanne Salas ◽

Renée M. Betancourt ◽

Peter F. Cronholm

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Family Medicine ◽

Behavioral Health ◽

Behavioral Health Care ◽

Program Directors ◽

The United States ◽

Training Methods ◽

Significant Difference

Background and Objectives: Behavioral health integration (BHI) in primary care settings is critical to mental health care in the United States. Family medicine resident experience in BHI in family medicine residency (FMR) continuity clinics is essential preparation for practice. We surveyed FMR program directors to characterize the status of BHI in FMR training. Methods: Using the Council of Academic Family Medicine Educational Research Alliance (CERA) 2017 survey, FMR program directors (n=478, 261 respondents, 54.6% response rate) were queried regarding the stage of BHI within the residency family medicine center (FMC), integration activities at the FMC, and the professions of the BH faculty. BHI was characterized by Substance Abuse and Mental Health Services Agency (SAMHSA) designations within FMRs, and chi-square or ANOVA with Tukey honest significant difference (HSD) post hoc testing was used to assess differences in reported BHI attributes. Results: Program directors reported a high level of BHI in their FMCs (44.1% full integration, 33.7% colocated). Higher levels of BHI were associated with increased use of warm handoffs, same day consultation, shared health records, and the use of behavioral health (BH) professionals for both mental health and medical issues. Family physicians, psychiatrists, and psychologists were most likely to be training residents in BHI. Conclusions: Almost half of FMR programs have colocated BH care or fully integrated BH as defined by SAMHSA. Highly integrated FMRs use a diversity of behavioral professionals and activities. Residencies currently at the collaboration stage could increase BH provider types and BHI practices to better prepare residents for practice. Residencies with full BHI may consider focusing on supporting BHI-trained residents transitioning into practice, or disseminating the model in the general primary care community.

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Patient-Centered Homes and Integrated Behavioral Health Care: Reclaiming the Role of “Consultant” for Psychiatric-Mental Health Nurse Practitioner

Issues in Mental Health Nursing ◽

10.3109/01612840.2016.1172686 ◽

2016 ◽

Vol 37 (6) ◽

pp. 387-391 ◽

Cited By ~ 4

Author(s):

Victoria Soltis-Jarrett

Keyword(s):

Mental Health ◽

Health Care ◽

Behavioral Health ◽

Nurse Practitioner ◽

Behavioral Health Care ◽

Patient Centered ◽

Integrated Behavioral Health ◽

Mental Health Nurse ◽

Health Nurse

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Patient Views of Behavioral Health Providers in Primary Care: A Qualitative Study of 2 Southeastern Clinics

Journal of Patient Experience ◽

10.1177/2374373519860357 ◽

2019 ◽

Vol 7 (4) ◽

pp. 527-533

Author(s):

Aubry N Koehler ◽

Grisel Trejo ◽

Joanne C Sandberg ◽

Brittany H Swain ◽

Gail S Marion ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Behavioral Health ◽

Care Delivery ◽

Behavioral Health Care ◽

Patient Care Team ◽

Care Team ◽

Care Practice ◽

Health Providers ◽

Integrated Behavioral Health

Background: Limited research is available around patient experience of integrated behavioral health care in primary care settings. Objective: We sought to identify the major themes through which patients described their integrated behavioral health care experiences as a means of informing and improving clinic processes of integrated health care delivery. Methods: We captured viewpoints from 16 patients who experienced an integrated behavioral health care model from 2 primary care clinics and completed at least 3 visits with a behavioral health provider (BHP). Using grounded theory analyses, we coded and analyzed transcriptions for emergent themes. Analysis: The interview process yielded 3 major themes related to the BHP including (a) the BHPs’ clinic presence made behavioral health care more convenient and accessible, (b) BHPs worked within time and program limitations, and (c) BHPs helped with coping, wellness, and patient-care team communication. Conclusion: The BHPs serving in a large primary care practice and a Federally Qualified Health Center played an important role in connecting patients with behavioral health care and improving care team collaboration, both in terms of communication within the team and between the team and the patient/family.

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State Mental Health Policy: Mending Missouri's Safety Net: Transforming Systems of Care by Integrating Primary and Behavioral Health Care

Psychiatric Services ◽

10.1176/ps.2009.60.5.585 ◽

2009 ◽

Vol 60 (5) ◽

pp. 585-588 ◽

Cited By ~ 4

Author(s):

Dorn Schuffman ◽

Benjamin G. Druss ◽

Joseph J. Parks

Keyword(s):

Mental Health ◽

Health Care ◽

Health Policy ◽

Behavioral Health ◽

Systems Of Care ◽

Mental Health Policy ◽

Behavioral Health Care ◽

Safety Net ◽

State Mental Health ◽

State Mental

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The Digital Revolution in Behavioral Health

Journal of the American Psychiatric Nurses Association ◽

10.1177/1078390319879750 ◽

2019 ◽

Vol 26 (1) ◽

pp. 102-111 ◽

Cited By ~ 3

Author(s):

Michael J Hasselberg

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Behavioral Health ◽

Digital Health ◽

Behavioral Health Care ◽

The United States ◽

Care Providers ◽

Digital Revolution ◽

The University

BACKGROUND: Technology is disrupting every modern industry, from supermarkets to car manufacturing, and is now entering the health care space. Technological innovations in psychiatry include the opportunity for conducting therapy via two-way video conferencing, providing electronic consultations, and telementoring and education of community health care providers. Use of mobile health applications is also an expanding area of interest and promise. OBJECTIVE: The purpose of this article is to review the evolution and pros and cons of technology-enabled health care since the digital movement in psychiatry began more than 50 years ago as well as describe the University of Rochester’s innovative digital behavioral health care model. METHODS: A review of the literature and recent reports on innovations in digital behavioral health care was conducted, along with a review of the University of Rochester’s model to describe the current state of digital behavioral health care. RESULTS: Given the lack of access to care and mental health professional shortages in many parts of the United States, particularly rural areas, digital behavioral health care will be an increasingly important strategy for managing mental health care needs. However, there are numerous hurdles to be overcome in adopting digital health care, including provider resistance and knowledge gaps, lack of reimbursement parity, restrictive credentialing and privileging, and overregulation at both the state and federal levels. CONCLUSIONS: Digital health innovations are transforming the delivery of mental health care services and psychiatric mental health nurses can be on the forefront of this important digital revolution.

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A qualitative study of urban hospital transitional care

Qualitative Research in Medicine & Healthcare ◽

10.4081/qrmh.2018.7216 ◽

2018 ◽

Vol 2 (2) ◽

Author(s):

Joe Feinglass ◽

Samuel Wein ◽

Caroline Teter ◽

Christine Schaeffer ◽

Angela Rogers

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Quality Improvement ◽

Transitional Care ◽

Behavioral Health Care ◽

Care Quality ◽

Care Staff ◽

Internal Quality ◽

Care Practice

This study is part of a mixed methods evaluation of a large urban medical center transitional care practice (NMG-TC). The NMG-TC provides integrated physical and behavioral health care for high need patients referred from the hospital emergency department or inpatient units and who lack a usual source of primary care. The study was designed for internal quality improvement and sought to evaluate staff perceptions of successful transitions for their medically and socially complex patients, and alternatively, the obstacles most likely to negatively impact patient outcomes. All 16 NMG-TC patient care staff were interviewed in a collaborative effort to produce empowered testimony that might go beyond expected clinical narratives. The interview schedule included questions on risk stratification, integrated mental health care, provider to provider handoffs, and how staff deal with key social determinates of patients’ health. The constant comparative method was used to deductively derive themes reflecting key domains of transitional care practice. Seven themes emerged: i) the need to quickly assess patient complexity; ii) emphasizing caring for major mental health and substance use issues; iii) obstacles to care for uninsured, often undocumented patients; iv) the intractability of homelessness; v) expertise in advancing patients’ health literacy, engagement and activation; vi) fragmented handoffs from hospital care and vii) to primary care in the community. Respondent stories emphasized methods of nurturing patients’ self-efficacy in a very challenging urban health environment. Findings will be used to conceptualize pragmatic, potentially high-impact transitional care quality improvement initiatives capable of better addressing frequent hospital use.

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