Collaborative mental health care

Introduction: Patient engagement in research can improve a health system's responsiveness to patient need, but patient experience with integrated care is not well understood. This qualitative study explores patient experience and provider perceptions of patient experience with the Behavioral Health Integration and Complex Care Initiative (BHICCI), which is a large-scale system redesign that delivers integrated care to persons with complex needs. Methods: We conducted 8 patient focus groups ( n = 54 patients) and n = 32 interviews with BHICCI providers at five community health settings participating in the BHICCI during which patients and providers described how patient experience with care had changed under the initiative...

This commentary discusses the journey to integrated behavioral health and primary care in the state of Colorado. The authors discuss integrated care, and the lessons learned by early adopters can help those just getting started. They argue integration is possible in practice settings of all types despite the barriers that exist - but these barriers must continue to be broken down for further scaling and long-term sustainability. While adequate payment, workforce, and data-sharing infrastructure and policy are necessary for scaling and sustainability, they are not sufficient: practice transformation support is crucial for a change this fundamental...

INTRODUCTION: Prevalence rates of anxiety disorders and symptoms in primary care (PC) settings are very high. Behavioral health consultants in primary care behavioral health (PCBH) settings enable increased access to evidence-based anxiety treatment. Despite strong extant support for exposure-based therapy for anxiety disorders, the use of exposure to treat anxiety in PC settings is low. Although barriers to exposure therapy (ET) may be exacerbated in PC settings, many anxiety presentations in PC warrant an exposure-based approach to treatment...

The increase in behavioral health problems presenting in pediatric primary care (PPC) has led to a greater focus on the prevention and treatment of mental health concerns. As a result, care has shifted from colocation to integrated PPC models. However, the literature provides limited guidance on the development and implementation of integrated PPC models that aim to transform both PPC and the larger health care system. We developed an integrated behavioral health (IBH) approach modeled with fidelity to the Integrated Practice Assessment Tool to fully integrate behavioral health into PPC...

BACKGROUND: Mental health conditions impose a major burden worldwide, especially in low- and middle-income countries (LMICs), where health specialists are scarce. A challenge to closing LMICs' mental health treatment gap is determining the most cost-effective task-shifting pathway for delivering mental health services using evidence-based interventions (EBIs). This article discusses the protocol for the first study implementing comprehensive mental health services in LMICs. METHODS: In partnership with the Mozambican Ministry of Health, this cluster-randomized, hybrid implementation effectiveness type-2 trial will evaluate implementation, patient, and service outcomes of three task-shifting delivery pathways in 20 Mozambican districts (population 4...

OBJECTIVE: The authors evaluated suicide risk rates detected via a depression screener administered within a large pediatric primary care system and examined 1-year follow-up care after adolescents' endorsement of suicide risk. METHODS: Retrospective electronic health record data were extracted to examine both suicide risk rates from items endorsed on the Patient Health Questionnaire-Modified for Teens (PHQ-9-M) and primary care providers' (PCPs') follow-up suicide risk assessments on the day of depression screening among adolescents ages 12-18 years during the period of September 1, 2014, to August 31, 2016...

Conducting systematic case reviews (SCRs) is a critical skill for psychiatrists leveraging their expertise to provide collaborative care in a primary care setting; however, there is little literature to guide best practices for executing an SCR. This column offers guidance to psychiatrists on best practices for conducting SCRs by drawing on experience from psychiatrists who teach collaborative care and who directly observe SCRs in established programs. Furthermore, it describes several common threats to successful SCR and presents potential solutions to assist programs in implementing indirect psychiatric care, an essential component of collaborative care...

OBJECTIVE: This study aimed to assess parents' satisfaction with the primary care provider (PCP) in the treatment of their child's mental health problems after the PCP consulted with the Massachusetts Child Psychiatry Access Program (MCPAP). It studied how parental satisfaction may vary across factors, including service utilization, parental perception of the child's illness, and parental perception of certain PCP attributes. METHODS: The study analyzed 374 telephone consultations made from PCPs to MCPAP between March 2010 and June 2012...

A quality improvement project was delivered by a federally qualified health center to improve patient access to psychiatric services. The effort was supported by training and technical assistance provided by the American Psychiatric Association Support and Alignment Network. Over a 3-year period, the collaborative care model (CoCM) and other integrated consultative strategies were implemented. As a result, the waitlist was reduced from 350 patients to 1 patient. The use of the CoCM and other integrated care strategies was successful in eliminating a psychiatric service waitlist in this primary care setting...

This review examines the history and contemporary landscape of school mental health, describing evidence that schools are an essential component of the system of child and adolescent care and providing recommendations to advance this vital care delivery system. This literature review of scientific data and shifts to policy and practice in school mental health documents the evolution of collaboration between the education and mental health systems to support student mental health. This review describes best practices and provides examples for achieving the standards of the comprehensive school mental health systems model in states and local communities...

OBJECTIVES: Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs' pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves...

Research from outside the medical field suggests that social ties between team-members influence knowledge sharing, improve coordination, and facilitate task completion. However, the relative importance of social ties among team-members for patient satisfaction remains unknown. In this study, we explored the association between social ties within emergency teams performing simulated caesarean sections (CS) and patient-actor satisfaction. Two hundred seventy-two participants were allocated to 33 teams performing two emergency CSs in a simulated setting...

INTRODUCTION: Under the current payment environment, the challenges to implementing and sustaining integrated behavioral health care are substantial. One key barrier for clinicians, administrators, researchers, and patients/families is a lack of clarity about who pays for integrated health care in the United States, and a lack of consensus about whether bending the health care cost curve is a fundamental goal of integrated care, and for whom. Clinicians caring for patients and families in integrated care settings would benefit from honing their "payment reform literacy skills" in order to advocate for integrated care...

In addition to providing critical behavioral health services for those with mental health issues and substance use disorders, some Community Mental Health Centers (CMHCs) in the United States have begun integrating primary care services, referred to as "reverse integration". Representing the interests of CMHCs across the United States, the National Council for Behavioral Health (NCBH) represents over 3,000 member organizations delivering mental health and/or addictions treatment and services to roughly 10 million patients and families...

No abstract text is available yet for this article.

Policy Points Individuals with behavioral health (BH) conditions comprise a medically complex population with high costs and high health care needs. Considering national shortages of BH providers, primary care providers serve a critical role in identifying and treating BH conditions and making referrals to BH providers. States are increasingly seeking ways to address BH conditions among their residents. States funded by the Centers for Medicare and Medicaid Services under the first round of the State Innovation Models (SIM) Initiative all invested in BH integration...

OBJECTIVE: This study examined organizational variability of process-of-care and depression outcomes at eight community health centers (CHCs) in the years following implementation of collaborative care (CC) for depression. METHODS: The authors used 8 years of observational data for 13,362 unique patients at eight CHCs that participated in Washington State's Mental Health Integration Program. Organization-level changes in depression and process-of-care outcomes over time were studied...

Background: Pathways to care are actions and strategies employed by individuals in order to get help for health-related distress and the related processes of care providers. On several systematic reviews regarding pathways to mental health care (PMHC), studies regarding South American countries were not present. This review synthesizes qualitative and quantitative research about PMHC in Brazil. Methods: LILACS, MEDLINE and SCIELO databases were searched for papers regarding PMHC in Brazil...

No abstract text is available yet for this article.

No abstract text is available yet for this article.