Behavioral Health Integration and Outcomes that Matter to Patients: a Longitudinal Mixed-Methods Observational Study

Wright, Bill; Broffman, Lauren; Mcmenamin, Kayla Albrecht; Jones, Kyle G; Weller, Maggie; Brown, Kristin M.; Jacobson, Laura; Bouranis, Nicole; Kenton, Natalie

doi:10.1007/s11414-020-09691-8

Cited by 7 publications

(8 citation statements)

References 39 publications

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“…18 Studies on care coordination and clinic-related outcomes indicate that integrated services result in improved access to and use of preventive and primary care services for persons with severe mental illness (SMI) regardless of a setting's degree of service integration. [22][23][24][25] However, other clinically significant results, including a decrease in unnecessary care utilization or improvement in chronic care conditions, are inconsistent or have not been consistently obtained. 22,23,26,27 True patient-centered outcomes, the primary objective of care integration, are less often assessed.…”

Section: Integrated Carementioning

confidence: 99%

“…According to the results of 1 qualitative study, patients with mental illness were "indifferent" to the concept of integration and structural aspects of care. 25 Their focus was rather on the experience of care. For these persons, who are more likely to have challenges developing and sustaining relationships, the number of relationships they must navigate is not reduced when differing providers are involved with colocated care.…”

Section: Integrated Carementioning

confidence: 99%

“…They feared being stigmatized and stereotyped and wanted to receive care from a trusted provider with whom they had an alliance and felt respected, valued, and heard. 25 The patient-provider therapeutic alliance is consistently a key predictor of positive outcomes regardless of setting, [29][30][31][32][33][34] and yet this highly interpersonal concept is not emphasized in SAMHSAchampioned integrated health care models that are system focused. For persons with SMI, the social process of engaging in care "begins when the patient feels that he or she matters to the provider."…”

Section: Integrated Carementioning

confidence: 99%

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Disrupting the System: An Innovative Model of Comprehensive Care

Conley¹,

Judge-Ellis²

2021

The Journal for Nurse Practitioners

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Despite health care reform, our nation continues to struggle containing health care costs while meeting the needs of persons with behavioral health disorders and comorbid chronic care conditions. The purpose of this article is to propose that dually certified primary care and psychiatric mental health nurse practitioners may be the disruptive innovation that becomes the solution for improving the coordination and care for high-need patients while containing costs. The concepts of disruptive innovation, integrated care, and whole person care are discussed followed by an introduction to the innovative primary care and psychiatric mental health nurse practitioner's role and its potential for health care system disruption. Finally, a call to nursing is proffered to seize current opportunities to meet the Triple Aim challenge by providing whole person care that is highquality, cost-effective, and satisfactory to patients because it is truly patient centered and meets their needs.

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Section: Integrated Carementioning

confidence: 99%

Section: Integrated Carementioning

confidence: 99%

Section: Integrated Carementioning

confidence: 99%

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Disrupting the System: An Innovative Model of Comprehensive Care

Conley¹,

Judge-Ellis²

2021

The Journal for Nurse Practitioners

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“…Mental health integrated models have emerged as a transformative and pragmatic approach to improve overall health management and access to specialty care (Wright et al, 2020). Integrated care definitions abound; we define it as collaboration between primary care and specialty mental health care to identify mental health concerns and facilitate mental health services access (Peek & The National Integration Academy Council, 2013).…”

Section: Introductionmentioning

confidence: 99%

Implementation outcomes from a pilot of “Access to Tailored Autism Integrated Care” for children with autism and mental health needs

Stadnick

Aarons

Martinez

et al. 2022

Autism

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The objective of the study is to report the feasibility, acceptability, and adoption of the “Access to Tailored Autism Integrated Care (ATTAIN),” a model to identify mental health needs and link to mental health care for autistic children. The Exploration, Preparation, Implementation, and Sustainment framework informed implementation outcome measurement and analysis. Thirty-six providers from seven pediatric primary care clinics within three health care systems enrolled and received an initial Access to Tailored Autism Integrated Care training and ongoing online support over 4 months with autistic patients ages 4–16 years old. Survey and interview assessments measured perceptions of feasibility, acceptability, and intentions to sustain Access to Tailored Autism Integrated Care use. Electronic health record (EHR) data assessed child characteristics and Access to Tailored Autism Integrated Care adoption. Descriptive statistics and one-way analyses of variance characterized implementation outcomes and differences between health care systems. Rapid qualitative methods were used to analyze interview data that were integrated with survey data for convergence and expansion. Providers reported that Access to Tailored Autism Integrated Care was feasible, acceptable, and that the initial training was helpful. Reports were mixed about providers’ intentions to continue using Access to Tailored Autism Integrated Care. Providers offered recommendations for more specific and tailored implementation support. There were significant differences in provider-reported adoption rates between health care systems. This is one of the first implementation studies examining integrated mental health care for autistic children and highlighted specific areas for refinement to facilitate scale-up. Lay abstract Children with autism frequently experience co-occurring mental health needs. The “Access to Tailored Autism Integrated Care (ATTAIN)” model was co-created with caregivers, pediatric providers, and health care leaders to identify mental health needs and link to mental health care for autistic children. This article describes outcomes from a pilot study of Access to Tailored Autism Integrated Care with 36 pediatric primary care providers from seven clinics within three healthcare systems. Providers participated in an initial Access to Tailored Autism Integrated Care training and received ongoing online support over 4 months with autistic patients ages 4–16 years old. Survey and interview assessments measured provider perceptions of feasibility, acceptability, and intentions to continue using Access to Tailored Autism Integrated Care after the pilot. Providers reported that Access to Tailored Autism Integrated Care was feasible, acceptable, that the initial training was helpful in their implementation but that more specific and tailored implementation support was needed. Results show that Access to Tailored Autism Integrated Care is a promising model to support mental health screening and linkage for children with autism in primary care. Findings provide information on specific areas of the Access to Tailored Autism Integrated Care model that could be benefit from additional refinement to support more widespread use in primary care settings.

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“…As part of a larger study that sought to examine the association of BHI on patient-reported and claims-based outcomes ( 11 , 12 ), the aim of this qualitative study was to characterize the shared experiences of patients and providers in a primary care BHI setting. There were two objectives: (1) identify experiences that were important to patients and (2) compare these experiences to those of corresponding providers.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Shared Experiences Among Patients and Providers Following Behavioral Health Integration in Primary Care

Kenton

Bouranis

Cox

et al. 2021

Journal of Patient Experience

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Behavioral health integration (BHI) changes the paradigm of primary care delivery by integrating behavioral healthcare into primary care. Thus, BHI likely alters the shared experiences of both patients and providers in an interrelated manner; however, their experiences are usually evaluated separately. The purpose of this study was to analyze these shared experiences together within patient–provider pairs in integrated clinics. First, patient interviews were conducted using semi-structured interview guides and transcripts were analyzed for major themes of patient experience. Next, providers named in patient interviews were interviewed around these same themes. Thematic analysis was performed on 18 transcripts (11 patients, 7 providers). Common themes included BHI experience, pain management, feeling heard by providers, and health care experiences. Areas of alignment included positive perception of BHI, an absence of long-term care, and a desire to share decision-making. Pain management was a persistent area of conflict, and the differing experiences were consistent with a change in the psychodynamic patient–provider model. This conflict highlights a gap in BHI and a need for provider education about psychodynamic relationship models.

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Behavioral Health Integration and Outcomes that Matter to Patients: a Longitudinal Mixed-Methods Observational Study

Cited by 7 publications

References 39 publications

Disrupting the System: An Innovative Model of Comprehensive Care

Disrupting the System: An Innovative Model of Comprehensive Care

Implementation outcomes from a pilot of “Access to Tailored Autism Integrated Care” for children with autism and mental health needs

Evaluation of Shared Experiences Among Patients and Providers Following Behavioral Health Integration in Primary Care

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