Preparing the Workforce for Behavioral Health and Primary Care Integration

Hall, Jennifer; Cohen, Deborah J.; Davis, Melinda M.; Gunn, Rose; Blount, Alexander; Pollack, David A.; Miller, William L.; Smith, Corey; Valentine, Nancy M.; Miller, Benjamin F.

doi:10.3122/jabfm.2015.s1.150054

Cited by 97 publications

(99 citation statements)

References 28 publications

(29 reference statements)

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“…In addition, local availability and capabilities of the BHC workforce, who may be trained in a referral model with 50-minute prescheduled therapy appointments, may constrain what is feasible to implement, at least initially. 27 Like other emergent properties of complex adaptive systems, staffing, scheduling, and approach to integrated care influence each other in nonlinear ways and may evolve based on local or national changes. 28 Multiple factors may shape staffing, scheduling patterns, and a practice's approach to integrated care (ie, referral, warm handoff).…”

Section: Discussionmentioning

confidence: 99%

Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care

Davis

Balasubramanian

Cifuentes

et al. 2015

The Journal of the American Board of Family Medicine

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Purpose: To examine the interrelationship among behavioral health clinician (BHC) staffing, scheduling, and a primary care practice's approach to delivering integrated care.Methods: Observational cross-case comparative analysis of 17 primary care practices in the United States focused on implementation of integrated care. Practices varied in size, ownership, geographic location, and integrated care experience. A multidisciplinary team analyzed documents, practice surveys, field notes from observation visits, implementation diaries, and semistructured interviews using a grounded theory approach.Results Integration of primary and behavioral health care is associated with improved experience of care, better quality, and controlled costs (ie, the triple aim) 1 and is an increasing focus of local, regional, and national transformation efforts. [2][3][4][5] We define inte-

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Section: Discussionmentioning

confidence: 99%

Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care

Davis

Balasubramanian

Cifuentes

et al. 2015

The Journal of the American Board of Family Medicine

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“…17 Practices also report challenges in finding primary care clinicians with a willingness and ability to work as a team, sharing the responsibility for patient care with other clinicians and incorporating their expertise into patient care. Primary care clinicians have to be able to identify and initially deal with patients' behavioral needs and then know when and how to involve behavioral health clinicians.…”

Section: Workforce and Training Issuesmentioning

confidence: 99%

“…This involves training programs, training manuals, an initial process of having clinicians shadow each other, ongoing mentoring, and ongoing interprofessional team meetings. 17 Support organizations must collect best practices, assist in the development of shared training programs and resources, and assist in the development of mentoring across practices within a learning community.…”

Section: Workforce and Training Issuesmentioning

confidence: 99%

Strategies to Support the Integration of Behavioral Health and Primary Care: What Have We Learned Thus Far?

Dickinson

2015

The Journal of the American Board of Family Medicine

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The articles in this supplement contain a wealth of practical information regarding the integration of behavioral health and primary care. This type of integration effort is complex and greatly benefits from support from outside organizations, as well as collaboration with other practices attempting similar work. This editorial extracts from these articles some of the key lessons learned regarding the integration of behavioral health and primary care for practices and for organizations that support practice transformation. (J Am Board Fam Med 2015;28:S102-S106.)

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“…These were published in a supplement along with 4 other articles that contend that successful integration requires: (1) appropriate workforce preparation 13 ; (2) integrated electronic health records (EHRs) 14 ; (3) adequate staffing ratios and flexible scheduling 15 ; and (4) external financing to cover the associated costs to the practice. 16 Editorials and commentaries in the supplement relate these findings to policy, 17 practice transformation research, 18 and leadership theory.…”

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confidence: 99%

From Our Practices to Yours: Key Messages for the Journey to Integrated Behavioral Health

2017

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Background:The historic, cultural separation of primary care and behavioral health has caused the spread of integrated care to lag behind other practice transformation efforts. The Advancing Care Together study was a 3-year evaluation of how practices implemented integrated care in their local contexts; at its culmination, practice leaders ("innovators") identified lessons learned to pass on to others.Methods: Individual feedback from innovators, key messages created by workgroups of innovators and the study team, and a synthesis of key messages from a facilitated discussion were analyzed for themes via immersion/crystallization.Results: Five key themes were captured: (1) frame integrated care as a necessary paradigm shift to patient-centered, whole-person health care; (2) initialize: define relationships and protocols up-front, understanding they will evolve; (3) build inclusive, empowered teams to provide the foundation for integration; (4) Of adults with a behavioral health (BH) disorder, 67% do not receive adequate treatment.1 Untreated BH conditions result in avoidable suffering and increase the cost of care through lack of medical improvement, decreased adherence to treatment, and inappropriate health care utilization. 2Most patients with BH conditions, including children, are seen in medical settings, most commonly primary care (PC), presenting the need and opportunity to replace separated systems of care that do not adequately meet the needs of patients with integrated, "whole-person" care.Integrated behavioral health (or integrated care) is the care that results from a practice team of PC and BH clinicians working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health, substance use conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization. The historic, cultural separation of training, payment, and delivery systems for PC and BH have caused the spread of integrated care to lag far behind other practice transformation efforts (eg, the Patient Centered Medical Home [PCMH]). New payment structures and delivery models that support the integration of PC and BH are emerging, facilitating the movement toward integrated care as part of the drive to achieve the This article was externally peer reviewed.

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Preparing the Workforce for Behavioral Health and Primary Care Integration

Cited by 97 publications

References 28 publications

Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care

Clinician Staffing, Scheduling, and Engagement Strategies Among Primary Care Practices Delivering Integrated Care

Strategies to Support the Integration of Behavioral Health and Primary Care: What Have We Learned Thus Far?

From Our Practices to Yours: Key Messages for the Journey to Integrated Behavioral Health

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