The behavioral health laboratory: Building a stronger foundation for the patient-centered medical home.

Abstract

The Veterans Health Affairs is in the process of implementing a new model for the delivery of primary care: The Patient-Centered Medical Home (PCMH). One critical challenge of any PCMH model will be the integration of basic mental health treatment into primary care. Such a mental health integration program must be flexible enough to incorporate new evidence-based treatments as patient demographics and health care needs evolve over time. This paper summarizes the Behavioral Health Laboratory (BHL) care management model, a program already in place in more than 20 Veterans Affairs facilities along with private sector insurance providers, as ideally suited to fill this role in the PCMH. The BHL uses a platform of standardized, software-aided mental health assessments and clinical care managers to deliver evidence-based treatments for depression, anxiety, and substance abuse in primary care settings. The authors review this comprehensive program of screening, assessment, treatment, and referral to specialty care when needed. The BHL program is consistent with the guiding principles of the Patient-Centered Medical Home: applying chronic illness disease management principles to provide more continuous, coordinated, and efficient primary care services to patients with diverse needs. Just as importantly, the authors review how this standardized platform for delivering integrated mental health services provides the flexibility to incorporate novel interventions for a changing population.

A Randomized Clinical Trial of Alcohol Care Management Delivered in Department of Veterans Affairs Primary Care Clinics Versus Specialty Addiction Treatment

“…20 ACM was developed to be assimilated into integrated care programs, which are clinical programs for delivering evidence-based mental health care in primary care. 21 The integrated care program starts by offering a rapid assessment for depression, alcohol use disorder, panic disorder, generalized anxiety disorder, PTSD, and drug use. …”

“…For ACM participants, depression and anxiety were managed concurrently by the BHP using defined care management strategies. 21 Initial Treatment with Naltrexone. In his/her role, the BHP would promote the use of evidence-based pharmacotherapy.…”

Evaluation of the PHQ-9 Item 3 as a Screen for Sleep Disturbance in Primary Care

“…BHAC is an extension of the Syracuse and Rochester VA primary care clinics and employs health technicians who complete a comprehensive clinical assessment of patients' mental health symptomatology over the telephone. 29 Veterans are called for this assessment either because of a direct referral from their PCP or because they scored positive on an annual primary care screen for hazardous alcohol use (scores of 4 and above for men and 3 or above for women on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) 30 ). At the end of the phone call, the patient is asked if he/she is willing to be contacted regarding research participation.…”

Measuring and improving the quality of mental health care: a global perspective

“…For example, the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) 50 , the US Department of Veterans Affairs Behavioral Health Laboratory model 51,52 and the US Department of Defense Behavioral Health Data Portal 53 are all examples of measurement-based care applied to patient populations. In the State of Minnesota, the Depression Improvement Across Minnesota, Offering a New Direction (DIA-MOND) initiative implemented measurement-based care to help benchmark quality improvement efforts as part of a bundled payment initiative for depression care management 54 .…”