The medical home and integrated behavioral health: advancing the policy agenda.
TL;DR: This article presents recommendations to build demonstration projects to test existing approaches of integration, develop interdisciplinary training programs to support members of the integrated care team, implement population-based strategies to improve behavioral health, eliminate behavioral health carve-outs and test innovative payment models.
Abstract: There has been a considerable expansion of the patient-centered medical home model of primary care delivery, in an effort to reduce health care costs and to improve patient experience and population health. To attain these goals, it is essential to integrate behavioral health services into the patient-centered medical home, because behavioral health problems often first present in the primary care setting, and they significantly affect physical health. At the 2013 Patient-Centered Medical Home Research Conference, an expert workgroup convened to determine policy recommendations to promote the integration of primary care and behavioral health. In this article we present these recommendations: Build demonstration projects to test existing approaches of integration, develop interdisciplinary training programs to support members of the integrated care team, implement population-based strategies to improve behavioral health, eliminate behavioral health carve-outs and test innovative payment models, and develop population-based measures to evaluate integration.
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TL;DR: Examining adolescent hospitalizations in California and found 63% of detained youth had a primary diagnosis of mental health disorder compared with 19.8% of nondetained youth, suggests the relationship between poverty, stress, and mental health is especially evident among the excessively high population of poor and minority youth in the juvenile justice system.
6 citations
03 May 2017
TL;DR: This dissertation aims to provide a history of web exceptionalism from 1989 to 2002, a period chosen in order to explore its roots as well as specific cases up to and including the year in which descriptions of “Web 2.0” began to circulate.
Abstract: Integrated behavioral health care (IBHC) , the simultaneous interface of medical and behavioral health care , is an emerging solution for the delivery of behavioral health in primary care contexts. While significant scholarship has been devoted to conceptualizing integrated care , little seems to be known about how IBHC is evaluated at the clinical , operational , and financial levels. This dissertation's intent is to evaluate IBHC according to those three levels as conceptualized by Peek's Three World view (2008). The success and sustainability of IBHC depends equally on the clinical , operational , and financial worlds of healthcare. This dissertation includes a systematic review on IBHC evaluation research , and presents the methodology and results from a survey distributed nationwide to 145 medical and behavioral health providers and administrators working in IBHC primary care settings. This dissertation concludes with research , evaluation , policy , and training implications and recommendations for measuring clinical , operational , and financial outcomes of integrated behavioral health care.
6 citations
Cites background or methods from "The medical home and integrated beh..."
...…demonstrated that patients have better clinical outcomes when receiving IBHC, but significant operational and financial barriers remain a concern (Ader et al., 2015; Butler et al., 2011; Bower, Gilbody, Richards, Fletcher, & Sutton, 2006; Craven & Bland, 2006; Gilbody, Bower, Fletcher, Richards,…...
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...Since most research has been model, disease, or population specific (Ader et al., 2015; Bower et al., 2006; Butler et al., 2011; Craven & Bland, 2006; Gilbody et al.,, 2006; Katon & Seelig, 2008; Oxman et al., 2005), a chasm remains in the literature....
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...…of Integrated Behavioral Health Care While research exists on the success of clinical interventions in integrated behavioral health settings (Ader et al., 2015; Bower, Gilbody, Richards, Fletcher, & Sutton, 2006; Butler et al., 2011; Craven & Bland, 2006; Gilbody, Bower, Fletcher, Richards,…...
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...This evidence is a critical to change policy and payer regulations that are common barriers to IBHC (Ader et al., 2015)....
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...As a system, primary health care is undergoing significant redesign (Ader et al., 2015)....
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TL;DR: Examination of facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective found education, community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.
Abstract: This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and in...
6 citations
Cites background from "The medical home and integrated beh..."
...Integration would allow children to receive mental health treatment in conjunction with other health services, and coordinated care across services and providers (Ader et al., 2015)....
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TL;DR: The primary domains for clinical care are delineated and clinical tools to achieve the provision of accessible, comprehensive, high-quality care within a family-centered medical home are offered.
6 citations
TL;DR: The cultural and organizational contexts for the project are discussed, with particular emphasis on models for cooperation among several institutions of varying size and scope.
Abstract: The integration of mental health and pediatric health care services has long been a goal for both research and practice. With the advent of federal policies developed to mandate clinical efficiency across the health care spectrum, this issue is becoming more salient. Applied literature on this topic is only recently emerging, however, and there are limited contextual examples to guide program development, research, and refinement. This article presents background information relevant to the development of such a program (the Center for Advancement of Youth). The cultural and organizational contexts for the project are discussed, with particular emphasis on models for cooperation among several institutions of varying size and scope. The implications for the future of tangible research in this area are also discussed, with attention to extending lessons learned to diverse settings motivated to integrate various aspects of health care service provision.
6 citations
Cites background or methods from "The medical home and integrated beh..."
...This includes research concerning methods, practices, and strategies at the level of providers, patients/consumers, and the systems in which service provision occurs (Ader et al., 2015; Croft & Parish, 2013; Foy, Kelleher, & Laraque, 2010; Kolko et al., 2014; Vickers et al., 2013)....
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...With respect to variation in these and other provider, patient, and system characteristics, primary medical-behavioral health care delivery has been described as falling along a continuum of integration (Ader et al., 2015; Kolko & Perrin, 2014)....
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References
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TL;DR: Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity, as shown in the recently completed US National Comorbidities Survey Replication.
Abstract: Background Little is known about the general population prevalence or severity of DSM-IV mental disorders. Objective To estimate 12-month prevalence, severity, and comorbidity of DSM-IV anxiety, mood, impulse control, and substance disorders in the recently completed US National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using a fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Participants Nine thousand two hundred eighty-two English-speaking respondents 18 years and older. Main Outcome Measures Twelve-month DSM-IV disorders. Results Twelve-month prevalence estimates were anxiety, 18.1%; mood, 9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%. Of 12-month cases, 22.3% were classified as serious; 37.3%, moderate; and 40.4%, mild. Fifty-five percent carried only a single diagnosis; 22%, 2 diagnoses; and 23%, 3 or more diagnoses. Latent class analysis detected 7 multivariate disorder classes, including 3 highly comorbid classes representing 7% of the population. Conclusion Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity.
10,951 citations
TL;DR: Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health care.
Abstract: Improving the U.S. health care system requires simultaneous pursuit of three aims: improving the experience of care, improving the health of populations, and reducing per capita costs of health car...
4,276 citations
University of California, Los Angeles1, University of Washington2, Indiana University3, Duke University4, Kaiser Permanente5, University of Texas Health Science Center at San Antonio6, Group Health Cooperative7, University of California, San Francisco8, Dartmouth College9, John A. Hartford Foundation10
TL;DR: The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.
Abstract: ContextFew depressed older adults receive effective treatment in primary care
settings.ObjectiveTo determine the effectiveness of the Improving Mood–Promoting
Access to Collaborative Treatment (IMPACT) collaborative care management program
for late-life depression.DesignRandomized controlled trial with recruitment from July 1999 to August
2001.SettingEighteen primary care clinics from 8 health care organizations in 5
states.ParticipantsA total of 1801 patients aged 60 years or older with major depression
(17%), dysthymic disorder (30%), or both (53%).InterventionPatients were randomly assigned to the IMPACT intervention (n = 906)
or to usual care (n = 895). Intervention patients had access for up to 12
months to a depression care manager who was supervised by a psychiatrist and
a primary care expert and who offered education, care management, and support
of antidepressant management by the patient's primary care physician or a
brief psychotherapy for depresssion, Problem Solving Treatment in Primary
Care.Main Outcome MeasuresAssessments at baseline and at 3, 6, and 12 months for depression, depression
treatments, satisfaction with care, functional impairment, and quality of
life.ResultsAt 12 months, 45% of intervention patients had a 50% or greater reduction
in depressive symptoms from baseline compared with 19% of usual care participants
(odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of
depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001),
more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group
difference, −0.4; 95% CI, −0.46 to −0.33; P<.001), less functional impairment (range, 0-10; between-group
difference, −0.91; 95% CI, −1.19 to −0.64; P<.001), and greater quality of life (range, 0-10; between-group
difference, 0.56; 95% CI, 0.32-0.79; P<.001) than
participants assigned to the usual care group.ConclusionThe IMPACT collaborative care model appears to be feasible and significantly
more effective than usual care for depression in a wide range of primary care
practices.
2,218 citations
01 Jan 2007
2,163 citations
Book•
01 Aug 2009
TL;DR: Mental, emotional, and behavioral (MEB) disorders—which include depression, conduct disorder, and substance abuse—affect large numbers of young people.
Abstract: This report builds on a highly valued predecessor, the 1994 Institute of Medicine (IOM) report entitled Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. That report provided the basis for understanding prevention science, elucidating its then-existing research base, and contemplating where it should go in the future. This report documents that an increasing number of mental, emotional, and behavioral problems in young people are in fact preventable. The proverbial ounce of prevention will indeed be worth a pound of cure: effectively applying the evidence-based prevention interventions at hand could potentially save billions of dollars in associated costs by avoiding or tempering these disorders in many individuals. Furthermore, devoting significantly greater resources to research on even more effective prevention and promotion efforts, and then reliably implementing the findings of such research, could substantially diminish the human and economic toll.
1,744 citations