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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01 Jan 2007
2,163 citations
TL;DR: The prevalence of depression in adolescents and young adults has increased in recent years and trends in prevalence translate into a growing number of young people with untreated depression, calling for renewed efforts to expand service capacity to best meet the mental health care needs of this age group.
Abstract: OBJECTIVES: This study examined national trends in 12-month prevalence of major depressive episodes (MDEs) in adolescents and young adults overall and in different sociodemographic groups, as well as trends in depression treatment between 2005 and 2014.
METHODS: Data were drawn from the National Surveys on Drug Use and Health for 2005 to 2014, which are annual cross-sectional surveys of the US general population. Participants included 172 495 adolescents aged 12 to 17 and 178 755 adults aged 18 to 25. Time trends in 12-month prevalence of MDEs were examined overall and in different subgroups, as were time trends in the use of treatment services.
RESULTS: The 12-month prevalence of MDEs increased from 8.7% in 2005 to 11.3% in 2014 in adolescents and from 8.8% to 9.6% in young adults (both P < .001). The increase was larger and statistically significant only in the age range of 12 to 20 years. The trends remained significant after adjustment for substance use disorders and sociodemographic factors. Mental health care contacts overall did not change over time; however, the use of specialty mental health providers increased in adolescents and young adults, and the use of prescription medications and inpatient hospitalizations increased in adolescents.
CONCLUSIONS: The prevalence of depression in adolescents and young adults has increased in recent years. In the context of little change in mental health treatments, trends in prevalence translate into a growing number of young people with untreated depression. The findings call for renewed efforts to expand service capacity to best meet the mental health care needs of this age group.
930 citations
TL;DR: Pediatric primary care clinicians are in an ideal position to implement routine postpartum depression screens at several well-child visits throughout infancy and to provide mental health support through referrals and/or the interdisciplinary services of a pediatric patient-centered medical home model.
Abstract: Perinatal depression (PND) is the most common obstetric complication in the United States. Even when screening results are positive, mothers often do not receive further evaluation, and even when PND is diagnosed, mothers do not receive evidence-based treatments. Studies reveal that postpartum depression (PPD), a subset of PND, leads to increased costs of medical care, inappropriate medical treatment of the infant, discontinuation of breastfeeding, family dysfunction, and an increased risk of abuse and neglect. PPD, specifically, adversely affects this critical early period of infant brain development. PND is an example of an adverse childhood experience that has potential long-term adverse health complications for the mother, her partner, the infant, and the mother-infant dyad. However, PND can be treated effectively, and the stress on the infant can be buffered. Pediatric medical homes should coordinate care more effectively with prenatal providers for women with prenatally diagnosed maternal depression; establish a system to implement PPD screening at the 1-, 2-, 4-, and 6-month well-child visits; use community resources for the treatment and referral of the mother with depression; and provide support for the maternal-child (dyad) relationship, including breastfeeding support. State chapters of the American Academy of Pediatrics, working with state departments of public health, public and private payers, and maternal and child health programs, should advocate for payment and for increased training for PND screening and treatment. American Academy of Pediatrics recommends advocacy for workforce development for mental health professionals who care for young children and mother-infant dyads, and for promotion of evidence-based interventions focused on healthy attachment and parent-child relationships.
162 citations
01 Jan 2016
TL;DR: The integration of behavioral health services into primary care can greatly increase the likelihood that at-risk children are identified and treated as early as possible, particularly in early childhood when primary care is the central universal access point.
Abstract: Pediatric primary care is a key setting that all young children are expected to visit routinely in their early development. As such, a young child’s visits to her or his pediatrician present major opportunities to detect any developmental challenges the child is experiencing and take appropriate steps to intervene. The integration of behavioral health services into primary care can greatly increase the likelihood that at-risk children are identified and treated as early as possible, particularly in early childhood when primary care is the central universal access point and because primary care is a non-stigmatizing environment (American Academy of Child and Adolescent Psychiatry, 2009; Substance Abuse and Mental Health Services Administration, 2013).
160 citations
TL;DR: The article provides a description of the key components and strategies used in the model, the rationale for those strategies, a brief comparison of this model to other integration approaches, a focused summary of PCBH model outcomes, and an overview of common challenges to implementing the model.
Abstract: The Primary Care Behavioral Health (PCBH) model is a prominent approach to the integration of behavioral health services into primary care settings. Implementation of the PCBH model has grown over the past two decades, yet research and training efforts have been slowed by inconsistent terminology and lack of a concise, operationalized definition of the model and its key components. This article provides the first concise operationalized definition of the PCBH model, developed from examination of multiple published resources and consultation with nationally recognized PCBH model experts. The definition frames the model as a team-based approach to managing biopsychosocial issues that present in primary care, with the over-arching goal of improving primary care in general. The article provides a description of the key components and strategies used in the model, the rationale for those strategies, a brief comparison of this model to other integration approaches, a focused summary of PCBH model outcomes, and an overview of common challenges to implementing the model.
119 citations
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TL;DR: In this issue of Families, Systems and Health, representatives of eight organizations, spanning behavioral health, nursing, medicine, and interdisciplinary practice, all endorse behavioral health integration in the health home.
Abstract: This editorial presents a brief historical overview of emerging knowledge since the 1970s that led to the birth of a new discipline, Family Practice (now Family Medicine). Family Medicine residencies were required to include training on mental health, family dynamics, communication skills, and other behavioral science topics. The next two decades witnessed an explosion of clinical research. High users of general medical services were found to have a two- to threefold higher prevalence of mental illness. These patients consumed disproportionate amounts of health care dollars, suggesting that cost containment may require mental health treatment. Over the last 30 years researchers have demonstrated that combining biomedical and psychosocial expertise in collaborative treatment models produces better outcomes for patients with mental illness, with physical illness, and for the majority who have a complicated mixture of biopsychosocial ailments. The advent of collaboration between disciplines and the integration of service designs is something to celebrate. In this issue of Families, Systems and Health, representatives of eight organizations, spanning behavioral health, nursing, medicine, and interdisciplinary practice, all endorse behavioral health integration in the health home. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
5 citations
01 Jan 2013
TL;DR: This chapter highlights four health care teams to connect the need for quality team-based care and the practice of how to maintain functional partnerships within the team and between provider and patient.
Abstract: Health care teams are increasingly utilized to provide care to patients as medicine has become more complex. Over the past decades providers have subspecialized to a greater degree and communication gaps have grown between providers of the same patient. Major health organizations now endorse the use of health care teams, and health profession education is recognizing the importance of educating its learners about how to function effectively in a health care team. The characteristics of successful health care teams are difficult to define but there are key elements associated with successful health care teams. This chapter highlights four health care teams to connect the need for quality team-based care and the practice of how to maintain functional partnerships within the team and between provider and patient.
3 citations