Behavioral Health Interventions Being Implemented in a VA Primary Care System

Funderburk, Jennifer S.; Sugarman, Dawn E.; Labbe, Allison K.; Rodrigues, Amy E.; Maisto, Stephen A.; Nelson, Bruce

doi:10.1007/s10880-011-9230-y

Cited by 50 publications

(86 citation statements)

References 27 publications

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“…On the other hand, the fact that only 10% of patients in our larger sample were seen for three visits is entirely consistent with the IBHC model and its focus on functional improvement rather than symptom amelioration (Robinson & Reiter, 2007). This proportion is also comparable with what has been reported in previous studies of IBHC in primary care settings (Bryan et al, 2012; Corso et al, 2012; Funderburk et al, 2011). The LGC analyses also excluded patients referred to outside providers.…”

Section: Discussionsupporting

confidence: 91%

“…Third, do intervention strategies predict patients’ rate of change? We expected to find a tendency for BHCs to use empirically supported, CBT-based interventions (Bryan et al, 2012; Funderburk et al, 2011). We also expected to find a concordance between diagnosis and intervention strategy that reflected published outcome studies with specific patient populations (Chambless & Ollendick, 2001), such as using behavioral activation for patients with depression and parent-management strategies for children with disruptive behaviors.…”

Section: The Current Study: Three Questions and An Extensionmentioning

confidence: 99%

“…and (c) Is there a relation between providers’ choice of intervention strategy and patient rate of change? Much of the research on IBHC-delivered services has been conducted in settings that serve military personnel and their families (e.g., Brawer et al, 2011; Funderburk, Fielder, DeMartini, & Flynn, 2012; Funderburk et al, 2011; Pomerantz et al, 2014). The current study extends that work with data gathered in IBHC settings that serve an ethnically diverse, predominately low-income community sample.…”

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confidence: 99%

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Diagnoses, intervention strategies, and rates of functional improvement in integrated behavioral health care patients.

Bridges¹,

Gregus²,

Rodríguez³

et al. 2015

Journal of Consulting and Clinical Psychology

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Objective Compared with more traditional mental health care, integrated behavioral health care (IBHC) offers greater access to services and earlier identification and intervention of behavioral and mental health difficulties. The current study examined demographic, diagnostic, and intervention factors that predict positive changes for IBHC patients. Method Participants were 1,150 consecutive patients (mean age = 30.10 years, 66.6% female, 60.1% Hispanic, 47.9% uninsured) seen for IBHC services at 2 primary care clinics over a 34-month period. Patients presented with depressive (23.2%), anxiety (18.6%), adjustment (11.3%), and childhood externalizing (7.6%) disorders, with 25.7% of patients receiving no diagnosis. Results The most commonly delivered interventions included behavioral activation (26.1%), behavioral medicine-specific consultation (14.6%), relaxation training (10.3%), and parent-management training (8.5%). There was high concordance between diagnoses and evidence-based intervention selection. We used latent growth curve modeling to explore predictors of baseline global assessment of functioning (GAF) and improvements in GAF across sessions, utilizing data from a subset of 117 patients who attended at least 3 behavioral health visits. Hispanic ethnicity and being insured predicted higher baseline GAF, while patients with an anxiety disorder had lower baseline GAF than patients with other diagnoses. Controlling for primary diagnosis, patients receiving behavioral activation or exposure therapy improved at faster rates than patients receiving other interventions. Demographic variables did not relate to rates of improvement. Conclusion Results suggest even brief IBHC interventions can be focused, targeting specific patient concerns with evidence-based treatment components.

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Section: Discussionsupporting

confidence: 91%

Section: The Current Study: Three Questions and An Extensionmentioning

confidence: 99%

mentioning

confidence: 99%

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Diagnoses, intervention strategies, and rates of functional improvement in integrated behavioral health care patients.

Bridges¹,

Gregus²,

Rodríguez³

et al. 2015

Journal of Consulting and Clinical Psychology

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“…Behavioral interventions, such as cognitive-behavioral therapy (CBT), motivational interviewing and brief counseling, have been used to treat substance use disorders in primary care (Babor et al 2007; Gordon et al 2008; Pilowsky & Wu 2012). Regarding CBT, face-to-face CBT has been used to treat primary care patients with primary substance use disorders (Funderburk et al 2011; Kay-Lambkin et al 2009; O’Malley et al 2003; Wittchen et al 2011) and dual diagnoses of substance use disorders and depression (Garcia Campayo et al 2008; Kay-Lambkin et al 2011). However, financial and organizational resources are usually limited in primary care (Johnson et al 2011; Turner 2009; Van Hook et al 2007).…”

Section: Introductionmentioning

confidence: 99%

Cognitive-Behavioral Therapy in Depressed Primary Care Patients with Co-Occurring Problematic Alcohol Use: Effect of Telephone-Administered vs. Face-to-Face Treatment—A Secondary Analysis

Kalapatapu

Cai³

et al. 2014

Journal of Psychoactive Drugs

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This secondary analysis of a larger study compared adherence to telephone-administered cognitive-behavioral therapy (T-CBT) vs. face-to-face CBT and depression outcomes in depressed primary care patients with co-occurring problematic alcohol use. To our knowledge, T-CBT has never been directly compared to face-to-face CBT in such a sample of primary care patients. Participants were randomized in a 1:1 ratio to face-to-face CBT or T-CBT for depression. Participants receiving T-CBT (n = 50) and face-to-face CBT (n = 53) were compared at baseline, end of treatment (week 18), and 3-month and 6-month follow-ups. Face-to-face CBT and T-CBT groups did not significantly differ in age, sex, ethnicity, marital status, educational level, severity of depression, antidepressant use and total score on the Alcohol Use Disorders Identification Test. Face-to-face CBT and T-CBT groups were similar on all treatment adherence outcomes and depression outcomes at all timepoints. In conclusion, T-CBT and face-to-face CBT had similar treatment adherence and efficacy for the treatment of depression in depressed primary care patients with co-occurring problematic alcohol use. When targeting patients who might have difficulties in accessing care, primary care clinicians may consider both types of CBT delivery when treating depression in patients with co-occurring problematic alcohol use.

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“…In the USA and England, different types of integrative models have been recommended and tried in order to create a closer collaboration between psychologists and general practitioners as a way of meeting the significant psychosocial demands of primary care provision (Collins, Hewson, Munger, & Wade, 2010;Funderburk et al, 2011). One such model, developed in the USA in the 1990s, is the Primary Care Behavioral Health (PCBH) model of integrated care (Robinson et al, 2010;Robinson & Reiter, 2007).…”

mentioning

confidence: 99%

Primary Care Behavioral Health Model: Perspectives of Outcome, Client Satisfaction, and Gender

Angantyr¹,

Rimner²,

Nordén³

et al. 2015

soc behav pers

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We examined clients' satisfaction and gender differences in relation to the outcome parameters of the Primary Care Behavioral Health model of integrated care. The model has been shown to be effective in minimizing symptoms and increasing levels of functioning with regard to different mental health concerns. Participants were 54 clients (22 men and 32 women) who received a psychology consultation in accordance with the model, at 1 of 3 primary care centers located in southwest Sweden. Results indicated minimized symptoms and increased levels of functioning and clients felt a high degree of satisfaction with the consultations with the psychologists. There were no gender differences found regarding treatment results or satisfaction with the treatment.

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Behavioral Health Interventions Being Implemented in a VA Primary Care System

Cited by 50 publications

References 27 publications

Diagnoses, intervention strategies, and rates of functional improvement in integrated behavioral health care patients.

Diagnoses, intervention strategies, and rates of functional improvement in integrated behavioral health care patients.

Cognitive-Behavioral Therapy in Depressed Primary Care Patients with Co-Occurring Problematic Alcohol Use: Effect of Telephone-Administered vs. Face-to-Face Treatment—A Secondary Analysis

Primary Care Behavioral Health Model: Perspectives of Outcome, Client Satisfaction, and Gender

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