Building Behavioral Health Homes: Clinician and Staff Perspectives on Creating Integrated Care Teams

Anastas, Tracy; Waddell, Elizabeth Needham; Howk, Sonya; Remiker, Mark; Horton-Dunbar, Gretchen; Fagnan, Lyle J.

doi:10.1007/s11414-018-9622-y

Cited by 21 publications

(55 citation statements)

References 15 publications

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“…23 Thus, we assessed the impact of BHI on clinical practice and identified facilitators and barriers to BHI implementation from the perspective of a multidisciplinary group of professionals involved in a comprehensive pediatric BHI initiative at 3 CHCs. Consistent with findings in the adult BHI literature, [24][25][26][27] we identified operational barriers to BHI including lack of staffing, space, and time for integrated activities. These factors, described by King et al as the "colder" elements of organizational structure, processes, and technologies, have been shown to influence uptake of pediatric BH services and are commonly targeted by implementation efforts.…”

Section: Discussionsupporting

confidence: 84%

“…Consistent with findings in the adult BHI literature, 24-27 we identified operational barriers to BHI including lack of staffing, space, and time for integrated activities. These factors, described by King et al as the “colder” elements of organizational structure, processes, and technologies, have been shown to influence uptake of pediatric BH services and are commonly targeted by implementation efforts.…”

Section: Discussionsupporting

confidence: 78%

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Perceptions of the Implementation of Pediatric Behavioral Health Integration in 3 Community Health Centers

Fong

Tamene

Morley

et al. 2019

Clin Pediatr (Phila)

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Pediatric behavioral health integration (BHI) represents a promising approach to address unmet child mental health need but little research exists to guide BHI implementation. Through in-depth interviews with 38 professionals involved in a comprehensive pediatric BHI initiative at 3 community health centers, we explored perceptions of the impact of BHI on clinical practice, and facilitators and barriers to BHI implementation. Professionals identified 2 overarching themes about the impact of BHI on clinical practice (greater interdisciplinary collaboration/communication and enhanced provider wellness); 5 themes about facilitators of BHI (staff buy-in for BHI, leadership support, staff belonging to the same team culturally and/or structurally, co-location with close physical proximity, and data-driven quality improvement); and 5 themes about barriers to BHI (inadequate clinician staffing, insufficient space, limited provider time, billing/reimbursement issues, and care coordination challenges). Future pediatric BHI efforts may consider these findings to develop strategies to promote facilitators and reduce barriers during implementation.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionsupporting

confidence: 78%

Perceptions of the Implementation of Pediatric Behavioral Health Integration in 3 Community Health Centers

Fong

Tamene

Morley

et al. 2019

Clin Pediatr (Phila)

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“…2016), seven from stakeholders and administrators (Anastas et al . 2019; Dollar et al . 2018; Grazier et al .…”

Section: Resultsmentioning

confidence: 99%

Facilitators and barriers for implementing the integrated behavioural health care model in the USA: An integrative review

Peer

Koren

2022

Int J Mental Health Nurs

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The integrated behavioural health care (IBHC) model incorporates mental health services with primary care. This service model is widely advocated due to its increasing access to health care and cost-saving. By connecting individuals with mental illnesses with a primary care provider, this model of care promotes collaboration between interdisciplinary teams, and therefore, increases health equity, decreases stigma, and increases patient satisfaction. This integrative review aimed to examine and synthesize available literature on facilitators and barriers related to the IBHC model implementation in the United States. An integrative review methodology by Whittemore and Knafl was utilized, and data evaluation was based on the JBI Critical Appraisal Checklist. The social-ecological model guided the review. Twenty-two articles were analysed, and nine themes were identified, which were further organized according to the five levels of the social-ecological model and consisted of intrapersonal levelpatient-centered care; interpersonal levelrelationships; community levelphysical accessibility; organizational leveloperation and infrastructure, team approach, training in behavioural health, electronic medical record, and staffing; and policy levelfunds and health insurance. Most facilitating factors were on the organizational level and related to infrastructure, team approach, patientcentered care, and the most noted barrier was poor relationships. Nurses can increase engagement in integrated care by assuming roles that oversee patient care, foster professional collaborations, and improve relationships. Future research should focus on vulnerable populations this model serves, patients' perspectives, and the effect of telehealth.

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“…Our proposed model differs from current models of integrated care (Anastas et al, 2018; Miller-Matero et al, 2016), which refer to colocation, consultation, or referral relationships between primary care practices and psychologists chiefly to address patients’ mental health needs. No resource comparable to the health promotionist, solely dedicated to treatment of chronic disease risk behaviors (smoking, obesity, physical inactivity, treatment nonadherence) exists in current care models.…”

Section: System Level Considerations and Recommendationsmentioning

confidence: 99%

“…No resource comparable to the health promotionist, solely dedicated to treatment of chronic disease risk behaviors (smoking, obesity, physical inactivity, treatment nonadherence) exists in current care models. Integrating health promotionists into care delivery channels would remove burden from overtaxed PCPs, reduce very high loss to follow-up that occurs with referral to community health promotion (Anastas et al, 2018; Leppin et al, 2018), and instantiate a comprehensive, actionable systems-level schema of behavioral strategies needed to have preventive impact with minimal interference to clinical work flow. The proposed system is designed to allow all health professionals, including health psychologists, to function to the top of their licensure.…”

Section: System Level Considerations and Recommendationsmentioning

confidence: 99%

Toward a health-promoting system for cancer survivors: Patient and provider multiple behavior change.

Spring¹,

Stump

Penedo³

et al. 2019

Health Psychology

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Objective: This paper examines how and why to improve care systems for disease management and health promotion for the growing population of cancer survivors with cardiovascular multi-morbidities. Method: We reviewed research characterizing cancer survivors' and their multiple providers' common sense cognitive models of survivors' main health threats, preventable causes of adverse health events, and optimal coping strategies. Results: Findings indicate that no entity in the health care system selfidentifies as claiming primary responsibility to address longstanding unhealthy lifestyle behaviors that heighten survivors' susceptibility to both cancer and cardiovascular disease (CVD) and whose improvement could enhance quality of life. Conclusions: To address this gap, we propose systems-level changes that integrate health promotion into existing survivorship services by including behavioral risk factor vital signs in the electronic medical record, with default proactive referral to a health promotionist (a paraprofessional coach adept with mobile technologies and supervised by a professional expert in health behavior change). By using the patient's digital tracking data to coach remotely and periodically report progress to providers, the health promotionist closes a gap, creating a connected care system that supports, reinforces, and maintains accountability for healthy lifestyle improvement. No comparable resource solely dedicated to treatment of chronic disease risk behaviors (smoking, obesity, physical inactivity, treatment nonadherence) exists in current models of integrated care. Integrating health promotionists into care delivery channels would remove burden from overtaxed PCPs and instantiate a comprehensive, actionable systems-level schema of health risks and coping strategies needed to have preventive impact with minimal interference to clinical work flow.

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Building Behavioral Health Homes: Clinician and Staff Perspectives on Creating Integrated Care Teams

Cited by 21 publications

References 15 publications

Perceptions of the Implementation of Pediatric Behavioral Health Integration in 3 Community Health Centers

Perceptions of the Implementation of Pediatric Behavioral Health Integration in 3 Community Health Centers

Facilitators and barriers for implementing the integrated behavioural health care model in the USA: An integrative review

Toward a health-promoting system for cancer survivors: Patient and provider multiple behavior change.

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