Evaluation of a collaborative mental health program in primary care: effects on patient distress and health care utilization

Cigrang, Jeffrey A.; Dobmeyer, Anne C.; Becknell, Milton E.; Roa-Navarrete, R. A.; Yerian, S. R.

doi:10.1185/135525706x121192

Cited by 36 publications

(25 citation statements)

References 20 publications

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“…Despite widespread adoption across health care systems, the evidence for CCC (and Primary Care Behavioral Health) has been slow to accumulate. Key findings from studies conducted in the Department of Defense family medicine clinics have suggested that patients show significant decreases in mental health symptoms and improved functioning in relation to brief treatment of less than four encounters [9,10]. Most recently, research has shown that outcomes associated with these brief treatments are sustained at two years following treatment [11].…”

Section: Introductionmentioning

confidence: 99%

Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)

Beehler

Funderburk

Possemato

et al. 2013

Behav. Med. Pract. Policy Res.

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Section: Introductionmentioning

confidence: 99%

Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)

Beehler

Funderburk

Possemato

et al. 2013

Behav. Med. Pract. Policy Res.

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“…The Primary Care Behavioral Health model (PCBH; Robinson & Reiter, 2007) is one of the most commonly used models. In a PCBH model, psychologists are embedded into the primary care setting and serve as behavioral health consultants (BHC) to the medical providers; the BHC provides brief, focused assessments and interventions for patients referred by their primary care provider Cigrang, Dobmeyer, Becknell, Roa-Navarrete, & Yerian, 2006;Goodie, Isler, Hunter, & Peterson, 2009;Wilson, 2003;Zeiss & Karlin, 2008). The fast paced, time-limited nature of BHC services in primary care adapts to the busy lifestyle of military members.…”

mentioning

confidence: 99%

Treatment of active-duty military with PTSD in primary care: Early findings.

Cigrang

Rauch

Avila

et al. 2011

Psychological Services

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The study presents early findings from an ongoing pilot study of a cognitive–behavioral treatment for assisting active-duty military members with deployment-related posttraumatic stress disorder (PTSD) designed for use by psychologists working in an integrated primary care clinic. Treatment protocol is based primarily on Prolonged Exposure but also includes elements of Cognitive Processing Therapy that were adapted for use in primary care. Individuals were recruited from the population of patients consulted to the psychologist by primary care providers during routine clinical care. The 15 participants include active-duty or activated reserve Operation Iraqi Freedom and Operation Enduring Freedom veterans seeking help for deployment-related PTSD symptoms, with a PTSD Checklist-Military Version score 32, and interest in treatment for PTSD in primary care. Baseline and 1-month posttreatment follow-up evaluations were conducted by an independent evaluator. Five participants (33%) dropped out of the intervention after one or two appointments. Using the last observation carried forward for intent-to-treat analyses, the results showed that PTSD severity, depression, and global mental health functioning all significantly improved with the intervention. Fifty percent of treatment completers no longer met criteria for PTSD.

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“…Items were developed to represent the critical components of the CCC model enacted by BHPs based on a qualitative review of published scientific literature [1,6-8,12,13,24-26,39-41], unpublished clinical practice guidelines from clinics using a CCC platform, clinical and administrative experience of the research team, and informal polling of CCC experts known to the research team but not asked to be part of the Delphi study [19,42]. The CCC-related publications reviewed were in-depth descriptions of CCC model aims, procedures, and components because empirical studies relating CCC components to clinical outcomes have not been conducted.…”

Section: Methodsmentioning

confidence: 99%

“…For example, in spite of the rapid growth in popularity of CCC models, the evidence base for the clinical effectiveness of CCC models has lagged considerably. Several studies conducted in the US Department of Defense (DOD) family medicine clinics found that patients who received four sessions or less of brief behavioral treatment from a BHP showed clinically significant decreases in distress symptoms and improved overall functioning [12,13]. Additionally, a recent longitudinal study suggested that the beneficial clinical effect was sustained at two years post-treatment [14].…”

Section: Introductionmentioning

confidence: 99%

Developing a measure of provider adherence to improve the implementation of behavioral health services in primary care: a Delphi study

et al. 2013

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BackgroundThe integration of behavioral health services into primary care is increasingly popular, yet fidelity of implementation in this area has been infrequently assessed due to the few measurement tools available. A sentinel indicator of fidelity of implementation is provider adherence, or utilization of prescribed procedures and engagement in model-specific behaviors. This study aimed to develop the first self-report measure of behavioral health provider adherence for co-located, collaborative care, a commonly adopted model of behavioral health service delivery in primary care.MethodsA preliminary 56-item measure was developed by the research team to represent critical components of adherence among behavioral health providers. To ensure the content validity of the measure, a modified Delphi study was conducted using a panel of co-located, collaborative care model experts. During three rounds of emailed surveys, panel members provided qualitative feedback regarding item content while rating each item’s relevance for behavioral health provider practice. Items with consensus ratings of 80% or greater were included in the final adherence measure.ResultsThe panel consisted of 25 experts representing the Department of Veterans Affairs, the Department of Defense, and academic and community health centers (total study response rate of 76%). During the Delphi process, two new items were added to the measure, four items were eliminated, and a high level of consensus was achieved on the remaining 54 items. Experts identified 38 items essential for model adherence, six items compatible (although not essential) for model adherence, and 10 items that represented prohibited behaviors. Item content addressed several domains, but primarily focused on behaviors related to employing a time-limited, brief treatment model, the scope of patient concerns addressed, and interventions used by providers.ConclusionsThis study yielded the first content valid self-report measure of critical components of collaborative care adherence for use by behavioral health providers in primary care. Although additional psychometric evaluation is necessary, this measure may assist implementation researchers in clarifying how provider behaviors contribute to clinical outcomes. This measure may also assist clinical stakeholders in monitoring implementation and identifying ways to support frontline providers in delivering high quality services.

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Evaluation of a collaborative mental health program in primary care: effects on patient distress and health care utilization

Cited by 36 publications

References 20 publications

Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)

Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)

Treatment of active-duty military with PTSD in primary care: Early findings.

Developing a measure of provider adherence to improve the implementation of behavioral health services in primary care: a Delphi study

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