Integrating Primary Care Into Community Behavioral Health Settings: Programs and Early Implementation Experiences

Scharf, Deborah M.; Eberhart, Nicole K.; Schmidt, Nicole; Vaughan, Christine Anne; Dutta, Trina; Pincus, Harold Alan; Burnam, M. Audrey

doi:10.1176/appi.ps.201200269

Cited by 87 publications

(106 citation statements)

References 13 publications

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“…FQHCs, which provide Bsafety net^health care for low income, minority, and uninsured or underinsured persons, 22 are less able to provide integrated mental health care than in the settings of prior studies. 28,29 The treatment of PTSD in FQHCs may be particularly challenging because patients face high levels of clinical comorbidity and social service needs, but there are limited resources to meet these needs. 30 ViStA compared the effectiveness of minimally enhanced usual care (MEU) to PTSD care management (PCM) in FQHCs.…”

Section: Introductionmentioning

confidence: 99%

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

et al. 2016

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BACKGROUND:The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs). OBJECTIVE: We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM). DESIGN: This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year. PARTICIPANTS: We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD. MAIN MEASURES: The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months. KEY RESULTS: Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7 % for PCM patients and 60.6 % for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14 % higher (p < 0.01) and mental health medication prescription rates that were 15.2 % higher (p < 0.01) than patients with no engagement. CONCLUSIONS:A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.

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Section: Introductionmentioning

confidence: 99%

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

et al. 2016

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“…In response to previous literature that highlights compounding barriers to primary care and wellness services for behavioral health consumers, [7][8][9]12 PBHCI initiatives aspire to facilitate access to these services as a means of improving overall health. 6 In this respect, the featured PBHCI site seems to have achieved this goal for active consumers, who by and large touted the accessibility of the program.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, this model of reverse integrated care delivery has been on the rise because of its unique capacity to meet the complex needs of behavioral health consumers. 6 Poor health behaviors and inadequate access to medical care are well documented among those with serious mental illness, 7-9 and engagement in wellness regimes and primary care services continue to pose distinct challenges for behavioral health consumers. Complications of mental illness such as nervousness, fatigue, amotivation, and other forms of psychological distress have been shown to hinder appointment attendance and health goal achievement.…”

mentioning

confidence: 99%

Perceived Barriers to and Facilitators of Engagement in Reverse Integrated Care

Gleason

Truong

Biebel

et al. 2016

J Behav Health Serv Res

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Introduction: Individuals with chronic mental illness and addiction have poorer health outcomes than the general population, largely because of preventable medical conditions. Early onset and heightened incidence of chronic disease—such as type two diabetes, chronic obstructive pulmonary disease, and hypertension—might limit behavioral health consumers’ quality life years and ultimately lead to early mortality. These health risks are exacerbated by coinciding poor health correlates such as low socioeconomic status, disrupted cycles of care, and substance use. Primary and Behavioral Health Care Integration (PBHCI) initiatives address these compounding health disparities by improving access to quality primary care and wellness services inside of behavioral health centers. As opposed to traditional integrated care models in which behavioral health services are co-located in medical settings, reverse integration targets consumers with serious and persistent mental illness who are more likely to frequent behavioral health care settings. Recently, this model of reverse integrated care delivery has been on the rise because of its unique capacity to meet the complex needs of behavioral health consumers... The current study employs semi-structured individual interviews to assess behavioral health consumers’ perceived barriers to and engagement in PBHCI services at an urban community mental health center

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“…Buck (2011) summarized these trends as consolidation, deinstitutionalization, medicalization, and integration. Although integrated health systems offer the possibility of providing whole person and comprehensive care, the looming challenge, as noted by Scharf et al (2013), is how to successfully engage and then retain individuals in services.…”

Section: Substance Abuse and Case Management Services In The Integratmentioning

confidence: 99%

Reprise: Case Management in Substance Use Services in the Age of the Affordable Care Act

Sullivan

McCabe

2015

Journal of Social Work Practice in the Addictions

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This article asserts that case management, particularly in the area of substance use, be promoted as an integral tool to complement the integrated care models put forth under the Patient Protection and Affordable Care Act (ACA). The potential expansion of addictions services under the ACA reaffirms and elevates the importance of case management in contemporary systems of care. The article briefly reintroduces the rationale for the continuation and expansion of case management in substance use intervention programs and discusses the efficacy of this service based on available research. Given the expertise social workers have in case management, social work leaders will be critical participants in health care system and policy discussions to ensure the enactment of best practices in case management in substance use services.

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Integrating Primary Care Into Community Behavioral Health Settings: Programs and Early Implementation Experiences

Abstract: Early implementation experiences of PBHCI grantees may inform other programs that seek to integrate primary care into behavioral health settings as part of new, large-scale government initiatives, such as specialty mental health homes.

Cited by 87 publications

References 13 publications

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

Perceived Barriers to and Facilitators of Engagement in Reverse Integrated Care

Reprise: Case Management in Substance Use Services in the Age of the Affordable Care Act

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