Elsevier

Current Opinion in Psychology

Volume 5, October 2015, Pages 37-41
Current Opinion in Psychology

Recent advances in primary care behavioral health

https://doi.org/10.1016/j.copsyc.2015.03.015Get rights and content

Highlights

  • We review evidence-based practices for integrated behavioral health providers.

  • Validated self-report measures facilitate screening and measurement-based care.

  • Evidence supports brief interventions for depression, alcohol, tobacco, insomnia.

  • Guidance on how to implement evidence-based interventions is limited.

  • Evidence for brief interventions for behavioral medicine issues is lacking.

Behavioral healthcare is being increasingly integrated into primary care settings. The primary care behavioral health (PCBH) model is one of the most common approaches to integrated care, but limited guidance exists to guide behavioral health providers (BHPs) in their everyday clinical practice. The purpose of this review is to summarize evidence-based assessment and intervention practices for PCBH providers and identify gaps for future research. Recent advances that can help support evidence-based practice among these providers include a measure of integrated behavioral health providers’ fidelity to the PCBH model, brief behavioral health assessment and outcome measures, and brief interventions.

Section snippets

Recent advances in primary care behavioral health (PCBH)

The transformation of primary care using the medical home model (i.e., providing comprehensive, coordinated, team-based, patient-centered, whole-person primary care) has been an impetus for the integration of mental health providers [1], [2], [3••]. This integration can take several forms, with one of the more common approaches involving behavioral health providers (BHPs) being embedded into primary care to offer functional assessments, brief treatments, and triage to specialty care. This model

Brief overview of BHP role in PCBH model

Within the PCBH model, integrated BHPs function as members of the primary care team and provide direct clinical services to patients as well as collaborate and consult with medical providers. Services take the form of brief assessments and interventions across approximately 1–4 appointments that are on average 30 min in length [8]. Although BHPs are well-suited to address the full spectrum of mental and behavioral health problems, a recent review [10] found that integrated BHPs are highly

Fidelity to the PCBH model

Substantial evidence supports the PCBH model's role in improving access to and utilization of mental health services [12•], [13], [14]. Although additional research, including the effects on patient-level clinical outcomes, is needed (see Carey [15] or Miller [16] for a review of gaps in integration research), we would argue that the extant research supports the PCBH model itself as an evidence-based ‘platform.’ Nevertheless, translating this complex health care delivery model into

Evidence-based screening/assessment tools

Evidence-based practice in PCBH incorporates screening, assessment, and measurement-based care. Primary care clinics using the PCBH model often use screening measures (see [19] for a review of measures) to identify patients with behavioral health concerns who would benefit from referral to the BHP [8]. Current evidence supports universal screening of adult primary care patients for depression [20], alcohol misuse [21], and tobacco use [22]. Self-report screening measures such as the Patient

Evidence-based brief clinical interventions

Given the diverse array of presenting problems and co-morbid medical conditions seen in primary care patients, integrated BHPs also need a broad repertoire of brief clinical interventions. We will focus our review on those interventions targeting the most common presenting problems in primary care [8] and having a strong level of evidence.

Conclusions and recommendations for future research

Existing research provides integrated BHPs an initial foundation for how to conduct an evidence-based clinical practice when working in primary care. However, there are still significant gaps that need to be addressed. Integrated BHPs need assessment tools and interventions that are brief, yet versatile enough to accommodate the diverse patient population in primary care, including patients with a range of symptomatology as well as multiple co-morbidities and functional complaints. This

Conflict of interest

Jennifer Funderburk and Robyn Shepardson declare that they have no conflict of interest.

References and recommended reading

Papers of particular interest, published within the period of review, have been highlighted as:

  • • of special interest

  • •• of outstanding interest

Acknowledgements

The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Veterans Affairs or other departments of the U.S. government.

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