Recent advances in primary care behavioral health
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.
References (59)
- et al.
The PHQ-9: validity of a brief depression severity measure
J Gen Intern Med
(2001) - et al.
Reliability and normative data for the Behavioral Health Measure (BHM) in primary care behavioral health settings
Fam Syst Health
(2014) - et al.
Safety planning intervention: a brief intervention to mitigate suicide risk
Cogn Behav Pract
(2012) - et al.
Efficacy of brief behavioral treatment for chronic insomnia in older adults
Arch Intern Med
(2011) - et al.
Treatment for insomnia in combat-exposed OEF/OIF/OND military veterans: preliminary randomized controlled trial
Behav Res Ther
(2014) - et al.
Preliminary findings for a brief posttraumatic stress intervention in primary mental health care
Psychol Serv
(2014) - et al.
Efficacy of motivational interviewing for smoking cessation: a systematic review and meta-analysis
Tob Control
(2010) Joint principles: integrating behavioral health care into the patient-centered medical home
Fam Syst Health
(2014)Behavioral health integration: a critical component of primary care and the patient-centered medical home
Fam Syst Health
(2014)- et al.
Mental health services in the medical home in the Department of Veterans Affairs: factors for successful integration
Psychol Serv
(2014)