COURSE DESCRIPTION: Describes the integration of Behavioral Health and Primary Care Practices. Topics include: systems oriented practice; interventions; whole person care, and; care coordination, collaboration, and teamwork.
- Describe integrated practice within the organization and culture of the inter-professional team.
- Identify evidence-based interventions and best practices for integrated care settings.
- Describe how to plan and deliver services with an understanding of the holistic needs of the individual.
- Use collaborative practice and services available to healthcare consumers, family members and other providers.
This course is an introduction to how to integrate behavioral health services into the primary care office. Students will be given the background necessary to promote the integrated care movement, the models of implementation, trajectory of the project in our region, and be able to explain the history. We will read about and discuss some of the best practices and pilot projects available today, as there is a variety of ways integration can occur. We will then focus on the Collaborative Care Model and Whole Person Philosophy in the delivery of integrated care in primary care.
The course is intended for a variety of audiences and each student will be coming from a variety of backgrounds. Some may be champion leaders, working with their current to create an integrated team. Others may already work at an organization with an integrated team and looking to improve the work flow and outcomes.
Students in the course may include behavioral health specialists, primary care providers, psychiatrists, chemical dependency counselors, nurses, clinical assistants, and/ or administrative staff. The class may be specifically for a clinic and their collaborative care team members. Some students may be using the course as professional development to apply with an organization offering integrated care.
The online textbook is part of a larger course, but also can stand on its own as a resource to students, professionals, or organizations. The online textbook is used to post recommended reading assignments and links to students to explore topics further. It also offers a platform to direct students to other textbooks, videos, and websites available. As this topic is ever-evolving the online textbook offers a way to always include the best evidence-based practice research available. The intent is to regularly update the online textbook with the latest in research.
We have two main textbooks and this online textbook to guide us through the basics of integration and provide additional resources and links for further study beyond this class. We utilize the example of the IMPACT Project with the University of Washington AIMS Center as a best practice and demonstration of how a collaborative care team functions. The online textbook provides link to supporting articles and videos from The Agency for Healthcare Research and Quality (AHRQ), Substance Abuse and Mental Health Services Administration (SAMHSA), Addiction Technology Transfer Center (ATTC) Network , Institute for Healthcare Improvement, the American Psychological Association, Kaiser Permanente, American Academy of Family Physicians, the State of Washington, and The North Sound Behavioral Health; to name a few. We also have two support textbooks, from which we will read a few chapters to round our full collaborative team perspective, strategies to maintain the fast paced workflow in the primary care office, maintain registries to demonstrate patient progress and outcome, risk management, as well as the systems required to facilitate and administer these services.
One of our main textbooks comes out of this project, “Integrated Care: Creating Effective Mental and Primary Health Care Teams.” This book focuses on the treatment of mental health conditions treated in the primary care office. It provides practical information and outlines how collaborative teams work together to treat these conditions. It is designed for care managers (behavioral health specialists), consulting psychiatrists, primary care providers, and administrators and each chapter outlines the team member’s role and gives clinical approaches needed to implement an integrated program. What is especially nice about the format of this book is how it demonstrates collaborative care workflow, giving case studies and guidance for each member of the team.
The second main textbook used in the course is The Behavioral Health Specialist in Primary Care: Skills for Integrated Practice. This book gives us historical perspective and background in the theory applied in integrated practice. It also offer another viewpoint, changing health behaviors related to chronic illness. The text describes psychosocial support and brief counseling techniques to help patients make lifestyle and behavioral changes to help prevent disease complications. The book gives great examples of interoffice communication such as referral and consultation notes, SOAP charting, screening tools, and an overview of common chronic diseases.
The course introduces tactics used create effective interventions, engage and activate the patient, and work towards behavioral changes with the patient and primary care team. We will discuss the main patient populations and diseases addressed by these methods. Then identify care management strategies to deliver better care by improving the patient experience, achieve better outcomes, and reduce health care dollars spent (“The Triple Aim”).
We will discuss six main levels of integration. (You may find some sites refer to 5 levels, but ultimately encompasses the same types of integration at an organizational level.) We will read about each level and discuss the pros and cons of each type. The course focuses on achieving full integration, which is the goal of the Innovative Health Plan of Washington and the Affordable Care Act. We will also look at innovations in addiction treatment and how this can be added to the integrated behavioral health services provided by an organizations.
We will work on team collaboration, work flow, and inter-professional communication. The key to successful integrated care services is a cohesive and dynamic team. It is important that team members respect each other’s role and support each other. We will use the Team STEPPS approach to demonstrate how a team can work together in a healthy manor to deliver quality care in an efficient way.
A significant part of the course is utilizing screening tools and office procedure to identify and assess physical and mental conditions, track progress, demonstrate outcomes, and chart consults to communicate in a consistent fashion in the patient chart. This allows a team to have a common language and reference to transition back and forth between interventions provided by different team members. It also provides data to demonstrate outcomes, a key component to reimbursement. These tools and procedures are selected based on state and regional mandates and/or best practices.
We transition into systems oriented practice standards and strategies. The course outlines the the primary care system, infrastructure, and common management practices. We look at the insurance coverage for integrated services, billing and reimbursement, electronic health records systems, coding, referral systems, registries, and scheduling strategies. This systems oriented approach is key to maintaining the underlying organization of the integrated practice and insure each patient receives the right care and the right time, the program is efficient, and patient retention.
The course ends with a return to care coordination, collaboration, and teamwork. We discuss strategies for maintaining workflow and techniques to streamline communication during the busy work day. Some examples are case presentation, brief action planning, SBIRT (Screening, Brief Intervention, and Referral to Treatment), intra-office referral systems, warm hand-offs, curb-side consults, meetings to discuss patient cases with higher risk health concerns and/or poor outcomes, and medication management. The integrated team needs to have specific guidelines regarding scope of practice and medication management. We discuss protocols that can be used to clarify this issue. We will also do a basic overview of medication names, uses, and precautions. With that we transition into risk management, health crisis management, suicide prevention, and relapse plans.
Students will be asked to keep a journal. The purpose of the journal is for the student to pull out the information most pertinent to their perspective role in an integrated health care team. The journal can also serve as a list resources available to maintain shared priorities and strategies for population health, including improved delivery systems, coordinated initiatives, and value-based payment models for the North Sound ACH.
The journal will be a professional planning and organization tool, a means of reflection, to give their own voice to the process of this paradigm shift in care. They will participate in online discussions to expand upon topics learned and further develop their own perspective on integrated practice. Students will be working toward the final presentation demonstrating a scenario or presenting on an integrated system they believe would work best at their current health care facility or preferred system at a perspective job.
One of our main sources for articles and references is The Substance Abuse and Mental Health Services Administration (SAMHSA). It is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health in our country. Their mission is “to reduce the impact of substance abuse and mental illness on America’s communities.” We will refer to their website frequently during this course, please go to the link. It will continue to be an excellent resource as you continue to perfect skills and services in integrated care. It is regularly updated to provide the latest in all areas of competencies identified by the the U.S. Department of Health and Human Services to deliver evidence-based integrated care. We have tried to include a survey of basic information from each competency area:
- Interpersonal Communication
- Collaboration & Teamwork
- Screening & Assessment
- Care Planning & Care Coordination
- Cultural Competence & Adaptation
- Systems Oriented Practice
- Practice Based Learning & Quality Improvement
To learn more visit the SAMHSA website, go to topics, and select “Health Care and Health Care Systems Integration.” Then go to the link for “Publications and Resources on Health Care and Health Systems Integration.” At the bottom of the page there is a link to The SAMHSA-Health Resources and Services Administration Center for Integrated Health Solutions under Training and Education (or follow this link). To read more about the competency areas above, go to the “Workforce” tab at this website, and select the “Core Competencies” link on the right.
Even navigating through these several pages, I am sure you noticed several other interesting links. I encourage you to spend some time looking around this website for articles interesting to you and your organization.
What Is Integrated Behavioral Health Care (IBHC)?
Integrated Behavioral Health, as defined by the Agency for Healthcare Research and Quality (AHRQ), is “The care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization.”
To read more please see the article from The Academy of AHRQ, Integrating Behavioral Health and Primary Care.