It’s important to note that IBHP is not endorsing any particular model nor method of integrated behavioral care; we are simply summarizing some generally accepted procedural protocols. The goal of the integrated program should be the optimal treatment of clients’ mental and physical health through staff collaboration. Policies and procedures should flow from that principle. Adherence to a particular model or procedure should be strengthened, modified or abandoned depending on how well that goal is being achieved.
As an example of integrated behavioral procedures, passages from the “Primary Care Behavioral Health Care Services Practice Manual 2.0” developed by the U.S. Air Force Medical Operations Agency, 2002, are presented in modified form below, along with other material developed by IBHP and others.
SERVICES PROVIDED BY BEHAVIORAL HEALTH COUNSELORS AND PSYCHIATRIST SERVICES
FEEDBACK TO PRIMARY CARE PROVIDER
Because the primary care providers have ultimate responsibility for the clients’ care, providing feedback to them is a critical role of the behavioral health counselors. Counselors are encouraged to provide feedback - in-person if possible, or via phone or e-mail - on the same day as the client contact. In addition, counselors generally provide formal written feedback via initial visit documentation (which, in some clinics, is noted on the initial referral form) and consultation notes.
The procedure at some integrated clinics is to obtain primary care provider authorization if the behavioral health counselor recommends that the client be seen beyond a specified number of visits.
REFERRAL TO OUTSIDE SERVICES
Many of the behavioral service clients have complex psychosocial needs that extend beyond what the clinic can provide. Unfortunately, connecting clients with appropriate services, like public benefits, jobs and housing, are often not reimburseable activities for primary care facilities. Because of their enormous value to the clientele, however, many clients at least try to promote such linkages. It is recommended that the counselor make the initial referral, then later follow up with the client to ensure that contact with the referral source has been established. Clinics should have established guidelines for when referrals to outside providers, particularly specialty mental health, should be made and, of course, should maintain a current resource directory.
SPECIALTY MENTAL HEALTH
Specialty mental health is generally more process-based and in-depth than the specific skill-building behavioral health sessions and is utilized for clients with more serious or complex issues than are appropriate for the short-term focused behavioral health intervention, or for clients that have not responded to the treatment regimen offered by primary care behavioral health. See "Comparison of Integrated Care with Specialty Mental Health."
Some clinics have reached procedural agreements with the local public mental health entity that delineate when and how clients should be referred. See the Four Quadrant Model , a conceptual framework for populations served by primary care vs. specialty mental health.
For more information about collaboration between government mental health programs and primary care clinics, go to "Collaboration Between Specialty Mental Health Agencies and Primary Care Behavioral Programs".