Simply locating a behavioral health program in the same facility as primary care services won’t accomplish integrated care. While physical proximity is vitally important, integration must take place on many levels – physical, financial, clinical, administrative, and attitudinal –– to achieve a true coordinated, multidisciplinary approach.
It’s a good idea for community health agencies contemplating or initiating an integrated behavioral program to first look at where on a continuum their agency currently falls: LEVELS OF INTEGRATED BEHAVIORAL HEALTH CARE.
An effective tool for readiness self-evaluation has been developed by Keith Miles et al. in "Conceptualizing and Measuring Dimensions of Integration in Service Models Delivering Mental Health Care to Primary Care Patients" below. The assessment instrument measures the level of integration along five basic dimensions: communication; physical proximity of primary and mental health care; temporal proximity of primary and mental care; integration of mental health expertise/services; and integration with respect to the degree of stigma. Click the title to access this measurement instrument.
by Keith M. Miles, MPA, Karen W. Linkins, PhD, Hongtu Chen, PhD, Cynthia Zubritsky, PhD, JoAnn Kirchner, MD, Eugenie H. Coakley, MA, MPH, Louise Quijano, PhD , and Stephen J. Bartels, MD, MS, 2007.
Dr. Jurgen Unutzer, a leader in the IMPACT depression treatment model and research, posed several fundamental questions clinics needed to ask themselves to prepare for implementation of the model. These questions apply equally to clinics contemplating all types of integrated behavioral care programs:
- How will clients be identified?
- Who will prescribe antidepressants?
- Who will provide counseling/psychotherapy?
- Who will provide mental health back-up?
- Who will track clinical outcomes and how?
- How will treatment changes be initiated?
- How will team members communicate?
- What is the overall implementation strategy?
- Who will lead/coordinate the effort?
- What kind of provider/staff training is needed?
- What structural/program changes are needed?
- What are anticipated barriers and challenges?
- How will we measure success?
- How can the model be sustained?
Several other instruments are available to both enable clinics to self-assess how prepared they are to undertake integrated care and to point them to specific areas that they need consider. Dale Jarvis, at the behest of the National Council, prepared "High Level Provider Assessment". Case Western Reserve developed the "Integrated Treatment Tool to Evaluate the Integration of Primary and Behavioral Health Care" and the AIMS Center developed the "Patient-Centered Integrated Behavioral Care Principles and Tasks" in consultation with national experts. Besides measuring readiness, the self-assessment survey can serve to direct and focus clinics embarking on integrated care. AIMS also created a team building checklist to help clinics identify and assign specific tasks associated with integrated care.
To assure that our grantees fell all across the spectrum of integrated behavioral care, IBHP developed an Integration Level Survey, a brief checklist grant applicants completed to provide an indication of how closely behavioral services were aligned with general health care at their primary clinics.
FOR MORE READINESS AND ASSESSMENT TOOLS, GO TO "LEVELS OF INTEGRATED BEHAVIORAL HEALTH CARE" AND "OTHER DIMENSIONS OF INTEGRATION" IN THE "WHAT" SECTION OF THIS WEBSITE.