Integrated Behavioral Healthcare Models

Abstract

The proliferation of integrated behavioral health over the past 30 years has been fostered by the development of a variety of practice models. While these models have evolved over time, the recognition of the need for, and development of, workforce development efforts has typically been slower to emerge. This chapter will describe the history and current state of models of integrated behavioral healthcare, as well as training initiatives and recommendations for key concepts to consider when selecting a practice model to implement.

Appendix: IBH Historical Development

References

Evolution of IBH	Seminal points in the history of IBH publications and training
1600s – Cartesian dualism, which views the mind and body as separate entities, is the prevailing view of healtha 1950s – Kaiser Permanente implements the first attempt at integrated (collaborative care) with prepaid psychology contacts 1967 – The American Academy of Pediatrics coins the term “medical home” for children with complex needsb 1971 – The term “medical model” is coined by R. D. Laing, who describes it as the “set of procedures in which all doctors are trained” 1977 – In response to Laing’s medical model, Engel publishes in paper on the biopsychosocial model of care, which emphasizes the influence of biological, social, and psychological factors associated with healthc 1980s – The “Hawaii Project” demonstrates medical cost offset as a result of collaboration between physicians and mental health providersd 1993 – The Collaborative Family Health Care Coalition (now CFHA) comprised of 15 colleagues from family medicine and family therapy meets for the first time to promote the integration of behavioral health and primary care 1996 – IOM defines primary care as the “provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal health needs, developing a sustained partnership with patients, and practicing in the context of family and communitye” 1998 – Chronic Care Model (CCM) shifted attention to proactive, population-based approaches to patient chronic care management Late 1990s – Several studies are published noting significant differences in the lifespans of patients with severe mental illness	1892 – Andrew Taylor Still founded the American School of Osteopathy, establishing the Doctor of Osteopathic medicine (D.O.) credential. Unlike the previously established M.D., D.O.s are trained to treat the cause of problems, rather than the ramifications of diseases, resulting in a more whole person 1969 – Family medicine is recognized as the 20th primary medical subspecialty, resulting in establishment of residency and board certification requirements. Understanding of behavioral science is viewed as a key element of trainingj 1989 – Kroenke and Mangelsdorff publish their article in the American Journal of Medicine indicating that the majority of primary care visits are related to behavioral factors (not diagnosed mental health disordersk) 1991 – The term “evidence-based medicine” emerges and becomes a central focus of medical education 1995 – CFHA holds its first national conference 1995 – Katon publishes his first article on the collaborative care modell 1998 – Alexander Blount publishes his book Integrated Primary Care: The Future of Medical and Mental Health Collaboration m
2001 – The Institute of Medicine endorses the principle of evidence-based practice 2006 – The Institute of Medicine articulates the critical need to integrated mental health and substance use in order to achieve quality healthcaref 2007 – The Patient-Centered Medical Home (PCMH) Joint Principles are establishedg 2009 – The World Health Organization launches its Mental Health Gap Action Program (mhGAP), aimed at improving access to evidence-based care in low-income countries by ensuring integration in primary care 2010 – The Affordable Care Act is passed, with provisions focused on reimbursement based on quality standards which promote integrated care 2010 – The US Department of Veterans Affairs launches its national implementation of Patient Aligned Care Teams (PACT), based on the PCMHh 2014 – The NCQA updates the PCMH Joint Principles to expand the importance and role of integration of behavioral health into the PCMHi	2004 – Frank, McDaniel, Bray, and Heldring publish their edited volume, Primary Care Psychology n 2007 – Patricia Robinson and Jeffrey Reiter publish Behavioral Consultation and Primary Care: A Guide to Integrating Services o 2007 – The University of Massachusetts Medical School launches a distance-learning training program in integrated primary care co-led by behavioral health clinicians and primary care providersp 2008 – Berwick, Nolan, and Whittington describe the Triple Aimq 2009 – The Interprofessional Education Collaborative (IPEC) is established; it publishes its first set of interprofessional competencies in 2011r 2009 – Hunter and colleagues publish Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention s 2009 – The Doctor of Behavioral Health (DBH) program at Arizona State University opens the first doctoral training program exclusively focused on training behavioral health providers in integrated primary care 2010 – Milbank Memorial Fund publishes its report on Evolving Models of Behavioral Health Integration in Primary Care t 2011- APA Report of the Primary Care Training Task Force is publishedu 2013 – AHRQ publishes the Lexicon for Behavioral Health and Primary Care Integration, providing a shared language for integrated primary carev 2013–present – There is a proliferation of both guild-specific and interprofessional competencies regarding the practice of integrated behavioral health in primary care 2016 – Corso et al. publish one of the first books focused on challenges with implementing primary care behavioral healthw 2017 – NCQA releases 2017 PCMH standards that more specifically articulate the value of behavioral health integration in primary care through the addition of a Behavioral Health Distinction Modulex

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