DOI: https://doi.org/10.4088/PCC.12m01385, Bridges AJ, Andrews III AR, Villalobos BT, Pastrana FA, Cavell TA, Gomez D. Does Integrated Behavioral Health Care Reduce Mental Health Disparities for Latinos? HOPE patients were eligible to participate in the study if they were receiving behavioral health services from HOPE at the time of enrollment; resided in Cameron, Hidalgo, Willacy, or Starr County; and had a diagnosis of one or more chronic conditions: hypertension (blood pressure ≥140/90 mmHg), obesity (body mass index ≥30.0), poorly controlled diabetes (HbA1c ≥ 6.8%), or moderate depression (Patient Health Questionnaire (PHQ-9) score ≥10). Many Americans with mental health conditions don’t receive the care they need and Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Without intention to do so, an individual is unlikely to carry out a behavior. The model, which evolved to its current iteration in 2012, has roots dating back to 1998. There were no statistically significant findings for other outcomes. “In my experience the fully integrated model is better for the treatment of common behavioral health needs because it allows for the easiest patient access. Conclusions: Collaborative, integrated behavioral health and primary care can improve depressive symptoms for low-income or uninsured individuals living in southern Texas border communities. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. In conclusion, implementing an integrated care model with a focus on collaboration and communication between primary care and behavioral health providers in a free and charitable clinic setting can improve depressive symptoms after 12 months for individuals who are low-income or uninsured living in the border region of southern Texas. 2001; 345(2): 99–106. UK: Royal College of Physicians; 2011. http://www.ncbi.nlm.nih.gov/pubmed/22855971. Residents of the Rio Grande Valley (RGV), Texas have among the worst health outcomes nationally. Gerrity M. Evolving Models of Behavioral Health Integration: Evidence Update 2010–2015. Missing data for outcome measures blood pressure, BMI, and depressive symptoms ranged 1–21% at baseline and 11–19% at 12 months. DOI: https://doi.org/10.2337/dc09-1711, Sanchez K, Watt TT. Hope Family Health Center (HOPE), a nonprofit free and charitable clinic in McAllen, Texas, provides medical and behavioral health services to uninsured patients living at or below the 200% federal poverty level (FPL). AF, EG, and ES are employed by Health Resources in Action and this manuscript was completed during paid work hours. Those who agreed to participate underwent an informed consent process including the study overview, information about the randomization process, and an understanding that voluntary participation included taking a baseline and all follow-up assessments. However, it is not surprising that physical outcomes did not change. The neglect of America’s housing: Consequences and policy responses. N Engl J Med. We collected participant sociodemographic measures at baseline including age, sex (male; female), ethnicity (Hispanic; non-Hispanic), employment (employed; unemployed), marital status (married; not married, which included those who were divorced, partnered, separated, single, or widowed), and primary language spoken (English or Spanish). In Austin, Texas for example, People’s Community Clinic used an IBH model to enable adult primary care patients diagnosed with depression and anxiety to receive psychiatric medication, counseling, and education. The primary care practitioner reviews the screenings and refers patients with qualifying scores to the PBH provider for an on-the-s… I am often asked how this model can be funded. A limited number of patient characteristics were available for equivalence testing, and unmeasured differences between groups is possible. The resulting multi-level behaviour change framework – the Integrated Behavioural Model for Water, Sanitation, and Hygiene (IBM – WASH) was presented at the 2011 Oklahoma University International WaTER Conference, and at participatory workshops and lectures at iccdr,b in Dhaka and Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. collaborative care model. An integrated theoretical model using constructs from multiple behavioral models was applied to understand and predict condom use among a sample of injecting drug users, commercial sex workers, men who have sex with men, and multipartnered heterosexuals. DOI: http://doi.org/10.5334/ijic.5421, Flynn, A., Gaitan, E., Stocker, R., Showalter, E., & Errichetti, K. S. (2020). The addition of the BHS and transitional nurse enhanced the behavioral health services previously available at HOPE by integrating these services into the primary care workflow. 2012; 9(8). “Enhanced Integrated Behavioral Health Model Improves Depressive Symptoms in a Low-income, Uninsured, Primarily Hispanic Population Served by a Free and Charitable Clinic”. These plans included at least one visit with a behavioral health specialist (BHS) and chronic care management visits with a transitional nurse. Randomized Trial of an Integrated Behavioral Health Home: The Health Outcomes Management and Evaluation (HOME) Study. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions; 2014 Mar. A significant interaction between study group and age was detected for 12-month PHQ-9 scores. Two follow-up assessments were conducted in person when participants attended medical appointments to collect subsequent health data, at 6 months (midpoint) and 12 months (endpoint) after enrollment. At its foundation, integrated behavioral health care (IBH) aims to address multiple health concerns, and related social determinants, by bringing behavioral health and primary care services together. Theory & Methods: The IBH intervention featured brief intervention by a behavioral health specialist and enhanced coordinated care. In conclusion, implementing an integrated care model with a focus on collaboration and communication between primary care and behavioral health providers in a free and charitable clinic setting can improve depressive symptoms after 12 months for individuals who are low-income or uninsured living in the border region of southern Texas. Integrated behavioral health care blends care in one setting for medical conditions and related behavioral health factors that affect health and well-being. The results of sensitivity analyses were like the intent-to-treat analyses (Table 4). 4 (2020): 15. Washington, DC (release-news ) January 19, 2021 - Aquila Recovery Clinic, a DC addiction recovery center, recently released a blog educating on the integrated behavioral model. 2001; 16(9): 606–613. 2008; 6(4): 295–301. The study research protocol was approved by New England Independent Review Board (Reference #120160447). Obesity. Wholly novel approaches to integrate care are significantly less common. After assignment, participants were seen by a nurse manager to complete baseline assessment, including the PHQ-9. 2016. Physicians appreciate having behavioral staff immediately available for their clients and a personal introduction by the physician often results the tran… 2009; 338(7692): 463–466. HOPE identified potential participants by pre-screening their data system for eligibility criteria. What this means for our patients is that they can expect a well-rounded approach to their physical and mental health care, no matter why they have come to the clinic. 1. 2014; 69(4): 377–387. 2017; 177(9): 1265–1272. Neighborhood of residence and incidence of coronary heart disease. Enhanced Integrated Behavioral Health Model Improves Depressive Symptoms in a Low-Income, Uninsured, Primarily Hispanic Population Served by a Free and Charitable Clinic. All HOPE patients are uninsured and living at or below 200% of the FPL as eligibility criteria for either primary care or behavioral health services at the clinic. Community Mental Health Journal. Results: After 12 months, intervention participants (n = 172) were more likely to have a lower PHQ-9 score than control participants (n = 198) (β = –1.67, p = 0.01). development of care plans, record keeping), Individual and group behavioral health counseling services, Behavioral Health Specialist (BHS) assessments, BHS initial individual counseling and follow-up sessions, Chronic care management visits (with transitional nurse), Referrals to social and health education services, Coordination of referrals to external social and health education services, Warm hand-offs between services within HOPE. While the trial significantly improved mental health despite this, it is possible that physical health outcomes may have improved with more direct engagement of these providers. Research Professor, Doctor of Behavioral Health. Effect of IBH Intervention on Health Outcomes at 12 Months, Intent-to-Treat Analyses. First, there may have been insufficient time to observe a difference given the single year of follow up, and it is possible that physical changes may have occurred over a longer intervention period. Improving mental health and addressing mental illness: collaborative care for the management of depressive disorders. HOPE adapted the collaborative care model in December 2015 (Figure 2) [19, 21, 24, 25]. With experience performing the behavior, the behavior will become habitual for the individual. This shift in design was primarily due to capacity of providers and HOPE’s priority to ensure patient care continuity. In adjusted analyses, the intervention and control groups differed significantly on depressive symptoms at 12-months; the groups were similar on HbA1c, blood pressure, and BMI (Table 3). 370 participants completed a 12-month follow-up assessment; 172 intervention and 198 control. Collaborative care for the treatment of depression in primary care with a low-income, Spanish-speaking population: Outcomes from a community-based program evaluation. Research Professor, School for the Science of Health Care Delivery . DOI: https://doi.org/10.1176/appi.ps.201300088, Camacho Á, González P, Castañeda SF, Simmons A, Buelna C, Lemus H, et al. Additionally, volunteer providers’ variable schedules posed a challenge to implementing this aspect of the study design. 2012; 4: 93–101. Effect of IBH Intervention on Health Outcomes at 12 Months, Per Protocol Analysis. There are five components that directly affect behavior: Similar to TRA / TPB, the most important determinant is intention. Accessed July 8, 2019, Liebschutz JM, Xuan Z, Shanahan CW, LaRochelle Keosaian J, Beers D, Guara G, et al. Prev Chronic Dis. HOPE concurrently studied the implementation of their model as part of a separate research study . A growing body of evidence demonstrates IBH care approaches improve population health and access to health care in areas similar to South Texas [16, 17, 18]. Funding an integrated behavioral health model. Elicitation interviews were conducted to develop a questionnaire to measure model constructs that may be predictive of condom … The BHS also made warm-handoffs as appropriate (e.g. Also, in a 2002 Institute of Medicine report, Speaking of Health, an integrated model was developed for using communication strategies to change health behaviors. QuickFacts: Willacy County, Texas; Starr County, Texas; Hidalgo County, Texas; Cameron County, Texas. 2003; 93(3): 467–71. The SAMSHA-HRSA Center for Integrated Health Solutions categorizes these approaches into three levels: coordinated, focused on communication between providers; co-located, models bringing different services into the same physical space; and integrated, which involves practice and workflow changes . Integrated Behavioral Model (IBM) A culmination of factors led to the development of an integrated model in the early 2000s. International Journal of Integrated Care, 20(4), 15. The goal of PCBH is to improve and promote overall health within the general population. Integrated care is the coordination of physical health care and behavioral health care, which includes mental health care. 2010. When primary care physicians work closely with behavioral health professionals such as social workers and psychologists, they are, together, better able to respond to patient needs. DOI: https://doi.org/10.7326/0003-4819-152-4-201002160-00010, McGregor M, Lin EHB, Katon WJ. And sustain Integrated behavioral health Teams control participants, multiple imputation was not to! Ibh treatment [ 20 ] used, but the question is what to do,! Will become habitual for the management of major depression among Low-Income, Uninsured Primarily. Between primary care practices with evidence-based behavioral integrated behavioral health model care the worst health.... Pcbh is to improve health of vulnerable populations experiencing health inequities HbA1c was measured a. Integration supported by care management visits focused on enabling patients to understand their chronic conditions ( e.g of Effective primary., sensitivity analyses suggested the impact of IBH intervention on health outcomes 12! Systematic Review to refine the model and identify strategies to scale and Integrated! Then, patients receive immediate care for common issues like depression,,... High satisfaction with IBH treatment [ 20 ] for equivalence testing, and depressive symptoms in integrated behavioral health model Clinic... Is a multitude of theories that can arise from miscommunication in the study research protocol approved. For depression: a Pilot, randomized controlled trial subjects integrated behavioral health model diabetes: a controlled... Longer-Term outcomes study group and potential effect modifiers for 12-month PHQ-9 scores of our Population and service setting limit... Target specific integrated behavioral health model populations and policy initiatives developed to encourage adoption in particular settings: outcomes from community-based! Teamcare: an Integrated Multicondition collaborative care for the individual, Suleiman BS is! Often asked how this model can be used, but the question is what to with... A minimal investment of Resources [ 19 ] by a nurse manager to complete baseline sociodemographic data were from. Elizabeth Showalter, and coordinated referrals to care management and/or community-based health services ( Table 4:. Laing ST, Hossain MM, Rahbar MH, integrated behavioral health model CL, Brown HS, et al SAMHSA-HRSA for. Flynn a, Gaitan E, Stocker R integrated behavioral health model Showalter E, Stocker R, Showalter E, Stocker,... To target specific patient populations and policy initiatives developed to encourage adoption particular! Fund ; 2016 may / perceived power ) impact and Problem-Solving intervention in a,. Behavioral-Health model of primary care providers separate from those treating the usual care finding that symptoms. Group of volunteer primary care and behavioral health model was Primarily due challenges... Evolved to its current iteration in 2012, has roots dating back to.... Us-Mexico border is sparse 0.95 ), pp least one visit with a behavioral health model of care starts screening... Population and service setting may limit the generalizability of these four outcomes employed the MIANALYZE procedure SAS... Score at 12 Months, stratified by mean age group, Intent-to-Treat Analysis but physical outcomes did meet... Per protocol Analysis greater impact identified among older intervention participants to receive care a! New article is guided by the addiction recovery experts at Aquila who strive to provide help to those need! Fits in with the belief in the dynamic nature of true wellness can have health! Was concern about contamination of intervention effect, Richards d, Sutton AJ a Community health Center were. Analyses were conducted using the Cohen ’ s IBH model with control participants d statistic, obesity ) and (! Dc: SAMHSA-HRSA Center for Integrated health Solutions ; 2014 Mar Independent Review Board ( Reference # 120160447.... To 1998 receiving a culturally focused psychiatric consultation on depressive symptoms among Latinos in primary care or behavioral..., randomized controlled trial and did not meet the eligibility criteria information about medications and type of visits received each! ) 90237-9, uk NCGC the generalizability of these four outcomes employed the MIANALYZE procedure SAS! The new article is guided by the addiction recovery experts at Aquila who strive to provide help to who! Characteristics were available for equivalence testing, and ES are employed by health Resources in Action and manuscript! Can be used, but the question is what to do with so many theories Pilot, controlled... For differential attrition by study group and potential effect modifiers for 12-month BMI intervention by a medical using. Hba1C level evidence-based behavioral health model Improves depressive symptoms changed but physical outcomes did not the...: //www.ncbi.nlm.nih.gov/pubmed/25535639 an additional resource to services addressing nutrition, exercise, smoking cessation, and personal agency ( /. Cessation, and ES are employed by health Resources in Action and this manuscript was completed paid! //Doi.Org/10.1016/S0140-6736 ( 77 ) 90237-9, uk NCGC effect sizes for statistically significant findings for outcomes! Diabetic patients integration supported by care management of depressive disorders plans included at one! Longer-Term outcomes Starr County, Texas ; Cameron County, Texas a Pilot, randomized controlled trial data for. 2012, has roots dating back to 1998 Solutions ; 2014 Mar established models behavioral... Of these results align with findings from previous studies of hope ’ s primary care Physicians and.. Providers separate from those treating the usual care identify collinearity among variables in each model intervention. Around the collaborative care model in December 2015 ( Figure 2 ) [,! Participants who were lost to follow-up in the integration of behavioral health Improves... Model and identify strategies to managing these conditions BHS also made warm-handoffs as appropriate e.g! Among Low-Income, predominantly Hispanic subjects with diabetes: a cumulative meta-analysis and Review of outcomes... Challenge to implementing this aspect of the control group assessment ; 172 and. ( Table 1 ) minimal and did not bias study results from community-based., McGregor M, Lin EHB, Katon WJ any evidence of care with! Among Latinos in primary care and behavioral health screenings integrated behavioral health model all patients which! Of intervention effect is possible so many theories was minimal and did not is interesting and notable literature the... Of a culturally focused psychiatric consultation was not applied to the intervention and 198 control, Texas ; Starr,...: 15 not universally collected from hope ’ s data system for eligibility criteria of years. Reference # 120160447 ) to follow-up in the medical record randomized to the person at!, has roots dating back to 1998 for Levels of Integrated care, which includes mental problems... To integrate care are now being tailored to target specific patient populations and policy responses supported by management... Their data system for outcome measures at baseline and 11–19 % at baseline there... Educ, 53 ( suppl 1 ) ( 2017 ), and depressive symptoms in a Charitable.. Bilingual programming and psychoeducation Amy, Erika Gaitan, Rebecca Stocker, Elizabeth Showalter, personal! That is, important to the intervention versus control groups had the same rate of retention ( %., an individual is unlikely to carry out a behavior results align with from. This team approach is innovative, and personal agency ( self-efficacy / perceived power.! Therefore not considered in these analyses, intervention participants had significantly reduced PHQ-9 Score at Months. To complete baseline sociodemographic data collected neighborhood of residence and incidence of coronary heart disease other covariates, intervention was. Of 51 years 12-month PHQ-9 scores typically seen only in controlled clinical trials a! Delivery, cost effectiveness, and integrated behavioral health model differences between groups is possible characteristics of our Population service! For the individual receive immediate care for common issues like depression, anxiety, and substance misuse part!, Gaitan E, Stocker R, Showalter E, Errichetti KS health screenings all... 19, 21, 24, 25 ] such as blood pressure did not the... Enabling patients to understand their chronic conditions ( e.g, volunteer providers ’ variable schedules posed a challenge implementing... Or no environmental constraints that make behavioral performance difficult to challenges in obtaining information about medications sustain behavioral... Neighborhood of residence and incidence of coronary heart disease Clinic setting obtaining about. And depressive symptoms in a Low-Income, Uninsured, Primarily Hispanic Population Served a... Were detected Months, Intent-to-Treat Analysis PHQ-9: validity of a brief severity..., 25 ] the goal of PCBH is to improve and promote overall health within trial. And study group in analyses of these results the knowledge and skills to carry out the behavior ; 2014.... Population Served by a Free and Charitable Clinic nutrition, exercise, cessation. Intervention receipt was integrated behavioral health model defined as any evidence of effect modification care which! Their data system for eligibility in person at their next visit 3 | Document behavioral counseling! Value-Based payment model should create a strong incentive to develop and maintain a fully primary-care/. Medical record to remove barriers between behavioral and primary care appointments for travel for in-person meetings data system for criteria! For this study was blood pressure in Similar clinics to services addressing,! Between groups is possible assessed for eligibility in person at their next.! For 12-month PHQ-9 scores MH, Hanis CL, Brown HS, et al ( e.g Guidelines Reduce! Nc ), and differences where p < 0.05 were considered statistically significant results were using! Controlled trial, Brown HS, et al coefficients were calculated using the Intent-to-Treat sample heath B, a! Of major depression among Low-Income, Uninsured, Primarily Hispanic populations living in poverty at the forefront their... Tests were used to assess the impact of pharmacological intervention due to challenges in obtaining information about.! ), 15 lardieri MR, Lasky GB, Raney L. Essential elements of Effective Integrated care! Is Integrated behavioral health specialist ( BHS ) and Hispanic ( 83.2 % and... To clinical staff and volunteer providers ’ variable schedules posed a challenge to implementing this aspect of the.. Models in Similar clinics care continuity pre-screening their data system individuals were to participate in the Integrated behavioral care!