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James and O’Donohue (Editors): Annotated Bibliography. The Primary Care Toolkit: Practical Resources for the Integrated Behavioral Care Provider. Springer Science+Business Media, LLC, NY, NY, 2009. This book is designed to be a guide for administrators and practitioners in medical settings who are committed to the full integration of behavioral health into primary care, beyond the co-location model. The editors stress the need for high levels of collaboration. They make the point that intentional planning and team development through a readiness survey, staff screening, and ongoing training, lead to successful integration. The book is a compilation of papers developed by 28 contributors from various academic and medical practice settings. It is divided into 2 sections. The first section has an administrative focus, and the second is more direct practice/disease-focused. A brief description of each chapter follows, including: information on the content, graphs and charts, and handouts supplied by the authors. Part I: Tools for Getting Started “How to Determine the Need: A Readiness Assessment System”: Emphasizes the need for the organization to be ready for the change, steps for completing an assessment, characteristics of readiness, and a tool to measure factors which impact organizational readiness. “What Administrators Should Know About the Primary Care Setting”: Describes the 4 motivating factors when delivering behavioral health services in primary care settings. Chart provides the Key Components of the Primary Care Model. “Financial Models for Integrated Behavioral Health Care”: Discusses the financial considerations for health care organizations and models to support it. Provides information on billing codes and makes the case for a focus upon medical cost offsets. Glossary of terms related to cost evaluation. “Essential Competencies of Medical Personnel in Integrated Care Settings”: Describes the need for new competencies in primary care providers. Table of Core Competencies in the areas of Knowledge, Clinical Skills, and Program-Level Competencies. Tips on how to change provider practice. “Integrated Care: Whom to Hire and How to Train”: Provides a list of necessary skills, types of formal training, past experience, and attitudes to consider for employees. Suggested training curriculum and required reading included. “Effective Consultative Liaison in Primary Care”: Introduces Behavioral Specialists to the world of primary care and makes the case for developing skills that lead to effective consultation with PCP’s. Provides guidance for scheduling and structuring treatment team meetings. “Cultural Competency in the Primary Care Setting”: Assists health care providers in recognizing the impact of cultural factors in both the provider and the patient, which may impact medical outcomes. Introduces Hayes’ ADRESSING model to capture 9 cultural factors, lists La Roche and Maxie’s 10 recommendations for addressing cultural differences, and provides an extensive bibliography for further reading. “The Primary Care Consultant Toolkit: Tools for Behavioral Medicine Training for PCPs in Integrated Care”: Reviews the importance of understanding the role of behavior in health care; how to provide “evidence-based” teaching of integrated care; and how to impact knowledge, skills, and attitudes of the primary care team. Each section is followed by a list of teaching tools and resources. “Quality Improvement in the Integrated Health Care Setting”: A how-to-guide for creating and effectively utilizing a quality improvement process using individual patient, provider and system level data. Several sample charts and graphs. Appendices include: Anxiety and Depression Scales; Health survey and Adult Daily Functioning form; and sample Provider and Client Satisfaction surveys. “Behavioral Screening in Adult Primary Care”: Describes the importance of screening for behavioral problems, the difference between screening and assessment, and how to design a tool as well as how/when to administer it. Brief section on suggested tools for adults.
Part II: Toolbox for Integrated Consultation-Liaison Services: Guidelines and Handouts Each Chapter is organized in areas including: basic facts about the condition, how to effectively screen and assess, what is an effective consultation/liaison approach, suggested interventions, referral and stepped care, self-help resources, and bibliography for further reading. “The Primary Care Consultant Toolkit: Tools for Behavioral Medicine”: Focuses on depression. Several sample patient education handouts included in Appendices. “Assessment and Treatment of Anxiety in Primary Care”: General approach to anxiety with specialized reference bibliographies for Panic and Phobias; Generalized Anxiety and Worry; Shyness and Social Anxiety; Trauma Recovery; and Obsessions and Compulsions. “Assessing and Managing Chronic Pain in the Primary Care Setting”: Self-help websites and Key Readings List on Assessment and Management. “Promoting Treatment Adherence using Motivational Interviewing: Guidelines and Tools”: This chapter provides a more in-depth review of the principles and techniques of MI, numerous sample dialogues, patient work sheets, and Provider reference diagrams and tables. “Diabetes- Guidelines and Handouts”: Includes approaches for adults, children and adolescents. Includes a sample diabetes management contract for teens and parents and a self-monitoring tool. “Attention Deficit Hyperactivity Disorder in Primary Care”: Provides resources for fact sheets and handouts for families, providers and educators, comparison of ADHD rating scales, and an algorithm for treating school-aged children. “Behavioral Health Consultation for Coronary Heart Disease”: Includes “Risk Factors for Heart Disease Checklist, a sample “Stress Diary”, and tools for stress reduction. “Smoking”: Includes a variety of easy to use tools for identifying and counseling patients on quitting the tobacco habit/dependence. “Pediatric Obesity”: Provides resources for fact sheets and other handouts for families and providers, suggested laboratory tests, evaluation for parental change readiness, and targeted goals and interventions. “Somatization in Primary Care”: Appendices include PHQ 15, Instructions for Diaphragmatic Breathing, and a self-reporting scale: Relaxation.
Blount, A. Integrated Primary Care: The Future of Medical and Mental Health Collaboration. New York City: W.W. Norton & Company. 1998.
In his book, Blount and his contributors describe best practices in integrated care in various settings, make a case for collaboration, and how to successfully develop and implement integrated programs in a variety of settings. Contributing authors outline the process for moving from pilot programs to fully integrated practices. Experiences contributors describe the cultural changes that take place over time. Each author emphasizes the uniqueness of approach required of each PCP (primary care provider) or clinic. The book ends with an overview of training programs, describing the current norm of postdoctoral fellowships and the author maintains routines and practices of IPC (integrated primary care) are developing faster outside academia rather than inside and the importance of utilizing current IPC sites for training.
Blount, A. Integrated Primary Care: Organizing the Evidence. Families, Systems & Health, 21(2), 21, 121-134. 2003.
Blount’s described his purpose in writing the article was to offer a structure for assessing the evidence regarding the impacts of integrating behavioral health care into primary care. He offered definitions of the categories of services between behavioral health and primary care, to include coordinated, co-located, and integrated care. The author drew a distinction between targeted and non-targeted programs when describing the relationship of services to populations. He further defined specified and unspecified treatment modalities. Blount suggested that there was an array of possible impacts that authors tend to report. These impacts included improved access to mental health serves, increased patient satisfaction, improved patients compliance, increased cost effectiveness in service delivery just to name a few. He ended by outlining what has been found in the literature that will help those interested understand what practices evidence supports and where the evidence is “poorly focused”. In conclusion, the author promoted that integrated care should be of interest to all. In addition, he advocated for reported outcomes to be broadened in order to make discussion of integrated care easier between those with an interest.
Cummings, N.A., Cummings, J.L., & Johnson, J.N. Behavioral Health in Primary Care: A Guide for Clinical Integration. Madison, WI: Psychosocial Press. 1997.
Book editors, Dr. Nicholas Cummings, Dr. Janet Cummings, and Dr. John Johnson provide a collection of chapters written by pioneers in the area of integration of behavioral health and primary care. The target audience for the book is practitioners, administrators, health economists, educators, program planners, and the purchasers of health care who want to gain an understanding of the what the editors call the “next wave in the rapid evolution in health care.” The book’s nineteen chapters cover a lot of ground on integrated care. From examining the evidence supporting the efficacy of integration, to models of integration, to the effects of capitation and the financial face of integration, the books gives a smart, understandable look at clinical, operational and financial views. In the book’s epilogue, a primary care physician interviewed by behavioral care specialist, Dr. CJ Peek, gives testimony to his first-hand experience with the integration of behavioral health.
Robinson and Reiter: Annotated Bibliography. Behavioral Consultation and Primary Care: a Guide to Integrating Services. Springer Science+Business Media, LLC, NY, NY, 2007. This book provides practical advice on integrating primary care and behavioral health services. The authors describe a specific model, Primary Care Behavioral Health (PCBH), in a readable manner. They have designed over 100 charts and tables, which are easy to find in the book’s Table of Contents, List of Figures, and List of Tables. They have included a CD-Rom with reproducible patient education materials and practitioner tools. The PCBH Model casts the behavioral health provider in the role of a Behavioral Health Consultant (BHC) to their primary care colleagues. Their experience is based upon the development of an integrated approach in Federally Qualified Health Centers. The book is divided into 6 parts and 4 appendices. Each section begins with a brief introduction, is divided into easily identified topics, provides specific practice tools, and ends each chapter with a concise summary of important points. This book is described by the authors as a toolkit, useful in many primary care settings. The Table of Contents serves as a clear guide to topic areas, but reading each chapter is recommended because many important insights and tips are included throughout the narrative. Paraphrasing the authors’ words (pages vii-ix, in the Preface), each section of the book is described, followed by the relevant excerpt from the Table of contents. Part I. The Perfect Storm of Primary Care Chapter 1. “An Overview of Primary Care Behavioral Health Consultation”: Provides an overview of the rationale for integrating care, describes the most common approaches and the rational for the PCBH model. Chapter 2. “A Primer on Primary Care”: Describes the primary care mission and roles of the clinic staff. Part II. Your Mission, Should You Accept It Chapter 3. “A Mission and Job Description”: Provides a clear listing of core competencies needed for an integrated team, elements of job descriptions, and interview questions for potential staff. Addresses training, job performance, and supervision. Chapter 4. “Your Services, Location and Support”: Tips on how to choose target populations, clinic sites, developing a budget, choosing a PCBH Assistant, and billing options. Part III. A Horizon and a Compass Chapter 5. “Theoretical Models and Therapeutic Approaches for Integrated Care”: Examines current dilemmas in health and reviews the recommended theories and therapies that work in a primary care setting. Chapter 6. “Measures for a Primary Care Behavioral Health Practice”: Provides guidelines for developing appropriate screening tools, and gives a sample of “home grown” and standardized tools for specific problems and tips for teaching PCPs to use the tools. Part IV. The Adventure Begins Chapter 7. “Practice Tools for the BHC”: Provides sample scripts for introducing BHC staff to patients, interview and dictation templates, SOAP note content, content for an introductory brochure, functional analysis questions, and guidance on what to ask and what not to ask. Chapter 8. “Start-up: What to Do and How to Influence PCPs: Includes a start-up check list for the first 3 weeks of introducing integrated care into the practice, tips on how to educate providers and eliminate barriers for referrals, and sample newsletters. Part V. The Heart of the Matter: Consulting with Patients and PCPs: each of these chapters begin with a hypothetical schedule for the BHC, followed by case scenarios, possible interventions, teaching points for patients, and teaching points for PCPs. Chapter 9. “Examples of Consultation with Youth and Their Families” Chapter 10. “Examples of Consultations with Adults” Chapter 11. “Examples of Consultations with Older Adults” Chapter 12. “More Than One Patient at a Time: Group Visits in Primary Care”: Provides guidance on setting up group services, ranging from seeing families to seeing large groups of patients for classes, workshops, and group medical visits. Part VI. Uncharted Territory Chapter 13. “Challenging Moments”: Offers ideas for handling common problems faced by BHCs in the primary care setting including substance abuse, engaging “biomedical” providers who may not be open to integrated care, handling psychiatric emergencies, and other miscellaneous challenges. Chapter 14. “Common Ethical Issues”: Provides examples of hypothetical cases of potential ethical conflicts that may arise in the areas of clinical competence, informed consent, confidentiality, and the development of guidelines in a new practice setting for behavioral health professionals. Chapter 15. “Evaluating Your Services”: Addresses productivity, model fidelity, PCP and patient satisfaction, clinical effectiveness, and suggestions for future program evaluation and research. Appendix A: Theories and Therapies: Recommended Reading for the BHC Appendix B: Recommended reading for Children, Parents, PCP’s and BCHs Appendix C: Recommended reading for BHCs and PCPs Concerning Adult Patients Appendix D: Patent Education Handouts and Practice Tools (accompanying CD for reproducible material)
Schneider and Levenson: Psychiatry Essentials for Primary Care. American College of Physicians, Philadelphia, 2008. Increasingly patients are arriving in primary care offices with co-occurring mental health and substance abuse conditions. According to the authors, this book is designed to “bring the psychiatric knowledge and skills of clinicians on par with their knowledge and skills of other medical specialties.” Their goal is to enable PCPs “to effectively and efficiently recognize, diagnose, and treat psychiatric illness” in their clinics and to determine at what point to refer to specialists. This book is an excellent resource, easily readable and well organized to quickly find information and tools that aid in improved patient care. It is divided into 6 parts which reflects a matrix of psychiatric symptoms and disorders called MAPSO (Mood Disorders, Anxiety Disorders, Psychosis, Substance- Induced Disorders, Organic and Other Disorders). Each chapter begins with a brief introduction or theme explaining the relevance of the topic to the general clinician. It is followed by a section on essential concepts and terms; a section on screening and case finding strategies; a section on evidence based treatment, including pharmacology and psychotherapy based on the DSM-IV; and a final section on key concepts which summarizes the fundamental information covered in the chapter. Throughout the chapter key information is presented succinctly in boxes or tables of practice tools, tips on relating to patients, medication management, and relapse prevention. The Table of Contents serves as a clear guide to topic areas, but reading each chapter is recommended because many important insights and tips are included throughout the narrative. Part I. Introduction Chapter 1. “Basic Concepts and Terminology in Psychiatry for Primary Care: MAPSO”: provides an explanation of the matrix and decision making in screening, medical interventions, treatment approaches and referral options. Chapter 2. “The Spectrum of Suicidality”: provides risk assessment guides, how to devise a plan addressing risk factors and naming the degree of risk, how to communicate with the patient and family observing confidentiality laws, a sample of documentation for the PC record. Part II. Mood Disorders Chapter 3. “Depression: Evaluation and Case- Finding Strategies”: information on proper identification, ruling out physiological causes (medical mimics) and normal grief. Chapter 4. “Treatments of Major Depression and Dysthymia: Initial Interventions”: guidance on pharmacological and non-pharmacological interventions. Chapter 5. “Treatment of Major Depression and Dysthymia: What to Do When the Initial Intervention Fails”: guidance on switching or adding medications, combining pharmacology and psychotherapy, and use of ECT. Chapter 6. “Bipolar Disorders”: guidance on proper diagnosis (use of the DIGFAST model), treatment and relapse prevention strategies, and use of mood stabilizers. Part III. Anxiety Disorders Chapter 7. “Panic Disorder and Generalized Anxiety Disorder”: identification of anxiety disorders and medical mimics, screening questions, pharmacological and non-pharmacological treatment options. Chapter 8. “Post-traumatic Stress Disorder”: identifies risk factors and symptoms, psychiatric mimics, pharmacological interventions. Chapter 9. “The Phobias”: screening for specific phobias and guidance on pharmacological interventions. Chapter 10. “Obsessive-Compulsive Disorder”: tips on case-finding, pharmacological and psychotherapy interventions. Part IV. Psychosis Chapter 11. “The Psychoses”: information on differential diagnosis of various disorders, possible medical causes (including side effects of medications prescribed for medical conditions), pharmacological treatment and side effects of the treatment medications. Part V. Substance – Induced Disorders Chapter 12. “Substance Use and Psychiatric Disorders”: differentiates among abuse, dependence, and addiction: information on psychiatric symptoms caused by non-abused medications and co-morbidity of substance use and psychiatric disorders. Less information on treatment options than in other chapters. Part VI. Organic and Other Disorders Chapter 13. “Cognitive (Organic) Disorders and Geropsychiatry”: describes the identification and treatment options of the “3 D’s” of geropsychiatry: dementia, delirium, and depression. Chapter 14. “Medically Unexplained Symptoms in Patients with Psychiatric Disorders”: defines somatization and offers a “5 Step” approach to dealing with patients with medically unexplained symptoms. Overview of somatization, conversion, hypochondriasis, malingering and factitious disorders. Chapter 15. “Personality Disorders”: delineates and defines 3 clusters of 10 personality disorders: Cluster A (odd, eccentric) Paranoid, Schizoid, Schizotypal; Cluster B (dramatic, emotional) Antisocial, Borderline, Histrionic, Narcissistic; and Cluster C (anxious, fearful) Avoidant, Dependent, Obsessive-Compulsive. Tips on management strategies and dealing with counter transference. Chapter 16. “Adult ADD, Eating Disorders, and Women’s Mental Health”: tips on case-finding for ADD and pharmacological and non-pharmacological treatment options; defines Anorexia Nervosa, Bulimia Nervosa, Binge-eating and other eating disorders and limited treatment options; and defines and offers treatment advice on Premenstrual Dysphoric Disorder, use of psychiatric medications during pregnancy and lactation, and Postpartum Disorders Appendix: Includes a Patient Medication Guide and an MAOI diet |
