integration for integrated behavioral health care in primary care facilities

integration for integrated behavioral health care in primary care facilities

There are many models of integration for integrated behavioral health care in primary care faciliities. Three of these

models are co-located care, collaborative care and priamry care behavioral health model (PCBH). There are pros and cons of

each model; however, they all elicit better outcomes for patients and decrease overall health care costs.

Three pros to co-located care are:
(1) that co-located services allows under-served populations to receive mental health services with more accessibility

(Miller, Petterson, Burke, Phillips, & Green, 2014),
(2) being in the same facility allows for PCP and Behavioral Health provider to speak informally about patients with more

ease (Collins et al., 2010), and
(3) consultations are made to increase both PCP and Behavioral Health Provider’s skills sets (Collins et al., 2010).
Three cons to co-located care are:
(1) health care policies have not changed to incorporate behavioral health services in a primary care model (Miller et al.,

2014),
(2) separate care plans from the PCP and the Behavioral Health yet provided in the same office/building (Collins et al.,

2010), and
(3) behavioral health is not a routine care provider; services are just readily available on site.

Pros to collaborative care include:
(1) the patient getting the right care at the right time with a better division of labor,
(2) utilizes a care manager/coordinator to facilitate referrals so that follow through is achieved more often (Collins et

al., 2010), and
(3) care is closely tracked with clinical rating scales (Unutzer, Harbin, Schoenbaum, & Druss, 2013).
Cons to collaborative care include:
(1) that the psychiatric consultant many not be a routine care provider within the clinic or even onsite at all and may only

tackle mental health issues rather than general behavioral issues (Unutzer et al., 2013),
(2) there are different levels of collaboration in which low levels do not have onsite collaboration, and
(3) data and notes are not regulated and can be done using different medical record systems.

Three pros to primary care behavioral health model are:
(1) behavioral health care is integrated on site embedded into the primary care clinic to allow immediate follow up to

positive screens with warm handoffs (Collins, C., Hewson, D. L., Munger, R., & Wade, T., 2010)
(2) there is constant on-going correspondence with the PCP via notes, phone, in-person conversations (Dundon, Dollar,

Schohn, & Lantinga, 2011), and
(3) the BHC uses a problem focused, solution oriented functional assessment during brief 20-30 minute sessions 1-6 times a

year (Dundon et al., 2011).
The cons to primary care behavioral health model are:
(1) the population of primary care is targeted rather than the individual (Collins et al., 2010),
(2) extended behavioral care is not typically provided, if needed it is referred to a mental health specialist (Dundon et

al., 2011), and
(3) PCP consultation and collaboration between PCP and BHC are not billable tasks (Dundon et al., 2011); it is initially

expensive to implement but in the long run decreases helath care costs per patient.

The primary care behavioral health model, in my opinion, is the best model to integrate beahivoral health care in primary

care facilities.

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