Prior to analysis, we multiply imputed the missing outcome data with the mi procedure in SAS using all available baseline sociodemographic and health data, generating 10 datasets. The finding that depressive symptoms changed but physical outcomes such as blood pressure did not is interesting and notable. The chronic care management visits focused on enabling patients to understand their chronic conditions (e.g. Participants enrolled in the study were followed for approximately 12 months and assessed for physical and behavioral health outcomes at baseline, 6- and 12-months. Secondary outcomes were diastolic blood pressure, HbA1c, BMI, and depressive symptoms. Arch Intern Med. 688 patients were identified as eligible to participate via pre-screening of records; 585 agreed to participate when approached by clinic staff and were allocated 1:1 to the intervention and control groups. American Psychologist. HOPE concurrently studied the implementation of their model as part of a separate research study . No single model of IBH can be applied universally to health or social service settings; however, each approach is team-based and involves collaboration between multidisciplinary health and social service providers to achieve shared patient and community outcomes . In order to improve patient physical and mental health outcomes, HOPE adapted the collaborative care model to its clinic operations [19, 21]. Study Participant Characteristics at Baseline by Intervention Group. Improving mental health and addressing mental illness: collaborative care for the management of depressive disorders. Then, patients receive immediate care for common issues like depression, anxiety, and substance misuse as part of the same meeting. Also, in a 2002 Institute of Medicine report, Speaking of Health, an integrated model was developed for using communication strategies to change health behaviors. Patients meeting the eligibility criteria were invited to participate in the study. Integrated Behavioral Model (IBM) A culmination of factors led to the development of an integrated model in the early 2000s. 3 | Document behavioral health screening, diagnosis and treat-ment in EHRs to improve care coordination. However, it is not surprising that physical outcomes did not change. Ann Rev Clin Psy. This trial demonstrated that a behavioral health and care coordination intervention implemented in a free and charitable clinic with voluntary care providers can reduce depressive symptoms in uninsured patients living at or below the 200% FPL compared to standard care. Additionally, receipt of services outside of HOPE was not tracked and therefore not considered in these analyses. We present the Integrated Behavior Change Model, a comprehensive multitheory model outlining the psy ... Health Psychology and Behavioral Medicine Research Group, School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth 6845, Western Australia, Australia (E-mail: [email protected]). collaborative care model. Similarities in constructs across TRA / TPB, IBM, Intention or decision to perform a behavior. 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). DOI: https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html, https://doi.org/10.1056/NEJM200107123450205, https://www.integration.samhsa.gov/workforce/team-members/Essential_Elements_of_an_Integrated_Team.pdf, https://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf, https://www.milbank.org/wp-content/uploads/2016/05/Evolving-Models-of-BHI.pdf, https://doi.org/10.7326/0003-4819-152-4-201002160-00010, https://doi.org/10.1097/JAC.0b013e31820ef6a4, https://doi.org/10.3122/jabfm.2017.02.160234, https://doi.org/10.1016/j.jadohealth.2016.11.013, https://doi.org/10.1176/appi.ajp.2016.16050507, https://doi.org/10.1176/appi.ps.201300088, https://doi.org/10.1007/s10597-014-9750-7, https://www.austinpcc.org/documents/specialprograms/IBH_year_3_report.pdf, https://www.census.gov/quickfacts/fact/table/cameroncountytexas,hidalgocountytexas,willacycountytexas,starrcountytexas/PST045218, http://www.thecommunityguide.org/mentalhealth/collab-care.html, https://doi.org/10.1001/archinte.166.21.2314, http://www.ncbi.nlm.nih.gov/pubmed/22855971, https://doi.org/10.1046/j.1525-1497.2001.016009606.x, https://doi.org/10.1016/S0140-6736(77)90237-9, http://www.ncbi.nlm.nih.gov/pubmed/25535639, https://doi.org/10.1001/jamainternmed.2017.2468, https://doi.org/10.1146/annurev.clinpsy.032408.153621, Coordinated information sharing (e.g. In this RCT, we evaluated the effectiveness of HOPE’s integrated care model in a predominantly Hispanic, uninsured population receiving services from a free and charitable clinic located near the US-Mexico border. DOI: https://doi.org/10.2105/AJPH.93.3.467, Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, et al. 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. Am J Psychiatry. A medical assistant assessed vitals including height, weight, and blood pressure. 2018. S59-S71. This model combines a multidisciplinary team that integrates treatment, program structure, systems of programs, and payment to provide whole person care rather than treating isolated symptoms or diagnosis. Clinic administrative data regarding visits with various providers were used to understand the extent participants received the level of care to which they were randomly assigned. Health and Fitness 19 January 2021 . Hypertension. Chair, Research and Evaluation. HOPE aimed to remove barriers between behavioral and primary care through service co-location and integration supported by care management. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions; 2014 Mar. As part of the intervention, participants received a care plan developed collaboratively by providers of different services. Availability of Services for Usual and Integrated Care Participants. Effect sizes for statistically significant results were calculated using the Cohen’s d statistic. Integrated care is the coordination of physical health care and behavioral health care, which includes mental health care. Because HbA1c level was not universally collected from participants, multiple imputation was not applied to the primary model of this outcome. Neighborhood physical conditions and health. 1. 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. a adjusted for age, sex, marital status, baseline systolic blood pressure, and baseline PHQ-9 score b adjusted for marital status, baseline diastolic blood pressure, and number of comorbidities at baseline c adjusted for baseline HbA1c level d adjusted for baseline BMI and baseline PHQ-9 score e adjusted for age, primary language, employment status, and baseline PHQ-9 score. Available here: https://www.milbank.org/wp-content/uploads/2016/05/Evolving-Models-of-BHI.pdf. Available here: https://www.integration.samhsa.gov/integrated-care-models/A_Standard_Framework_for_Levels_of_Integrated_Healthcare.pdf. DOI: https://doi.org/10.1370/afm.843, Foy R, Hempel S, Rubenstein L, Suttorp M, Seelig M, Shanman R, et al. QuickFacts: Willacy County, Texas; Starr County, Texas; Hidalgo County, Texas; Cameron County, Texas. All participants enrolled had complete baseline sociodemographic data collected. Without intention to do so, an individual is unlikely to carry out a behavior. International Journal of Integrated Care. The grant also provided funds for travel for in-person meetings. T-tests were conducted to test within-group differences across time (baseline to endpoint) and between groups at study baseline and endpoint for each of the continuous outcomes. There is a multitude of theories that can be used, but the question is what to do with so many theories. TEAMcare: An Integrated Multicondition Collaborative Care Program for Chronic Illnesses and Depression. Centers for Disease Control and Prevention. 2017; 5(2): 118–125. Second, literature suggests that patients on anti-depressant drugs have increased risk of cardiovascular disease particularly if there is pre-existing cardiovascular disease . Use of a screening tool to identify mental health problems. 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). The unique characteristics of our population and service setting may limit the generalizability of these results. Integrated behavioral health care, a part of “whole-person care,” is a rapidly emerging shift in the practice of high-quality health care. DOI: https://doi.org/10.1176/appi.ajp.2016.16050507, Pollard RQ, Betts WR, Carroll JK, Waxmonksky JA, Barnett S, DeGruy FV, et al. Neighborhood of residence and incidence of coronary heart disease. Significant interactions were detected between sex and study group in analyses of 12-month blood pressure measures and HbA1c level. DOI: https://doi.org/10.5888/pcd9.110298, Cohen DA, Mason K, Bedimo A, Scribner R, Basolo V, Farley TA. The Agency for Healthcare Research and Quality (AHRQ) defines integrated behavioral health as: The care a patient experiences as a result of a team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. Obesity. It includes studies of care delivery, cost effectiveness, and workplace effects. Professional shortages are common in areas served by free and charitable clinics, and engagement of mental health professionals in an IBH intervention may improve feasibility and sustainability of the approach; however, additional research is needed to validate this finding and guide other clinics working to provide similar programming. Enhanced Integrated Behavioral Health Model Improves Depressive Symptoms in a Low-Income, Uninsured, Primarily Hispanic Population Served by a Free and Charitable Clinic. The AIMS Center is most widely known for its work in spreading the Collaborative Care Model (CoCM) but many of the practices we work with incorporate CoCM into a “blended” or stepped model that combines other behavioral health interventions and strategies. HOPE adapted the collaborative care model in December 2015 (Figure 2) [19, 21, 24, 25]. Diagnosed Diabetes. DOI: https://doi.org/10.1037/lat0000067, Fiske A, Wetherell JL, Margaret G. Depression and Older Adults. 2013 Mar. 2012; 14(6). This study builds on prior work promoting breast cancer screenings among Asian women by applying constructs from the Health Belief Model (HBM) and the Integrated Behavioral Model (IBM) to investigate why Asian-American women are less inclined to donate their healthy breast tissue than non-Asian women and how this population may be motivated to donate in the future. What is Integrated Behavioral Health Care: A model agnostic view of the core elements. to primary care or additional behavioral health counseling). Health Resources in Action used grant funds from Methodist Healthcare Ministries who received federal funding for this project from the Corporation for National and Community Service, Social Innovation Fund for this project to pay for time used to conduct the study and prepare this manuscript. Guide to Community Preventive Services. DOI: http://doi.org/10.5334/ijic.5421, Flynn A, Gaitan E, Stocker R, Showalter E, Errichetti KS. In age-stratified models, intervention participants aged 51 years or older had a PHQ-9 score 2.08 points lower than those in the control group (p = 0.01, d = 0.34, Table 5) on average; however, the intervention effect was not significant among participants under 51 years of age. Gaitan E, Auerbach A, Stocker R, Marquez N, Sautter Errichetti K. Integrating Behavioral Health and Primary Care at the US-Mexico Border: Results from an Implementation Study from a Safety Net Clinic with Volunteer Providers. JAMA Intern Med. Available here: https://www.integration.samhsa.gov/workforce/team-members/Essential_Elements_of_an_Integrated_Team.pdf. Arizona State University. International Journal of Integrated Care, 20(4), 15. 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. Rodger Kessler, PhD, ABPP. DOI: https://doi.org/10.1097/JAC.0b013e31820ef6a4, Balasubramanian BA, Cohen DJ, Jetelina KK, Dickinson LM, Davis M, Gunn R, et al. DOI: https://doi.org/10.2147/DHPS.S28804, Flynn, A., Gaitan, E., Stocker, R., Showalter, E. and Errichetti, K.S., 2020. Background: Residents living in US-Mexico border communities have some of the worst health outcomes nationally. The grant also provided funds for travel for in-person meetings. Our results demonstrate the positive impact integrated care can have on health outcomes. After the informed consent process, participants were allocated to the intervention or control group through simple random assignment using a computer-generated random number calculator and participant selection of number from individual, unmarked envelopes. The primary outcome was systolic blood pressure. HOPE identified potential participants by pre-screening their data system for eligibility criteria. 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. 370 participants completed a 12-month follow-up assessment; 172 intervention and 198 control. Aquila Recovery Clinic, a DC addiction recovery center, recently released a blog educating readers on the integrated behavioral model. 20, no. HOPE’s primary care providers are exclusively volunteers. Accessed July 8, 2019, Liebschutz JM, Xuan Z, Shanahan CW, LaRochelle Keosaian J, Beers D, Guara G, et al. Integrated behavioral health care blends care in one setting for medical conditions and related behavioral health factors that affect health and well-being. The BHS also made warm-handoffs as appropriate (e.g. UK NCGC. A rural Federally Qualified Health Center (FQHC) in Virginia is co-located with the Behavioral Health Services of the Shenandoah Valley Medical System, which offers consultations via a Primary Behavioral Health (PBH) service. The intervention and control groups had the same rate of retention (63%; p = 0.95), indicating no differential attrition. Lardieri MR, Lasky GB, Raney L. Essential Elements of Effective Integrated Primary Care and Behavioral Health Teams. These findings provide evidence that may help develop IBH programs to improve health of vulnerable populations experiencing health inequities. International Journal of Integrated Care 20 (4): 15. Bogner HR, de Vries HF. A new integrated behavioral health model at Sixteenth Street Community Health Centers (SSCHC) in Milwaukee encourages closer collaborations between medical providers and mental health team members to better address the needs — and meet the goals — of patients together. 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. The IBH model improved patients’ mental health outcomes with a minimal investment of resources . 2020;20(4):15. The value-based payment model should create a strong incentive to develop and maintain a fully integrated primary-care/ behavioral-health model of care. Participants randomized to the intervention group received enhanced integrated primary care and behavioral health services (Table 1). The program achieved results typically seen only in controlled clinical trials. J Soc Work Educ, 53 (suppl 1) (2017), pp. UK: Royal College of Physicians; 2011. http://www.ncbi.nlm.nih.gov/pubmed/22855971. 18: Working Vibrant Neighborhoods, Successful Schools. The PHQ-9 assessment was administered through provider interview. Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial. The FQHC administers yearly behavioral health screenings to all patients. However, external referrals were not coordinated by the care coordinator and these participants did not receive warm-handoffs to other HOPE providers from the care coordinator. Funding an integrated behavioral health model. 2012; 9(8). Retention rates for both groups were lower than anticipated which may have limited our ability to see effects in some outcomes; however, no differential attrition was detected. The integrated behavioral health model of care starts with screening for behavioral health problems during primary care appointments. An individual needs the knowledge and skills to carry out the behavior. US Census. Ann Intern Med. With behavioral health clinicians and community health workers (CHWs) available to provide comprehensive behavioral health services as part of routine medical care, the TEAM UP model focuses on meeting … Baseline sociodemographic data were collected from HOPE’s data system. Journal of Latina/o Psychology. DOI: http://doi.org/10.5334/ijic.5421, Flynn, A., Gaitan, E., Stocker, R., Showalter, E., & Errichetti, K. S. (2020). Under Review. However, sensitivity analyses suggested the impact of contamination was minimal and did not bias study results. BMJ (Online). We then estimated multivariate linear regression models adjusting for important covariates and potential confounders identified in the assessment of baseline equivalence and bivariate analyses using backward elimination model selection for parsimony ; covariates were removed from the model where p > 0.15. 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. We compared the proportion of participants who were lost to follow-up in the intervention versus control groups using a Chi-square test. While efforts were made to collect full data for outcome measures at baseline, there were some challenges. However, covariates included in our final models encompass biological and social factors known to be influential for health outcomes; additionally, randomization was successful based on the measured covariates, supporting the credibility of our results. This result has the potential to respond to the literature that has identified difficulties in treating depression in older adults and the need for approaches targeting symptoms in an older population [33, 34]. 2003; 93(3): 467–71. L. Zerden, A. Jones, R. Brigham, M. Kanfer, M. ZomorodiInfusing integrated behavioral health in an MSW program: Curricula, field, and interprofessional educational activities. 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. DOI: https://doi.org/10.1176/appi.ps.201300088, Camacho Á, González P, Castañeda SF, Simmons A, Buelna C, Lemus H, et al. A significant interaction between study group and age was detected for 12-month PHQ-9 scores. 1977; 2(8041): 734–737. DOI: http://doi.org/10.5334/ijic.5421, Flynn, A., et al.. “Enhanced Integrated Behavioral Health Model Improves Depressive Symptoms in a Low-income, Uninsured, Primarily Hispanic Population Served by a Free and Charitable Clinic”. The goal of PCBH is to improve and promote overall health within the general population. Because primary and sensitivity analyses produced similar results, effect modification analyses were conducted using the intent-to-treat sample. 2009; 5: 363–389. bi3 granted a funding extension to scale the model … Improving Adherence to Long-term Opioid Therapy Guidelines to Reduce Opioid Misuse in Primary Care. Accessed July 8, 2019. This list of resources, put forth by the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS), assists providers in integrating primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings. All analyses were conducted using SAS version 9.4 (Cary, NC), and differences where p < 0.05 were considered statistically significant. 2001; 16(9): 606–613. The results from this study can have funding implications when decisions on settings for IBH, or other innovative care models, are being made. “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. KSE was employed by Health Resources in Action and this manuscript was completed during paid work hours. Many times there is a lot of frustration that can arise from miscommunication in the non-integrated models. Most participants were female (73.5%) and Hispanic (83.2%) with a mean age of 51 years. N Engl J Med. Flynn A, Gaitan E, Stocker R, Showalter E, Errichetti KS. DOI: https://doi.org/10.1001/jamainternmed.2017.2468, Eghaneyan BH, Sanchez K, Killian M. Integrated health care for decreasing depressive symptoms in Latina women: Initial findings. We subsequently explored the potential for effect modification by baseline health condition (e.g., baseline depression as an effect modifier for impact on PHQ-9 score at 12 months), age (below versus equal to or above the mean study age of 51 years), and sex. 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 . TriHealth continues to refine the model and identify strategies to scale and sustain integrated behavioral health services. Randomized Trial of an Integrated Behavioral Health Home: The Health Outcomes Management and Evaluation (HOME) Study. Wholly novel approaches to integrate care are significantly less common. Accepted for publication: October 22, 2013. A 2016 update on research on integration of behavioral health and primary care emphasized the increasing strength of evidence highlighting the success of these approaches . Control group participants received HOPE’s usual care including primary care services and behavioral health counseling co-located within the clinic, but unlike the intervention participants, they were not offered the enhanced services from the transitional nurse or BHS. HOPE intended for intervention participants to receive care from a group of volunteer primary care providers separate from those treating the usual care participants. 2014; 69(4): 377–387. Outcome of depression in later life in primary care: Longitudinal cohort study with three years’ follow-up. Contamination occurred within the trial due to implementation challenges and the single clinic setting. DOI: http://doi.org/10.5334/ijic.5421, Flynn, Amy, Erika Gaitan, Rebecca Stocker, Elizabeth Showalter, and Karen Sautter Errichetti. Retrieved from: https://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html Accessed on: August 30, 2019. Patients were excluded if they were pregnant or did not meet the eligibility criteria (Figure 1). Research Professor, Department of Biomedical Informatics. 2014; 65(10): 1256–1262. 2017; 174: 246–255. Improvement in Depressive Symptoms Among Hispanic/Latinos Receiving a Culturally Tailored IMPACT and Problem-Solving Intervention in a Community Health Center. Integrating care between primary care and behavioral health services is a complex process. Our primary analyses used an intent-to-treat approach to assess the difference in health outcomes between individual participants in the intervention and control groups at 12 months. Watt T. A Process and Outcome Evaluation of Two Integrated Behavioral Health Care Models: People’s Community Clinic and Lone Star Circle of Care. Clinical use of antidepressant therapy and associated cardiovascular risk. Patients flagged as potentially eligible were then assessed for eligibility in person at their next visit. However, we were unable to assess the impact of pharmacological intervention due to challenges in obtaining information about medications. In sex-stratified models, the intervention was not statistically associated with blood pressure or HbA1c level for either sex (not shown). Control participants could be referred to additional specialty and community-based services. 2 | Equip and educate affiliated primary care practices with evidence-based behavioral health screening and assessment tools to use during each patient care visit. 2017; 30(2): 130–139. Retrieved June 12, 2015, from http://www.thecommunityguide.org/mentalhealth/collab-care.html. 2008; 6(4): 295–301. DOI: https://doi.org/10.1037/lat0000009. Blended models of care seen in successful integrated care practices frequently combine CoCM and the Primary Care DOI: https://doi.org/10.1007/s10597-014-9750-7, Ell K, Katon W, Xie B, Lee PJ, Kapetanovic S, Guterman J, et al. Diabetes Care. 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. We hypothesized that integrated care would reduce blood pressure, HbA1c, body mass index, and depressive symptoms among adult patients with chronic illness living at or below the 200% FPL. Thus, sensitivity analyses using a per protocol approach were conducted to verify the validity of results found in the intent-to-treat analyses following the approach described above. The Integrated Behavioral Model combined parts of the TRA/TPB. 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integrated behavioral health model 2021