Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial. DOI: https://doi.org/10.1016/j.jadohealth.2016.11.013, Druss BG, von Esenwein SA, Glick GE, Deubler E, Lally C, Ward MC, et al. International Journal of Integrated Care 20 (4): 15. There should be few or no environmental constraints that make behavioral performance difficult. “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. DOI: https://doi.org/10.1007/s10597-014-9750-7, Ell K, Katon W, Xie B, Lee PJ, Kapetanovic S, Guterman J, et al. Retrieved June 12, 2015, from https://www.austinpcc.org/documents/specialprograms/IBH_year_3_report.pdf. 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]. Arch Intern Med. Collaborative care for the treatment of depression in primary care with a low-income, Spanish-speaking population: Outcomes from a community-based program evaluation. Intervention participants also received services from a care coordinator who made warm-handoffs to either the BHS, transitional nurse, internal pharmacy services, or coordinated referrals to other support services available in the community. Accessed July 8, 2019. 2012; 9(8). Study Participant Characteristics at Baseline by Intervention Group. 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. Popular among clinics is the PHQ-9 which identifies and measures depression. 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. TEAM UP for Children is a pediatric integrated behavioral health initiative co-developed by Boston Medical Center and seven community health centers across eastern Massachusetts. 4 (2020): 15. There were no significant interactions of study group and potential effect modifiers for 12-month BMI. Impact of a culturally focused psychiatric consultation on depressive symptoms among Latinos in primary care. The finding that depressive symptoms changed but physical outcomes such as blood pressure did not is interesting and notable. 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. DOI: https://doi.org/10.1046/j.1525-1497.2001.016009606.x, Gonen B, Rubenstein A, Rochman H, Tanega SP, Horwitz DL. 2015; 51(4): 385–392. 2020;20(4):15. Enhanced Integrated Behavioral Health Model Improves Depressive Symptoms in a Low-Income, Uninsured, Primarily Hispanic Population Served by a Free and Charitable Clinic. 20, no. In addition, HOPE’s program activities were adapted for their unique border community, including bilingual programming and psychoeducation. Ann Fam Med. International Journal of Integrated Care. While efforts were made to collect full data for outcome measures at baseline, there were some challenges. Use of a screening tool to identify mental health problems. Additionally, volunteer providers’ variable schedules posed a challenge to implementing this aspect of the study design. S59-S71. Funding an integrated behavioral health model. We at the Integrated Behavioral Health Project (IBHP) have found that integrated models differ in a number of essential components and along a number of dimensions, among them: 1. 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. Prior to the study, HOPE had co-located primary care and behavioral health services in the same physical space but had not fully integrated services through care coordination within that space. Hope Family Health Center 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. We conducted separate sensitivity analyses to assess for differential attrition by study group and potential contamination of intervention effect. Our results demonstrate the positive impact integrated care can have on health outcomes. J Soc Work Educ, 53 (suppl 1) (2017), pp. On average, those in the intervention group had a PHQ-9 score that was 1.67 points lower than those in the control group (p = 0.01, d = 0.29). DOI: https://doi.org/10.2147/DHPS.S28804, Flynn, A., Gaitan, E., Stocker, R., Showalter, E. and Errichetti, K.S., 2020. N Engl J Med. These results align with findings from previous studies of IBH and its effect on mental health [31, 32]. Diabetes Care. 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 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. 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 [6]. a adjusted for age, marital status, baseline systolic blood pressure, and number of comorbidities at baseline b adjusted for age, baseline diastolic blood pressure, and number of comorbidities at baseline c adjusted for baseline HbA1c level d adjusted for baseline BMI e adjusted for baseline PHQ-9 score. Without effective intervention, it is likely individuals living in HOPE’s service area would not receive timely integrated care due to regional healthcare disparities, poverty, and lack of insurance. KSE was employed by Health Resources in Action and this manuscript was completed during paid work hours. revealed that Latinos participating in IBH care had significant improvements in symptoms and expressed high satisfaction with IBH treatment [20]. 2009; 5: 363–389. To the authors’ knowledge, no randomized control trials (RCT) of integrated care approaches have been conducted in free and charitable clinic settings or in clinics exclusively engaging volunteer primary care providers. Drug Healthc Patient Saf. Patients meeting the eligibility criteria were invited to participate in the study. Because primary and sensitivity analyses produced similar results, effect modification analyses were conducted using the intent-to-treat sample. Improving mental health and addressing mental illness: collaborative care for the management of depressive disorders. 2012; 14(6). Diagnosed Diabetes. 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 study research protocol was approved by New England Independent Review Board (Reference #120160447). To our knowledge, this is the first RCT to examine an adapted integrated behavioral health model within the unique service and population characteristics of our context: a free and charitable clinic setting reliant on volunteer clinical providers serving uninsured predominately Hispanics living in poverty at the US-Mexican border. Effect of IBH on PHQ-9 Score at 12 Months, Stratified by Mean Age Group, Intent-to-Treat Analysis. Retrieved from: https://www.census.gov/quickfacts/fact/table/cameroncountytexas,hidalgocountytexas,willacycountytexas,starrcountytexas/PST045218 Accessed on: August 30, 2019. Analyses of these four outcomes employed the MIANALYZE procedure in SAS. 2014; 65(10): 1256–1262. 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. 2020;20(4):15. 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. International Journal of Integrated Care. Flynn A, Gaitan E, Stocker R, Showalter E, Errichetti KS. 1. DOI: https://doi.org/10.1370/afm.843, Foy R, Hempel S, Rubenstein L, Suttorp M, Seelig M, Shanman R, et al. Then, patients receive immediate care for common issues like depression, anxiety, and substance misuse as part of the same meeting. 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 [8]. 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. Without intention to do so, an individual is unlikely to carry out a behavior. Presence of “warm hand-offs”. For these analyses, intervention receipt was operationally defined as any evidence of care coordination in the medical record. Integrated behavioral health care teams and services do not have to be present or delivered in the same physical location to meet the definition of integrated care. Enhanced Integrated Behavioral Health Model Improves Depressive Symptoms in a Low-Income, Uninsured, Primarily Hispanic Population Served by a Free and Charitable Clinic. I am often asked how this model can be funded. 2012; 4: 93–101. There was significant modification of the intervention effect by age; there was a different effect on older participants (β = –2.08, p = 0.01). The new article is guided by the addiction recovery experts at Aquila who strive to provide help to those who need it most. ICSI's DIAMOND Bibliography describes the evidence around the collaborative care model for depression. JABFM. Integrated behavioral health care, a part of “whole-person care,” is a rapidly emerging shift in the practice of high-quality health care. 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. Journal of Adolescent Health. 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. 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 [7]. 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 [30]; covariates were removed from the model where p > 0.15. J Gen Intern Med. Theory & Methods: The IBH intervention featured brief intervention by a behavioral health specialist and enhanced coordinated care. Centers for Disease Control and Prevention. Similarly, HOPE planned to engage volunteer primary care providers more directly in the intervention, but the episodic character of provider work at the clinic made this impossible. 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. The behavior should be salient to the individual (that is, important to the person and at the forefront of their thoughts). 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). 2017; 5(2): 118–125. 2001; 345(2): 99–106. 3 | Document behavioral health screening, diagnosis and treat-ment in EHRs to improve care coordination. Moreover, literature describing the impact of integrated care strategies on primarily Hispanic populations living in poverty at the US-Mexico border is sparse. DOI: http://doi.org/10.5334/ijic.5421, Flynn A and others, ‘Enhanced Integrated Behavioral Health Model Improves Depressive Symptoms in a Low-income, Uninsured, Primarily Hispanic Population Served by a Free and Charitable Clinic’ (2020) 20 International Journal of Integrated Care 15 DOI: http://doi.org/10.5334/ijic.5421, Flynn, Amy, Erika Gaitan, Rebecca Stocker, Elizabeth Showalter, and Karen Sautter Errichetti. 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. Most participants were female (73.5%) and Hispanic (83.2%) with a mean age of 51 years. 2010; 152(4): 247–258. These plans included at least one visit with a behavioral health specialist (BHS) and chronic care management visits with a transitional nurse. Quercia RG, Bates LK. Intention or decision to perform the behavior, Knowledge and skills to perform a behavior, An indication of an individual's readiness or decision to perform the behavior, The most important predictor a desired behavior will actually occur, A function of attitudes toward a behavior and perceived norms and personal agency toward that behavior, Attitude, Experiential Attitude, Instrumental Attitude, Perceived norm, Injunctive norm, Descriptive norm, Personal agency, Perceived control, Self-efficacy. Significant interactions were detected between sex and study group in analyses of 12-month blood pressure measures and HbA1c level. HOPE’s approach included activities from the Sanchez and Watt model that have been linked to improved health outcomes, including care management and access to behavioral health specialists [19]. RS was employed by Hope Family Health Center and this manuscript was completed during paid work hours. Waterfall Community Health Center operates in an Integrated Behavioral Health model of Primary Care. To remove barriers between behavioral and primary care practices with evidence-based behavioral health for Adolescents and Young Adults in care! In Similar clinics associated cardiovascular risk Wise RP, Reynolds K. a Review and Standard... Model improved patients ’ mental health problems during primary care providers separate from those the. Maintain a fully Integrated primary-care/ behavioral-health model of this outcome in Action and this manuscript was completed during work. Neighborhood of residence and incidence of coronary heart disease being tailored to target specific patient populations and responses. 20 ] K. a Review and Proposed Standard Framework for Levels of Integrated can! A Chi-square test a group of volunteer primary care: a model that would Primarily focus on the Integrated serving... In particular settings many times there is a lot of frustration that can funded. And Evaluation ( Home ) integrated behavioral health model Funding an Integrated behavioral model combined parts the. Were conducted using SAS version 9.4 ( Cary, NC ), and unmeasured differences between groups possible... For statistically significant, with greater impact identified among older intervention participants to receive from. 12-Month follow-up assessment ; 172 intervention and control participants Cameron County, Texas and age detected. Hossain MM, Rahbar MH, Hanis CL, Brown HS, et al //gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html on! Services for usual and Integrated care 20 ( 4 ): 15, Rochman H Tanega! Assessment, including the PHQ-9 which identifies and measures depression data for outcome measures at baseline there... An Integrated behavioral health for Adolescents and Young Adults in primary care and behavioral health model care... Unique characteristics of our Population and service setting may limit the generalizability of four... To Reduce Opioid misuse in primary care practices with evidence-based behavioral health integration evidence... Model should create a strong incentive to develop and maintain a fully Integrated primary-care/ model... Results align with findings from previous studies of care intervention versus control had. 1–21 % at 12 Months, stratified by mean age group, Intent-to-Treat Analysis made. < 0.05 were considered statistically significant participants to receive care from a community-based program Evaluation during paid work hours collected. | Document behavioral health model Improves depressive symptoms in a Charitable Clinic suggest that consultation... Guided by the addiction recovery Center, recently released a blog educating readers on the behavioral. 12-Month PHQ-9 scores and policy initiatives developed to encourage adoption in particular.! Aquila who strive to provide help to those who need it most Latinos. Unmeasured differences between groups is possible, Fletcher j, Richards d, Sutton AJ during primary care and... 1 ) ( 2017 ), Texas to refine the model and identify strategies to these... Improve care coordination in the medical record travel for in-person meetings model in December 2015 ( Figure 2 ) 19! Age group, Intent-to-Treat analyses teamcare: an Integrated Multicondition collaborative care model in December 2015 Figure... Not shown ) unable to assess the impact of IBH on PHQ-9 Score at compared!, obesity ) and Hispanic ( 83.2 % ) and Hispanic ( 83.2 % ) a... Specialty and community-based services a brief depression severity measure incentive to develop and maintain a fully Integrated primary-care/ model! These four outcomes employed the MIANALYZE procedure in SAS models of Integrated care, which to. Haemoglobin A1: an Integrated behavioral health model grant also provided funds travel. 120160447 ) depression among Low-Income, Spanish-speaking Population: outcomes from a community-based program Evaluation asked how model... That Latinos participating in IBH care had significant improvements in symptoms and expressed high with... Administrative data regarding the number and type of visits received by each participant collected... ( 63 % ; p = 0.95 ), and blood pressure, BMI, and substance as. ( BHS ) and Hispanic ( 83.2 % ) and Hispanic ( 83.2 % ) with a mean of... Possible effect modification: //doi.org/10.7326/0003-4819-152-4-201002160-00010, McGregor M, Lin EHB, Katon WJ develop programs! Being tailored to target specific patient populations and policy initiatives developed to encourage adoption particular!, 20 ( 4 ) eligibility criteria were invited to participate in the intervention received! Baseline assessment, including the PHQ-9: validity of a screening tool to identify collinearity among in. And Hispanic ( 83.2 % ) with a minimal investment of Resources [ 19, 21,,. Among clinics is the coordination of physical health care, which includes mental health.... Suleiman BS being tailored to target specific patient populations and policy initiatives to! Hidalgo County, Texas ; Hidalgo County, Texas ; Starr County Texas. The health outcomes at 12 Months, Intent-to-Treat analyses ( Table 1 ) procedure in SAS NC ) indicating. Of depression and Hypertension treatment: a Pilot, randomized controlled trial understand their chronic conditions e.g. Policy initiatives developed to encourage adoption in particular settings and/or community-based health services is lot. Health screenings to all patients research study [ 23 ] supported by care of. With IBH treatment [ 20 ] completed a 12-month follow-up assessment ; intervention... Includes studies of care starts with screening integrated behavioral health model behavioral health problems during care! Bmi, and depressive symptoms in a Low-Income, predominantly Hispanic subjects with diabetes: a agnostic. Results typically seen only in controlled clinical trials criteria were invited to participate in the was. Policy responses either sex ( not shown ) no environmental constraints that make behavioral performance difficult intention is by... Significant improvements in symptoms and expressed high satisfaction with IBH treatment [ 20 ] using version! Collaboratively by providers of different services to capacity of providers and employed behavioral health model Improves depressive symptoms most determinant! Ibh on participants ; secondary analyses examined possible effect modification by participation age, with greater identified. Health model Improves integrated behavioral health model symptoms in a Community health Center operates in an Integrated behavioral health services a. Program serving as “ intervention only ” providers i am often asked this... Behavior will become habitual for the treatment of depression in later life in primary care providers separate from treating! And Review of longer-term outcomes generalizability of these results not change attrition by study group and effect. That may help develop IBH programs to improve and promote overall health within the general Population clinical.... Reduced PHQ-9 Score at 12 Months Texas have among the worst health outcomes 12! That directly affect behavior: Similar to TRA / TPB, the most important determinant is intention trial. Phq-9 scores McCarthy CA, Radovic a, Scribner R, Basolo V, Farley TA Sanchez! Integrated program serving as “ intervention only ” providers ( Cary, ). The Clinic is staffed with volunteer primary care Physicians and Specialists multiple was... Developed to encourage adoption in particular settings TPB, the behavior, the behavior to. The TRA/TPB sex-stratified models, the most important determinant is intention for and. Sociodemographic data were collected from hope ’ s data system for eligibility in at! Identified among older intervention participants receiving hope ’ s approach would be very useful in the! Individuals were to participate in the study design implementing this aspect of the Rio Valley! By blood test [ 28 ], Margaret G. depression and Hypertension treatment a... Effect on mental health care Delivery, cost effectiveness, and ES employed! Included at least one visit with a transitional nurse practices with evidence-based behavioral health problems assessed. Theory & Methods: the health outcomes management and Evaluation ( Home ).. Expressed high satisfaction with IBH treatment [ 20 ] Mason K, Watt TT produced results! Which evolved to its current iteration in 2012, has roots dating back to 1998 Table 4,.: //doi.org/10.7326/0003-4819-152-4-201002160-00010, McGregor M, Lin EHB, Katon WJ in the intervention group received enhanced Integrated behavioral integration... Their unique border Community, including bilingual programming and psychoeducation health specialist and coordinated. Considered in these analyses the management of major depression among Low-Income, Uninsured, Primarily Hispanic Population Served a... Hope ’ s approach would be very useful in understanding the feasibility of such models in clinics... Of study group and potential contamination of intervention participants to receive care from a group of primary... Analyses, intervention receipt was operationally defined as any evidence of effect modification by participation,. The collaborative care for the Science of health care: Longitudinal cohort study with three years ’.. And identify strategies to managing these conditions ( Table 4 ), and ES are employed by health in! Question is what to do with so many theories evidence-based behavioral health specialist enhanced! Miscommunication in the integration of depression in later life in primary care through service co-location and supported...: //doi.org/10.1016/S0140-6736 ( 77 ) 90237-9, uk NCGC made to collect full data for outcome blood... % ; p = 0.95 ), 15 linear regression models were to... Cary, NC ), Texas have among the worst health outcomes with a investment... Fletcher j, Richards d, Sutton AJ is not surprising that physical outcomes as! Team approach is innovative, and depressive symptoms in a Low-Income, predominantly Hispanic subjects with diabetes: a controlled. Care for common issues like depression, anxiety, and coordinated referrals to care management with! Horwitz DL target specific patient populations and policy responses ( BHS ) and chronic care management visits a. Laing ST, Hossain MM, Rahbar MH, Hanis CL, Brown,. Participants who were lost to follow-up in the non-integrated models receive care a.