Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals

Deborah Cohen, Melinda Davis, Bijal A. Balasubramanian, Rose Gunn, Jennifer Hall, Frank V. deGruy, C. J. Peek, Larry A. Green, Kurt C. Stange, Carla Pallares, Sheldon Levy, David Pollack, Benjamin F. Miller

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

PURPOSE: This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions.

METHODS: This was a comparative case study in which a multidisciplinary team used an immersion-crystallization approach to analyze data from observations of practice operations, interviews with practice members, and implementation diaries. The observed practices were drawn from 2 studies: Advancing Care Together, a demonstration project of 11 practices located in Colorado; and the Integration Workforce Study, consisting of 8 practices located across the United States.

RESULTS: Primary care and behavioral health clinicians used 3 interpersonal strategies to work together in integrated settings: consulting, coordinating, and collaborating (3Cs). Consulting occurred when clinicians sought advice, validated care plans, or corroborated perceptions of a patient's needs with another professional. Coordinating involved 2 professionals working in a parallel or in a back-and-forth fashion to achieve a common patient care goal, while delivering care separately. Collaborating involved 2 or more professionals interacting in real time to discuss a patient's presenting symptoms, describe their views on treatment, and jointly develop a care plan. Collaborative behavior emerged when a patient's care or situation was complex or novel. We identified contextual factors shaping use of the 3Cs, including: time to plan patient care, staffing, employing brief therapeutic approaches, proximity of clinical team members, and electronic health record documenting behavior.

CONCLUSION: Primary care and behavioral health clinicians, through their interactions, consult, coordinate, and collaborate with each other to solve patients' problems. Organizations can create integrated care environments that support these collaborations and health professions training programs should equip clinicians to execute all 3Cs routinely in practice.

Original languageEnglish (US)
Pages (from-to)S21-S31
JournalJournal of the American Board of Family Medicine : JABFM
Volume28
DOIs
StatePublished - Sep 1 2015

Fingerprint

Primary Health Care
Patient Care
Health Occupations
Electronic Health Records
Immersion
Crystallization
Interviews
Education
Therapeutics

Keywords

  • Behavioral Medicine
  • Communication
  • Delivery of Health Care
  • Integrated
  • Interdisciplinary Health Team

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice

Cite this

Integrating Behavioral Health and Primary Care : Consulting, Coordinating and Collaborating Among Professionals. / Cohen, Deborah; Davis, Melinda; Balasubramanian, Bijal A.; Gunn, Rose; Hall, Jennifer; deGruy, Frank V.; Peek, C. J.; Green, Larry A.; Stange, Kurt C.; Pallares, Carla; Levy, Sheldon; Pollack, David; Miller, Benjamin F.

In: Journal of the American Board of Family Medicine : JABFM, Vol. 28, 01.09.2015, p. S21-S31.

Research output: Contribution to journalArticle

Cohen, D, Davis, M, Balasubramanian, BA, Gunn, R, Hall, J, deGruy, FV, Peek, CJ, Green, LA, Stange, KC, Pallares, C, Levy, S, Pollack, D & Miller, BF 2015, 'Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals', Journal of the American Board of Family Medicine : JABFM, vol. 28, pp. S21-S31. https://doi.org/10.3122/jabfm.2015.S1.150042
Cohen, Deborah ; Davis, Melinda ; Balasubramanian, Bijal A. ; Gunn, Rose ; Hall, Jennifer ; deGruy, Frank V. ; Peek, C. J. ; Green, Larry A. ; Stange, Kurt C. ; Pallares, Carla ; Levy, Sheldon ; Pollack, David ; Miller, Benjamin F. / Integrating Behavioral Health and Primary Care : Consulting, Coordinating and Collaborating Among Professionals. In: Journal of the American Board of Family Medicine : JABFM. 2015 ; Vol. 28. pp. S21-S31.
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