Integrated primary care behavioural health in a regional network of FQHC agencies during COVID-19.

Objectives: (1) Examine the ability to sustain integrated primary care behavioural health (eg, colocation, communication and coordination) in 40 community health centres, during the COVID-19 pandemic and (2) review adaptations and challenges to provide integrated behavioural health via telehealth. Methods and analysis: This qualitative investigation assessed 55 behavioural health consultants (BHCs), via semistructured interviews, spanning 40 practice sites and 10 organisations, on their adjustment to telehealth delivery, modified practice workflows and challenges of maintaining integration while displaced by the pandemic. Assessment of the level of integrated care was also conducted with available semistructured tools. Results: The results highlight rapid service adjustment, positive patient and provider satisfaction, increased but lowered ratings of remote BHC integration and collaboration with the primary care teams and reduced behavioural health screening, compared with prepandemic levels. This investigation also highlights the co-occurring importance of racial disparities and injustice in patient care. In several settings, BHCs had a significant support role for staff self-care. Conclusion: The COVID-19 pandemic, and its subsequent shelter-in-place mandates and telehealth care provision, has altered standard integrated behavioural health practice, yet harnessed the accessible, generalist and team-based spirit to meet the increasing behavioural health needs in this community.

CFHA 2019 Don Bloch Award acceptance speech.

The acceptance speech by the recipient of the CFHA 2019 Don Bloch Award is presented. The recipient notes that her work for the last 35 years has focused on increasing access to comprehensive and high quality health care for underresourced and marginalized populations, with a strong emphasis on strengthening systems and clinical practice. Her journey to promote integrated behavioral health began in 2005 and has led to some success in accelerating the adoption and robust expansion of behavioral health integration into primary care in the Philadelphia region. While she has been gratified to create a structure for training, advocacy, and ongoing process improvement to support the talented and dedicated behavioral health providers and clinical teams who do the hard work of caring for our vulnerable patient populations, "everything I know and believe about integrated care I have learned from this association and those affiliated with CFHA." (PsycInfo Database Record (c) 2020 APA, all rights reserved).

COVID-19 and mental health in America: Crisis and opportunity?

There is opportunity in every crisis. COVID-19 has presented an unprecedented crisis. What opportunity can be gleaned from it? Unlike crises in the more recent past, such as the bombing of the Twin Towers and Pentagon on 9/11, COVID-19 is an ongoing global pandemic, affecting nearly every person on the planet in some shape or form. It is not only the physical effects of the SARS-CoV-2 virus that are lethal; the mental health effects are also taking their toll. The impact of physical distancing, stay-at-home orders, job loss, isolation, and fear have resulted in a considerably greater number of people's experiencing symptoms of anxiety disorder and depressive disorder in the United States. Accessing health care services has been a particular challenge given concerns about exposure to the virus and an overwhelmed health care delivery system. In response, policymakers at the federal and state levels implemented changes aimed at addressing access to essential care to include telehealth services. As the public experiences firsthand the struggles of coping with mental health issues in a fragmented dysfunctional health system, there is an opportunity is to use this crisis as a springboard to advocate for permanent changes to promote telehealth, to elevate the importance of integrated behavioral health, and to support the destigmatization of mental illness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Who is driving change, and where is it taking us? Interview with an expert.

In addition to providing critical behavioral health services for those with mental health issues and substance use disorders, some Community Mental Health Centers (CMHCs) in the United States have begun integrating primary care services, referred to as "reverse integration". Representing the interests of CMHCs across the United States, the National Council for Behavioral Health (NCBH) represents over 3,000 member organizations delivering mental health and/or addictions treatment and services to roughly 10 million patients and families. This article reflects a recent wide-ranging conversation with Linda Rosenberg, the president and CEO of NCBH. Trained as a social worker, Rosenberg was senior deputy commissioner of the New York State Office of Mental Health prior to joining the NCBH and is a dynamic and high-energy strategist and thought leader in the field of community mental health and integrated care. We discussed issues impacting payment for integrated care, including private equity investment, capitated payment, and the role of risk, and how these market dynamics impact vulnerable populations. For the sake of brevity, we summarize our conversation with Ms. Rosenberg and offer her perspective to integrated care practitioners and researchers who largely operate outside of this world of business built on calculated risks and rewards. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Promoting health payment reform literacy: Does integrated care save money?

INTRODUCTION: Under the current payment environment, the challenges to implementing and sustaining integrated behavioral health care are substantial. One key barrier for clinicians, administrators, researchers, and patients/families is a lack of clarity about who pays for integrated health care in the United States, and a lack of consensus about whether bending the health care cost curve is a fundamental goal of integrated care, and for whom. Clinicians caring for patients and families in integrated care settings would benefit from honing their "payment reform literacy skills" in order to advocate for integrated care. METHOD: This paper offers a primer on the current state of health care spending in the United States, an overview of public and private payers, and the challenges each faces in paying for integrated care. DISCUSSION: Future journal articles in the FSH Policy and Management Department will describe key payment policy and management opportunities for integrated care payment reform. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Relaunching the Policy and Management section.

Follow the money, the saying goes, and you will understand why things are the way they are. Serving as coeditors for Families, Systems, and Health's Policy and Management section, we seek to do just that. As new models of payment offer hope for improved delivery of integrated care for families, this newly relaunched section of the journal will highlight both the opportunities and the deeply rooted challenges in the evolving US payment system. While many of the challenges associated with integrated care payment are driven by public policy, others are driven by management and leadership decisions. We wish to explore both this year. Drawing on our combined experience in health care policy and management-nearly 70 years and counting-our aim is to offer readers timely, thoughtful, and promising insights into payment policy reforms and cost reduction opportunities that impact the spread and sustainability of integrated care. We invite your opinions, case studies, and research as we follow the money, and explore how to best pay for integrated care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Using standardized patients as a means of training and evaluating behavioral health consultants in primary care.

INTRODUCTION: The Health Federation of Philadelphia, which hosts a network of Behavioral Health Consultants (BHC) operating within the Primary Care Behavioral Health model (PCBH), identified a need to systematically evaluate PCBH model fidelity and to rigorously evaluate the competency assessment process to further their workforce development. A simulated patient exercise was developed for evaluating BHC PCBH specific competencies. METHOD: A simulated BHC encounter was held at a clinical learning center using standardized patients, repeated twice over 2 years. A competency based rating scale was developed by the network for the simulation (BHC-ORS), patient feedback was captured using the Working Alliance Inventory (WAI), and BHC feedback was collected using a questionnaire. Dedicated consultants were hired to develop the internal process, as well as conduct the evaluation in a way that might make a contribution to research. RESULTS: Targeted PCBH competencies generally improved after being identified as training needs in Year 1 of the simulation. Patient feedback showed average ratings for the majority of the BHCs. BHCs identified the experience as valid and useful. Important changes in methodology between Years 1 and 2 of the pilot limited a more complete analysis. DISCUSSION: The use of simulated patients to evaluate BHC adherence to the PCBH model was helpful for training and adds to the workforce development literature. The authors suggest that doing practice based research will always entail unanticipated needs that interfere with quantitative research but that there are ways in which researchers can attempt to anticipate these changes. Review of possible applications to community PCBH practice is included. (PsycINFO Database Record

Where do we stand?

This president's column provides the current position of the Collaborative Family Healthcare Association (CFHA) in reference to the law passed in North Carolina on March 23, 2016, limiting the civil rights of LGBTQ people. This law troubles the CFHA deeply. This is an organization that promotes collaborative patient- and family-centered care. It currently celebrates diversity and rejects discrimination in any form. After considerable thought and review of alternative actions, the Board of CFHA determined that our best course is to proceed with plans for an annual conference in Charlotte, a city that has attempted to strengthen legal protection of the rights of its LGBTQ citizens. CFHA will use this opportunity to demonstrate our support for inclusion and cultural competence by convening a robust and timely conversation about the underlying issues raised by House Bill 2 and our role as collaborative care professionals. (PsycINFO Database Record

The fourth aim: How do we care for our healthcare workforce?

In this column, the president of the Collaborative Family Healthcare Association (CFHA) addresses the question of what the CFHA is doing to create and maintain an engaged, motivated, and satisfied workforce, in the midst of its transformational goals and inherent challenges. The president focuses on three strategies that have the potential to sustain and nurture the people who deliver healthcare. (PsycINFO Database Record

The next frontier: Bringing collaborative care to scale.

In my position as CEO of the Health Federation of Philadelphia (HFP), I am acutely aware of the effort required to implement practice transformation, including fully integrated behavioral health (IBH) and primary care. We integrate knowledge of our marketplace, best practices from the field, and the wisdom of our providers to achieve our practice goals. We have found this to be a key to the success of our advocacy, efficient replication, and rapid regional spread of IBH. Even when payment models, the other driving barrier to IBH, catch up and reflect a better fit with the demands of efficiently integrated, whole-person, teambased care, the challenges resulting from lack of implementation support will still exist. That's where the Collaborative Family Healthcare Association (CFHA) comes in. CFHA can be that centralized and reliable structure to help guide the planning and application of the essential core elements of integrated care: aligned systems, metrics and operations; patient and family centered approaches; workforce competencies; and strategies for stakeholder engagement. In spite of its influence, integrity, and accomplishments, CFHA is still a "too-well-kept secret." By embracing a focused approach, strategic partnerships, clear communication of our unique strengths and capabilities, and the collective might that exists within our own CFHA family, CFHA can grow and thrive and continue to lead the field of collaborative family health care. (PsycINFO Database Record

Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement.

Cost pressures and changes in the health care environment pose ethical challenges and hard choices for patients, physicians, policymakers, and society. In 2000 and 2001, the American College of Physicians, with the Harvard Pilgrim Health Care Ethics Program, convened a working group of stakeholders--patients, physicians, and managed care representatives, along with medical ethicists--to develop a statement of ethics for managed care. The group explored the impact of a changing health care environment on patient-physician relationships and how to best apply the principles of professionalism in this environment. The statement that emerged offers guidance on preserving the patient-clinician relationship, patient rights and responsibilities, confidentiality and privacy, resource allocation and stewardship, the obligation of health plans to foster an ethical environment for the delivery of care, and the clinician's responsibility to individual patients, the community, and the public health, among other issues.