Preparing the Workforce for Behavioral Health and Primary Care Integration.

PURPOSE: To identify how organizations prepare clinicians to work together to integrate behavioral health and primary care. METHODS: Observational cross-case comparison study of 19 U.S. practices, 11 participating in Advancing Care Together, and 8 from the Integration Workforce Study. Practices varied in size, ownership, geographic location, and experience delivering integrated care. Multidisciplinary teams collected data (field notes from direct practice observations, semistructured interviews, and online diaries as reported by practice leaders) and then analyzed the data using a grounded theory approach. RESULTS: Organizations had difficulty finding clinicians possessing the skills and experience necessary for working in an integrated practice. Practices newer to integration underestimated the time and resources needed to train and organizationally socialize (onboard) new clinicians. Through trial and error, practices learned that clinicians needed relevant training to work effectively as integrated care teams. Training efforts exclusively targeting behavioral health clinicians (BHCs) and new employees were incomplete if primary care clinicians (PCCs) and others in the practice also lacked experience working with BHCs and delivering integrated care. Organizations' methods for addressing employees' need for additional preparation included hiring a consultant to provide training, sending employees to external training programs, hosting residency or practicum training programs, or creating their own internal training program. Onboarding new employees through the development of training manuals; extensive shadowing processes; and protecting time for ongoing education, mentoring, and support opportunities for new and established clinicians and staff were featured in these internal training programs. CONCLUSION: Insufficient training capacity and practical experience opportunities continue to be major barriers to supplying the workforce needed for effective behavioral health and primary care integration. Until the training capacity grows to meet the demand, practices must put forth considerable effort and resources to train their own employees.

Unrounding the corners of collaborative family health care.

C. J. Peek has done us two lasting services with this beautiful summary. He has reminded us of Don Bloch's contributions to the beginning of collaborative family health care, and he has catalogued the elements of Don's vision for the field. Don's vision was for "collaborative family health care." Although we have made a great deal of progress developing collaborative health care that he would endorse, the full vision including the family as a basic unit of care and of understanding in health care is still ahead of us. The requirement of the inclusion of the family in the formulation of the patient-centered medical home may provide the impetus for a full realization of the "unrounded corners" version of Don's vision.

Getting mental health care where it is needed.

There has been a powerful call for better funding for mental health services in the United States. The effort to build capacity in mental health centers is much needed. We need more and better-trained staff, funding that can reduce barriers, and shorten waiting times. The movement to integrate mental health clinicians as part of the care team in primary care will be much more likely to find and engage people who are very troubled but are not seeking mental health care. To increase the likelihood of getting care to troubled people earlier and engaging them in care more effectively, any effort to improve funding for mental health should include a clear focus on improving the integration of mental health into primary care. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Form(s) in the patient-centered medical home.

Care plans are becoming a focus of conversation and development in primary care as the patient-centered medical home is developing in the various states. In this issue, there are two accounts of attempts to develop and implement such generative processes through the use of a form. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

A special issue on the patient-centered medical home.

This special issue on the Patient-Centered Medical Home (PCMH) reflects its times. At the present time, the PCMH is an aspirational model with a few pilots functioning well around the country. How long the current period of idealism, fueled by the energy of early adopters, the consensus of diverse stakeholders, and the dollars of the Affordable Care Act will continue is anybody's guess. Representing the thinking of some of the best minds in the field, the articles in this issue have an aspirational and idealistic tone as much as a descriptive and analytic one. A year ago the balance would have been tipped more toward idealism and model building and a year from now it would, in all likelihood, tip more toward model description and analysis. The authors in this volume have been personally responsible for helping to move behavioral health to a more central position in the PCMH model.

A vision for Families, Systems, & Health.

Producing a journal that regularly offers clear articulations from many domains of relationship in health and healthcare, and occasionally offers a new articulation of the patterns that connect across domains, is the first goal the new editorial team for Families, Systems, & Health has set itself. The second is making FSH an accepted and well-used outlet in the worlds of medicine, mental health, and systems thought. As an approach to both goals, the editorial team wants to broaden the readership and the contributors to FSH by making the journal accessible to authors who do their scholarly writing in Spanish. The plan is to be able to take a manuscript in Spanish from submission, through all the steps in the editing process, to an accepted final form before it is translated. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Primary care mental health: a new frontier for psychology.

The medical system in this country is divided into primary care and specialty care. Mental health is for the most part a specialty service dependent on referrals, often from primary care providers. The authors propose a new model where psychologists work in collaboration with primary care medical teams. This integrated, coordinated model enables psychologists to help patients they would not otherwise see in a mental health system. Examples of patients in this category are seniors, those with somatizing disorders, and those experiencing the challenges of dealing with a chronic illness. This model also enables psychologists to provide consultation to the medical teams. In this article, the authors discuss the world of the primary care medical team and present the rationale for integration or collaboration. They describe the barriers to collaborative practices and ways to overcome these barriers. Finally, they present practical strategies that psychologists can use on a regular basis to increase their collaboration with primary care. These strategies can be used by those who work in colocated practices as well as those who work in separate locations.