Can the electronic medical record provide reliable indicators of primary care behavioral health fidelity? Comparison of accessibility and productivity indicators assessed through observational coding.

INTRODUCTION: The primary care behavioral health (PCBH) model is one of the most widely implemented integrated care approaches. However, research on the model has been limited by inconsistent measurement and reporting of model fidelity. One way of making measurement of PCBH model fidelity more routine is to incorporate fidelity indicators into the electronic medical record (EMR), though research regarding the accuracy of EMR data is mixed. In this study, we aimed to assess the reliability of EMR data as a PCBH fidelity measurement tool by comparing key EMR indicators of PCBH fidelity to those recorded by an observational coder. METHOD: Over an 8-month period (October 2021-May 2022), 12 behavioral health consultants (BHCs; 92% White, 75% female) across five primary care clinics recorded indicators of PCBH fidelity in the EMR as part of their routine charting of behavioral health visits. During that same period, one observational coder completed seven 4-hr visits per clinic to obtain multiple samples of data from each over time and recorded the same variables (i.e., percentage of visits prompted by warm handoffs, number of warm handoffs, and number of patient visits). We used bivariate correlations to test the associations between the EMR variables and the observer-coded variables. RESULTS: Correlations between EMR and observer-coded variables were moderate to strong, ranging from r = .46 to r = .97. DISCUSSION: Leveraging EMR data appears to be a fairly reliable approach to capturing indicators of PCBH model fidelity in the key domains of accessibility and high productivity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Does it work and can we do it? Hybrid research that answers both questions.

The perceived disconnect between research and clinic contexts may thus result in frontline clinicians and administrators questioning the approachability and applicability of science to their day-to-day work with patients and families in integrated care. Science grinds along so painstakingly slowly that even within the research community, some thought leaders have called for a moratorium on RCTs in favor of approaches that will yield more immediate public health impact (Kessler & Glasgow, 2011). The aim of this editorial is to describe a both/and research approach called "hybrid studies" and to discuss achievable strategies for doing this kind of work on the front lines. Sure, you can get a multimillion-dollar grant and do a formal research study, but real people on the frontlines can do this type of work too! Hybrid studies have the capacity to answer the two essential questions in healthcare science concurrently and advance the progress of science translation (usable science). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Peer review: The jury duty of science.

In this editorial, the authors explain the function and process of peer review, challenges they experienced in the wake of the COVID-19 pandemic, and strategies for ensuring that this fundamental process continues with integrity. In conclusion, the efforts of this editorial team to maintain a robust reviewer pool by inspiring, rewarding, training, and growing diversity cannot be the only efforts in this area. Those who "decline" jury duty may experience punitive consequences; however, there are no direct consequences for a qualified professional who declines to review, even routinely. Ultimately, the scientific community suffers, with a slower process that can then deteriorate. As a collective of professionals who value the contributions of science, we must all work to protect and grow participation in reviewing. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Leveraging the electronic medical record to measure fidelity to the primary care behavioral health model: Implications for clinical and research pursuits.

INTRODUCTION: The primary care behavioral health (PCBH) model of integration has been widely implemented across a number of noteworthy health care systems. However, lack of consistent measurement and reporting of the degree to which the PCBH model has been implemented as developers intended has resulted in two disadvantages in the field. First, clinical quality improvement efforts are hampered by lack of clear guidance on what elements are central to PCBH implementation. Second, the dearth of empirical studies reporting model fidelity impedes cross-study comparisons and limits the rigor of PCBH-focused research. Efforts to expand measurement of PCBH model fidelity would benefit from identification of accessible, unbiased metrics that could complement existing self-report measures. METHOD: In this article, we describe how we partnered with our clinical informatics team to incorporate PCBH fidelity metrics into the electronic medical record (EMR), allowing for monthly extraction and review of these data. RESULTS: Next, we describe how we have used monthly fidelity monitoring to inform clinical quality improvement efforts in the context of a developing integrated care program and provide an example of how PCBH fidelity data might be reported in a research article. DISCUSSION: Leveraging EMR data to support PCBH fidelity measurement has the potential to strengthen clinical quality improvement efforts and enable more consistent measurement and reporting of PCBH fidelity data in research. Future efforts should aim to parse out the relative contribution of different variables to the success of PCBH integration and evaluate the effectiveness of implementation strategies at supporting high fidelity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Developing a behavioral health workforce for team based care.

This is an introduction to the special issue "Innovations in Developing a Behavioral Health Workforce for Team Based Care." The purpose of this special issue was to highlight emerging research and projects to address workforce shortages and innovations in training paradigms, including those that could address the need for increased diversity. In this introduction, the authors spotlight some of the key themes as well as a few of the noticeable gaps they found as they completed this project. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Interprofessional microteaching: An innovation to strengthen the behavioral health competencies of the primary care workforce.

BACKGROUND: There is significant variability in how residency programs prepare the primary care workforce in behavioral health competencies. One approach that warrants further exploration is to have integrated behavioral health consultants (BHCs) capitalize on in vivo clinical teaching opportunities in the context of team-based care. This article presents preliminary results from the implementation of a pilot program wherein BHCs use warm handoffs and other clinical interactions to provide brief, targeted education to medical residents. METHOD: Twelve BHCs from five resident training clinics participated in a 1-hr training on "microteaching" skills that could be used in clinical teaching interactions. BHCs were asked to track instances of microteaching using an Excel spreadsheet. After 3 months, BHCs and residents responded to electronic surveys that assessed the acceptability and feasibility of this process. RESULTS: In 3 months, BHCs provided 269 instances of microteaching with 66 residents (66.7%) across five clinics. These microteachings occurred within the context of various interactions, including warm handoffs (n = 138, 51.3%), curbside consultations (n = 78, 29.0%), debriefs (n = 46, 17.1%), and team huddles (n = 7, 2.6%). Roughly half (n = 149, 55.4%) of these encounters involved Level 1 microteaching (i.e., lasting 2 min or less), while half (n = 120, 44.6%) involved Level 2 (i.e., lasting 3-10 min). BHCs and residents rated the microteaching interactions as acceptable and feasible. DISCUSSION: Leveraging embedded BHCs as clinical educators in integrated care environments may hold value for increasing behavioral health competencies among medical residents. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Enhancing equity, diversity, and inclusion in Families, Systems, & Health.

Our annual coeditors' retreat is a time to step back from the words on the page and reflect on our values for this work. Our values set the course for goals and subsequent actions for the year. In our 3 days away from the office to focus on the journal, we have the quiet space to set intentions. Then, we set timelines, we send emails, we put things in motion. We came to this year's retreat prepared to consider a critical topic: equity, diversity, and inclusion (EDI). That Families, Systems, & Health (FSH) recruit, welcome, review, and publish science that is representative of the widest range of experience and perspective is a core value for us as coeditors. We feel we have a moral and ethical obligation as leaders, scientists, and humans, to pursue social justice and equitable health outcomes for all. Such efforts are needed to help rectify the longstanding history of systemic racism and discrimination against minoritized communities that continues even today. In the context of recent events including protests against racial injustices as well as health disparities experienced by people of color during the coronavirus disease 2019 (COVID-19) pandemic, the scientific community is realizing we can no longer remain bystanders. Our role as coeditors of a journal affords the opportunity to support equitable and inclusive practices representing a diverse array of individuals and communities throughout the peer review and publication process, which not only enhances equity but also improves science. In exploratory conversations with our leadership team (i.e., coeditors, associate editors, and department editors) and editorial board, we knew that all of us were of a mind in our values and aspirations to improve EDI in FSH. We write this editorial to transparently communicate in a way that provides context for recent and upcoming changes in journal processes designed to support EDI. We want to clearly state our intentions to work on improving EDI throughout all aspects of FSH. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Building research and evaluation into the Collaborative Family Healthcare Association with intention.

In 2013, a bunch of us ran around collecting paper surveys off chairs after a plenary address at the Collaborative Family Healthcare Association's (CFHA) annual conference. From 150 responses, we found that less than a quarter would take the time to attend a workshop about research and evaluation. Fast forward 5 years: The organization showed robust attendance at research and evaluation training sessions, and interest in a preconference had risen to 77%. What prompted this shift? In response to survey findings, the Research and Evaluation Committee (REC), supported by the CFHA, engaged a data-informed and stakeholder-responsive approach to cultivating empiricism within the CFHA. The activities led by the REC demonstrate the need for creativity and leadership in this area and the CFHA's strong. organizational values around such efforts. As past and present leaders in the CFHA's REC initiatives, we write this editorial to make explicit the value of research to the organization and the value of the organization to the evidence base. In addition, we document some key institutional history in this area and, with input from the CFHA's current chief executive officer, Neftali Serrano, and REC chair, Will Lusenhop, forecast a vision for the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What is the recipe for PCBH? Proposed resources, processes, and expected outcomes.

What is the Primary Care Behavioral Health (PCBH) model of service delivery? Clinician innovators, administrators, and researchers have continued to refine the answer to this question. In the same way a recipe for mac n cheese provides the resources needed (i.e., ingredients), processes to make the dish, and expected outcomes (e.g., number of servings), a comprehensive operational definition for PCBH is needed to help improve the rigor of research being conducted. This recipe can also help clinicians/administrators identify a basic recipe for PCBH that standardizes the necessary components and amounts to achieve the expected outcomes. In this editorial, we provide a comprehensive operational recipe for PCBH based on current research. We are calling people to assist us by (a) utilizing the recipe to help improve the reporting and rigor of PCBH research and (b) applying the proposed operational definitions and targets within the recipe to help us refine and validate them. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

What to do with that policy paper (and why).

In this editorial we describe the clinician/administrator/researcher experience of frustration or confusion around how to effectively advocate for policy change in health care. By the end of the piece the reader will (a) understand the importance of health professionals' advocacy; (b) know how to use policy papers to advocate; and (c) understand how policy organizations use policy papers. We also discuss the National Academies of Medicine, Science, & Engineering High Quality Primary Care report as an example of a policy paper, introduce our new coeditors for the Policy and Management Department, and describe the Collaborative Family Health Care Association's new policy principles. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Lessons from the team care playbook: Recommendations for COVID-19 vaccination dissemination and uptake.

For too many of us, the implications of a worldwide pandemic unfolded in graduated stages of understanding that seemed too sluggish for the opponent we faced. For too many of us, even those of us in health care, the unfolding was terrifying; we felt blindsided and unprepared. If coronavirus disease 2019 (COVID-19) were a bully picking a fight, they got the first punch in before we even raised a fist. Now, many rounds in, health care teams will have an opportunity to deploy a new weapon against COVID-19. Vaccines are coming. We do not know when, who will pay for them, or the logistical aspects (e.g., storage and administration). We do not even know how effective they will be. Moreover, we must plan for mass vaccination in a chaotic and politically charged context that bears little resemblance to the ones with which we have experience. Nevertheless, in this fight, vaccines could be our winning blow. We are getting better at working with unknowns and in disrupted environments during COVID-19. We have some time to prepare, and we have some extant knowledge and experience in vaccine distribution and uptake. Health care teams can use these to best their adversary, and we can and should begin now. The aim of this article is to discuss how to mobilize interprofessional teams within systems of care to engage best practices in vaccine dissemination and uptake in the unique COVID-19 context. We begin by discussing challenges to dissemination and uptake and then provide solutions using our experiences in the primary care system. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A walk on the translational science bridge with leaders in integrated care: Where do we need to build?

Entrepreneurs in integrated care face some of the same challenges in empirically demonstrating impact, regardless of the model of care they espouse. In this editorial, 2 leading model developers reflect on the state of the science in primary care integration, including research gaps and promising research underway. We asked these leaders to discuss conceptual areas of shared concern, and we present those with reference to the metaphor of the translational research bridge. Their insights resonate with one another and suggest a role for collaboration to advance empirical support for the implementation of integrated care. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Evaluating the Prevalence of Child Psychosocial Concerns in Rural Primary Care.

OBJECTIVE: Child psychosocial concerns in rural areas are assumed to be greater than national averages due to mental health provider shortages, however, there is minimal empirical support for this claim. The present study aimed to replicate findings showing a higher prevalence of child psychosocial concerns in rural areas. In addition, this study evaluated six distinct definitions of "rural" to determine whether the operational definition of rurality was associated with prevalence of psychosocial concerns. METHODS: Caregivers presenting with their child at 8 pediatric primary care sites (N = 2,672) completed a demographic questionnaire and the Pediatric Symptom Checklist (PSC). Logistic regression models tested associations between operational definitions of rurality and prevalence of clinically significant child psychosocial concerns. Multiple logistic regression models were used to test additional independent effects of maternal education level while controlling for child age. RESULTS: The effects of rurality on prevalence of clinically significant psychosocial concerns were inconsistent across the six measures of rurality; when significant, however, effects were small and in the opposite direction than hypothesized. CONCLUSIONS: These findings highlight discrepancies in results based on disparate operational definitions and measures of rurality. When rurality was associated with child psychosocial concerns, children in more highly populated areas reported more psychosocial concerns than children in smaller rural areas.

Evaluating time in health care: What are we busy about?

At the end of the day, there are both economic and less tangible benefits to having predictable clinic operations in which people's medical and behavioral health needs are met. These different benefits, stemming from changes in how time is used, are relevant to a wide range of stakeholders including administrators, clinicians, and patients. In short, time is one of our most important resources in health care. Therefore, time studies have a crucial role to play in advancing the implementation of integrated care. In this editorial we describe several methods for measuring time and invite readers to consider which of these (or another method you're aware of) balances your needs for precision and feasibility of measurement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Patient access: How do we measure it?

The aim of this article is to introduce key definitions to patient access and a measurement approach, translated for a clinic-based research study or program evaluation. The authors hope this piece will provide those seeking to improve access with some basic starting points and replace rhetoric with rigor in evaluation. Issues discussed include defining access for measurement, measuring access, starting with the end point in mind, and using a logic model. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A recipe for assessing fidelity in family and health systems.

Following recipes is an analogy for maintaining intervention integrity, or, fidelity. Fidelity is the extent to which an intervention is implemented as intended. This editorial presents a recipe for assessing fidelity in family and health systems. The author discusses the challenges posed by the complex recipes of families and health systems interventions, in both research and clinical practice. The author concludes that increasing the measurement and reporting of fidelity is paramount in the exploding literature around family and health systems research. Researchers and practice improvement champions must find ways to assess fidelity or its proximal indicators and work to innovate new, more efficient methods that allow for ubiquitous fidelity assessment and monitoring systems, ensuring the best care for the families and system stakeholders they serve. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Why and how to use patient-oriented research to promote translational research.

As we discussed in our first editorial in the December 2018 issue (Polaha & Sunderji, 2018), an emerging science of knowledge translation (also known as implementation and dissemination science) aims to bridge the disconnect between evidence and practice. Researchers are increasingly engaging with knowledge users and other stakeholders as a key strategy to promote uptake. This may include policymakers, payers, and-the focus of this editorial-patients. Patient-oriented research is featured in national research agendas around the world including in Canada (Canadian Institutes of Health Research, 2018) and the United States (Patient-Centered Outcomes Research Institute, see https://www.pcori.org/), in part as it may contribute one solution to the "bench to bedside" gap (Greenhalgh, Jackson, Shaw, & Janamian, 2016; Jull, Giles, & Graham, 2017; McGavin, 2017). In this editorial, we provide a general introduction to research, its potential, and its realized value. We also suggest strategies for conducting patient-oriented research effectively, including a description of common barriers and how they can be dealt with. We hope this background will inspire you to get started with patient-oriented research and to learn more, as well as to share your patient-oriented research through Families, Systems, & Health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A vision for the future of Families, Systems, & Health: Focusing on science at the point of care delivery.

The authors are pleased to introduce themselves as the new co-editors. They are Nadiya Sunderji and Jodi Polaha, midcareer academic clinicians whose careers have balanced research, teaching, and clinical practice in integrated care. They continue the Families, Systems, & Health (FSH) tradition of interprofessional co-editor teams (Dr. Sunderji is a psychiatrist and Dr. Polaha is a psychologist) and add a new twist: international collaboration. Dr. Sunderji is Canadian, and they welcome the new contributors and readers this collaboration will bring. The authors thank those who worked so diligently to develop a strong journal with a tradition of contributing important work in health care. They thank outgoing Associate Editors, Drs. Douglas Brock and Todd Edwards, as well as outgoing Department Editors, Drs. Ben Miller and Randall Reitz, who served the journal faithfully for many years. They also note that in 2003, Zerhouni (2003) laid out a roadmap for research in the journal Science, using a bridge as a metaphor to explain how scientific infrastructure (journals, grants, training, and the development and dissemination of advanced scientific methods) supports the translation of knowledge from bench to bedside. The authors borrow the bridge metaphor here to discuss the direction for FSH under their leadership. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Adoption and reach of behavioral health services for behavior problems in pediatric primary care.

INTRODUCTION: The field of implementation science provides the variables adoption and reach, which can be used to evaluate aspects to access, a primary incitement for integrated care. This study compared two integrated models: In Year 1, behavioral health consultants worked collaboratively with pediatricians to provide brief on-the-spot consultations to patients with behavioral concerns, and in Year 2, a structured, evidence-based treatment (EBT), the Family Check-Up, was developed to be delivered in conjunction with the existing collaborative model. METHOD: A chart review revealed the number of children who (a) attended a 4- to 5-year-old well-visit, (B) were screened, (c) were identified as having behavior problems, (d) were referred, and (e) accessed the services. Outcomes were calculated as percentages of children with behavioral concerns who were referred to (adoption) and received (reach) the services in each year. RESULTS: Key findings were that (a) physician referrals increased when an EBT was added, but (b) patients had better first-session contact with the brief approach than the EBT, which few patients completed. DISCUSSION: Results underscore the utility of measuring adoption and reach as partial indicators of access to services. These are accessible variables, collected in every practice that can be measured routinely in the context of quality improvement and, ideally, reported in studies as a way to disseminate knowledge about how to build behavioral health technology into primary care. Future research should strive for more rigor in measuring adoption and reach, and consider including a number of other implementation outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Primary Care Behavioral Health (PCBH) Model Research: Current State of the Science and a Call to Action.

The Primary Care Behavioral Health (PCBH) model of service delivery is being used increasingly as an effective way to integrate behavioral health services into primary care. Despite its growing popularity, scientifically robust research on the model is lacking. In this article, we provide a qualitative review of published PCBH model research on patient and implementation outcomes. We review common barriers and potential solutions for improving the quantity and quality of PCBH model research, the vital data that need to be collected over the next 10 years, and how to collect those data.