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

Journal of Clinical Psychology in Medical Settings

Volumn 25, Issue 2, 2018, Pages 127-156

  Hunter, Christopher L ^a   Funderburk, Jennifer S ^b,c,d   Polaha, Jodi ^e   Bauman, David ^f   Goodie, Jeffrey L ^g   Hunter, Christine M ^h  

^a Defense Health Agency   (United States)

^b SYRACUSE VA MEDICAL CENTER   (United States)

^c SYRACUSE UNIVERSITY   (United States)

^d UNIVERSITY OF ROCHESTER MEDICAL CENTER   (United States)

^e East Tennessee State University   (United States)

^f Central Washington Family Medicine Residency   (United States)

^g Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center   (United States)

^h NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES   (United States)

Author keywords

Collaborative primary care; Integrated behavioral health; Integrated mental health; Integrated primary care; Primary care behavioral health; Primary care mental health

Indexed keywords

ARTICLE; CLINICAL FEATURE; COMORBIDITY; CONFOUNDING VARIABLE; FUNCTIONAL STATUS; FUNDING; HEALTH BEHAVIOR; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE PLANNING; HUMAN; MEDICAL RESEARCH; MENTAL HEALTH SERVICE; PATIENT SATISFACTION; PRIMARY MEDICAL CARE; PRIORITY JOURNAL; PROGRAM ACCEPTABILITY; PUBLIC-PRIVATE PARTNERSHIP; QUASI EXPERIMENTAL STUDY; SOCIAL ADAPTATION; SYMPTOMATOLOGY; TREATMENT OUTCOME; BEHAVIORAL MEDICINE; FORECASTING; HEALTH SERVICE; HEALTH SERVICES RESEARCH; INTEGRATED HEALTH CARE SYSTEM; INTERDISCIPLINARY COMMUNICATION; INTERSECTORAL COLLABORATION; ORGANIZATION AND MANAGEMENT; PATIENT CARE; PRIMARY HEALTH CARE; TRENDS; UNITED STATES;

BEHAVIORAL MEDICINE; DELIVERY OF HEALTH CARE, INTEGRATED; FORECASTING; HEALTH SERVICES NEEDS AND DEMAND; HEALTH SERVICES RESEARCH; HUMANS; INTERDISCIPLINARY COMMUNICATION; INTERSECTORAL COLLABORATION; PATIENT CARE TEAM; PRIMARY HEALTH CARE; UNITED STATES;

EID: 85030330984     PISSN: 10689583     EISSN: 15733572     Source Type: Journal    
DOI: 10.1007/s10880-017-9512-0     Document Type: Article

References (77)

1. Agency for Healthcare Research and Quality (ARHQ). (n.d.). About PBRNs. In Practice-based research networks. Retrieved from https://pbrn.ahrq.gov/about.
2. *Aguirre, J., & Carrion, V. G. (2012). Integrated behavioral health services: A collaborative care model for pediatric patients in low-income settings. Clinical Pediatrics, 52, 1178–1180.
3. *Angantyr, K., Rimner, A., & Norden, T. (2015). Primary care behavioral health model: Perspectives of outcome, client satisfaction, and gender. Social Behavior and Personality, 43, 287–302.
4. Baird, M., Blount, A., Brungardt, S., Dickinson, P., Dietrich, A., Epperly, T., … deGruy, F. (2014). Joint principles: Integrating behavioral health care into the patient-centered medical home. Annals of Family Medicine, 12, 183–185.
5. Bastien, C., Vallieres, A., & Morin, C. M. (2001). Validation of the insomnia severity index as a clinical outcome measure for insomnia research. Sleep Medicine, 2, 297–307.
6. Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893.
7. Beehler, G. P., Funderburk, J. S., Possemato, K., & Dollar, K. M. (2013). Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ). Translational Behavioral Medicine, 3, 379–391.
8. Beehler, G. P., Funderburk, J. S., Possemato, K., & Vair, C. L. (2013). Developing a measure of provider adherence to improve the implementation of behavioral health services in primary care: A Delphi study. Implementation Science, 8, 19. 10.1186/1748-5908-8-19.
9. Bradley, K. A., DeBenedetti, A. F., Volk, R. J., Williams, E. C., Frank, D., & Kivlahan, D. R. (2007). AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoholism: Clinical & Experimental Research, 31, 1208–1217.
10. 2 CE): Integrated-collaborative care on a large scale model. Families, Systems, & Health, 28, 175–187.
11. *Bridges, A. J., Andrews, A. R., Villalobos, B. T., Pastrana, F. A., Cavell, T. A., & Gomez, D. (2014). Does integrated behavioral health care reduce mental health disparities for Latinos? Initial findings. Journal of Latina/o Psychology, 2, 37–53.
12. *Bridges, A. J., Gregus, S. J., Rodriquez, J. H., Andrews, A.R. III, Villalobos, B. T., Pastrana, F. A., & Cavell, T. A. (2015). Diagnoses, intervention strategies, and rates of functional improvement in integrated behavioral health care patients. Journal of Consulting and Clinical Psychology, 83, 590–601.
13. *Bryan, C. J., Corso, K. A., Corso, M. L., Kanzler, K. E., Ray-Sannerud, B., & Morrow, C. E. (2012). Therapeutic alliance and change in suicidal ideation during treatment in integrated primary care settings. Archives of Suicide Research, 16, 316–323.
14. *Bryan, C. J., Corso, K. A., Kanzler, K. E., Corso, M. L., Morrow, C. E., & Ray-Sannerud, B. (2012). Severity of mental health impairment and trajectories of improvement in and integrated primary care clinic. Journal of Clinical and Consulting Psychology, 80, 396–403.
15. *Bryan, C. J., Morrow, C., & Appolonio, K. (2009). Impact of behavioral health consultant interventions on patient symptoms and functioning in an integrated family medicine clinic. Journal of Clinical Psychology, 65, 281–293.
16. *Cigrang, J. A., Avila, L. L., Goodie, J. L., Peterson, A. L., Rauch, S. A. M., Bryan, C. J., & Hryshko-Mullen, A. (2011). Treatment of active-duty military with PTSD in primary care: Early findings. Psychological Services, 8, 104–113.
17. *Cigrang, J. A., Dobmeyer, A. C., Becknell, M. E., Roa-Navarrete, R. A., & Yerian, S. R. (2006). Evaluation of a collaborative mental health program in primary care: Effects on patient distress and health care utilization. Primary Care and Community Psychiatry, 11, P1–P7.
18. *Cigrang, J. A., Rauch, S. A. M., Mintz, J., Brundige, A., Avila, L. L., Bryan, C. J., … Peterson, A. L. (2015). Treatment of active duty military with PTSD in primary care: A follow-up report. Journal of Anxiety Disorders, 36, 110–114.
19. *Corso, K. A., Bryan, C. J., Corso, M. L., Kanzler, K. E., Houghton, D. C., Ray-Sannerud, B., & Morrow, C. E. (2012). Therapeutic alliance and treatment outcome in the primary care behavioral health model. Families, Systems & Health, 30, 87–100.
20. *Corso, K. A., Bryan, C. J., Morrow, C. E., Appolonio, K. K., Dodendorf, D. M., & Baker, M. T. (2009). Managing posttraumatic stress disorder symptoms in active-duty military personnel in primary care settings. Journal of Mental Health Counseling, 31, 119–137.
21. Corso, K. A., Hunter, C. L., Dahl, O., Kallenberg, G., & Manson, L. (2016). Integrating behavioral health in the medical home: A rapid implementation guide. Phoenix: Greenbranch Publishing.
22. Davis, M. M., Keller, S., DeVoe, J. E., & Cohen, D. J. (2012). Characteristics and lessons learned from practice-based research networks (PBRNs) in the United States. Journal of Healthcare Leadership. doi:10.2147/jhl.s16441.
23. *Felker, B. L., Barnes, R. F., Greenberg, D. M., Chaney, E. F., Shores, M. M., Gillespie-Gateley, L., … Morton, C. E. (2004). Preliminary outcomes from an integrated mental health primary care team. Psychiatric Services, 55, 442–444.
24. Ford, I., & Norrie, J. (2016). Pragmatic trials. New England Journal of Medicine, 375, 454–463.
25. Frisch, M. B. (1994). Test manual and treatment guide for the QOLI (Quality of Life Inventory). Minneapolis, MN: Pearson Assessments (formerly NCS Assessments).
26. *Funderburk, J. S., Dobmeyer, A. C., Hunter, C. L., & Walsh, C. O. (2013). Provider practices in the primary care behavioral health (PCBH) model: An initial examination in the Veterans Health Administration and United States Air Force. Families, Systems & Health, 31, 341–353.
27. *Funderburk, J. S., Fielder, R. L., DeMartini, K. S., & Flynn, C. A. (2012). Integrating behavioral health services into a university health centers: Patient and provider satisfaction. Families, Systems & Health, 30, 130–140.
28. Funderburk, J. S., Kenneson, A., & Maisto, S. A. (2014). Identifying classes of veterans with multiple risk factors. Military Medicine, 179(10), 1119–11267. doi: 10.7205/MILMED-D-14-00119.
29. *Funderburk, J. S., Sugarman, D. E., Maisto, S. A., Ouimette, P., Schohn, M., Lantinga, L., … Strutynski, K. (2010). The description and evaluation of the implementation of an integrated healthcare model. Families, Systems & Health, 28, 146–160.
30. Gill, L., & White, L. (2009). A critical review of patient satisfaction. Leadership in Health Services, 22(1), 8–19.
31. *Gomez, D., Bridges, A. J., Andrews, A. R., Cavell, T. A., Pastrana, F. A., Gregus, S. J., & Ojeda, C. A. (2014). Delivering parent management training in an integrated primary care setting: Description and preliminary outcome data. Cognitive and Behavioral Practice, 21, 296–309.
32. *Goodie, J. L., Isler, W. C., Hunter, C., & Peterson, A. L. (2009). Using behavioral health consultants to treat insomnia in primary care: A clinical case series. Journal of Clinical Psychology, 65, 294–304.
33. *Gouge, N., Polaha, J., Rogers, R., & Harden, A. (2016). Integrating behavioral health into pediatric primary care: Implications for provider time and cost. Southern Medical Journal, 109, 774–778.
34. Hawkins, N. G., Sanson-Fisher, R. W., Shakeshaft, A., D’Este, C., & Green, L. W. (2007). The multiple baseline design for evaluating population-based research. American Journal of Preventive Medicine, 33(2), 162–168.
35. Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerstrom, K. O. (1991). The Fagerstrom test for nicotine dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction, 86, 1119–1127.
36. *Hill, J. (2015). Behavioral health integrations: Transforming patient care, medical resident education, and physician effectiveness. The International Journal of Psychiatry in Medicine, 50, 36–49.
37. *Horevitz, E., Organista, K. C., & Arean, P. A. (2015). Depression treatment uptake in integrated primary care: How a “warm handoff” and other factors affect decision making by Latinos. Psychiatric Services, 66, 824–830.
38. *Katon, W., Robinson, P., Von Korff, M., Lin, E., Bush, T., Ludman, E.,… Walker, E. (1996). A multifaceted intervention to improve treatment of depression in primary care. Archives of General Psychiatry, 53, 924–932.
39. *Kessler, R. (2012). Mental health care treatment initiation when mental health services are incorporated into primary care practice. Journal of the American Board of Family Medicine, 25, 255–259.
40. Kopta, S. M., & Lowry, J. L. (2002). Psychometric evaluation of the Behavioral Health Questionnaire-20: A brief instrument for assessing global mental health and the three phases of psychotherapy outcome. Psychotherapy Research, 12, 413–426.
41. Kozica, S. L., Lombard, C. B., Hider, K., Harrison, C. L., & Teede, H. J. (2015). Developing comprehensive health promotion evaluations: A methodological review. MedCrave Online Journal of Public Health, 2, 1–9. doi: 10.15406/mojph.2015.02.00007.
42. Krebs, E. E., Lorenz, K. A., Bair, M. J., Damush, T. M., Jingwei, W., Sutherland, J. M., … Kroenke, K. (2009). Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. Journal of General Internal Medicine, 24(6), 733–738.
43. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The Phq-9. Journal of General Internal Medicine, 16(9), 606–613.
44. *Lanoye, A., Stewart, K. E., Rybarczyk, B. D., Auerbach, S. M., Sadock, E., Aggarwal, A., … Austin, K. (2016). The impact of integrated psychological services in a safety net primary care clinic on medical utilization. Journal of Clinical Psychology. doi:10.1002/jclp.22367.
45. Larsen, D. L., Attkisson, C. C., Hargreaves, W. A., & Nguyen, T. D. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2(3), 197–207.
46. Lerner, D., Amick, I. I. I., Rogers, B. C., Malspeis, W. H., Bungay, S., K., & Cynn, D. (2001). The work limitations questionnaire. Medical Care, 39(1), 72–85.
47. Litz, B., Gray, M., Bryant, R., & Adler, A. (2002). Early intervention for trauma: Current status and future directions. Clinical Psychology: Science and Practice, 9, 112–134.
48. Loudon, K., Treweek, S., Sullivan, F., Donnan, P., Thorpe, K. E., & Zwarenstein, M. (2015). The PRECIS-2 tool: Designing trials that are fit for purpose. British Medical Journal, 350, h2147. doi: 10.1136/bmj.h2147.
49. Marshal, G. N., & Hays, R. D. (1994). The patient satisfaction questionnaire short-form (PSQ-18). RAND. Retrieved from https://www.rand.org/pubs/papers/p7865.html.
50. *McFeature, B., & Pierce, T. W. (2012). Primary care behavioral health consultation reduces depression levels among mood-disordered patients. Journal of Health Disparities Research and Practice, 5, 36–44.
51. McNally, R. J., Bryant, R. A., & Ehlers, A. (2003). Does early psychological intervention promote recovery from posttraumatic stress? Psychological Science in the Public Interest, 4, 45–79.
52. Mostert, M. P. (2001). Facilitated communication since 1995: A review of published studies. Journal of autism and Developmental Disorder, 31, 287–313.
53. Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., … Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695–699.
54. National Association of Community Health Centers (NACHC). (n.d.). About our health centers. In NACHC. Retrieved from http://nachc.org/about-our-health-centers/.
55. Parkerson, G. R., & Broadhead, W. E. (1990). The Duke Health Profile. A 17-item measure of health and dysfunction. Medical Care, 28(11), 1056–1072.
56. Pascoe, G. C. (1983). Patient satisfaction in primary health care: A literature review and analysis. Evaluation and Program Planning, 6, 185–210.
57. Prins, A., Ouimette, P., Kimerling, R., Cameron, R. P., Hugelshofer, D. S., Shaw-Hegwer, J., Thrailkill, A., Gusman, F. D., & Sheikh, J. I. (2003). The Primary Care PTSD Screen (PC-PTSD): Development and operating characteristics. Primary Care Psychiatry, 9(1), 9–14.
58. Proctor, E., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administrative Policies in Mental Health, 36, 24–34.
59. Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., … Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38, 65–76.
60. PROMIS-29 Profile v2.0 © 2008–2016 PROMIS Health Organization and PROMIS Cooperative Group, May, 27, 2016. http://www.nihpromis.org.
61. *Ray-Sannerud, B. N., Dolan, D. C., Morrow, C. E., Corso, K. A., Kanzler, K. E., Corso, M. L., & Bryan, C. J. (2012). Longitudinal outcomes after brief behavioral health intervention in an integrated primary care clinic. Families, Systems & Health, 30, 60–71.
62. Reiter, J. T., Dobmeyer, A. C., & Hunter, C. L. (2017). The primary care behavioral health (PCBH) model: An overview and operational definition. Journal of Clinical Psychology in Medical Settings, 24(4).
63. *Runyan, C., Fonseca, V. P., Meyer, J. G., Oordt, M. S., & Talcott, G. W. (2003). A novel approach for mental health disease management: The Air Force Medical Service’s interdisciplinary model. Disease Management, 6, 179–187.
64. *Sadock, E., Auerbach, S. M., Rybarczyk, B., & Aggarwal, A. (2014). Evaluation of integrated psychological services in a university-based primary care clinic. Journal of Clinical Psychology in Medical Settings, 21, 19–32.
65. Scharf, D. M., Eberhart, N. K., Hackbarth, N. S., Horvitz-Lennon, M., Beckman, R., Han, B., … Burnam, M. A. (2014). Evaluation of the SAMHSA primary and behavioral health care integration (PBHCI) grant program: Final report (task 13). Retrieved from http://www.rand.org/content/dam/rand/pubs/research_reports/RR500/RR546/RAND_RR546.pdf.
66. Seelert, K. R., Hill, R. D., Rigdon, M. A., & Schwenzfeier, E. (1999). Measuring patient distress in primary care. Family Medicine, 31, 483–487.
67. *Serrano, N., & Monden, K. (2011). The effect of behavioral health consultation on the care of depression by primary care clinicians. WMJ, 110, 113–113.
68. Smith, J., D. (2012). Single-case experimental designs: A systematic review of published research and current standards. Psychological Methods. doi:10.1037/a0029312.
69. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.
70. Strosahl, K. (1994). New dimensions in behavioral health/primary care integration. HMO Practice, 8, 176–179.
71. Strosahl, K. (1998). Integrating behavioral health and primary care services: The primary mental health care model. In A. Blount (Ed.), Integrated primary care: The future of medical and mental health collaboration. New York: W.W. Norton.
72. Strosahl, K., & Robinson, P. (2008). The primary care behavioral health model: Applications to prevention, acute care and chronic condition management. In R. Keesler & D. Stafford (Eds.), Collaborative medicine case studies: Evidence in practice (pp. 85–95). New York: Springer.
73. Strosahl, K., & Sobel, D. (1996). Behavioral health and the medical cost offset effect: Current status, key concepts and future applications. HMO Practice, 10, 156–162.
74. *Torrence, N. D., Mueller, A. E., Ilem, A. A., Renn, B. N., DeSantis, B., & Segal, D. L. (2014). Medical provider attitudes about behavioral health consultants in integrated primary care: A preliminary study. Families, Systems & Health, 32, 426–432.
75. Vogeli, C., Shields, A., Lee, T. A., Gibson, T. B., Marder, W. D., Weiss, K. B., & Blumenthal, D. (2007). Multiple chronic conditions: Prevalence, health consequences, and implications for quality, care management, and costs. Journal of General Internal Medicine, 22, 391–395.
76. Ware, J. E. Jr., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.
77. Werch, C. E., & Owen, D. M. (2002). Iatrogenic effects of alcohol and drug prevention programs. Journal of Studies on Alcohol, 63, 581–590.