Mapping Out Action Plan
Jaia3926
Integration_Competencies_Final.pdf
JANUARY 2014
CORE COMPETENCIES FOR INTEGRATED
BEHAVIORAL HEALTH AND PRIMARY CARE
SAMHSA Substance Abuse and Mental Health Services Administration
www.samhsa.gov 1-877-SAMHSA-7 (1-877-726-4727)
2SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
A C
K N
O W
L E
D G
E M
E N
T S
SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings. CIHS is the first “national home” for information, experts, and other resources dedicated to bidirectional integration of behavioral health and primary care.
Jointly funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration, and run by the National Council for Behavioral Health, CIHS provides training and technical assistance to community behavioral health organizations that received SAMHSA Primary and Behavioral Health Care Integration grants, as well as to community health centers and other primary care and behavioral health organizations.
CIHS’ wide array of training and technical assistance helps improve the effectiveness, efficiency, and sustainability of integrated services, which ultimately improves the health and wellness of individuals living with behavioral health disorders.
1701 K Street NW, Suite 400
Washington, DC 20006
202.684.7457
www.integration.samhsa.gov
RECOMMENDED CITATION Hoge M.A., Morris J.A., Laraia M., Pomerantz A., & Farley, T. (2014). Core Competencies for Integrated Behavioral Health and Primary Care. Washington, DC: SAMHSA - HRSA Center for Integrated Health Solutions.
3SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
Prepared by the Annapolis Coalition on the Behavioral Health Workforce under contract to the HRSA-SAMHSA Center for Integrated Health Solutions at the National Council for Behavioral Health.
For further information contact Michael Hoge, Ph.D. at [email protected].
PROJECT TEAM CIHS engaged the Annapolis Coalition on the Behavioral Health Workforce (www.annapoliscoalition.org) to lead and manage the competency development project. The Coalition is a non-profit organization dedicated to improving the recruitment, retention, training and performance of the prevention and treatment workforce in the mental health and addictions sectors of the behavioral health field.
The core Annapolis Coalition team managing the project included:
Michael A. Hoge, PhD, Senior Science and Policy Advisor, The Annapolis Coalition
John A. Morris, MSW, Executive Director, The Annapolis Coalition
Michele Laraia, PhD, APRN, Project Consultant, The Annapolis Coalition
Ann McManis, Director of Operations, The Annapolis Coalition
SENIOR CONTENT ADVISORS Andrew Pomerantz, MD, National Mental Health Director for Integrated Care, Veterans Administration and Associate Professor, Dartmouth Medical School
Tillman Farley, MD, Director of Medical Services, Salud Family Health Centers, Colorado
ACKNOWLEDGEMENTS The project team is indebted to HRSA and SAMHSA for their support and guidance on this project; to Laura Galbreath and the CIHS team at the National Council; to our senior content advisors and key informants; and to our administrative team at The Annapolis Coalition.
While we are grateful for the input from the senior content advisors and all of the key informants listed in Appendix I, the final decisions on the content of this report were made by the project team. They alone are responsible for any errors or omissions.
SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS 4
TA B
L E
O F
C O
N T
E N
T S
TABLE OF CONTENTS SAMHSA-HRSA Center for Integrated Health Solutions ................................................................2
Project Team ...................................................................................................................3
Introduction ....................................................................................................................4
Workforce Sectors ...................................................................................................4
Types of “Integrated Care” .........................................................................................4
Finding Common Language ........................................................................................4
Guiding Assumptions ...............................................................................................5
A Single Integrated Set of Competencies ......................................................................5
Method ..........................................................................................................................6
Using the Core Competencies ..............................................................................................6
Shaping Workforce Training ........................................................................................6
Informing Job Descriptions ........................................................................................6
Employee Recruitment ..............................................................................................6
A Guide to Orientation .............................................................................................6
Performance Assessment ..........................................................................................6
Shaping Existing & Future Competency Sets ..................................................................6
Core Competency Categories ...............................................................................................7
I. Interpersonal Communication ..................................................................................8
II. Collaboration & Teamwork......................................................................................9
III. Screening & Assessment .................................................................................... 10
IV. Care Planning & Care Coordination ........................................................................ 10
V. Intervention ..................................................................................................... 11
VI. Cultural Competence & Adaptation ........................................................................ 12
VII. Systems Oriented Practice .................................................................................. 12
VIII. Practice-Based Learning & Quality Improvement ..................................................... 13
IX. Informatics ..................................................................................................... 13
References.................................................................................................................... 14
Appendix I: Contributors ................................................................................................... 19
Senior Content Experts ........................................................................................... 19
Expert Key Informants ............................................................................................ 19
Appendix II: Detailed Method ............................................................................................. 22
Overview ............................................................................................................ 22
Key Informants ..................................................................................................... 22
Literature Review .................................................................................................. 22
Review of Other Competency Sets ............................................................................. 22
Development of the Competency Set .......................................................................... 23
5SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
INTRODUCTION
Despite the increasing national focus on integrated care, there is no single, widely recognized set of competencies on this service approach for either the behavioral health or primary care workforce. To address this gap, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) charged the Center for Integrated Health Solutions (CIHS; www. integration.samhsa.gov) to identify and disseminate core competencies on integrated practice relevant to behavioral health and primary care providers. The development of these competencies was performed by the Annapolis Coalition on the Behavioral Health Workforce (www. annapoliscoalition.org) under the auspices of CIHS.
The core competencies developed through this project are intended to serve as a resource for provider organizations as they shape job descriptions, orientation programs, supervision, and performance reviews for workers delivering integrated care. Similarly, the competencies are to be a resource for educators as they shape curricula and training programs on integrated care. The charge was to develop a “core” or “common” set of competencies broadly relevant to working in diverse settings with diverse populations. The competency sets are not intended to be setting or population specific. Their principal relevance is to the integration of behavioral health with primary care as opposed
to the integration of behavioral health with specialty medical care.
Workforce Sectors Behavioral health encompasses prevention, intervention, and recovery from mental health and substance use conditions. Equally important, it focuses on promoting behaviors that support health and wellness. This workforce, which is described in a previous SAMHSA- funded report (www.annapoliscoalition.org/download_actionplan.aspx), is comprised of graduate trained professionals, direct care staff with on the job training and experience, and persons in recovery from behavioral health conditions. This includes, but is not limited to: psychiatrists, psychologists, social workers, advanced practice psychiatric nurses, marriage and family therapists, addiction counselors, mental health counselors, psychiatric rehabilitation specialists, psychiatric aides and technicians, and peer support specialists and recovery coaches.
Primary care is a complex concept that focuses on the provision of “…comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern…” (American Academy of Family Practitioners, www.aafp.org). It includes health promotion, disease prevention, education, diagnosis and treatment. The primary care workforce includes, but is not limited to, physicians, physician assistants, advanced practice nurses, registered nurses, and a range of allied health professionals.
Types of “Integrated Care” While the concept of integration, as used within this document, refers to collaboration between behavioral health and primary care providers, there are many forms and models of integrated care. CIHS developed a framework, which can be accessed online (www.integration.samhsa. gov/resource/standard-framework-for-levels-of-integrated-healthcare). The competencies reported are principally intended to address levels 4, 5, and 6 in that framework, which involve either close or full collaboration and one of three organizational models: some systems
integration, integrated practice, or transformed/merged practice.
Finding Common Language The competency set requires the use of consistent language to refer to the recipients of healthcare. The terms used by different professions/ specialties and in different settings vary widely (i.e. patient, client, or consumer) and it is clear that no single term is preferred by, and perhaps even acceptable to, the many groups and individuals involved in the delivery of integrated care.
For this document, the term healthcare consumer or simply consumer has been selected as one that is understood, though perhaps not preferred, in primary care, mental health, and the field of addictions. As captured below in the competencies, it is generally recommended that providers adopt the language of the setting in which care is delivered. To the extent to which such language is unacceptable to providers, they are encouraged to educate others within their
team and setting about their rationale for using alternative language.
6SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
Within this document, the term behavioral health is used to refer to mental health and addictions. Behavioral health is distinguished from “general health,” recognizing the imperfections in the distinction and the language used to describe it. Behavioral health is also distinct from healthy or health behavior. Unless otherwise noted, the term health conditions refers to all health conditions and is not specific to
behavioral health.
Guiding Assumptions The development of this core competency set was guided by a series of assumptions that are articulated below.
1. It is crucial to stress that these competencies reinforce or enhance the basic competencies of each discipline and the specialty competencies that each provider must have to practice in his or her field. There is not a bright line between those competencies and many of the competencies that are essential for the provision of integrated care. Some competencies that are generic to most forms of healthcare, such as those related to interpersonal communication, are included in this set because they are absolutely essential to the effective delivery of integrated care.
2. In order for a core competency set to be practical and useful, it has to have a manageable number of competency categories and individual competencies. Long and detailed competency sets overwhelm the reader, the educator, the interprofessional team leader, and the direct care provider. Clarity and simplicity was the goal.
3. The competencies are optimally skill oriented, focusing on what the provider of integrated care can actually “do.” Knowledge and attitudes make the desired behavior possible, but demonstration of an essential skill is the desired outcome.
4. The focus of integrated care and these workforce competencies is very broadly defined, not narrowly focused on particular diagnosable disorders. Similarly, the competencies are intended to be relevant to healthcare consumers across the lifespan from diverse populations, and are not specific to a particular age or population.
5. The competency set specifies skills such as the use of evidence-based treatments and tools, but generally does not identify specific treatments or tools. These will vary by setting and population and will change over time as the evidence base grows and prevention and treatment approaches evolve. Up-to-date information on evidence-based treatments and tools can be
accessed at various websites including www.samsha.gov and www.hrsa.gov.
6. The competencies are premised on consumers and family members as partners in the healthcare process whose strengths, goals and preferences should drive healthcare decisions.
7. The issue of culture must be considered in all efforts to understand health, illness, treatment, resilience and recovery.
8. The effective delivery of integrated care requires system modifications to support changed practice. However, system design was outside of the scope of this project. Clearly the financing and organization of care delivery can have a major impact on the ultimate competence of the providers working in those delivery systems.
9. Core competencies are defined as those that apply to the majority of providers involved in integrated care. Each competency is not necessarily relevant to every provider. For example, more complex, clinically oriented competencies may not be applicable to care managers or navigators. Many of these competencies may be relevant to peer support roles. The employer
must designate the competencies applicable to each position.
A Single Integrated Set of Competencies The initial project goal was to develop two competency sets: one for behavioral health practitioners and the other for primary care practitioners. However, the results of the data gathering process revealed that most competencies required for integrated care were common to behavioral health and primary care providers. The initial draft of competencies, which contained some distinctions between behavioral health and primary care skills, met with criticism from a number of key informant reviewers who argued that such separation would promote continued silos between disciplines and professions and foster an unnecessary
interprofessional divide. Thus the competencies that appear below are structured as a single integrated set.
Long and detailed
competency sets
overwhelm the reader,
the educator, the
interprofessional team
leader, and the direct
care provider. Clarity and
simplicity was the goal.
7SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
METHOD The method for arriving at the core set of competencies involved three major activities: (1) structured interviews with the key informants; (2) review of the recent literature on integration, and (3) review and analysis of selected competency sets judged to have relevance to this process. Each of these sources yielded potential content for inclusion in the competency set. Using a qualitative and consensus driven process, the Project Team integrated and distilled the recommendations into a number of competency categories and then placed individual competencies within those categories. A draft competency set was reviewed by the Senior Content Advisors and Key Informants
and revised based on the feedback received. A more detailed description of the methodology is contained in Appendix II.
USING THE CORE COMPETENCIES The identification of core competencies creates an essential foundation for preparing and further developing a workforce to deliver
integrated care. These competencies can be used to further that agenda in multiple ways.
Shaping Workforce Training Competency sets are a reference point for educators who are designing and delivering a training curriculum. This set of competencies on integrated care can be used to identify the need for training courses and can shape the content of such courses. It can be used to update and expand the focus of existing courses, to design continuing education events, and to select topics for in-service education
within healthcare organizations.
Informing Job Descriptions The competencies can be used to develop or update job descriptions and duties for positions within settings where integrated care is delivered. Lack of role clarity is a prime driver of dissatisfaction with and turnover in healthcare positions. Greater clarity in job
descriptions and job roles can help improve employee satisfaction and retention.
Employee Recruitment These competencies in integrated care can be used in the recruitment process to educate prospective employees about the nature of the work, since “realistic job previews” tend to decrease the frequency with which candidates are offered and/or accept jobs for which they are not well suited. Similarly, the competencies can be used to assess the qualifications of job candidates, both during a review of
applications and during the interview process.
A Guide to Orientation The competencies can be used as a guide to orienting new employees to their role and responsibilities in the delivery of integrated care. Supervisors and employees can jointly review the competencies and discuss the employee’s perspective on areas where additional
training and mentoring may be beneficial.
Performance Assessment Competencies should be the foundation on which assessments of performance are based. These competencies on integrated care can be incorporated into employee self-assessment tools, 360-degree evaluations, and formal performance reviews used within
healthcare organizations.
Shaping Existing & Future Competency Sets There are many existing competency sets that have been developed for the health professions, for the direct care workforce, and for peer support workers. The integrated care competencies identified in this document can be used by the developers of existing competency sets as a benchmark for assessing the extent to which those other sets adequately incorporate content regarding integrated care. Those sets can be updated based on such a review and new competency sets under development can draw from the information within this
report as well.
8SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
CORE COMPETENCY CATEGORIES
The competencies are organized into nine competency categories. These were not determined in advance, but emerged from the key informant interviews, the literature review, and examination of other competency sets. Some of the competencies could appear in more than one category, but were placed in the category deemed most relevant. The categories that emerged from the process are outlined in Table 1.
TABLE 1. SPECIFIC COMPETENCIES BY CATEGORY
I. INTERPERSONAL COMMUNICATION
The ability to establish rapport quickly and to communicate effectively with consumers of healthcare, their family members and other providers.
Examples include: active listening; conveying information in a jargon-free, non-judgmental manner; using terminology common to the setting in which care is delivered; and adapting to the preferred mode of communication of the consumers and families served.
II. COLLABORATION & TEAMWORK
The ability to function effectively as a member of an interprofessional team that includes behavioral health and primary care providers, consumers and family members.
Examples include: understanding and valuing the roles and responsibilities of other team members, expressing professional opinions and resolving differences of opinion quickly, providing and seeking consultation, and fostering shared decision-making.
III. SCREENING & ASSESSMENT
The ability to conduct brief, evidence-based and developmentally appropriate screening and to conduct or arrange for more detailed assessments when indicated.
Examples include screening and assessment for: risky, harmful or dependent use of substances; cognitive impairment; mental health problems; behaviors that compromise health; harm to self or others; and abuse, neglect, and domestic violence.
IV. CARE PLANNING & CARE COORDINATION
The ability to create and implement integrated care plans, ensuring access to an array of linked services, and the exchange of information among consumers, family members, and providers.
Examples include: assisting in the development of care plans, whole health, and wellness recovery plans; matching the type and intensity of services to consumers’ needs; providing patient navigation services; and implementing disease management programs.
V. INTERVENTION
The ability to provide a range of brief, focused prevention, treatment and recovery services, as well as longer-term treatment and support for consumers with persistent illnesses.
Examples include: motivational interventions, health promotion and wellness services, health education, crisis intervention, brief treatments for mental health and substance use problems, and medication assisted treatments.
VI. CULTURAL COMPETENCE & ADAPTATION
The ability to provide services that are relevant to the culture of the consumer and their family.
Examples include: identifying and addressing disparities in healthcare access and quality, adapting services to language preferences and cultural norms, and promoting diversity among the providers working in interprofessional teams.
9SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
VII. SYSTEMS ORIENTED PRACTICE
The ability to function effectively within the organizational and financial structures of the local system of healthcare.
Examples include: understanding and educating consumers about healthcare benefits, navigating utilization management processes, and adjusting the delivery of care to emerging healthcare reforms.
VIII. PRACTICE-BASED LEARNING & QUALITY IMPROVEMENT
The ability to assess and continually improve the services delivered as an individual provider and as an interprofessional team.
Examples include: identifying and implementing evidence-based practices, assessing treatment fidelity, measuring consumer satisfaction and healthcare outcomes, recognizing and rapidly addressing errors in care, and collaborating with other team members on service improvement.
IX. INFORMATICS
The ability to use information technology to support and improve integrated healthcare.
Examples include: using electronic health records efficiently and effectively; employing computer and web-based screening, assessment, and intervention tools; utilizing telehealth applications; and safeguarding privacy and confidentiality.
1. Establish rapport, rapidly develop, and maintain effective working relationships with diverse individuals, including healthcare consumers, family members, and other providers.
2. Listen actively and effectively, as demonstrated by the ability to quickly grasp presenting problems, needs, and preferences as communicated by others, and reflect back that information to ensure that others have been accurately understood.
3. Clearly convey relevant information in a non- judgmental manner about behavioral health, general health, and health behaviors using person-centered concepts and terms that are free of jargon and acronyms and are easily understood by the listener.
4. Explain to the healthcare consumer and family the roles and responsibilities of each team member and how they will work together to provide services.
5. In speaking to healthcare consumers or professionals, use the terminology that is common to the setting in which care is delivered or advocate for and educate others about the rationale for using alternative language.
6. Use the primary language and preferred mode of communication of the healthcare consumer and family members or communicate through the use of qualified interpreters.
7. Adapt the style of communication to account for the impact of health conditions on a healthcare consumer’s ability to process and understand information.
8. Provide health education materials that are appropriate to the communication style and literacy of the healthcare consumer and family and that reinforce information provided verbally during healthcare visits.
9. Recognize and manage personal biases related to healthcare consumers, families, health conditions and healthcare delivery.
I. INTERPERSONAL COMMUNICATION
10SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
1. Recognize, respect and value the role and expertise of healthcare consumers, family members, and both behavioral health and primary care providers in the process of healthcare delivery.
2. Develop a shared understanding of the respective roles and responsibilities of team members to ensure that collaboration is efficient.
3. Recognize the limits of one’s knowledge and skills and seek assistance from other providers.
4. Serve as an effective member of an interprofessional team, helping other providers on the team to quickly conceptualize a healthcare consumer’s strengths, healthcare problems, and an appropriate plan of care.
5. Exhibit leadership by directing, guiding, or influencing the collaboration and service delivery of the healthcare team.
6. Respect and respond to the leadership displayed by other providers in a healthcare setting or team.
7. Assertively represent one’s professional opinions, encourage other team members to express opinions, and resolve differences of opinion or conflicts quickly and without acrimony.
8. Advocate within the healthcare setting or team for the role of the healthcare consumer and family member in healthcare decisions.
9. Facilitate collaborative care by actively sharing relevant information with others through communications that are authorized by the healthcare consumer and are permissible under HIPAA and related laws, regulations and policies.
10. Foster shared decision-making with healthcare consumers, family members, and other providers.
11. Respond to the expressed needs of healthcare consumers, family members, and other providers, while minimizing the extent to which provider preconceptions of illness and treatment obscure those expressed needs.
12. Demonstrate practicality, flexibility, and adaptability in the process of working with others, emphasizing the achievement of treatment goals as opposed to rigid adherence to treatment models.
13. Connect healthcare consumers and family members to other members of the healthcare team through face-to-face encounters known as “warm hand-offs.”
14. Use behavioral health and general health interventions to support the work of the team and to enhance healthcare consumer outcomes.
15. Respond immediately, if at all possible, to requests for consultation or intervention from other providers.
16. Adapt health interventions to the work flow and pace that typically characterizes the provision of primary care, including rapid assessment, brief treatment, and a high daily volume of healthcare consumer contacts.
17. Advocate for, teach, and support illness and whole health self-management and recovery approaches to health conditions within the healthcare team and setting.
18. Advocate for and foster the use of peer support approaches and peer support providers in the healthcare setting as a
component of healthcare delivery.
II. COLLABORATION & TEAMWORK
11SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
1. Use strengths-based wellness, resilience, and recovery models in conceptualizing the health and healthcare of consumers.
2. Routinely conduct brief, evidence-based, and developmentally sensitive screens for the risky, harmful, or dependent use of substances, including alcohol, illicit drugs, and prescription medications, and appropriateness for agonist, antagonist, and anti- craving medications.
3. Routinely conduct brief, evidence-based, and developmentally appropriate screens for cognitive impairment, common mental health problems, and behaviors that compromise health.
4. Routinely conduct brief screens for risk related to self-harm, harm to others, impairments in functional self-care, and environmental safety.
5. Detect signs of abuse, neglect, domestic violence, and other trauma in individuals across the lifespan.
6. Conduct or have other team members conduct more detailed, yet efficient, assessments of healthcare consumers who screen positive for mental and substance use conditions, risk to self or others, or potential abuse and neglect.
7. Recognize and diagnose, using established classification criteria, the most common mental health and substance use conditions seen in the healthcare setting.
8. Recognize the signs, symptoms and treatments of the most common health conditions, health crises, and comorbidity seen in the healthcare setting.
9. Understand the symptoms and treatments for the major healthcare conditions of the consumers under the provider’s care.
10. Briefly assess the nature of the consumer’s family and social support system and other socio-economic resources that have an impact on health and healthcare.
11. Determine collaboratively the feasibility of providing effective treatment to the healthcare consumer and family within the context of
the healthcare team and setting.
III. SCREENING & ASSESSMENT
IV. CARE PLANNING & CARE COORDINATION
1. Create and periodically update integrated care plans in consultation with healthcare consumers, family members, and other providers, including individuals identified by consumers as part of their healthcare team.
2. Work with healthcare consumers to develop whole health and wellness recovery plans.
3. Match and adjust the type and intensity of services to the needs of the healthcare consumer, ensuring the timely and unduplicated provision of care.
4. Through the care plans, link multiple services, healthcare providers, and community resources to meet the healthcare consumers’ needs.
5. Ensure the flow and exchange of information among the healthcare consumer, family members, and linked providers.
6. Work collaboratively to resolve differing perspectives, priorities and schedules among providers.
12SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
7. Provide or arrange access to “patient navigation” services that focus on benefits and financial counseling, transportation, home care, and access to social services, peer support, and treatment, including medications.
8. Establish and support systems and procedures within the team and healthcare setting for the use of agonist, antagonist, and anti-craving medications.
9. Coordinate with health plans in identifying and addressing individual consumer and population needs.
10. Implement disease management programs and strategies for selected health conditions, combining the use of engagement tools, health risk assessments, cognitive and behavioral interventions, medications, web-based tools, protocols and guidelines, formularies, monitoring devices, shared decision-making aides, illness and whole health self-management strategies, peer support and empowerment approaches, and call centers.
11. Effectively connect healthcare consumers who cannot be adequately treated by the team or within the setting to other
appropriate services.
V. INTERVENTION 1. Demonstrate a fundamental belief in the value and
effectiveness of brief interventions to improve health through practice patterns and communications with healthcare consumers, family members, and other providers.
2. Use focused interventions to engage healthcare consumers and increase their desire to improve health (e.g., motivational interviewing, motivational enhancement therapy).
3. Promote healthcare consumer and family adherence to care plans.
4. Educate healthcare consumers, family members, and other providers about healthcare conditions, prevention, available treatments, illness and whole health self-management, peer support and recovery.
5. Identify evidence-based interventions and best practices for integrated care settings.
6. Provide health promotion, wellness and prevention interventions.
7. Deliver brief, trauma-informed, problem-oriented treatment for mental conditions or problematic health behaviors.
8. Deliver brief, trauma-informed treatment for risky or harmful substance use conditions, including the misuse of prescription drugs.
9. Deliver brief, supportive interventions addressing the consequences of illness and injury.
10. Implement longer-term models of treatment and support for healthcare consumers with persistent illnesses that require follow-up over time.
11. Prescribe and manage medications for mental health and substance use conditions (appropriately licensed providers only), including Medically Assisted Treatments for addictions, with consultation, as needed, from other prescribing professionals.
12. Educate healthcare consumers and family members about the common effects, side effects, potential long-term adverse health effects, and interactions of pharmacological treatments for mental health and substance use conditions.
13. Recognize the primary indications, effects, and side effects of pharmacological agents used in the treatment setting for the most common health conditions.
14. Recognize the potential impact and interaction of over-the-counter medications and other non-prescription remedies on health and healthcare treatments.
15. Manage behavioral health crises through office and home-based interventions and linkage to treatment facilities.
13SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
16. Link healthcare consumers and family members with other resources, including but not limited to specialty healthcare, rehabilitation and social services, peer support, financial assistance, and transportation, following up to ensure that effective connections have been made.
17. Support healthcare consumers in considering and accessing complementary and alternative services designed to support health and wellness.
18. Provide information, education, guidance, and support to family members and other caregivers.
VI. CULTURAL COMPETENCE & ADAPTATION
1. Identify and address disparities in healthcare access and quality for diverse individuals and populations served.
2. Adapt services, including evidence-based interprofessional team approaches, to the language, cultural norms, and individual preferences of healthcare consumers and family members.
3. Develop collaborative relationships with providers of services tailored to the needs of culturally diverse healthcare consumers and family members.
4. Examine the experiences of culturally diverse healthcare consumers and family members with respect to quality of care and adjust the delivery of care as needed.
5. Educate members of the team about the characteristics, healthcare needs, health behaviors, and views toward illness and treatment of diverse populations served in the treatment setting.
6. Foster and value diversity in terms of the composition of the interprofessional team members in all roles, including, but not
limited to, community health workers.
VII. SYSTEMS ORIENTED PRACTICE
1. Understand and practice effectively within the organization and culture of the interprofessional team, practice setting, and local healthcare system.
2. Provide or arrange assistance to healthcare consumers, family members and other providers in understanding applicable healthcare benefits, coverage limits, and utilization management procedures.
3. Organize and deliver services with an understanding of the impact of team based care on billing, reimbursement, and healthcare coverage.
4. Consider both clinical and cost-effectiveness in decision-making about the organization and delivery of services.
5. Anticipate and adjust the delivery of care to emerging healthcare reforms and structures, such as accountable care organizations, medical homes, and health insurance exchanges.
6. Plan and deliver services with an understanding of the healthcare needs of the population being served.
14SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
VIII. PRACTICE-BASED LEARNING & QUALITY IMPROVEMENT
1. Search and evaluate the literature for evidence of the most effective interventions for specific health conditions.
2. Apply relevant practice guidelines to the delivery of care.
3. Deliver evidence-based, integrated approaches to the treatment of health conditions, adapting them to the population, treatment setting, and local system of care.
4. Assess the fidelity of team-based care to evidence-based treatment models.
5. Identify and rapidly address errors in care and assist in implementing policies and procedures to reduce future errors.
6. Measure and monitor individual health outcomes in collaboration with the consumer, adjusting care plans based on outcome data.
7. Monitor healthcare consumer and family satisfaction with care on multiple dimensions and adjust care and practice patterns based on the feedback.
8. Recognize the importance of monitoring client outcomes in the aggregate and demonstrate an ability to read and interpret outcomes monitoring reports.
9. Monitor aggregate consumer health care outcomes and collaborate with the team in improving the process of care based on the data.
10. Collaborate with the healthcare organization and other local healthcare agencies to continuously assess and improve service system design.
11. Establish and pursue individual and team-based learning and improvement goals.
IX. INFORMATICS
1. Use an electronic health record to retrieve relevant information and to document care concisely.
2. Screen, assess and provide services to healthcare consumers using computer-based and web-based tools.
3. Employ telehealth applications to ensure consumer access to appropriate care and to deliver healthcare.
4. Assist healthcare consumers in using web-based tools as part of their personal healthcare plan.
5. Communicate with healthcare consumers and family members using secure online, mobile, and “smart” technology and devices.
6. Safeguard healthcare consumer privacy and confidentiality with respect to communication, documentation, and data.
15SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
REFERENCES Air Force Medical Operations Agency, Behavioral Health Optimization Program, Mental Health Division/SGHW. (2011, April). Primary behavioral health care services practice manual, version 2.0. Lackland AFB, TX: Author.
Alakeson, V., Frank, R. G., & Katz, R. E. (2010). Specialty care medical homes for people with severe, persistent mental disorders. Health Affairs, 29(5), 867-873. doi: 10.1377/hlthaff.2010.0080
Alexander, L., Quintanilla, R., Schlesinger, B., & Goldstein, B. (2010, June 3). Addressing mental health problems in primary care: IMPACT and other approaches [Webinar series]. California Institute for Mental Health, Alcohol & Drug Policy Institute, Integrated Behavioral Health Project. Retrieved from http://www.cimh.org/post/integration-initiatives-webinars
Anastasi, J. K., Capili, B., & Schenkman, F. (2009). Developing an integrative therapies in primary care program. Nurse Educator, 34(6), 271-275. doi:10.1097/NNE.0b013e3181bc747a
Bascetta, C. A. (2010). Healthcare delivery: Features of integrated systems support patient care strategies and access to care, but systems face challenges (GAO-11-49). Washington, DC: United States Government Accountability Office.
Bjerkan, J., & Alonso, A. (2010). Patients and professionals in collaborative testing. Studies in Health Technology and Informatics, 157, 66-71. Retrieved from http://www.ebooks.iospress.nl/bookseries/studies-in-health-technology-and-informatics
Blount, A. F., & Miller, B. F. (2009). Addressing the workforce crisis in integrated primary care. Journal of Clinical Psychology in Medical Settings, 16(1), 113-119. doi: 10.1007/s10880-008-9142-7
Bluestein, D., & Cubic, B. A. (2009). Psychologists and primary care physicians: A training model for creating collaborative relationships. Journal of Clinical Psychology in Medical Settings, 16(1), 101-112. doi:10.1007/s10880-009-9156-9
Brawer, P. A., Martielli, M., Patrice, P. L., Manwaring, J., & Tierney, A. (2010). St. Louis initiative for integrated care excellence (SLI2CE): Integrated-collaborative care on a large scale model. Families, Systems & Health, 28(2), 175-187. doi:10.1037/A0020342
Bryan, C. J., Morrow, C., & Appolonio, K. K. (2009). Impact of behavioral health consultant interventions on patient symptoms and functioning in an integrated family medicine clinic. Journal of Clinical Psychology, 65(3), 281-293. doi:10.1002/jclp.20539
Chalk, M., Dilonardo, J., Gelber Rinaldo, S. G, & Oehlmann, P. (2010, July). Integrating appropriate services for substance use conditions in health care settings: An issue brief on lessons learned and challenges ahead. Forum on Integration: A collaborative for States. Retrieved from http://www.tresearch.org/download/policy_briefs/LessonsLearned.pdf
Chang-Quan, H., Bi-Rong, D., Zhen-Chan, L., Yuan, Z., Yu-Sheng, P., & Qing-Xiu, L. (2009). Collaborative care interventions for depression in the elderly: A systematic review of randomized controlled trials. Journal of Investigative Medicine, 57(2), 446-455. doi: 10.231/JIM.0b013e3181954c2f
Cummings, N. A., O’Donohue, W. T., & Cummings, J. L. (2009). The financial dimension of integrated behavioral/primary care. Journal of Clinical Psychological Medical Settings, 16(1), 31-39. doi:10.1007/s10880-008-9139-2
Cunningham, P. J. (2009). Beyond parity: Primary care physicians’ perspectives on access to mental health care. Health Affairs, 28(3), w490-w501. doi:10.1377/hlthaff.28.3.w490
Daniels, A. S., Adams, A., Carroll, C., & Beinecke, R. H. (2009). A conceptual model for behavioral health and primary care integration. International Journal of Mental Health, 38(1), 100-112. doi:10.2753,imh0020-7411380109
Druss, B. G., & Walker, E. R. (2011, February). Mental disorders and medical comorbidity. (Research Synthesis Report No. 21). Retrieved from Robert Wood Johnson website: http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/02/mental- disorders-and-medical-comorbidity.html
Easterly, L. (2009). An educational model for workforce development: Dissemination of evidence-based practices. Community Mental Health Journal, 45, 199-208. doi: 10.1007/s10597-008-9170-7
Eichbaum, Q., Grennan, T., Young, H., & Hurt, M. (2010). An alternative model for medical education: Longitudinal medical education within an integrated health care organization - a vision of a model for the future? The Permanente Journal, 14(3), 44-49. Retrieved from http://www.thepermanentejournal.org
16SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
Fielding, S. (2010). Integrative medicine: Improving health care for patients and health care delivery for providers and payors. Minneapolis, MN: The Bravewell Collaborative.
Foy, J. M., Kelleher, K. J., & Laraque, D. (2010). Enhancing pediatric mental health care: Strategies for preparing a primary care practice. Pediatrics, 125, S87-S108. doi: 10.1542/peds.2010-0788E
Funderbunk, J. S., Sugarman, D. E., Maisto, A. M., Ouimette, P., Schohn, M., Lantinga, L.,… Strutynski, K. (2010). The description and evaluation of the implementation of an integrated health care model. Families, Systems & Health, 28(2), 146-160. doi:10.1037/a0020223
Gaboury, I., Lapierre, L. M., Boon, H., & Moher, D. (2011). Interprofessional collaboration within integrative healthcare clinics through the lens of the relationship-centered care model. Journal of Interprofessional Care, 25, 124-130. doi:10.3109/13561820.2010.523654
Goodell, S., Druss, B. G., & Walker, E. R. (2011, February). Mental disorders and medical comorbidity (Policy Brief No. 21). Retrieved from Robert Wood Johnson website: http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/02/mental-disorders-and- medical-comorbidity.html
Haggerty, J. M., Ryan-Nicholls, K. D., & Jarva, J. A. (2010). Mental health collaborative care: A synopsis of the rural and isolated toolkit. Rural and Remote Health, 10(1), 1-10. Retrieved from http://www.rrh.org.au
Hawkes, N. (2009). Joined up thinking: The government hopes that integration of services will improve care, but as Nigel Hawkes reports the pilot schemes have a lot to prove. British Medical Journal, 338, 1238-1239. Retrieved from http://www.bmj.com
Hoge, M. A., Morris, J. A., Stuart, G. W., Leighton, Y. H., Bergeson, S., Flaherty, M.,… Madenwald, K. (2009). A national action plan for workforce development in behavioral health. Psychiatric Services, 60(7), 883-887. doi:10.1176/appi.ps.60.7.883
Hogg Foundation for Mental Health & Methodist Healthcare Ministries. (2011). Crisis point: Mental health workforce shortages in Texas. Austin, TX: Author.
Homer, C. J. (2009). Health disparities and the primary care medical home: Could it be that simple? Academic Pediatrics, 9(4), 203-205. doi:10.1016/j.acap.2009.06.001
Humphreys, J., Wakerman, J., Kuipers, P., Wells, B., Russell, P., Siegloff, S., & Homer, K. (2009). Improving workforce retention: Developing an integrated logic to maximise sustainability of small rural & remote healthcare services. Acton ACT, Australia: The Australian National University.
Hunter, C. L., Goodie , J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Integrated behavioral health in primary care. Washington, DC: American Psychological Association.
Integrated Behavioral Health Project. (2009, October). Partners in Health – primary care / county mental health collaboration toolkit. Retrieved from http://www.ibhp.org/uploads/file/IBHP%20Collaborative%20Tool%20Kit%20final.pdf
James L. C., & O’Donohue, W. T. (2010). The primary care toolkit: Practical resources for the integrated behavioral care provider. New York, NY: Springer.
Katon, W. J. (2009). Collaborative care: Evidence-based models that improve primary care depressive outcomes. CNS Spectrums, 14(12 Suppl 14), 10-13. Retrieved from http://journals.cambridge.org/action/displayJournal?jid=CNS
Kessler, W., & Cubic, B. (2009). The train is leaving the station: Is psychology aboard? Journal of Clinical Psychology in Medical Settings, 16, 1-3. doi:10.1007/s10880-009-9157-8
Kessler, W., Stafford, D., & Messier, R. (2009). The problem of integrating behavioral health in the medical home and the question it leads to. Journal of Clinical Psychology in Medical Settings, 16(1), 4-12. doi:10.1007/s10880-009-9146-y
Kilbourne, A. M., Greenwald, D. E., Hermann, R. C., Charns, M. P., McCarthy, J. F., & Yano, E. M. (2010). Financial incentives and accountability for integrated medical care in department of veteran affairs mental health programs. Psychiatric Services, 61(1), 38-44. doi:10.1176/appi.ps.61.1.38
Kirchner, J., Edlund, C. N., Haenderson, K., Daily, L., Parker, L. E., & Fortney, J. C. (2010). Using a multi-level approach to implement a primary care mental health (pcmh) program. Families, Systems & Health, 28(2), 161-174. doi:10.1037/a0020250
17SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
Knowles, P. (2009). Collaborative communication between psychologists and primary care providers. Journal of Clinical Psychology in Medical Settings, 16, 72-76. doi: 10.1007/s10880-009-9151-1
Kodner, D. (2009). All together now: A conceptual exploration of integrated care. Healthcare Quarterly, 13, 6-15. doi:10.12927/ hcq.2009.21091
Koo, D., & Miner, K. (2010). Outcome-based workforce development and education in public health. Annual Review of Public Health, 31, 253-269. doi: 10.1146/annurev.publhealth.012809.103705
Lardiere, M. R., Jones, E., & Perez, M. (2011). NACHC 2010 assessment of behavioral health services in federally qualified health centers. Bethesda, MD: National Association of Community Health Centers.
Mathematica Policy Research. (2010). Integrating mental health treatment into the patient centered medical home (AHRQ Publication No. 10-0084-EF). Retrieved from http://pcmh.ahrq.gov/page/integrating-mental-health-treatment-patient-centered-medical-home
Mauer, B. J. (2009). Behavioral health / primary care integration and the person-centered healthcare home. Washington, DC: National Council for Community Behavioral Healthcare.
Mauer, B. J. (2010). Substance use disorders and the person-centered healthcare home. Washington, DC: National Council for Community Behavioral Healthcare.
Mauer, B. J., & Jarvis, D. (2010). The business case for bidirectional integrated care: Mental health and substance use services in primary care settings and primary care services in specialty mental health and substance use settings. Seattle, WA: MCPP Healthcare Consulting.
Maxwell, W. A., Alexander, K. P., & Ratliff, R. E. (2009, April). Reorganizing to provide integrated care. Behavioral healthcare, 29, 5. Retrieved from http://www.behavioral.net/article/reorganizing-provide-integrated-care
McColl, M. A., Shortt, S., Godwin, M., Smith, K., Rowe, K., O’Brien, P., & Donnelly, C. (2009). Models for integrating rehabilitation and primary care: A scoping study. Archives of Physical Medicine and Rehabilitation, 90(9), 1523-1531. doi: 10.1016/j.apmr.2009.03.017
Meyer, F., Peteet, J., & Joseph, R. (2009). Models of care for co-occurring mental and medical disorders. Harvard Review of Psychiatry, 17(6), 353-360. doi:10.3109/10673220903463325
Miller, B. F., Mendenhall, T. J., & Malik, A. D. (2008). Integrated primary care: An inclusive three-world view through process metrics and empirical discrimination. Journal of Clinical Psychology in Medical Settings, 16(1), 21-30. doi:10.1007/s10880-008-9137-4
Ministry of Health. (2009). Towards optimal primary mental health care in the new primary care environment: A draft guidance paper. Wellington: Author.
Morgan, M., Dunbar, J., Reddy, P., Coates, M., & Leahy, R. (2009). The true blue story: Is practice nurse-led collaborative care effective in the management of depression for patients with heart disease or diabetes? BMC Family Practice, 10(46), doi:10.1186/1471-2296-10-46
Morrow, C. E., Mansoor, E., Hanson, K. L., Vogel, A. L., Rose-Jacobs, R., Genatossio, C. S.,… Bandstra, E. S. (2009). The starting early starting smart integrated services model: Improving access to behavioral health services in the pediatric health care setting for at-risk families with young children. Journal of Child and Family Studies, 19(1), 42-56. doi: 10.1007/s10826-009-9280-z
Murphy, M. K., Chabon, B., Delgado, A., Newville, H., & Nicolson, S. E. (2009). Development of a substance abuse consultation and referral service in an academic medical center: Challenges, achievements and dissemination. Journal of Clinical Psychology in Medical Settings, 16(1), 77-86. doi:10.1007/s10880-009-9149-8
O’Donohue, W. T., Cummings, N. A., & Cummings, J. L. (2009). The unmet educational agenda in integrated care. Journal of Clinical Psychology in Medical Settings, 16(1), 94-100. doi: 10.1007/s10880-008-9138-3
Patel, K. J., & Dwamena, F. (2009). Impact of collaborative care management of depression among patients with cancer. Journal of Clinical Oncology, 27(10), 1730. doi: 10.1200/JCO.2008.21.1094
Peek, C. J. (2009). Integrating care for persons, not only diseases. Journal of Clinical Psychology in Medical Settings, 16(1), 13-20. doi:10.1007/s10880-009-9154-y
Pisani, A. R., leRoux, P., Phil, D., & Siegel, D. M. (2011). Educating residents in behavioral health care and collaboration: Integrated clinical training of pediatric residents and psychology fellows. Academic Medicine, 86(2), 166-173. doi: 10.1097/ACM.0b013e318204fd94
18SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
Pomerantz, A. S., Corson, J. A., & Detzer, M. J. (2009). The challenge of integrated care for mental health: Leaving the 50 minute hour and other sacred things. Journal of Clinical Psychology in Medical Settings, 16(1), 40-46. doi:10.1007/s10880-009-9147-x
Pomerantz, A. S., & Sayers, S. L. (2010). Primary care-mental health integration in healthcare in the department of veteran affairs. Families, Systems & Health, 28(2), 78-82. doi: 10.1037/a0020341
Pomerantz, A. S., Shiner, B., Watts, B. V., Detzer, M. J., Kutter, C., Street, B., & Scott, D. (2010). The white river model of colocated collaborative care: A platform for mental and behavioral health care in the medical home. Families, Systems & Health, 28(2), 114-129. doi:10.1037/a0020261
Post, E. P., Metzger, M., Dumas, P., & Lehmann, L. (2010). Integrating mental health into primary care within the veterans health administration. Families, Systems & Health, 28(2), 83-90. doi:10.1037/a0020130
Protti, D. (2009). Integrated care needs integrated information management and technology. Healthcare Quarterly, 13, 24-29. Retrieved from http://www.longwoods.com/publications/healthcare-quarterly
Pyne, J. M., Fortney, J. C., Curran, G. M., Tripathi, S., Atkinson, J. H., Kilbourne, A. M.,…Gifford, A. L. (2011). Effectiveness of collaborative care for depression in human immunodeficiency virus clinics. Archives of Internal Medicine, 171(1), 23-31. doi:10.1001/ archinternmed.2010.395
Ring, J. M. (2009). Psychology and medical education: Collaborations for culturally responsive care. Journal of Clinical Psychology in Medical Settings, 16(1), 120-126. doi: 10.1007/s10880-008-9141-8
Robinson, P. J., & Strosahl, K. D. (2009). Behavioral health consultation and primary care: Lessons learned. Journal of Clinical Psychology in Medical Settings, 16(1), 58-71. doi: 10.1007/s10880-009-9145-z
Roche, A. M., Pidd, K., & Freeman, T. (2009). Achieving professional practice change: From training to workforce development. Drug and Alcohol Review, 28(5), 550-557. doi: 10.1111/j.1465-3362.2009.00111.x
Rosenthal, E. L., Brownstein, J. N., Rush, C. H., Hirsch, G. R., Willaert, A. M., Scott, J. R.,…Fox, D. J. (2010). Community health workers: Part of the solution. Health Affairs, 29(7), 1338-1342. doi:10.1377/hlthaff.2010.0081
RTI–UNC Evidence-Based Practice Center. (2010). Future research needs for the integration of mental health/substance abuse and primary care (AHRQ Publication No. 10-EHC069-EF). Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK51247
Russell, L. (2010). Mental health care services in primary care tackling the issues in the context of health care reform. Washington, DC: Center for American Progress.
Ruston, A., & Tavabie, A. (2010). Fostering clinical engagement and medical leadership and aligning cultural values: An evaluation of a general practice specialty trainee integrated training placement in a primary care trust. Quality in Primary Care, 18(4), 263-268. Retrieved from http://www.ingentaconnect.com/content/rmp/qpc
Sanchez, K., Thompson, S., & Alexander, L. (2010). Current strategies and barriers in integrated health care: A survey of publicly funded providers in Texas. General Hospital Psychiatry, 32(1), 26-32. doi:10.1016/j.genhosppsych.2009.10.007
Schmied, V., Mills, A., Kruske, S., Kemp, L., Fowler, C., & Homer, C. (2010). Understanding the needs and experiences of families: The nature and impact of collaboration and integrated service delivery for pregnant women, children and families. Journal of Clinical Nursing, 19, 3516–3526. doi:10.1111/j.1365-2702.2010.03321.x
Schoen, C., Osborn, R., Doty, M. M., Squires, D., Peugh, J., & Applebaum, S. (2009). A survey of primary care physicians in eleven countries, 2009: Perspectives on care, costs, and experiences. Health Affairs, 28(6), w1171-w1183. doi:10.1377/hlthaff.28.6.w1171
Schoenwald, S. K., Hoagwood, K. E., Atkins, M. S., Evans, M. E., & Ringeisen, H. (2010). Workforce development and the organization of work: The science we need. Administration and Policy in Mental Health, 37(1-2), 71–80. doi:10.1007/s10488-010-0278-z
Schuffman, D., Druss, B. G., & Parks, J. J. (2009). State mental health policy: Mending Missouri’s safety net: Transforming systems of care by integrating primary and behavioral health care. Psychiatric Services, 60(5), 585-588. doi: 10.1176/appi.ps.60.5.585
Sevin, C., Moore, G., Shepherd, J., Jacobs, T., & Hupke, C. (2009). Transforming care teams to provide the best possible patient-centered, collaborative care. Journal of Ambulatory Care Management, 32(1), 24-31. doi:10.1097/01.JAC.0000343121.07844.e0
19SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
Smith, M. (2010). Collaborative care models for late-life depression and anxiety: Roles for nurses. Journal of Gerontological Nursing, 36(9), 3-4. doi:10.3928/00989134-20100803-01
Strandberg-Larsen, M., & Krasnik, A. (2009). Measurement of integrated healthcare delivery: A systematic review of methods and future research directions. International Journal of Integrated Care, 9(4), 1-10. Retrieved from http://www.ijic.org/index.php/ijic
Summerfelt, W. T., Tilson, H. H., & Crawford, C. A. (2009). Moving forward with workforce development research in public health. Journal of Public Health Management Practice, 15(6 Suppl), 1-2. doi:10.1097/PHH.0b013e3181c5c050
Sved-Williams, A., & Poulton, J. (2010). Primary care mental health consultation-liaison: A connecting system for private psychiatrists and general practitioners. Australasian Psychiatry, 18(2), 125-129. doi:10.3109/10398560903469783
Thacker, S. B. (2009). Guide for applied public health workforce research: An evidence-based approach to workforce development. Journal of Public Health Management Practice, 15(6 Suppl), S109-112. doi:10.1097/PHH.0b013e3181b1eb85
The Commonwealth Fund. (2010). Quality matters: A bimonthly report on innovations in health care quality improvement. Washington, DC: Author.
Thombs, B. D., Adeponle, A. B., Kirmayer, L. J., & Morgan, J. F. (2010). A brief scale to assess hospital doctors’ attitudes toward collaborative care for mental health. Canadian Journal of Psychiatry, 55(4), 264-267. Retrieved from http://publications.cpa-apc.org/ browse/documents/2
U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2008). Integration of mental health/ substance abuse and primary care (AHRQ Publication No. 09-E003). Retrieved from http://www.ahrg.gov
van Orden, M., Hoffman, T., Haffmans, J., Spinhoven, P., & Hoencamp, E. (2009). Collaborative mental health care versus care as usual in a primary care setting: A randomized controlled trial. Psychiatric Services, 60(1), 74-79. doi: 10.1176/appi.ps.60.1.74
Walker, B. B., & Collins, C. A. (2009). Developing an integrated primary care practice: Strategies, techniques, and a case illustration. Journal of Clinical Psychology, 65(3), 268-280. doi:10.1002/jclp.20552
Weiss, S. J., Haber, J., Horowitz, J. A., Stuart, G. W., & Wolfe, B. (2009). The inextricable nature of mental and physical health: Implications for integrative care. Journal of the American Psychiatric Nurses Association, 15(6), 371-382. doi: 10.1177/1078390309352513
Wu, M. P., Lin, P. F., Lin, K. J., Sun, R. S., Yu, W. R,, Peng, L. N., & Chen, L. K. (2010). Integrated care for severely disabled long-term care facility residents: Is it better? Archives of Gerontology and Geriatrics, 50(3), 315-318. doi: 10.1016/j.archger.2009.05.004
Wylie, L. W. J. (2010). Assessing user perceptions of staff training requirements in the substance use workforce: A review of the literature. Drugs: Education, Prevention, and Policy, 17(5), 618-631. doi: 10.3109/09687631003705538
Zismer, D. K., McCullough, J., & Person, P. E. (2009). Integrated health care economics part 2: Understanding the revenue drivers in fully integrated community health systems. Physician Executive, 35(4), 26-28. Retrieved from http://www.acpe.org/publications/pej
Zismer, D. K., McCullough, J., Person, P. E., & Renier, C., & Knutson, D. (2009). Integrated health care economics part 1: Are specialty physician services revenues reliable predictors of community health system financial performance? Physician Executive, 35(3), 26-31. Retrieved from http://www.acpe.org/publications/pej
Zivin, K., Pfeiffer, P. N., Szymanski, B. R., Valenstein, M., Post, E. P., Miller, E. M., & McCarthy, J. F. (2010). Initiation of primary care-mental health integration programs in the VA health system: Associations with psychiatric diagnoses in primary care. Medical Care, 48(9), 843- 851. doi:10.1097/MLR.0b013e3181e5792b
20SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
APPENDIX I: CONTRIBUTORS
PROJECT TEAM CIHS engaged the Annapolis Coalition on the Behavioral Health Workforce (www.annapoliscoalition.org) to lead and manage the competency development project. The Coalition is a non-profit organization dedicated to improving the recruitment, retention, training and performance of the prevention and treatment workforce in the mental health and addictions sectors of the behavioral health field.
The core Annapolis Coalition team managing the project included:
Michael A. Hoge, PhD, Senior Science and Policy Advisor, The Annapolis Coalition John A. Morris, MSW, Executive Director, The Annapolis Coalition Michele Laraia, PhD, APRN, Project Consultant, The Annapolis Coalition
Ann McManis, Director of Operations, The Annapolis Coalition
Senior Content Experts Two individuals with nationally recognized expertise in this field were engaged as Senior Content Experts to provide a broad and high-level review of the product.
Andrew Pomerantz, M.D. is the National Mental Health Director for Integrated Services in the Veterans Health Administration and Associate Professor of Psychiatry at Dartmouth Medical School. His “White River” model of primary care – mental health integration, developed over a 15-year period, became a national model for the Veterans Administration in 2004. He is currently engaged in development of the VA’s Patient Centered Medical Home.
Tillman Farley, M.D. is the Medical Services Director of Salud Family Health Centers, a migrant / federally qualified community health center with clinics across north and northeast Colorado. He completed his residency in family medicine in Rochester, New York and now serves as an Associate Professor in the Department of Family Medicine at the University of Colorado School of Medicine. He moved to Colorado from far west Texas where he spent three years directing a federally qualified rural health clinic. Dr. Farley has a strong interest in integrated primary care and health disparities, particularly as these apply to immigrant populations.
Expert Key Informants The selection process and expertise of key informants is described in the Detailed Method section below.
Marty Adelman, MA, CRP Mental Health Coordinator Community Clinics Health Network San Diego, CA
Sergio Aguilar-Gaxiola, MD, PhD Professor & Director of the Center for Reducing Health Disparities University of California at Davis Davis, CA
Stephen J. Bartels, MD, MS Professor of Psychiatry, Community & Family Medicine Director, Center on Aging Research Dartmouth University Hanover, NH
Sue Bergeson Vice President Optum Health Chicago, IL
Richard Brown, MD, MPH Professor Department of Family Medicine University of Wisconsin Madison, WI
Kathleen Buckwalter, RN, PhD, FAAN Professor Emeritus, Sally Mathis Hartwig Professor in Gerontological Nursing University of Iowa College of Nursing Iowa City, IA
Elisabeth Cannata, PhD Vice President of Community-Based Family Services and
Practice Innovation Wheeler Clinic Plainville, CT
Jeff Capobianco, PhD Director of Practice Improvement SAMHSA-HRSA Center for Integrated Health Solutions, National
Council for Behavioral Health Washington, DC
Mady Chalk, PhD, MSW Director Center for Performance-Based Policy Treatment Research Institute Philadelphia, PA
21SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
Kathleen R. Delaney, PhD, PMH-NP, FAAN Professor and Specialty Coordinator Rush College of Nursing Chicago, IL
Guillermo Diaz, Jr, MD, CPHIMS Chief Medical Information Director QueensCare Family Clinics Los Angeles, CA
Tillman Farley, MD Director of Medical Services Salud Family Health Center Fort Lupton, CO
Michael Flaherty, PhD Consultant Former Director, NE Addiction Technology Transfer Center Pittsburgh, PA
Dennis Freeman CEO Cherokee Health Systems Knoxville, TN
Larry Fricks Deputy Director SAMHSA-HRSA Center for Integrated Health Solutions, National
Council for Behavioral Health Washington, DC
Steven L. Gallon, PhD Chair, Blending Team Northwest Frontier ATTC Oregon Health & Science University Portland, OR
Eric Goplerud, PhD Vice President for Mental Health, Substance Use and Justice NORC at University of Chicago Washington, DC
Catherine Grus, PhD Deputy Executive Director, Education Directorate American Psychological Association Washington, DC
Judith Haber, PhD, APRN, BC FAAN Interim Dean NYU College of Nursing New York, NY
Nancy P. Hanrahan, PhD, RN Psychiatric MH Nursing Center for Health Outcomes and Policy
Research University of Pennsylvania, School of Nursing Philadelphia, PA
Tom Hill, MSW Policy Director Faces and Voices of Recovery Washington, DC
Joseph Holshoe, PMHNP Commander, US Public Health Service Behavioral Health Consultant Primary Care Clinic Naval Health Center New England Newport, RI
Leighton Huey, MD Professor of Psychiatry University of Connecticut Farmington, CT
DJ Ida, PhD Executive Director National Asian American Pacific Islander Mental Health Association Denver, CO
Brain Kaskie, MD, PhD Associate Professor Dept. of Health Management and Policy College of Public Health University of Iowa Iowa City, IA
Kelly J. Kelleher, MD, MPH, FAAP Director, Center for Innovation in Pediatric Practice Nationwide Children’s Hospital Professor of Pediatrics Ohio State University Columbus, OH
Michael R. Lardieri, MSW Vice President, Health Information Technology National Council for Behavioral Health Washington, DC
Virna Little, PsyD, LCSW Senior Vice President for Psychosocial Services and Community Affairs The Institute for Family Health New York, NY
Amy Brock Martin, DrPH Deputy Director SC Rural Health Research Center University of South Carolina School of Public Health Columbia, SC
Dennis McCarty, PhD Professor Department of Public Health and Preventive Medicine Oregon Health & Science University Portland, OR
22SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
Mimi McFaul, PsyD Deputy Director, Mental Health Program Western Interstate Commission on Higher Education (WICHE) Boulder, CO
Bill McFeature, PhD Director of Integrative Behavioral Health Southwest Virginia Community Health Center Bristol, VA
Oscar Morgan, MHSA Vice President Magna Systems, Inc. Annapolis, MD
Rich Munger, PhD Planner/Evaluator Buncombe County Human Service Support Team Asheville, NC
Phyllis Panzano, PhD Founder and President Decision Support Services, Inc. Columbus, OH
Beth Phoenix, RN, PhD Health Sciences Clinical Professor Director, Psychiatric Nursing Graduate Program UCSF School of Nursing San Francisco, CA
Andrew Pomerantz, MD National Mental Health Director for Integrated Care Veterans Health Administration White River Junction VA Medical Center White River Junction, VT
Richard A. Rawson, PhD Associate Director UCLA Integrated Substance Abuse Programs Los Angeles, CA
Katherine Reynolds, MSW Vice President, Health Integration and Wellness Promotion National Council for Behavioral Health Washington, DC
Ruth Shim, MD Assistant Professor, Department of Psychiatry and Behavioral Sciences Associate Director of Behavioral Health National Center for Primary Care Morehouse School of Medicine Atlanta, GA
Tony Salerno, PhD Practice and Policy Scholar McSilver Institute for Poverty Policy & Research Silver School of Social Work New York University Senior Consultant, CIHS New York, NY
Kim Schwartz, MSW CEO Roanoke Chowan Community Health Center Ahoskie, NC
Margaret Sharf, DNP PMHNP Program Director Oregon Health & Science University School of Nursing Portland, OR
Diane Snow, PhD, APRN, BC, CARN, PMHNP Clinical Professor and Director PMHNP Program University of Texas at Arlington Hurst, TX
Mark B. Snowden, MD, MPH Associate Professor University of Washington Seattle, WA
Gail Stern, MSN, PMHCNS-BS Administrator Department of Psychiatry Lehigh Valley Health Network Coopersburg, PA
Gail Stuart, PhD, RN, FAAN Dean College of Nursing Medical University of South Carolina Charleston, SC
Michael Terry, DNP, APRN-PMH/FNP Associate Clinical Professor Nurse Practitioner Program University of San Diego Hahn School of Nursing & Health Sciences San Diego, CA
Roberta Waite, EdD, APRN, CNS-BC, FAAN Assistant Dean of Integration Division of Graduate Nursing Drexel University Philadelphia, PA
Karen Williams, MS VP for Programs West End Medical Centers Atlanta, GA
Beth Wrobel CEO Healthlinc Community Health Center, Michigan City, IN
23SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
APPENDIX II: DETAILED METHOD
Overview The method for arriving at the core set of competencies involved three major activities: (1) structured interviews with the key informants; (2) review of the recent literature on integration; and (3) review and analysis of selected competency sets judged to have relevance to this process.
Key Informants The foundation of the core competencies rests on recommendations from 50 key informants who were selected because of their expertise on integrated care. They were identified in multiple ways, including: authorship of articles and other resources on the topic of integration, nomination by other experts, nomination by the SAMHSA-HRSA Center for Integrated Health Solutions, leadership within a HRSA- supported FQHC, leadership role in a community behavioral health organization that is a grantee within the SAMHSA-sponsored Primary and Behavioral Health Care Integration (PBHCI) program, and national leadership in peer support and recovery.
Special efforts were made to ensure that the key informant pool included individuals whose expertise reflected knowledge of and practice in the following: integration of primary care and behavioral healthcare; development of professional competencies; the unique needs of children, adults, and older adults; urban and rural healthcare; cultural competence, diversity, and disparities; and healthcare financing and managed care. Experts were drawn from varied disciplines and specialties, including: internal medicine and family medicine, public health, addictions, psychiatry, social work, nursing and peer support and recovery. The list of key informants is contained in Appendix I.
Key informants were interviewed by project team members using a semi-structured format. With respect to integration, they were asked to identify published works, other resources, and additional key informants. Their most important task was to recommend specific competencies for inclusion in the competency set. All recommended competencies were distilled into a single set, condensed to eliminate redundancy, and organized into categories in an iterative qualitative process managed by the project team.
Literature Review A review of the relevant literature pertaining to workforce factors in integrated health care from 2008 through 2011 was conducted using a dozen databases. In addition, bibliographies in selected articles and reports were reviewed to identify other articles that may not have surfaced in the electronic subject search or that were not catalogued in the bibliographic databases. Titles and abstracts from the various database searches were reviewed and full articles were retrieved for those that met inclusion criteria. A total of 120 resources were retrieved, including: published articles; federal, state, and non-governmental reports; and book chapters. These works were supplemented through the key informant process, which identified new resources recommended by informants that were not covered in the initial search.
The literature on integration is predominantly composed of journal articles that represent opinion papers, literature reviews, and research reports, as well as a number of government and private sector documents, guides, books, and “tool kits.” Most of this literature focuses on the U.S. health care system, although there are significant contributions from several international sources. Regardless of the country of origin of these works, there was agreement within them that, in integrated settings, practitioner roles and responsibilities are often dramatically different from the content of what is currently taught across traditional educational programs or the nature of the roles and responsibilities in traditional clinical settings (see, for example: O’Donohue, Cummings, & Cummings, 2009; Pomerantz, Corson & Detzer, 2009).
The literature reviewed was, by and large, very descriptive and very general about the nature of integration. A very small portion of the literature specifically discussed workforce competencies, which were distilled and added to the list identified through the key informant process.
Review of Other Competency Sets While there are no widely recognized competency sets on integrated care, the project team members reviewed general competency sets to gather additional input regarding the structure and content of the set of competencies under development. This review generated information regarding the most common approaches to identifying categories of competencies and yielded suggestions for content related to integration. The competency sets reviewed and analyzed were:
Center for Substance Abuse Treatment. (2006). Addiction counseling competencies: The knowledge, skills, & attitudes of professional practice (DHHS Publication No. (SMA) 06-4171). Technical Assistance Publication (TAP) Series 21. Rockville, MD.
The original version of this document was authored by the National Addiction Technology Transfer Center (ATTC) and was updated in 2005 through the work of a committee of experts.
24SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
C O
R E
C O
M P
E T
E N
C IE
S F
O R
I N
T E
G R
A T
E D
C A
R E
Psychiatric, Mental Health and Substance Abuse Essential Competencies Task Force. (2012). Essential psychiatric, mental health and substance use competencies for the registered nurse. Archives of Psychiatric Nursing, 26(2), 80-110.
National Panel for Psychiatric-Mental Health NP Competencies, National Organization of Nurse Practitioner Faculties. (2003, September). Psychiatric-mental health nurse practitioner competencies. Retrieved from www.aacn.nche.edu/leading-initiatives/ education-resources/PMHNP.pdf
This document is currently under revision.
Note that this competency project is distinct from another federally sponsored effort funded by the Agency for Healthcare Research and Quality (AHRQ). The two projects could be viewed as complementary since the competencies described in this report are drawn principally from expert opinion, while the competencies in the AHRQ-funded project are drawn largely from observation of providers delivering integrated care. Both works will contribute useful information to the ongoing effort to define competencies for integration.
Development of the Competency Set Three senior project team members, working independently, reviewed the comprehensive list of potential competencies identified through the three sources listed above and identified proposed competency categories. Differences were resolved through a consensus process that produced a working set of competency categories and tentative titles for the categories. A senior project team member placed individual competencies from the comprehensive list into competency categories. Other team members then proposed modifications to the placement and organization of competencies and achieved a complete set through a consensus process. Category titles were modified to fit the content of competencies within the categories.
The resulting competency set was circulated electronically to the senior content experts and all key informants. They were asked to respond to the set and recommend any additions or edits to the proposed competency categories or individual competencies. The competency sets were revised based on the recommendations received, some of which were contradictory in nature. Approximately 80% of recommended changes were incorporated into a revised competency set. The revised competency set was reviewed and approved by the Senior Content Advisors.
- Structure Bookmarks
- CORE COMPETENCIES FOR INTEGRATED CARE
- CORE COMPETENCIES FOR INTEGRATED CARE
- CORE COMPETENCIES FOR INTEGRATED CARE
- CORE COMPETENCIES FOR INTEGRATED CARE
- CORE COMPETENCIES FOR INTEGRATED CARE
- CORE COMPETENCIES FOR INTEGRATED CARE
- CORE COMPETENCIES FOR INTEGRATED CARE
- CORE COMPETENCIES FOR INTEGRATED CARE
- 10
- 10
- 10
- SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
- SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
- SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
- SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
- SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
- SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
- 2
- 2
- 2
- Figure
- CORE COMPETENCIES FOR INTEGRATED
- CORE COMPETENCIES FOR INTEGRATED
- CORE COMPETENCIES FOR INTEGRATED
- BEHAVIORAL HEALTH AND PRIMARY CARE
- BEHAVIORAL HEALTH AND PRIMARY CARE
- Figure
- Figure
- Figure
- Figure
- Figure
- SAMHSASubstance Abuse and Mental Health Services Administrationwww.samhsa.gov 1-877-SAMHSA-7 (1-877-726-4727)
- JANUARY 2014
- JANUARY 2014
- JANUARY 2014
- ACKNOWLEDGEMENTS
- ACKNOWLEDGEMENTS
- ACKNOWLEDGEMENTS
- SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
- SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
- SAMHSA-HRSA CENTER FOR INTEGRATED HEALTH SOLUTIONS
- The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) promotes the development of integrated primary and behavioral
- The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) promotes the development of integrated primary and behavioral
- health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty
- behavioral health or primary care provider settings. CIHS is the first “national home” for information, experts, and other resources
- dedicated to bidirectional integration of behavioral health and primary care.
- Jointly funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services
- Jointly funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services
- Administration, and run by the National Council for Behavioral Health, CIHS provides training and technical assistance to community
- behavioral health organizations that received SAMHSA Primary and Behavioral Health Care Integration grants, as well as to community
- health centers and other primary care and behavioral health organizations.
- CIHS’ wide array of training and technical assistance helps improve the effectiveness, efficiency, and sustainability of integrated
- CIHS’ wide array of training and technical assistance helps improve the effectiveness, efficiency, and sustainability of integrated
- services, which ultimately improves the health and wellness of individuals living with behavioral health disorders.
- RECOMMENDED CITATION
- RECOMMENDED CITATION
- Hoge M.A., Morris J.A., Laraia M., Pomerantz A., & Farley, T. (2014).
- Hoge M.A., Morris J.A., Laraia M., Pomerantz A., & Farley, T. (2014).
- Core Competencies for Integrated Behavioral Health and Primary Care
- .
- Washington, DC: SAMHSA - HRSA Center for Integrated Health Solutions.
- 1701 K Street NW, Suite 400
- 1701 K Street NW, Suite 400
- 1701 K Street NW, Suite 400
- Washington, DC 20006
- Washington, DC 20006
- 202.684.7457
- 202.684.7457
- [email protected]
- www.integration.samhsa.gov
- www.integration.samhsa.gov
- www.integration.samhsa.gov
- Figure
- Prepared by the Annapolis Coalition on the Behavioral Health Workforce under contract to the HRSA-SAMHSA
- Prepared by the Annapolis Coalition on the Behavioral Health Workforce under contract to the HRSA-SAMHSA
- Prepared by the Annapolis Coalition on the Behavioral Health Workforce under contract to the HRSA-SAMHSA
- Center for Integrated Health Solutions at the National Council for Behavioral Health.
- For further information contact Michael Hoge, Ph.D. at
- For further information contact Michael Hoge, Ph.D. at
- [email protected]
- .
- PROJECT TEAM
- PROJECT TEAM
- CIHS engaged the Annapolis Coalition on the Behavioral Health Workforce (
- CIHS engaged the Annapolis Coalition on the Behavioral Health Workforce (
- www.annapoliscoalition.org)
- www.annapoliscoalition.org)
- to lead and manage the competency
- development project. The Coalition is a non-profit organization dedicated to improving the recruitment, retention, training and performance of
- the prevention and treatment workforce in the mental health and addictions sectors of the behavioral health field.
- The core Annapolis Coalition team managing the project included:
- The core Annapolis Coalition team managing the project included:
- Michael A. Hoge, PhD, Senior Science and Policy Advisor, The Annapolis Coalition
- Michael A. Hoge, PhD, Senior Science and Policy Advisor, The Annapolis Coalition
- John A. Morris, MSW, Executive Director, The Annapolis Coalition
- John A. Morris, MSW, Executive Director, The Annapolis Coalition
- Michele Laraia, PhD, APRN, Project Consultant, The Annapolis Coalition
- Michele Laraia, PhD, APRN, Project Consultant, The Annapolis Coalition
- Ann McManis, Director of Operations, The Annapolis Coalition
- Ann McManis, Director of Operations, The Annapolis Coalition
- SENIOR CONTENT ADVISORS
- SENIOR CONTENT ADVISORS
- Andrew Pomerantz, MD, National Mental Health Director for Integrated Care, Veterans Administration and Associate Professor,
- Andrew Pomerantz, MD, National Mental Health Director for Integrated Care, Veterans Administration and Associate Professor,
- Dartmouth Medical School
- Tillman Farley, MD, Director of Medical Services, Salud Family Health Centers, Colorado
- Tillman Farley, MD, Director of Medical Services, Salud Family Health Centers, Colorado
- ACKNOWLEDGEMENTS
- ACKNOWLEDGEMENTS
- The project team is indebted to HRSA and SAMHSA for their support and guidance on this project; to Laura Galbreath and the CIHS team
- The project team is indebted to HRSA and SAMHSA for their support and guidance on this project; to Laura Galbreath and the CIHS team
- at the National Council; to our senior content advisors and key informants; and to our administrative team at The Annapolis Coalition.
- While we are grateful for the input from the senior content advisors and all of the key informants listed in Appendix I, the final
- While we are grateful for the input from the senior content advisors and all of the key informants listed in Appendix I, the final
- decisions on the content of this report were made by the project team. They alone are responsible for any errors or omissions.
- TABLE OF CONTENTS
- TABLE OF CONTENTS
- TABLE OF CONTENTS
- TABLE OF CONTENTS
- TABLE OF CONTENTS
- TABLE OF CONTENTS
- SAMHSA-HRSA Center for Integrated Health Solutions
- SAMHSA-HRSA Center for Integrated Health Solutions
- SAMHSA-HRSA Center for Integrated Health Solutions
- ................................................................
- 2
- Project Team
- Project Team
- ...................................................................................................................
- 3
- Introduction
- Introduction
- ....................................................................................................................
- 4
- Workforce Sectors
- Workforce Sectors
- ...................................................................................................
- 4
- Types of “Integrated Care”
- Types of “Integrated Care”
- .........................................................................................
- 4
- Finding Common Language
- Finding Common Language
- ........................................................................................
- 4
- Guiding Assumptions
- Guiding Assumptions
- ...............................................................................................
- 5
- A Single Integrated Set of Competencies
- A Single Integrated Set of Competencies
- ......................................................................
- 5
- Method
- Method
- ..........................................................................................................................
- 6
- Using the Core Competencies
- Using the Core Competencies
- ..............................................................................................
- 6
- Shaping Workforce Training
- Shaping Workforce Training
- ........................................................................................
- 6
- Informing Job Descriptions
- Informing Job Descriptions
- ........................................................................................
- 6
- Employee Recruitment
- Employee Recruitment
- ..............................................................................................
- 6
- A Guide to Orientation
- A Guide to Orientation
- .............................................................................................
- 6
- Performance Assessment
- Performance Assessment
- ..........................................................................................
- 6
- Shaping Existing & Future Competency Sets
- Shaping Existing & Future Competency Sets
- ..................................................................
- 6
- Core Competency Categories
- Core Competency Categories
- ...............................................................................................
- 7
- I. Interpersonal Communication
- I. Interpersonal Communication
- ..................................................................................
- 8
- II. Collaboration & Teamwork
- II. Collaboration & Teamwork
- ......................................................................................
- 9
- III. Screening & Assessment
- III. Screening & Assessment
- ....................................................................................
- 10
- IV. Care Planning & Care Coordination
- IV. Care Planning & Care Coordination
- ........................................................................
- 10
- V. Intervention
- V. Intervention
- .....................................................................................................
- 11
- VI. Cultural Competence & Adaptation
- VI. Cultural Competence & Adaptation
- ........................................................................
- 12
- VII. Systems Oriented Practice
- VII. Systems Oriented Practice
- ..................................................................................
- 12
- VIII. Practice-Based Learning & Quality Improvement
- VIII. Practice-Based Learning & Quality Improvement
- .....................................................
- 13
- IX. Informatics
- IX. Informatics
- .....................................................................................................
- 13
- References
- ....................................................................................................................
- 14
- Appendix I: Contributors
- Appendix I: Contributors
- ...................................................................................................
- 19
- Senior Content Experts
- Senior Content Experts
- ...........................................................................................
- 19
- Expert Key Informants
- Expert Key Informants
- ............................................................................................
- 19
- Appendix II: Detailed Method
- .............................................................................................
- 22
- Overview
- ............................................................................................................
- 22
- Key Informants
- Key Informants
- .....................................................................................................
- 22
- Literature Review
- Literature Review
- ..................................................................................................
- 22
- Review of Other Competency Sets
- Review of Other Competency Sets
- .............................................................................
- 22
- Development of the Competency Set
- Development of the Competency Set
- ..........................................................................
- 23
- 4
- 4
- 4
- INTRODUCTION
- INTRODUCTION
- INTRODUCTION
- Despite the increasing national focus on integrated care, there is no single, widely recognized set of competencies on this service approach for
- Despite the increasing national focus on integrated care, there is no single, widely recognized set of competencies on this service approach for
- either the behavioral health or primary care workforce. To address this gap, the Substance Abuse and Mental Health Services Administration
- (SAMHSA) and the Health Resources and Services Administration (HRSA) charged the Center for Integrated Health Solutions (CIHS;
- www.
- www.
- integration.samhsa.gov
- ) to identify and disseminate core competencies on integrated practice relevant to behavioral health and primary
- care providers. The development of these competencies was performed by the Annapolis Coalition on the Behavioral Health Workforce (
- www.
- www.
- annapoliscoalition.org
- ) under the auspices of CIHS.
- The core competencies developed through this project are intended to serve as a resource for provider organizations as they shape job
- The core competencies developed through this project are intended to serve as a resource for provider organizations as they shape job
- descriptions, orientation programs, supervision, and performance reviews for workers delivering integrated care. Similarly, the competencies
- are to be a resource for educators as they shape curricula and training programs on integrated care. The charge was to develop a “core”
- or “common” set of competencies broadly relevant to working in diverse settings with diverse populations. The competency sets are not
- intended to be setting or population specific. Their principal relevance is to the integration of behavioral health with primary care as opposed
- to the integration of behavioral health with specialty medical care.
- Workforce Sectors
- Workforce Sectors
- Behavioral health encompasses prevention, intervention, and recovery from mental health and substance use conditions. Equally
- Behavioral health encompasses prevention, intervention, and recovery from mental health and substance use conditions. Equally
- important, it focuses on promoting behaviors that support health and wellness. This workforce, which is described in a previous SAMHSA-
- funded report (
- www.annapoliscoalition.org/download_actionplan.aspx
- www.annapoliscoalition.org/download_actionplan.aspx
- ), is comprised of graduate trained professionals, direct care staff
- with on the job training and experience, and persons in recovery from behavioral health conditions. This includes, but is not limited to:
- psychiatrists, psychologists, social workers, advanced practice psychiatric nurses, marriage and family therapists, addiction counselors,
- mental health counselors, psychiatric rehabilitation specialists, psychiatric aides and technicians, and peer support specialists and
- recovery coaches.
- Primary care is a complex concept that focuses on the provision of “…comprehensive first contact and continuing care for persons
- Primary care is a complex concept that focuses on the provision of “…comprehensive first contact and continuing care for persons
- with any undiagnosed sign, symptom, or health concern…” (American Academy of Family Practitioners,
- www.aafp.org
- www.aafp.org
- ). It includes
- health promotion, disease prevention, education, diagnosis and treatment. The primary care workforce includes, but is not limited to,
- physicians, physician assistants, advanced practice nurses, registered nurses, and a range of allied health professionals.
- Types of “Integrated Care”
- Types of “Integrated Care”
- While the concept of integration, as used within this document, refers to collaboration between behavioral health and primary care providers,
- While the concept of integration, as used within this document, refers to collaboration between behavioral health and primary care providers,
- there are many forms and models of integrated care. CIHS developed a framework, which can be accessed online (
- www.integration.samhsa.
- www.integration.samhsa.
- gov/resource/standard-framework-for-levels-of-integrated-healthcare
- ). The competencies reported are principally intended to address
- levels 4, 5, and 6 in that framework, which involve either close or full collaboration and one of three organizational models: some systems
- integration, integrated practice, or transformed/merged practice.
- Finding Common Language
- Finding Common Language
- The competency set requires the use of consistent language to refer to the recipients of healthcare. The terms used by different professions/
- The competency set requires the use of consistent language to refer to the recipients of healthcare. The terms used by different professions/
- specialties and in different settings vary widely (i.e. patient, client, or consumer) and it is clear that no single term is preferred by, and
- perhaps even acceptable to, the many groups and individuals involved in
- the delivery of integrated care.
- For this document, the term
- For this document, the term
- healthcare consumer
- or simply
- consumer
- has been
- selected as one that is understood, though perhaps not preferred, in primary
- care, mental health, and the field of addictions. As captured below in the
- competencies, it is generally recommended that providers adopt the language
- of the setting in which care is delivered. To the extent to which such language is
- unacceptable to providers, they are encouraged to educate others within their
- team and setting about their rationale for using alternative language.
- Within this document, the term
- Within this document, the term
- behavioral health
- is used to refer to mental health and addictions. Behavioral health is distinguished from
- “general health,” recognizing the imperfections in the distinction and the language used to describe it. Behavioral health is also distinct
- from healthy or health behavior. Unless otherwise noted, the term
- health conditions
- refers to all health conditions and is not specific to
- behavioral health.
- Guiding Assumptions
- Guiding Assumptions
- The development of this core competency set was guided by a series of assumptions that are articulated below.
- The development of this core competency set was guided by a series of assumptions that are articulated below.
- 1.
- 1.
- 1.
- 1.
- It is crucial to stress that these competencies reinforce or enhance the basic competencies of each discipline and the
- It is crucial to stress that these competencies reinforce or enhance the basic competencies of each discipline and the
- specialty competencies that each provider must have to practice in his or her field. There is not a bright line between those
- competencies and many of the competencies that are essential for the provision of integrated care. Some competencies
- that are generic to most forms of healthcare, such as those related to
- interpersonal communication
- , are included in this set
- because they are
- absolutely essential
- to the effective delivery of integrated care.
- 2.
- 2.
- 2.
- In order for a core competency set to be practical and useful, it has to have a manageable number of competency categories
- In order for a core competency set to be practical and useful, it has to have a manageable number of competency categories
- and individual competencies. Long and detailed competency sets overwhelm the reader, the educator, the interprofessional
- team leader, and the direct care provider. Clarity and simplicity was the goal.
- 3.
- 3.
- 3.
- The competencies are optimally skill oriented, focusing on what the provider of integrated care can actually “do.” Knowledge
- The competencies are optimally skill oriented, focusing on what the provider of integrated care can actually “do.” Knowledge
- and attitudes make the desired behavior possible, but demonstration of an essential skill is the desired outcome.
- 4.
- 4.
- 4.
- The focus of integrated care and these workforce competencies is very broadly defined, not narrowly focused on particular
- The focus of integrated care and these workforce competencies is very broadly defined, not narrowly focused on particular
- diagnosable disorders. Similarly, the competencies are intended to be relevant to healthcare consumers across the lifespan
- from diverse populations, and are not specific to a particular age or population.
- 5.
- 5.
- 5.
- The competency set specifies skills such as the use of evidence-based treatments and tools, but generally does not identify
- The competency set specifies skills such as the use of evidence-based treatments and tools, but generally does not identify
- specific treatments or tools. These will vary by setting and population and will change over time as the evidence base grows
- and prevention and treatment approaches evolve. Up-to-date information on evidence-based treatments and tools can be
- accessed at various websites including
- www.samsha.gov
- www.samsha.gov
- and
- www.hrsa.gov
- www.hrsa.gov
- .
- 6.
- 6.
- 6.
- The competencies are premised on consumers and family members as partners in the healthcare process whose strengths,
- The competencies are premised on consumers and family members as partners in the healthcare process whose strengths,
- goals and preferences should drive healthcare decisions.
- 7.
- 7.
- 7.
- The issue of culture must be considered in all efforts to understand health, illness, treatment, resilience and recovery.
- The issue of culture must be considered in all efforts to understand health, illness, treatment, resilience and recovery.
- 8.
- 8.
- 8.
- The effective delivery of integrated care requires system modifications to support changed
- The effective delivery of integrated care requires system modifications to support changed
- practice. However, system design was outside of the scope of this project. Clearly the financing
- and organization of care delivery can have a major impact on the ultimate competence of the
- providers working in those delivery systems.
- 9.
- 9.
- 9.
- Core competencies are defined as those that apply to the
- Core competencies are defined as those that apply to the
- majority
- of providers involved in
- integrated care. Each competency is not necessarily relevant to
- every
- provider. For example,
- more complex, clinically oriented competencies may not be applicable to care managers or
- navigators. Many of these competencies may be relevant to peer support roles. The employer
- must designate the competencies applicable to each position.
- A Single Integrated Set of Competencies
- A Single Integrated Set of Competencies
- The initial project goal was to develop two competency sets: one for behavioral health practitioners and
- The initial project goal was to develop two competency sets: one for behavioral health practitioners and
- the other for primary care practitioners. However, the results of the data gathering process revealed that
- most competencies required for integrated care were common to behavioral health
- and
- primary care
- providers. The initial draft of competencies, which contained some distinctions between behavioral health
- and primary care skills, met with criticism from a number of key informant reviewers who argued that such
- separation would promote continued silos between disciplines and professions and foster an unnecessary
- interprofessional divide. Thus the competencies that appear below are structured as a single integrated set.
- METHOD
- METHOD
- The method for arriving at the core set of competencies involved three major activities: (1) structured interviews with the key informants;
- The method for arriving at the core set of competencies involved three major activities: (1) structured interviews with the key informants;
- (2) review of the recent literature on integration, and (3) review and analysis of selected competency sets judged to have relevance to
- this process. Each of these sources yielded potential content for inclusion in the competency set. Using a qualitative and consensus
- driven process, the Project Team integrated and distilled the recommendations into a number of competency
- categories
- and then placed
- individual competencies within those categories. A draft competency set was reviewed by the Senior Content Advisors and Key Informants
- and revised based on the feedback received. A more detailed description of the methodology is contained in Appendix II.
- USING THE CORE COMPETENCIES
- USING THE CORE COMPETENCIES
- The identification of core competencies creates an essential foundation for preparing and further developing a workforce to deliver
- The identification of core competencies creates an essential foundation for preparing and further developing a workforce to deliver
- integrated care. These competencies can be used to further that agenda in multiple ways.
- Shaping Workforce Training
- Shaping Workforce Training
- Competency sets are a reference point for educators who are designing and delivering a training curriculum. This set of competencies
- Competency sets are a reference point for educators who are designing and delivering a training curriculum. This set of competencies
- on integrated care can be used to identify the need for training courses and can shape the content of such courses. It can be used to
- update and expand the focus of existing courses, to design continuing education events, and to select topics for in-service education
- within healthcare organizations.
- Informing Job Descriptions
- Informing Job Descriptions
- The competencies can be used to develop or update job descriptions and duties for positions within settings where integrated care
- The competencies can be used to develop or update job descriptions and duties for positions within settings where integrated care
- is delivered. Lack of role clarity is a prime driver of dissatisfaction with and turnover in healthcare positions. Greater clarity in job
- descriptions and job roles can help improve employee satisfaction and retention.
- Employee Recruitment
- Employee Recruitment
- These competencies in integrated care can be used in the recruitment process to educate prospective employees about the nature of
- These competencies in integrated care can be used in the recruitment process to educate prospective employees about the nature of
- the work, since “realistic job previews” tend to decrease the frequency with which candidates are offered and/or accept jobs for which
- they are not well suited. Similarly, the competencies can be used to assess the qualifications of job candidates, both during a review of
- applications and during the interview process.
- A Guide to Orientation
- A Guide to Orientation
- The competencies can be used as a guide to orienting new employees to their role and responsibilities in the delivery of integrated care.
- The competencies can be used as a guide to orienting new employees to their role and responsibilities in the delivery of integrated care.
- Supervisors and employees can jointly review the competencies and discuss the employee’s perspective on areas where additional
- training and mentoring may be beneficial.
- Performance Assessment
- Performance Assessment
- Competencies should be the foundation on which assessments of performance are based. These competencies on integrated care
- Competencies should be the foundation on which assessments of performance are based. These competencies on integrated care
- can be incorporated into employee self-assessment tools, 360-degree evaluations, and formal performance reviews used within
- healthcare organizations.
- Shaping Existing & Future Competency Sets
- Shaping Existing & Future Competency Sets
- There are many existing competency sets that have been developed for the health professions, for the direct care workforce, and for peer
- There are many existing competency sets that have been developed for the health professions, for the direct care workforce, and for peer
- support workers. The integrated care competencies identified in this document can be used by the developers of existing competency
- sets as a benchmark for assessing the extent to which those other sets adequately incorporate content regarding integrated care. Those
- sets can be updated based on such a review and new competency sets under development can draw from the information within this
- report as well.
- CORE COMPETENCY CATEGORIES
- CORE COMPETENCY CATEGORIES
- The competencies are organized into nine competency categories. These were not determined in advance, but emerged from the key informant interviews, the literature review, and examination of other competency sets. Some of the competencies could appear in more than one category, but were placed in the category deemed most relevant. The categories that emerged from the process are outlined in Table 1.
- 1.
- 1.
- 1.
- 1.
- Establish rapport, rapidly develop, and maintain
- Establish rapport, rapidly develop, and maintain
- effective working relationships with diverse
- individuals, including healthcare consumers, family
- members, and other providers.
- 2.
- 2.
- 2.
- Listen actively and effectively, as demonstrated by
- Listen actively and effectively, as demonstrated by
- the ability to quickly grasp presenting problems,
- needs, and preferences as communicated by others,
- and reflect back that information to ensure that
- others have been accurately understood.
- 3.
- 3.
- 3.
- Clearly convey relevant information in a non-
- Clearly convey relevant information in a non-
- judgmental manner about behavioral health, general
- health, and health behaviors using person-centered
- concepts and terms that are free of jargon and acronyms and are easily understood by the listener.
- 4.
- 4.
- 4.
- Explain to the healthcare consumer and family the roles and responsibilities of each team member and how they will work
- Explain to the healthcare consumer and family the roles and responsibilities of each team member and how they will work
- together to provide services.
- 5.
- 5.
- 5.
- In speaking to healthcare consumers or professionals, use the terminology that is common to the setting in which care is
- In speaking to healthcare consumers or professionals, use the terminology that is common to the setting in which care is
- delivered or advocate for and educate others about the rationale for using alternative language.
- 6.
- 6.
- 6.
- Use the primary language and preferred mode of communication of the healthcare consumer and family members or
- Use the primary language and preferred mode of communication of the healthcare consumer and family members or
- communicate through the use of qualified interpreters.
- 7.
- 7.
- 7.
- Adapt the style of communication to account for the impact of health conditions on a healthcare consumer’s ability to
- Adapt the style of communication to account for the impact of health conditions on a healthcare consumer’s ability to
- process and understand information.
- 8.
- 8.
- 8.
- Provide health education materials that are appropriate to the communication style and literacy of the healthcare consumer
- Provide health education materials that are appropriate to the communication style and literacy of the healthcare consumer
- and family and that reinforce information provided verbally during healthcare visits.
- 9.
- 9.
- 9.
- Recognize and manage personal biases related to healthcare consumers, families, health conditions and healthcare delivery.
- Recognize and manage personal biases related to healthcare consumers, families, health conditions and healthcare delivery.
- 1.
- 1.
- 1.
- Recognize, respect and value the role and expertise
- Recognize, respect and value the role and expertise
- of healthcare consumers, family members, and both
- behavioral health and primary care providers in the
- process of healthcare delivery.
- 2.
- 2.
- 2.
- Develop a shared understanding of the respective roles
- Develop a shared understanding of the respective roles
- and responsibilities of team members to ensure that
- collaboration is efficient.
- 3.
- 3.
- 3.
- Recognize the limits of one’s knowledge and skills and
- Recognize the limits of one’s knowledge and skills and
- seek assistance from other providers.
- 4.
- 4.
- 4.
- Serve as an effective member of an interprofessional
- Serve as an effective member of an interprofessional
- team, helping other providers on the team to quickly
- conceptualize a healthcare consumer’s strengths,
- healthcare problems, and an appropriate plan of care.
- 5.
- 5.
- 5.
- Exhibit leadership by directing, guiding, or influencing the collaboration and service delivery of the healthcare team.
- Exhibit leadership by directing, guiding, or influencing the collaboration and service delivery of the healthcare team.
- 6.
- 6.
- 6.
- Respect and respond to the leadership displayed by other providers in a healthcare setting or team.
- Respect and respond to the leadership displayed by other providers in a healthcare setting or team.
- 7.
- 7.
- 7.
- Assertively represent one’s professional opinions, encourage other team members to express opinions, and resolve
- Assertively represent one’s professional opinions, encourage other team members to express opinions, and resolve
- differences of opinion or conflicts quickly and without acrimony.
- 8.
- 8.
- 8.
- Advocate within the healthcare setting or team for the role of the healthcare consumer and family member in healthcare decisions.
- Advocate within the healthcare setting or team for the role of the healthcare consumer and family member in healthcare decisions.
- 9.
- 9.
- 9.
- Facilitate collaborative care by actively sharing relevant information with others through communications that are authorized
- Facilitate collaborative care by actively sharing relevant information with others through communications that are authorized
- by the healthcare consumer and are permissible under HIPAA and related laws, regulations and policies.
- 10.
- 10.
- 10.
- Foster shared decision-making with healthcare consumers, family members, and other providers.
- Foster shared decision-making with healthcare consumers, family members, and other providers.
- 11.
- 11.
- 11.
- Respond to the expressed needs of healthcare consumers, family members, and other providers, while minimizing the extent
- Respond to the expressed needs of healthcare consumers, family members, and other providers, while minimizing the extent
- to which provider preconceptions of illness and treatment obscure those expressed needs.
- 12.
- 12.
- 12.
- Demonstrate practicality, flexibility, and adaptability in the process of working with others, emphasizing the achievement of
- Demonstrate practicality, flexibility, and adaptability in the process of working with others, emphasizing the achievement of
- treatment goals as opposed to rigid adherence to treatment models.
- 13.
- 13.
- 13.
- Connect healthcare consumers and family members to other members of the healthcare team through face-to-face
- Connect healthcare consumers and family members to other members of the healthcare team through face-to-face
- encounters known as “warm hand-offs.”
- 14.
- 14.
- 14.
- Use behavioral health and general health interventions to support the work of the team and to enhance healthcare
- Use behavioral health and general health interventions to support the work of the team and to enhance healthcare
- consumer outcomes.
- 15.
- 15.
- 15.
- Respond immediately, if at all possible, to requests for consultation or intervention from other providers.
- Respond immediately, if at all possible, to requests for consultation or intervention from other providers.
- 16.
- 16.
- 16.
- Adapt health interventions to the work flow and pace that typically characterizes the provision of primary care, including rapid
- Adapt health interventions to the work flow and pace that typically characterizes the provision of primary care, including rapid
- assessment, brief treatment, and a high daily volume of healthcare consumer contacts.
- 17.
- 17.
- 17.
- Advocate for, teach, and support illness and whole health self-management and recovery approaches to health conditions
- Advocate for, teach, and support illness and whole health self-management and recovery approaches to health conditions
- within the healthcare team and setting.
- 18.
- 18.
- 18.
- Advocate for and foster the use of peer support approaches and peer support providers in the healthcare setting as a
- Advocate for and foster the use of peer support approaches and peer support providers in the healthcare setting as a
- component of healthcare delivery.
- 1.
- 1.
- 1.
- Use strengths-based wellness, resilience, and recovery models in
- Use strengths-based wellness, resilience, and recovery models in
- conceptualizing the health and healthcare of consumers.
- 2.
- 2.
- 2.
- Routinely conduct brief, evidence-based, and developmentally
- Routinely conduct brief, evidence-based, and developmentally
- sensitive screens for the risky, harmful, or dependent use of
- substances, including alcohol, illicit drugs, and prescription
- medications, and appropriateness for agonist, antagonist, and anti-
- craving medications.
- 3.
- 3.
- 3.
- Routinely conduct brief, evidence-based, and developmentally
- Routinely conduct brief, evidence-based, and developmentally
- appropriate screens for cognitive impairment, common mental
- health problems, and behaviors that compromise health.
- 4.
- 4.
- 4.
- Routinely conduct brief screens for risk related to self-harm, harm to others, impairments in functional self-care, and
- Routinely conduct brief screens for risk related to self-harm, harm to others, impairments in functional self-care, and
- environmental safety.
- 5.
- 5.
- 5.
- Detect signs of abuse, neglect, domestic violence, and other trauma in individuals across the lifespan.
- Detect signs of abuse, neglect, domestic violence, and other trauma in individuals across the lifespan.
- 6.
- 6.
- 6.
- Conduct or have other team members conduct more detailed, yet efficient, assessments of healthcare consumers who screen
- Conduct or have other team members conduct more detailed, yet efficient, assessments of healthcare consumers who screen
- positive for mental and substance use conditions, risk to self or others, or potential abuse and neglect.
- 7.
- 7.
- 7.
- Recognize and diagnose, using established classification criteria, the most common mental health and substance use conditions
- Recognize and diagnose, using established classification criteria, the most common mental health and substance use conditions
- seen in the healthcare setting.
- 8.
- 8.
- 8.
- Recognize the signs, symptoms and treatments of the most common health conditions, health crises, and comorbidity seen in the
- Recognize the signs, symptoms and treatments of the most common health conditions, health crises, and comorbidity seen in the
- healthcare setting.
- 9.
- 9.
- 9.
- Understand the symptoms and treatments for the major healthcare conditions of the consumers under the provider’s care.
- Understand the symptoms and treatments for the major healthcare conditions of the consumers under the provider’s care.
- 10.
- 10.
- 10.
- Briefly assess the nature of the consumer’s family and social support system and other socio-economic resources that have an
- Briefly assess the nature of the consumer’s family and social support system and other socio-economic resources that have an
- impact on health and healthcare.
- 11.
- 11.
- 11.
- Determine collaboratively the feasibility of providing effective treatment to the healthcare consumer and family within the context of
- Determine collaboratively the feasibility of providing effective treatment to the healthcare consumer and family within the context of
- the healthcare team and setting.
- 1.
- 1.
- 1.
- Create and periodically update integrated care plans in
- Create and periodically update integrated care plans in
- consultation with healthcare consumers, family members, and
- other providers, including individuals identified by consumers as
- part of their healthcare team.
- 2.
- 2.
- 2.
- Work with healthcare consumers to develop whole health and
- Work with healthcare consumers to develop whole health and
- wellness recovery plans.
- 3.
- 3.
- 3.
- Match and adjust the type and intensity of services to the
- Match and adjust the type and intensity of services to the
- needs of the healthcare consumer, ensuring the timely and
- unduplicated provision of care.
- 4.
- 4.
- 4.
- Through the care plans, link multiple services, healthcare providers, and community resources to meet the healthcare
- Through the care plans, link multiple services, healthcare providers, and community resources to meet the healthcare
- consumers’ needs.
- 5.
- 5.
- 5.
- Ensure the flow and exchange of information among the healthcare consumer, family members, and linked providers.
- Ensure the flow and exchange of information among the healthcare consumer, family members, and linked providers.
- 6.
- 6.
- 6.
- Work collaboratively to resolve differing perspectives, priorities and schedules among providers.
- Work collaboratively to resolve differing perspectives, priorities and schedules among providers.
- 7.
- 7.
- 7.
- Provide or arrange access to “patient navigation” services that focus on benefits and financial counseling, transportation,
- Provide or arrange access to “patient navigation” services that focus on benefits and financial counseling, transportation,
- home care, and access to social services, peer support, and treatment, including medications.
- 8.
- 8.
- 8.
- Establish and support systems and procedures within the team and healthcare setting for the use of agonist, antagonist,
- Establish and support systems and procedures within the team and healthcare setting for the use of agonist, antagonist,
- and anti-craving medications.
- 9.
- 9.
- 9.
- Coordinate with health plans in identifying and addressing individual consumer and population needs.
- Coordinate with health plans in identifying and addressing individual consumer and population needs.
- 10.
- 10.
- 10.
- Implement disease management programs and strategies for selected health conditions, combining the use of engagement
- Implement disease management programs and strategies for selected health conditions, combining the use of engagement
- tools, health risk assessments, cognitive and behavioral interventions, medications, web-based tools, protocols and
- guidelines, formularies, monitoring devices, shared decision-making aides, illness and whole health self-management
- strategies, peer support and empowerment approaches, and call centers.
- 11.
- 11.
- 11.
- Effectively connect healthcare consumers who cannot be adequately treated by the team or within the setting to other
- Effectively connect healthcare consumers who cannot be adequately treated by the team or within the setting to other
- appropriate services.
- 1.
- 1.
- 1.
- Demonstrate a fundamental belief in the value and
- Demonstrate a fundamental belief in the value and
- effectiveness of brief interventions to improve health through
- practice patterns and communications with healthcare
- consumers, family members, and other providers.
- 2.
- 2.
- 2.
- Use focused interventions to engage healthcare consumers
- Use focused interventions to engage healthcare consumers
- and increase their desire to improve health (e.g., motivational
- interviewing, motivational enhancement therapy).
- 3.
- 3.
- 3.
- Promote healthcare consumer and family adherence to care plans.
- Promote healthcare consumer and family adherence to care plans.
- 4.
- 4.
- 4.
- Educate healthcare consumers, family members, and other
- Educate healthcare consumers, family members, and other
- providers about healthcare conditions, prevention, available treatments, illness and whole health self-management, peer
- support and recovery.
- 5.
- 5.
- 5.
- Identify evidence-based interventions and best practices for integrated care settings.
- Identify evidence-based interventions and best practices for integrated care settings.
- 6.
- 6.
- 6.
- Provide health promotion, wellness and prevention interventions.
- Provide health promotion, wellness and prevention interventions.
- 7.
- 7.
- 7.
- Deliver brief, trauma-informed, problem-oriented treatment for mental conditions or problematic health behaviors.
- Deliver brief, trauma-informed, problem-oriented treatment for mental conditions or problematic health behaviors.
- 8.
- 8.
- 8.
- Deliver brief, trauma-informed treatment for risky or harmful substance use conditions, including the misuse of
- Deliver brief, trauma-informed treatment for risky or harmful substance use conditions, including the misuse of
- prescription drugs.
- 9.
- 9.
- 9.
- Deliver brief, supportive interventions addressing the consequences of illness and injury.
- Deliver brief, supportive interventions addressing the consequences of illness and injury.
- 10.
- 10.
- 10.
- Implement longer-term models of treatment and support for healthcare consumers with persistent illnesses that require
- Implement longer-term models of treatment and support for healthcare consumers with persistent illnesses that require
- follow-up over time.
- 11.
- 11.
- 11.
- Prescribe and manage medications for mental health and substance use conditions (appropriately licensed providers only),
- Prescribe and manage medications for mental health and substance use conditions (appropriately licensed providers only),
- including Medically Assisted Treatments for addictions, with consultation, as needed, from other prescribing professionals.
- 12.
- 12.
- 12.
- Educate healthcare consumers and family members about the common effects, side effects, potential long-term adverse
- Educate healthcare consumers and family members about the common effects, side effects, potential long-term adverse
- health effects, and interactions of pharmacological treatments for mental health and substance use conditions.
- 13.
- 13.
- 13.
- Recognize the primary indications, effects, and side effects of pharmacological agents used in the treatment setting for the
- Recognize the primary indications, effects, and side effects of pharmacological agents used in the treatment setting for the
- most common health conditions.
- 14.
- 14.
- 14.
- Recognize the potential impact and interaction of over-the-counter medications and other non-prescription remedies on
- Recognize the potential impact and interaction of over-the-counter medications and other non-prescription remedies on
- health and healthcare treatments.
- 15.
- 15.
- 15.
- Manage behavioral health crises through office and home-based interventions and linkage to treatment facilities.
- Manage behavioral health crises through office and home-based interventions and linkage to treatment facilities.
- 16.
- 16.
- 16.
- Link healthcare consumers and family members with other resources, including but not limited to specialty healthcare,
- Link healthcare consumers and family members with other resources, including but not limited to specialty healthcare,
- rehabilitation and social services, peer support, financial assistance, and transportation, following up to ensure that effective
- connections have been made.
- 17.
- 17.
- 17.
- Support healthcare consumers in considering and accessing complementary and alternative services designed to support
- Support healthcare consumers in considering and accessing complementary and alternative services designed to support
- health and wellness.
- 18.
- 18.
- 18.
- Provide information, education, guidance, and support to family members and other caregivers.
- Provide information, education, guidance, and support to family members and other caregivers.
- 1.
- 1.
- 1.
- Identify and address disparities in healthcare access and
- Identify and address disparities in healthcare access and
- quality for diverse individuals and populations served.
- 2.
- 2.
- 2.
- Adapt services, including evidence-based interprofessional team
- Adapt services, including evidence-based interprofessional team
- approaches, to the language, cultural norms, and individual
- preferences of healthcare consumers and family members.
- 3.
- 3.
- 3.
- Develop collaborative relationships with providers of services
- Develop collaborative relationships with providers of services
- tailored to the needs of culturally diverse healthcare consumers
- and family members.
- 4.
- 4.
- 4.
- Examine the experiences of culturally diverse healthcare
- Examine the experiences of culturally diverse healthcare
- consumers and family members with respect to quality of care and adjust the delivery of care as needed.
- 5.
- 5.
- 5.
- Educate members of the team about the characteristics, healthcare needs, health behaviors, and views toward illness and
- Educate members of the team about the characteristics, healthcare needs, health behaviors, and views toward illness and
- treatment of diverse populations served in the treatment setting.
- 6.
- 6.
- 6.
- Foster and value diversity in terms of the composition of the interprofessional team members in all roles, including, but not
- Foster and value diversity in terms of the composition of the interprofessional team members in all roles, including, but not
- limited to, community health workers.
- 1.
- 1.
- 1.
- Understand and practice effectively within the organization
- Understand and practice effectively within the organization
- and culture of the interprofessional team, practice setting, and
- local healthcare system.
- 2.
- 2.
- 2.
- Provide or arrange assistance to healthcare consumers,
- Provide or arrange assistance to healthcare consumers,
- family members and other providers in understanding
- applicable healthcare benefits, coverage limits, and utilization
- management procedures.
- 3.
- 3.
- 3.
- Organize and deliver services with an understanding of the
- Organize and deliver services with an understanding of the
- impact of team based care on billing, reimbursement, and
- healthcare coverage.
- 4.
- 4.
- 4.
- Consider both clinical and cost-effectiveness in decision-making about the organization and delivery of services.
- Consider both clinical and cost-effectiveness in decision-making about the organization and delivery of services.
- 5.
- 5.
- 5.
- Anticipate and adjust the delivery of care to emerging healthcare reforms and structures, such as accountable care
- Anticipate and adjust the delivery of care to emerging healthcare reforms and structures, such as accountable care
- organizations, medical homes, and health insurance exchanges.
- 6.
- 6.
- 6.
- Plan and deliver services with an understanding of the healthcare needs of the population being served.
- Plan and deliver services with an understanding of the healthcare needs of the population being served.
- 1.
- 1.
- 1.
- Search and evaluate the literature for evidence of the most effective
- Search and evaluate the literature for evidence of the most effective
- interventions for specific health conditions.
- 2.
- 2.
- 2.
- Apply relevant practice guidelines to the delivery of care.
- Apply relevant practice guidelines to the delivery of care.
- 3.
- 3.
- 3.
- Deliver evidence-based, integrated approaches to the treatment of
- Deliver evidence-based, integrated approaches to the treatment of
- health conditions, adapting them to the population, treatment setting,
- and local system of care.
- 4.
- 4.
- 4.
- Assess the fidelity of team-based care to evidence-based treatment
- Assess the fidelity of team-based care to evidence-based treatment
- models.
- 5.
- 5.
- 5.
- Identify and rapidly address errors in care and assist in implementing
- Identify and rapidly address errors in care and assist in implementing
- policies and procedures to reduce future errors.
- 6.
- 6.
- 6.
- Measure and monitor individual health outcomes in collaboration with
- Measure and monitor individual health outcomes in collaboration with
- the consumer, adjusting care plans based on outcome data.
- 7.
- 7.
- 7.
- Monitor healthcare consumer and family satisfaction with care on
- Monitor healthcare consumer and family satisfaction with care on
- multiple dimensions and adjust care and practice patterns based on the feedback.
- 8.
- 8.
- 8.
- Recognize the importance of monitoring client outcomes in the aggregate and demonstrate an ability to read and interpret
- Recognize the importance of monitoring client outcomes in the aggregate and demonstrate an ability to read and interpret
- outcomes monitoring reports.
- 9.
- 9.
- 9.
- Monitor aggregate consumer health care outcomes and collaborate with the team in improving the process of care based
- Monitor aggregate consumer health care outcomes and collaborate with the team in improving the process of care based
- on the data.
- 10.
- 10.
- 10.
- Collaborate with the healthcare organization and other local healthcare agencies to continuously assess and improve service
- Collaborate with the healthcare organization and other local healthcare agencies to continuously assess and improve service
- system design.
- 11.
- 11.
- 11.
- Establish and pursue individual and team-based learning and improvement goals.
- Establish and pursue individual and team-based learning and improvement goals.
- 1.
- 1.
- 1.
- Use an electronic health record to retrieve relevant information and to
- Use an electronic health record to retrieve relevant information and to
- document care concisely.
- 2.
- 2.
- 2.
- Screen, assess and provide services to healthcare consumers using
- Screen, assess and provide services to healthcare consumers using
- computer-based and web-based tools.
- 3.
- 3.
- 3.
- Employ telehealth applications to ensure consumer access to appropriate
- Employ telehealth applications to ensure consumer access to appropriate
- care and to deliver healthcare.
- 4.
- 4.
- 4.
- Assist healthcare consumers in using web-based tools as part of their
- Assist healthcare consumers in using web-based tools as part of their
- personal healthcare plan.
- 5.
- 5.
- 5.
- Communicate with healthcare consumers and family members using
- Communicate with healthcare consumers and family members using
- secure online, mobile, and “smart” technology and devices.
- 6.
- 6.
- 6.
- Safeguard healthcare consumer privacy and confidentiality with respect
- Safeguard healthcare consumer privacy and confidentiality with respect
- to communication, documentation, and data.
- Figure
- Long and detailed competency sets overwhelm the reader, the educator, the interprofessional team leader, and the direct care provider. Clarity and simplicity was the goal.
- Long and detailed competency sets overwhelm the reader, the educator, the interprofessional team leader, and the direct care provider. Clarity and simplicity was the goal.
- TABLE 1. SPECIFIC COMPETENCIES BY CATEGORY
- TABLE 1. SPECIFIC COMPETENCIES BY CATEGORY
- TABLE 1. SPECIFIC COMPETENCIES BY CATEGORY
- I. INTERPERSONAL COMMUNICATION
- I. INTERPERSONAL COMMUNICATION
- I. INTERPERSONAL COMMUNICATION
- I. INTERPERSONAL COMMUNICATION
- I. INTERPERSONAL COMMUNICATION
- I. INTERPERSONAL COMMUNICATION
- I. INTERPERSONAL COMMUNICATION
- The ability to establish rapport quickly and to communicate effectively with consumers of healthcare, their family members and
- The ability to establish rapport quickly and to communicate effectively with consumers of healthcare, their family members and
- The ability to establish rapport quickly and to communicate effectively with consumers of healthcare, their family members and
- The ability to establish rapport quickly and to communicate effectively with consumers of healthcare, their family members and
- other providers.
- Examples include: active listening; conveying information in a jargon-free, non-judgmental manner; using terminology common to
- Examples include: active listening; conveying information in a jargon-free, non-judgmental manner; using terminology common to
- the setting in which care is delivered; and adapting to the preferred mode of communication of the consumers and families served.
- II. COLLABORATION & TEAMWORK
- II. COLLABORATION & TEAMWORK
- II. COLLABORATION & TEAMWORK
- II. COLLABORATION & TEAMWORK
- The ability to function effectively as a member of an interprofessional team that includes behavioral health and primary care
- The ability to function effectively as a member of an interprofessional team that includes behavioral health and primary care
- The ability to function effectively as a member of an interprofessional team that includes behavioral health and primary care
- The ability to function effectively as a member of an interprofessional team that includes behavioral health and primary care
- providers, consumers and family members.
- Examples include: understanding and valuing the roles and responsibilities of other team members, expressing professional opinions
- Examples include: understanding and valuing the roles and responsibilities of other team members, expressing professional opinions
- and resolving differences of opinion quickly, providing and seeking consultation, and fostering shared decision-making.
- III. SCREENING & ASSESSMENT
- III. SCREENING & ASSESSMENT
- III. SCREENING & ASSESSMENT
- III. SCREENING & ASSESSMENT
- The ability to conduct brief, evidence-based and developmentally appropriate screening and to conduct or arrange for more
- The ability to conduct brief, evidence-based and developmentally appropriate screening and to conduct or arrange for more
- The ability to conduct brief, evidence-based and developmentally appropriate screening and to conduct or arrange for more
- The ability to conduct brief, evidence-based and developmentally appropriate screening and to conduct or arrange for more
- detailed assessments when indicated.
- Examples include screening and assessment for: risky, harmful or dependent use of substances; cognitive impairment; mental
- Examples include screening and assessment for: risky, harmful or dependent use of substances; cognitive impairment; mental
- health problems; behaviors that compromise health; harm to self or others; and abuse, neglect, and domestic violence.
- IV. CARE PLANNING & CARE COORDINATION
- IV. CARE PLANNING & CARE COORDINATION
- IV. CARE PLANNING & CARE COORDINATION
- IV. CARE PLANNING & CARE COORDINATION
- The ability to create and implement integrated care plans, ensuring access to an array of linked services, and the exchange of
- The ability to create and implement integrated care plans, ensuring access to an array of linked services, and the exchange of
- The ability to create and implement integrated care plans, ensuring access to an array of linked services, and the exchange of
- The ability to create and implement integrated care plans, ensuring access to an array of linked services, and the exchange of
- information among consumers, family members, and providers.
- Examples include: assisting in the development of care plans, whole health, and wellness recovery plans; matching the type and
- Examples include: assisting in the development of care plans, whole health, and wellness recovery plans; matching the type and
- intensity of services to consumers’ needs; providing patient navigation services; and implementing disease management programs.
- V. INTERVENTION
- V. INTERVENTION
- V. INTERVENTION
- V. INTERVENTION
- The ability to provide a range of brief, focused prevention, treatment and recovery services, as well as longer-term treatment and support
- The ability to provide a range of brief, focused prevention, treatment and recovery services, as well as longer-term treatment and support
- The ability to provide a range of brief, focused prevention, treatment and recovery services, as well as longer-term treatment and support
- The ability to provide a range of brief, focused prevention, treatment and recovery services, as well as longer-term treatment and support
- for consumers with persistent illnesses.
- Examples include: motivational interventions, health promotion and wellness services, health education, crisis intervention, brief treatments
- Examples include: motivational interventions, health promotion and wellness services, health education, crisis intervention, brief treatments
- for mental health and substance use problems, and medication assisted treatments.
- VI. CULTURAL COMPETENCE & ADAPTATION
- VI. CULTURAL COMPETENCE & ADAPTATION
- VI. CULTURAL COMPETENCE & ADAPTATION
- VI. CULTURAL COMPETENCE & ADAPTATION
- The ability to provide services that are relevant to the culture of the consumer and their family.
- The ability to provide services that are relevant to the culture of the consumer and their family.
- The ability to provide services that are relevant to the culture of the consumer and their family.
- The ability to provide services that are relevant to the culture of the consumer and their family.
- Examples include: identifying and addressing disparities in healthcare access and quality, adapting services to language preferences
- Examples include: identifying and addressing disparities in healthcare access and quality, adapting services to language preferences
- and cultural norms, and promoting diversity among the providers working in interprofessional teams.
- VII. SYSTEMS ORIENTED PRACTICE
- VII. SYSTEMS ORIENTED PRACTICE
- VII. SYSTEMS ORIENTED PRACTICE
- VII. SYSTEMS ORIENTED PRACTICE
- The ability to function effectively within the organizational and financial structures of the local system of healthcare.
- The ability to function effectively within the organizational and financial structures of the local system of healthcare.
- The ability to function effectively within the organizational and financial structures of the local system of healthcare.
- The ability to function effectively within the organizational and financial structures of the local system of healthcare.
- Examples include: understanding and educating consumers about healthcare benefits, navigating utilization management processes,
- Examples include: understanding and educating consumers about healthcare benefits, navigating utilization management processes,
- and adjusting the delivery of care to emerging healthcare reforms.
- VIII. PRACTICE-BASED LEARNING & QUALITY IMPROVEMENT
- VIII. PRACTICE-BASED LEARNING & QUALITY IMPROVEMENT
- VIII. PRACTICE-BASED LEARNING & QUALITY IMPROVEMENT
- VIII. PRACTICE-BASED LEARNING & QUALITY IMPROVEMENT
- The ability to assess and continually improve the services delivered as an individual provider and as an interprofessional team.
- The ability to assess and continually improve the services delivered as an individual provider and as an interprofessional team.
- The ability to assess and continually improve the services delivered as an individual provider and as an interprofessional team.
- The ability to assess and continually improve the services delivered as an individual provider and as an interprofessional team.
- Examples include: identifying and implementing evidence-based practices, assessing treatment fidelity, measuring consumer satisfaction and
- Examples include: identifying and implementing evidence-based practices, assessing treatment fidelity, measuring consumer satisfaction and
- healthcare outcomes, recognizing and rapidly addressing errors in care, and collaborating with other team members on service improvement.
- IX. INFORMATICS
- IX. INFORMATICS
- IX. INFORMATICS
- IX. INFORMATICS
- The ability to use information technology to support and improve integrated healthcare.
- The ability to use information technology to support and improve integrated healthcare.
- The ability to use information technology to support and improve integrated healthcare.
- The ability to use information technology to support and improve integrated healthcare.
- Examples include: using electronic health records efficiently and effectively; employing computer and web-based screening,
- Examples include: using electronic health records efficiently and effectively; employing computer and web-based screening,
- assessment, and intervention tools; utilizing telehealth applications; and safeguarding privacy and confidentiality.
- I. INTERPERSONAL COMMUNICATION
- I. INTERPERSONAL COMMUNICATION
- I. INTERPERSONAL COMMUNICATION
- Figure
- II. COLLABORATION & TEAMWORK
- II. COLLABORATION & TEAMWORK
- II. COLLABORATION & TEAMWORK
- Figure
- III. SCREENING & ASSESSMENT
- III. SCREENING & ASSESSMENT
- III. SCREENING & ASSESSMENT
- Figure
- IV. CARE PLANNING & CARE COORDINATION
- IV. CARE PLANNING & CARE COORDINATION
- IV. CARE PLANNING & CARE COORDINATION
- Figure
- V. INTERVENTION
- V. INTERVENTION
- V. INTERVENTION
- Figure
- VI. CULTURAL COMPETENCE & ADAPTATION
- VI. CULTURAL COMPETENCE & ADAPTATION
- VI. CULTURAL COMPETENCE & ADAPTATION
- Figure
- VII. SYSTEMS ORIENTED PRACTICE
- VII. SYSTEMS ORIENTED PRACTICE
- VII. SYSTEMS ORIENTED PRACTICE
- Figure
- VIII. PRACTICE-BASED LEARNING & QUALITY IMPROVEMENT
- VIII. PRACTICE-BASED LEARNING & QUALITY IMPROVEMENT
- VIII. PRACTICE-BASED LEARNING & QUALITY IMPROVEMENT
- Figure
- IX. INFORMATICS
- IX. INFORMATICS
- IX. INFORMATICS
- Figure
- REFERENCES
- REFERENCES
- REFERENCES
- Air Force Medical Operations Agency, Behavioral Health Optimization Program, Mental Health Division/SGHW. (2011, April).
- Air Force Medical Operations Agency, Behavioral Health Optimization Program, Mental Health Division/SGHW. (2011, April).
- Air Force Medical Operations Agency, Behavioral Health Optimization Program, Mental Health Division/SGHW. (2011, April).
- Primary
- behavioral health care services practice manual, version 2.0
- . Lackland AFB, TX: Author.
- Alakeson, V., Frank, R. G., & Katz, R. E. (2010). Specialty care medical homes for people with severe, persistent mental disorders.
- Alakeson, V., Frank, R. G., & Katz, R. E. (2010). Specialty care medical homes for people with severe, persistent mental disorders.
- Health Affairs, 29
- (5), 867-873. doi: 10.1377/hlthaff.2010.0080
- Alexander, L., Quintanilla, R., Schlesinger, B., & Goldstein, B. (2010, June 3).
- Alexander, L., Quintanilla, R., Schlesinger, B., & Goldstein, B. (2010, June 3).
- Addressing mental health problems in primary care:
- IMPACT and other approaches
- [Webinar series]. California Institute for Mental Health, Alcohol & Drug Policy Institute, Integrated
- Behavioral Health Project. Retrieved from
- http://www.cimh.org/post/integration-initiatives-webinars
- http://www.cimh.org/post/integration-initiatives-webinars
- Anastasi, J. K., Capili, B., & Schenkman, F. (2009). Developing an integrative therapies in primary care program.
- Anastasi, J. K., Capili, B., & Schenkman, F. (2009). Developing an integrative therapies in primary care program.
- Nurse Educator,
- 34
- (6), 271-275. doi:10.1097/NNE.0b013e3181bc747a
- Bascetta, C. A. (2010).
- Bascetta, C. A. (2010).
- Healthcare delivery: Features of integrated systems support patient care strategies and access to care, but
- systems face challenges
- (GAO-11-49). Washington, DC: United States Government Accountability Office.
- Bjerkan, J., & Alonso, A. (2010). Patients and professionals in collaborative testing.
- Bjerkan, J., & Alonso, A. (2010). Patients and professionals in collaborative testing.
- Studies in Health Technology and Informatics, 157
- ,
- 66-71. Retrieved from
- http://www.ebooks.iospress.nl/bookseries/studies-in-health-technology-and-informatics
- http://www.ebooks.iospress.nl/bookseries/studies-in-health-technology-and-informatics
- Blount, A. F., & Miller, B. F. (2009). Addressing the workforce crisis in integrated primary care.
- Blount, A. F., & Miller, B. F. (2009). Addressing the workforce crisis in integrated primary care.
- Journal of Clinical Psychology in Medical
- Settings, 16
- (1), 113-119. doi: 10.1007/s10880-008-9142-7
- Bluestein, D., & Cubic, B. A. (2009). Psychologists and primary care physicians: A training model for creating collaborative
- Bluestein, D., & Cubic, B. A. (2009). Psychologists and primary care physicians: A training model for creating collaborative
- relationships.
- Journal of Clinical Psychology in Medical Settings, 16
- (1), 101-112. doi:10.1007/s10880-009-9156-9
- Brawer, P. A., Martielli, M., Patrice, P. L., Manwaring, J., & Tierney, A. (2010). St. Louis initiative for integrated care excellence (SLI2CE):
- Brawer, P. A., Martielli, M., Patrice, P. L., Manwaring, J., & Tierney, A. (2010). St. Louis initiative for integrated care excellence (SLI2CE):
- Integrated-collaborative care on a large scale model.
- Families, Systems & Health, 28
- (2), 175-187. doi:10.1037/A0020342
- Bryan, C. J., Morrow, C., & Appolonio, K. K. (2009). Impact of behavioral health consultant interventions on patient symptoms and
- Bryan, C. J., Morrow, C., & Appolonio, K. K. (2009). Impact of behavioral health consultant interventions on patient symptoms and
- functioning in an integrated family medicine clinic.
- Journal of Clinical Psychology, 65
- (3), 281-293. doi:10.1002/jclp.20539
- Chalk, M., Dilonardo, J., Gelber Rinaldo, S. G, & Oehlmann, P. (2010, July).
- Chalk, M., Dilonardo, J., Gelber Rinaldo, S. G, & Oehlmann, P. (2010, July).
- Integrating appropriate services for substance use
- conditions in health care settings: An issue brief on lessons learned and challenges ahead
- . Forum on Integration: A collaborative for
- States. Retrieved from
- http://www.tresearch.org/download/policy_briefs/LessonsLearned.pdf
- http://www.tresearch.org/download/policy_briefs/LessonsLearned.pdf
- Chang-Quan, H., Bi-Rong, D., Zhen-Chan, L., Yuan, Z., Yu-Sheng, P., & Qing-Xiu, L. (2009). Collaborative care interventions for
- Chang-Quan, H., Bi-Rong, D., Zhen-Chan, L., Yuan, Z., Yu-Sheng, P., & Qing-Xiu, L. (2009). Collaborative care interventions for
- depression in the elderly: A systematic review of randomized controlled trials.
- Journal of Investigative Medicine, 57
- (2), 446-455. doi:
- 10.231/JIM.0b013e3181954c2f
- Cummings, N. A., O’Donohue, W. T., & Cummings, J. L. (2009). The financial dimension of integrated behavioral/primary care.
- Cummings, N. A., O’Donohue, W. T., & Cummings, J. L. (2009). The financial dimension of integrated behavioral/primary care.
- Journal
- of Clinical Psychological Medical Settings, 16
- (1), 31-39. doi:10.1007/s10880-008-9139-2
- Cunningham, P. J. (2009). Beyond parity: Primary care physicians’ perspectives on access to mental health care.
- Cunningham, P. J. (2009). Beyond parity: Primary care physicians’ perspectives on access to mental health care.
- Health Affairs
- , 28(3),
- w490-w501. doi:10.1377/hlthaff.28.3.w490
- Daniels, A. S., Adams, A., Carroll, C., & Beinecke, R. H. (2009). A conceptual model for behavioral health and primary care integration.
- Daniels, A. S., Adams, A., Carroll, C., & Beinecke, R. H. (2009). A conceptual model for behavioral health and primary care integration.
- International Journal of Mental Health, 38
- (1), 100-112. doi:10.2753,imh0020-7411380109
- Druss, B. G., & Walker, E. R. (2011, February).
- Druss, B. G., & Walker, E. R. (2011, February).
- Mental disorders and medical comorbidity
- . (Research Synthesis Report No. 21).
- Retrieved from Robert Wood Johnson website:
- http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/02/mental-
- http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/02/mental-
- disorders-and-medical-comorbidity.html
- Easterly, L. (2009). An educational model for workforce development: Dissemination of evidence-based practices.
- Easterly, L. (2009). An educational model for workforce development: Dissemination of evidence-based practices.
- Community Mental
- Health Journal, 45
- , 199-208. doi: 10.1007/s10597-008-9170-7
- Eichbaum, Q., Grennan, T., Young, H., & Hurt, M. (2010). An alternative model for medical education: Longitudinal medical education
- Eichbaum, Q., Grennan, T., Young, H., & Hurt, M. (2010). An alternative model for medical education: Longitudinal medical education
- within an integrated health care organization - a vision of a model for the future?
- The Permanente Journal, 14
- (3), 44-49. Retrieved
- from
- http://www.thepermanentejournal.org
- http://www.thepermanentejournal.org
- Fielding, S. (2010).
- Fielding, S. (2010).
- Integrative medicine: Improving health care for patients and health care delivery for providers and payors.
- Minneapolis, MN: The Bravewell Collaborative.
- Foy, J. M., Kelleher, K. J., & Laraque, D. (2010). Enhancing pediatric mental health care: Strategies for preparing a primary care
- Foy, J. M., Kelleher, K. J., & Laraque, D. (2010). Enhancing pediatric mental health care: Strategies for preparing a primary care
- practice.
- Pediatrics, 125
- , S87-S108. doi: 10.1542/peds.2010-0788E
- Funderbunk, J. S., Sugarman, D. E., Maisto, A. M., Ouimette, P., Schohn, M., Lantinga, L.,… Strutynski, K. (2010). The description and evaluation
- Funderbunk, J. S., Sugarman, D. E., Maisto, A. M., Ouimette, P., Schohn, M., Lantinga, L.,… Strutynski, K. (2010). The description and evaluation
- of the implementation of an integrated health care model.
- Families, Systems & Health, 28
- (2), 146-160. doi:10.1037/a0020223
- Gaboury, I., Lapierre, L. M., Boon, H., & Moher, D. (2011). Interprofessional collaboration within integrative healthcare clinics through the
- Gaboury, I., Lapierre, L. M., Boon, H., & Moher, D. (2011). Interprofessional collaboration within integrative healthcare clinics through the
- lens of the relationship-centered care model.
- Journal of Interprofessional Care, 25
- , 124-130. doi:10.3109/13561820.2010.523654
- Goodell, S., Druss, B. G., & Walker, E. R. (2011, February).
- Goodell, S., Druss, B. G., & Walker, E. R. (2011, February).
- Mental disorders and medical comorbidity
- (Policy Brief No. 21). Retrieved
- from Robert Wood Johnson website:
- http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/02/mental-disorders-and-
- http://www.rwjf.org/en/research-publications/find-rwjf-research/2011/02/mental-disorders-and-
- medical-comorbidity.html
- Haggerty, J. M., Ryan-Nicholls, K. D., & Jarva, J. A. (2010). Mental health collaborative care: A synopsis of the rural and isolated toolkit.
- Haggerty, J. M., Ryan-Nicholls, K. D., & Jarva, J. A. (2010). Mental health collaborative care: A synopsis of the rural and isolated toolkit.
- Rural and Remote Health, 10
- (1), 1-10. Retrieved from
- http://www.rrh.org.au
- http://www.rrh.org.au
- Hawkes, N. (2009). Joined up thinking: The government hopes that integration of services will improve care, but as Nigel Hawkes reports
- Hawkes, N. (2009). Joined up thinking: The government hopes that integration of services will improve care, but as Nigel Hawkes reports
- the pilot schemes have a lot to prove.
- British Medical Journal, 338
- , 1238-1239. Retrieved from
- http://www.bmj.com
- http://www.bmj.com
- Hoge, M. A., Morris, J. A., Stuart, G. W., Leighton, Y. H., Bergeson, S., Flaherty, M.,… Madenwald, K. (2009). A national action plan for
- Hoge, M. A., Morris, J. A., Stuart, G. W., Leighton, Y. H., Bergeson, S., Flaherty, M.,… Madenwald, K. (2009). A national action plan for
- workforce development in behavioral health.
- Psychiatric Services, 60
- (7), 883-887. doi:10.1176/appi.ps.60.7.883
- Hogg Foundation for Mental Health & Methodist Healthcare Ministries. (2011). Crisis point: Mental health workforce shortages in Texas. Austin,
- Hogg Foundation for Mental Health & Methodist Healthcare Ministries. (2011). Crisis point: Mental health workforce shortages in Texas. Austin,
- TX: Author.
- Homer, C. J. (2009). Health disparities and the primary care medical home: Could it be that simple?
- Homer, C. J. (2009). Health disparities and the primary care medical home: Could it be that simple?
- Academic Pediatrics, 9
- (4), 203-205.
- doi:10.1016/j.acap.2009.06.001
- Humphreys, J., Wakerman, J., Kuipers, P., Wells, B., Russell, P., Siegloff, S., & Homer, K. (2009).
- Humphreys, J., Wakerman, J., Kuipers, P., Wells, B., Russell, P., Siegloff, S., & Homer, K. (2009).
- Improving workforce retention: Developing
- an integrated logic to maximise sustainability of small rural & remote healthcare services
- . Acton ACT, Australia: The Australian National
- University.
- Hunter, C. L., Goodie , J. L., Oordt, M. S., & Dobmeyer, A. C. (2009).
- Hunter, C. L., Goodie , J. L., Oordt, M. S., & Dobmeyer, A. C. (2009).
- Integrated behavioral health in primary care
- . Washington, DC: American
- Psychological Association.
- Integrated Behavioral Health Project. (2009, October).
- Integrated Behavioral Health Project. (2009, October).
- Partners in Health – primary care / county mental health collaboration toolkit
- .
- Retrieved from
- http://www.ibhp.org/uploads/file/IBHP%20Collaborative%20Tool%20Kit%20final.pdf
- http://www.ibhp.org/uploads/file/IBHP%20Collaborative%20Tool%20Kit%20final.pdf
- James L. C., & O’Donohue, W. T. (2010).
- James L. C., & O’Donohue, W. T. (2010).
- The primary care toolkit: Practical resources for the integrated behavioral care provider
- . New
- York, NY: Springer.
- Katon, W. J. (2009). Collaborative care: Evidence-based models that improve primary care depressive outcomes.
- Katon, W. J. (2009). Collaborative care: Evidence-based models that improve primary care depressive outcomes.
- CNS Spectrums, 14
- (12
- Suppl 14), 10-13. Retrieved from
- http://journals.cambridge.org/action/displayJournal?jid=CNS
- http://journals.cambridge.org/action/displayJournal?jid=CNS
- Kessler, W., & Cubic, B. (2009). The train is leaving the station: Is psychology aboard?
- Kessler, W., & Cubic, B. (2009). The train is leaving the station: Is psychology aboard?
- Journal of Clinical Psychology in Medical Settings,
- 16
- , 1-3. doi:10.1007/s10880-009-9157-8
- Kessler, W., Stafford, D., & Messier, R. (2009). The problem of integrating behavioral health in the medical home and the question it leads
- Kessler, W., Stafford, D., & Messier, R. (2009). The problem of integrating behavioral health in the medical home and the question it leads
- to.
- Journal of Clinical Psychology in Medical Settings, 16
- (1), 4-12. doi:10.1007/s10880-009-9146-y
- Kilbourne, A. M., Greenwald, D. E., Hermann, R. C., Charns, M. P., McCarthy, J. F., & Yano, E. M. (2010). Financial incentives and
- Kilbourne, A. M., Greenwald, D. E., Hermann, R. C., Charns, M. P., McCarthy, J. F., & Yano, E. M. (2010). Financial incentives and
- accountability for integrated medical care in department of veteran affairs mental health programs.
- Psychiatric Services, 61
- (1), 38-44.
- doi:10.1176/appi.ps.61.1.38
- Kirchner, J., Edlund, C. N., Haenderson, K., Daily, L., Parker, L. E., & Fortney, J. C. (2010). Using a multi-level approach to implement a
- Kirchner, J., Edlund, C. N., Haenderson, K., Daily, L., Parker, L. E., & Fortney, J. C. (2010). Using a multi-level approach to implement a
- primary care mental health (pcmh) program.
- Families, Systems & Health, 28
- (2), 161-174. doi:10.1037/a0020250
- Knowles, P. (2009). Collaborative communication between psychologists and primary care providers.
- Knowles, P. (2009). Collaborative communication between psychologists and primary care providers.
- Journal of Clinical Psychology in
- Medical Settings, 16
- , 72-76. doi: 10.1007/s10880-009-9151-1
- Kodner, D. (2009). All together now: A conceptual exploration of integrated care.
- Kodner, D. (2009). All together now: A conceptual exploration of integrated care.
- Healthcare Quarterly, 13
- , 6-15. doi:10.12927/
- hcq.2009.21091
- Koo, D., & Miner, K. (2010). Outcome-based workforce development and education in public health.
- Koo, D., & Miner, K. (2010). Outcome-based workforce development and education in public health.
- Annual Review of Public Health, 31
- ,
- 253-269. doi: 10.1146/annurev.publhealth.012809.103705
- Lardiere, M. R., Jones, E., & Perez, M. (2011).
- Lardiere, M. R., Jones, E., & Perez, M. (2011).
- NACHC 2010 assessment of behavioral health services in federally qualified health centers
- .
- Bethesda, MD: National Association of Community Health Centers.
- Mathematica Policy Research. (2010).
- Mathematica Policy Research. (2010).
- Integrating mental health treatment into the patient centered medical home
- (AHRQ Publication
- No. 10-0084-EF). Retrieved from
- http://pcmh.ahrq.gov/page/integrating-mental-health-treatment-patient-centered-medical-home
- http://pcmh.ahrq.gov/page/integrating-mental-health-treatment-patient-centered-medical-home
- Mauer, B. J. (2009).
- Mauer, B. J. (2009).
- Behavioral health / primary care integration and the person-centered healthcare home
- . Washington, DC: National
- Council for Community Behavioral Healthcare.
- Mauer, B. J. (2010).
- Mauer, B. J. (2010).
- Substance use disorders and the person-centered healthcare home
- . Washington, DC: National Council for Community
- Behavioral Healthcare.
- Mauer, B. J., & Jarvis, D. (2010).
- Mauer, B. J., & Jarvis, D. (2010).
- The business case for bidirectional integrated care: Mental health and substance use services in primary
- care settings and primary care services in specialty mental health and substance use settings
- . Seattle, WA: MCPP Healthcare Consulting.
- Maxwell, W. A., Alexander, K. P., & Ratliff, R. E. (2009, April). Reorganizing to provide integrated care.
- Maxwell, W. A., Alexander, K. P., & Ratliff, R. E. (2009, April). Reorganizing to provide integrated care.
- Behavioral healthcare, 29
- , 5.
- Retrieved from
- http://www.behavioral.net/article/reorganizing-provide-integrated-care
- http://www.behavioral.net/article/reorganizing-provide-integrated-care
- McColl, M. A., Shortt, S., Godwin, M., Smith, K., Rowe, K., O’Brien, P., & Donnelly, C. (2009). Models for integrating rehabilitation and
- McColl, M. A., Shortt, S., Godwin, M., Smith, K., Rowe, K., O’Brien, P., & Donnelly, C. (2009). Models for integrating rehabilitation and
- primary care: A scoping study.
- Archives of Physical Medicine and Rehabilitation, 90
- (9), 1523-1531. doi: 10.1016/j.apmr.2009.03.017
- Meyer, F., Peteet, J., & Joseph, R. (2009). Models of care for co-occurring mental and medical disorders.
- Meyer, F., Peteet, J., & Joseph, R. (2009). Models of care for co-occurring mental and medical disorders.
- Harvard Review of Psychiatry,
- 17
- (6), 353-360. doi:10.3109/10673220903463325
- Miller, B. F., Mendenhall, T. J., & Malik, A. D. (2008). Integrated primary care: An inclusive three-world view through process metrics and
- Miller, B. F., Mendenhall, T. J., & Malik, A. D. (2008). Integrated primary care: An inclusive three-world view through process metrics and
- empirical discrimination.
- Journal of Clinical Psychology in Medical Settings, 16
- (1), 21-30. doi:10.1007/s10880-008-9137-4
- Ministry of Health. (2009).
- Ministry of Health. (2009).
- Towards optimal primary mental health care in the new primary care environment: A draft guidance paper
- .
- Wellington: Author.
- Morgan, M., Dunbar, J., Reddy, P., Coates, M., & Leahy, R. (2009). The true blue story: Is practice nurse-led collaborative care effective in the
- Morgan, M., Dunbar, J., Reddy, P., Coates, M., & Leahy, R. (2009). The true blue story: Is practice nurse-led collaborative care effective in the
- management of depression for patients with heart disease or diabetes?
- BMC Family Practice, 10
- (46), doi:10.1186/1471-2296-10-46
- Morrow, C. E., Mansoor, E., Hanson, K. L., Vogel, A. L., Rose-Jacobs, R., Genatossio, C. S.,… Bandstra, E. S. (2009). The starting early
- Morrow, C. E., Mansoor, E., Hanson, K. L., Vogel, A. L., Rose-Jacobs, R., Genatossio, C. S.,… Bandstra, E. S. (2009). The starting early
- starting smart integrated services model: Improving access to behavioral health services in the pediatric health care setting for at-risk
- families with young children.
- Journal of Child and Family Studies, 19
- (1), 42-56. doi: 10.1007/s10826-009-9280-z
- Murphy, M. K., Chabon, B., Delgado, A., Newville, H., & Nicolson, S. E. (2009). Development of a substance abuse consultation and
- Murphy, M. K., Chabon, B., Delgado, A., Newville, H., & Nicolson, S. E. (2009). Development of a substance abuse consultation and
- referral service in an academic medical center: Challenges, achievements and dissemination.
- Journal of Clinical Psychology in Medical
- Settings, 16
- (1), 77-86. doi:10.1007/s10880-009-9149-8
- O’Donohue, W. T., Cummings, N. A., & Cummings, J. L. (2009). The unmet educational agenda in integrated care.
- O’Donohue, W. T., Cummings, N. A., & Cummings, J. L. (2009). The unmet educational agenda in integrated care.
- Journal of Clinical
- Psychology in Medical Settings, 16
- (1), 94-100. doi: 10.1007/s10880-008-9138-3
- Patel, K. J., & Dwamena, F. (2009). Impact of collaborative care management of depression among patients with cancer.
- Patel, K. J., & Dwamena, F. (2009). Impact of collaborative care management of depression among patients with cancer.
- Journal of
- Clinical Oncology, 27
- (10), 1730. doi: 10.1200/JCO.2008.21.1094
- Peek, C. J. (2009). Integrating care for persons, not only diseases.
- Peek, C. J. (2009). Integrating care for persons, not only diseases.
- Journal of Clinical Psychology in Medical Settings, 16
- (1), 13-20.
- doi:10.1007/s10880-009-9154-y
- Pisani, A. R., leRoux, P., Phil, D., & Siegel, D. M. (2011). Educating residents in behavioral health care and collaboration: Integrated clinical
- Pisani, A. R., leRoux, P., Phil, D., & Siegel, D. M. (2011). Educating residents in behavioral health care and collaboration: Integrated clinical
- training of pediatric residents and psychology fellows.
- Academic Medicine, 86
- (2), 166-173. doi: 10.1097/ACM.0b013e318204fd94
- Pomerantz, A. S., Corson, J. A., & Detzer, M. J. (2009). The challenge of integrated care for mental health: Leaving the 50 minute hour
- Pomerantz, A. S., Corson, J. A., & Detzer, M. J. (2009). The challenge of integrated care for mental health: Leaving the 50 minute hour
- and other sacred things.
- Journal of Clinical Psychology in Medical Settings, 16
- (1), 40-46. doi:10.1007/s10880-009-9147-x
- Pomerantz, A. S., & Sayers, S. L. (2010). Primary care-mental health integration in healthcare in the department of veteran affairs.
- Pomerantz, A. S., & Sayers, S. L. (2010). Primary care-mental health integration in healthcare in the department of veteran affairs.
- Families, Systems & Health, 28
- (2), 78-82. doi: 10.1037/a0020341
- Pomerantz, A. S., Shiner, B., Watts, B. V., Detzer, M. J., Kutter, C., Street, B., & Scott, D. (2010). The white river model of colocated
- Pomerantz, A. S., Shiner, B., Watts, B. V., Detzer, M. J., Kutter, C., Street, B., & Scott, D. (2010). The white river model of colocated
- collaborative care: A platform for mental and behavioral health care in the medical home.
- Families, Systems & Health, 28
- (2), 114-129.
- doi:10.1037/a0020261
- Post, E. P., Metzger, M., Dumas, P., & Lehmann, L. (2010). Integrating mental health into primary care within the veterans health
- Post, E. P., Metzger, M., Dumas, P., & Lehmann, L. (2010). Integrating mental health into primary care within the veterans health
- administration.
- Families, Systems & Health, 28
- (2), 83-90. doi:10.1037/a0020130
- Protti, D. (2009). Integrated care needs integrated information management and technology.
- Protti, D. (2009). Integrated care needs integrated information management and technology.
- Healthcare Quarterly, 13
- , 24-29. Retrieved
- from
- http://www.longwoods.com/publications/healthcare-quarterly
- http://www.longwoods.com/publications/healthcare-quarterly
- Pyne, J. M., Fortney, J. C., Curran, G. M., Tripathi, S., Atkinson, J. H., Kilbourne, A. M.,…Gifford, A. L. (2011). Effectiveness of
- Pyne, J. M., Fortney, J. C., Curran, G. M., Tripathi, S., Atkinson, J. H., Kilbourne, A. M.,…Gifford, A. L. (2011). Effectiveness of
- collaborative care for depression in human immunodeficiency virus clinics.
- Archives of Internal Medicine, 171
- (1), 23-31. doi:10.1001/
- archinternmed.2010.395
- Ring, J. M. (2009). Psychology and medical education: Collaborations for culturally responsive care.
- Ring, J. M. (2009). Psychology and medical education: Collaborations for culturally responsive care.
- Journal of Clinical Psychology in
- Medical Settings, 16
- (1), 120-126. doi: 10.1007/s10880-008-9141-8
- Robinson, P. J., & Strosahl, K. D. (2009). Behavioral health consultation and primary care: Lessons learned.
- Robinson, P. J., & Strosahl, K. D. (2009). Behavioral health consultation and primary care: Lessons learned.
- Journal of Clinical Psychology
- in Medical Settings, 16
- (1), 58-71. doi: 10.1007/s10880-009-9145-z
- Roche, A. M., Pidd, K., & Freeman, T. (2009). Achieving professional practice change: From training to workforce development.
- Roche, A. M., Pidd, K., & Freeman, T. (2009). Achieving professional practice change: From training to workforce development.
- Drug and
- Alcohol Review, 28
- (5), 550-557. doi: 10.1111/j.1465-3362.2009.00111.x
- Rosenthal, E. L., Brownstein, J. N., Rush, C. H., Hirsch, G. R., Willaert, A. M., Scott, J. R.,…Fox, D. J. (2010). Community health workers:
- Rosenthal, E. L., Brownstein, J. N., Rush, C. H., Hirsch, G. R., Willaert, A. M., Scott, J. R.,…Fox, D. J. (2010). Community health workers:
- Part of the solution.
- Health Affairs, 29
- (7), 1338-1342. doi:10.1377/hlthaff.2010.0081
- RTI–UNC Evidence-Based Practice Center. (2010).
- RTI–UNC Evidence-Based Practice Center. (2010).
- Future research needs for the integration of mental health/substance abuse and
- primary care
- (AHRQ Publication No. 10-EHC069-EF). Retrieved from
- http://www.ncbi.nlm.nih.gov/books/NBK51247
- http://www.ncbi.nlm.nih.gov/books/NBK51247
- Russell, L. (2010).
- Russell, L. (2010).
- Mental health care services in primary care tackling the issues in the context of health care reform
- . Washington, DC:
- Center for American Progress.
- Ruston, A., & Tavabie, A. (2010). Fostering clinical engagement and medical leadership and aligning cultural values: An evaluation of
- Ruston, A., & Tavabie, A. (2010). Fostering clinical engagement and medical leadership and aligning cultural values: An evaluation of
- a general practice specialty trainee integrated training placement in a primary care trust.
- Quality in Primary Care, 18
- (4), 263-268.
- Retrieved from http://www.ingentaconnect.com/content/rmp/qpc
- Sanchez, K., Thompson, S., & Alexander, L. (2010). Current strategies and barriers in integrated health care: A survey of publicly funded
- Sanchez, K., Thompson, S., & Alexander, L. (2010). Current strategies and barriers in integrated health care: A survey of publicly funded
- providers in Texas.
- General Hospital Psychiatry, 32
- (1), 26-32. doi:10.1016/j.genhosppsych.2009.10.007
- Schmied, V., Mills, A., Kruske, S., Kemp, L., Fowler, C., & Homer, C. (2010). Understanding the needs and experiences of families: The
- Schmied, V., Mills, A., Kruske, S., Kemp, L., Fowler, C., & Homer, C. (2010). Understanding the needs and experiences of families: The
- nature and impact of collaboration and integrated service delivery for pregnant women, children and families.
- Journal of Clinical Nursing,
- 19
- , 3516–3526. doi:10.1111/j.1365-2702.2010.03321.x
- Schoen, C., Osborn, R., Doty, M. M., Squires, D., Peugh, J., & Applebaum, S. (2009). A survey of primary care physicians in eleven
- Schoen, C., Osborn, R., Doty, M. M., Squires, D., Peugh, J., & Applebaum, S. (2009). A survey of primary care physicians in eleven
- countries, 2009: Perspectives on care, costs, and experiences.
- Health Affairs, 28
- (6), w1171-w1183. doi:10.1377/hlthaff.28.6.w1171
- Schoenwald, S. K., Hoagwood, K. E., Atkins, M. S., Evans, M. E., & Ringeisen, H. (2010). Workforce development and the organization of
- Schoenwald, S. K., Hoagwood, K. E., Atkins, M. S., Evans, M. E., & Ringeisen, H. (2010). Workforce development and the organization of
- work: The science we need.
- Administration and Policy in Mental Health, 37
- (1-2), 71–80. doi:10.1007/s10488-010-0278-z
- Schuffman, D., Druss, B. G., & Parks, J. J. (2009). State mental health policy: Mending Missouri’s safety net: Transforming systems of
- Schuffman, D., Druss, B. G., & Parks, J. J. (2009). State mental health policy: Mending Missouri’s safety net: Transforming systems of
- care by integrating primary and behavioral health care.
- Psychiatric Services, 60
- (5), 585-588. doi: 10.1176/appi.ps.60.5.585
- Sevin, C., Moore, G., Shepherd, J., Jacobs, T., & Hupke, C. (2009). Transforming care teams to provide the best possible patient-centered,
- Sevin, C., Moore, G., Shepherd, J., Jacobs, T., & Hupke, C. (2009). Transforming care teams to provide the best possible patient-centered,
- collaborative care.
- Journal of Ambulatory Care Management, 32
- (1), 24-31. doi:10.1097/01.JAC.0000343121.07844.e0
- Smith, M. (2010). Collaborative care models for late-life depression and anxiety: Roles for nurses.
- Smith, M. (2010). Collaborative care models for late-life depression and anxiety: Roles for nurses.
- Journal of Gerontological Nursing,
- 36
- (9), 3-4. doi:10.3928/00989134-20100803-01
- Strandberg-Larsen, M., & Krasnik, A. (2009). Measurement of integrated healthcare delivery: A systematic review of methods and future
- Strandberg-Larsen, M., & Krasnik, A. (2009). Measurement of integrated healthcare delivery: A systematic review of methods and future
- research directions.
- International Journal of Integrated Care, 9
- (4), 1-10. Retrieved from
- http://www.ijic.org/index.php/ijic
- http://www.ijic.org/index.php/ijic
- Summerfelt, W. T., Tilson, H. H., & Crawford, C. A. (2009). Moving forward with workforce development research in public health.
- Summerfelt, W. T., Tilson, H. H., & Crawford, C. A. (2009). Moving forward with workforce development research in public health.
- Journal
- of Public Health Management Practice, 15
- (6 Suppl), 1-2. doi:10.1097/PHH.0b013e3181c5c050
- Sved-Williams, A., & Poulton, J. (2010). Primary care mental health consultation-liaison: A connecting system for private psychiatrists
- Sved-Williams, A., & Poulton, J. (2010). Primary care mental health consultation-liaison: A connecting system for private psychiatrists
- and general practitioners.
- Australasian Psychiatry, 18
- (2), 125-129. doi:10.3109/10398560903469783
- Thacker, S. B. (2009). Guide for applied public health workforce research: An evidence-based approach to workforce development.
- Thacker, S. B. (2009). Guide for applied public health workforce research: An evidence-based approach to workforce development.
- Journal of Public Health Management Practice, 15
- (6 Suppl), S109-112. doi:10.1097/PHH.0b013e3181b1eb85
- The Commonwealth Fund. (2010).
- The Commonwealth Fund. (2010).
- Quality matters: A bimonthly report on innovations in health care quality improvement
- . Washington, DC:
- Author.
- Thombs, B. D., Adeponle, A. B., Kirmayer, L. J., & Morgan, J. F. (2010). A brief scale to assess hospital doctors’ attitudes toward
- Thombs, B. D., Adeponle, A. B., Kirmayer, L. J., & Morgan, J. F. (2010). A brief scale to assess hospital doctors’ attitudes toward
- collaborative care for mental health.
- Canadian Journal of Psychiatry, 55
- (4), 264-267. Retrieved from
- http://publications.cpa-apc.org/
- http://publications.cpa-apc.org/
- browse/documents/2
- U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2008).
- U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. (2008).
- Integration of mental health/
- substance abuse and primary care
- (AHRQ Publication No. 09-E003). Retrieved from
- http://www.ahrg.gov
- http://www.ahrg.gov
- van Orden, M., Hoffman, T., Haffmans, J., Spinhoven, P., & Hoencamp, E. (2009). Collaborative mental health care versus care as usual
- van Orden, M., Hoffman, T., Haffmans, J., Spinhoven, P., & Hoencamp, E. (2009). Collaborative mental health care versus care as usual
- in a primary care setting: A randomized controlled trial.
- Psychiatric Services, 60
- (1), 74-79. doi: 10.1176/appi.ps.60.1.74
- Walker, B. B., & Collins, C. A. (2009). Developing an integrated primary care practice: Strategies, techniques, and a case illustration.
- Walker, B. B., & Collins, C. A. (2009). Developing an integrated primary care practice: Strategies, techniques, and a case illustration.
- Journal of Clinical Psychology, 65
- (3), 268-280. doi:10.1002/jclp.20552
- Weiss, S. J., Haber, J., Horowitz, J. A., Stuart, G. W., & Wolfe, B. (2009). The inextricable nature of mental and physical health: Implications
- Weiss, S. J., Haber, J., Horowitz, J. A., Stuart, G. W., & Wolfe, B. (2009). The inextricable nature of mental and physical health: Implications
- for integrative care.
- Journal of the American Psychiatric Nurses Association, 15
- (6), 371-382. doi: 10.1177/1078390309352513
- Wu, M. P., Lin, P. F., Lin, K. J., Sun, R. S., Yu, W. R,, Peng, L. N., & Chen, L. K. (2010). Integrated care for severely disabled long-term care
- Wu, M. P., Lin, P. F., Lin, K. J., Sun, R. S., Yu, W. R,, Peng, L. N., & Chen, L. K. (2010). Integrated care for severely disabled long-term care
- facility residents: Is it better?
- Archives of Gerontology and Geriatrics, 50
- (3), 315-318. doi: 10.1016/j.archger.2009.05.004
- Wylie, L. W. J. (2010). Assessing user perceptions of staff training requirements in the substance use workforce: A review of the literature.
- Wylie, L. W. J. (2010). Assessing user perceptions of staff training requirements in the substance use workforce: A review of the literature.
- Drugs: Education, Prevention, and Policy, 17
- (5), 618-631. doi: 10.3109/09687631003705538
- Zismer, D. K., McCullough, J., & Person, P. E. (2009). Integrated health care economics part 2: Understanding the revenue drivers in fully
- Zismer, D. K., McCullough, J., & Person, P. E. (2009). Integrated health care economics part 2: Understanding the revenue drivers in fully
- integrated community health systems.
- Physician Executive, 35
- (4), 26-28. Retrieved from
- http://www.acpe.org/publications/pej
- http://www.acpe.org/publications/pej
- Zismer, D. K., McCullough, J., Person, P. E., & Renier, C., & Knutson, D. (2009). Integrated health care economics part 1: Are specialty
- Zismer, D. K., McCullough, J., Person, P. E., & Renier, C., & Knutson, D. (2009). Integrated health care economics part 1: Are specialty
- physician services revenues reliable predictors of community health system financial performance?
- Physician Executive, 35
- (3), 26-31.
- Retrieved from
- http://www.acpe.org/publications/pej
- http://www.acpe.org/publications/pej
- Zivin, K., Pfeiffer, P. N., Szymanski, B. R., Valenstein, M., Post, E. P., Miller, E. M., & McCarthy, J. F. (2010). Initiation of primary care-mental
- Zivin, K., Pfeiffer, P. N., Szymanski, B. R., Valenstein, M., Post, E. P., Miller, E. M., & McCarthy, J. F. (2010). Initiation of primary care-mental
- health integration programs in the VA health system: Associations with psychiatric diagnoses in primary care.
- Medical Care, 48
- (9), 843-
- 851. doi:10.1097/MLR.0b013e3181e5792b
- APPENDIX I: CONTRIBUTORS
- APPENDIX I: CONTRIBUTORS
- PROJECT TEAM
- PROJECT TEAM
- CIHS engaged the Annapolis Coalition on the Behavioral Health Workforce (
- CIHS engaged the Annapolis Coalition on the Behavioral Health Workforce (
- www.annapoliscoalition.org)
- www.annapoliscoalition.org)
- to lead and manage the competency
- development project. The Coalition is a non-profit organization dedicated to improving the recruitment, retention, training and performance of
- the prevention and treatment workforce in the mental health and addictions sectors of the behavioral health field.
- The core Annapolis Coalition team managing the project included:
- The core Annapolis Coalition team managing the project included:
- Michael A. Hoge, PhD, Senior Science and Policy Advisor, The Annapolis Coalition
- Michael A. Hoge, PhD, Senior Science and Policy Advisor, The Annapolis Coalition
- John A. Morris, MSW, Executive Director, The Annapolis Coalition
- John A. Morris, MSW, Executive Director, The Annapolis Coalition
- Michele Laraia, PhD, APRN, Project Consultant, The Annapolis Coalition
- Michele Laraia, PhD, APRN, Project Consultant, The Annapolis Coalition
- Ann McManis, Director of Operations, The Annapolis Coalition
- Ann McManis, Director of Operations, The Annapolis Coalition
- Senior Content Experts
- Senior Content Experts
- Two individuals with nationally recognized expertise in this field were engaged as Senior Content Experts to provide a broad and high-level
- Two individuals with nationally recognized expertise in this field were engaged as Senior Content Experts to provide a broad and high-level
- review of the product.
- Andrew Pomerantz, M.D.
- Andrew Pomerantz, M.D.
- is the National Mental Health Director for Integrated Services in the Veterans Health Administration and Associate
- Professor of Psychiatry at Dartmouth Medical School. His “White River” model of primary care – mental health integration, developed over
- a 15-year period, became a national model for the Veterans Administration in 2004. He is currently engaged in development of the VA’s
- Patient Centered Medical Home.
- Tillman Farley, M.D.
- Tillman Farley, M.D.
- is the Medical Services Director of Salud Family Health Centers, a migrant / federally qualified community health
- center with clinics across north and northeast Colorado. He completed his residency in family medicine in Rochester, New York and now
- serves as an Associate Professor in the Department of Family Medicine at the University of Colorado School of Medicine. He moved to
- Colorado from far west Texas where he spent three years directing a federally qualified rural health clinic. Dr. Farley has a strong interest
- in integrated primary care and health disparities, particularly as these apply to immigrant populations.
- Expert Key Informants
- Expert Key Informants
- The selection process and expertise of key informants is described in the Detailed Method section below.
- The selection process and expertise of key informants is described in the Detailed Method section below.
- Marty Adelman, MA, CRP
- Marty Adelman, MA, CRP
- Mental Health Coordinator
- Mental Health Coordinator
- Community Clinics Health Network
- Community Clinics Health Network
- San Diego, CA
- San Diego, CA
- Sergio Aguilar-Gaxiola, MD, PhD
- Sergio Aguilar-Gaxiola, MD, PhD
- Professor & Director of the Center for Reducing Health Disparities
- Professor & Director of the Center for Reducing Health Disparities
- University of California at Davis
- University of California at Davis
- Davis, CA
- Davis, CA
- Stephen J. Bartels, MD, MS
- Stephen J. Bartels, MD, MS
- Professor of Psychiatry, Community & Family Medicine
- Professor of Psychiatry, Community & Family Medicine
- Director, Center on Aging Research
- Director, Center on Aging Research
- Dartmouth University
- Dartmouth University
- Hanover, NH
- Hanover, NH
- Sue Bergeson
- Sue Bergeson
- Vice President
- Vice President
- Optum Health
- Optum Health
- Chicago, IL
- Chicago, IL
- Richard Brown, MD, MPH
- Richard Brown, MD, MPH
- Professor
- Professor
- Department of Family Medicine
- Department of Family Medicine
- University of Wisconsin
- University of Wisconsin
- Madison, WI
- Madison, WI
- Kathleen Buckwalter, RN, PhD, FAAN
- Kathleen Buckwalter, RN, PhD, FAAN
- Professor Emeritus, Sally Mathis Hartwig
- Professor Emeritus, Sally Mathis Hartwig
- Professor in Gerontological Nursing
- Professor in Gerontological Nursing
- University of Iowa College of Nursing
- University of Iowa College of Nursing
- Iowa City, IA
- Iowa City, IA
- Elisabeth Cannata, PhD
- Elisabeth Cannata, PhD
- Vice President of Community-Based Family Services and
- Vice President of Community-Based Family Services and
- Practice Innovation
- Practice Innovation
- Wheeler Clinic
- Wheeler Clinic
- Plainville, CT
- Plainville, CT
- Jeff Capobianco, PhD
- Jeff Capobianco, PhD
- Director of Practice Improvement
- Director of Practice Improvement
- SAMHSA-HRSA Center for Integrated Health Solutions, National
- SAMHSA-HRSA Center for Integrated Health Solutions, National
- Council for Behavioral Health
- Council for Behavioral Health
- Washington, DC
- Washington, DC
- Mady Chalk, PhD, MSW
- Mady Chalk, PhD, MSW
- Director
- Director
- Center for Performance-Based Policy
- Center for Performance-Based Policy
- Treatment Research Institute
- Treatment Research Institute
- Philadelphia, PA
- Philadelphia, PA
- Kathleen R. Delaney, PhD, PMH-NP, FAAN
- Kathleen R. Delaney, PhD, PMH-NP, FAAN
- Professor and Specialty Coordinator
- Professor and Specialty Coordinator
- Rush College of Nursing
- Rush College of Nursing
- Chicago, IL
- Chicago, IL
- Guillermo Diaz, Jr, MD, CPHIMS
- Guillermo Diaz, Jr, MD, CPHIMS
- Chief Medical Information Director
- Chief Medical Information Director
- QueensCare Family Clinics
- QueensCare Family Clinics
- Los Angeles, CA
- Los Angeles, CA
- Tillman Farley, MD
- Tillman Farley, MD
- Director of Medical Services
- Director of Medical Services
- Salud Family Health Center
- Salud Family Health Center
- Fort Lupton, CO
- Fort Lupton, CO
- Michael Flaherty, PhD
- Michael Flaherty, PhD
- Consultant
- Consultant
- Former Director, NE Addiction Technology Transfer Center
- Former Director, NE Addiction Technology Transfer Center
- Pittsburgh, PA
- Pittsburgh, PA
- Dennis Freeman
- Dennis Freeman
- CEO
- CEO
- Cherokee Health Systems
- Cherokee Health Systems
- Knoxville, TN
- Knoxville, TN
- Larry Fricks
- Larry Fricks
- Deputy Director
- Deputy Director
- SAMHSA-HRSA Center for Integrated Health Solutions, National
- SAMHSA-HRSA Center for Integrated Health Solutions, National
- Council for Behavioral Health
- Council for Behavioral Health
- Washington, DC
- Washington, DC
- Steven L. Gallon, PhD
- Steven L. Gallon, PhD
- Chair, Blending Team
- Chair, Blending Team
- Northwest Frontier ATTC
- Northwest Frontier ATTC
- Oregon Health & Science University
- Oregon Health & Science University
- Portland, OR
- Portland, OR
- Eric Goplerud, PhD
- Eric Goplerud, PhD
- Vice President for Mental Health, Substance Use and Justice
- Vice President for Mental Health, Substance Use and Justice
- NORC at University of Chicago
- NORC at University of Chicago
- Washington, DC
- Washington, DC
- Catherine Grus, PhD
- Catherine Grus, PhD
- Deputy Executive Director, Education Directorate
- Deputy Executive Director, Education Directorate
- American Psychological Association
- American Psychological Association
- Washington, DC
- Washington, DC
- Judith Haber, PhD, APRN, BC FAAN
- Judith Haber, PhD, APRN, BC FAAN
- Interim Dean
- Interim Dean
- NYU College of Nursing
- NYU College of Nursing
- New York, NY
- New York, NY
- Nancy P. Hanrahan, PhD, RN
- Nancy P. Hanrahan, PhD, RN
- Psychiatric MH Nursing Center for Health Outcomes and Policy
- Psychiatric MH Nursing Center for Health Outcomes and Policy
- Research
- Research
- University of Pennsylvania, School of Nursing
- University of Pennsylvania, School of Nursing
- Philadelphia, PA
- Philadelphia, PA
- Tom Hill, MSW
- Tom Hill, MSW
- Policy Director
- Policy Director
- Faces and Voices of Recovery
- Faces and Voices of Recovery
- Washington, DC
- Washington, DC
- Joseph Holshoe, PMHNP
- Joseph Holshoe, PMHNP
- Commander, US Public Health Service
- Commander, US Public Health Service
- Behavioral Health Consultant
- Behavioral Health Consultant
- Primary Care Clinic
- Primary Care Clinic
- Naval Health Center New England
- Naval Health Center New England
- Newport, RI
- Newport, RI
- Leighton Huey, MD
- Leighton Huey, MD
- Professor of Psychiatry
- Professor of Psychiatry
- University of Connecticut
- University of Connecticut
- Farmington, CT
- Farmington, CT
- DJ Ida, PhD
- DJ Ida, PhD
- Executive Director
- Executive Director
- National Asian American Pacific Islander Mental Health Association
- National Asian American Pacific Islander Mental Health Association
- Denver, CO
- Denver, CO
- Brain Kaskie, MD, PhD
- Brain Kaskie, MD, PhD
- Associate Professor
- Associate Professor
- Dept. of Health Management and Policy
- Dept. of Health Management and Policy
- College of Public Health
- College of Public Health
- University of Iowa
- University of Iowa
- Iowa City, IA
- Iowa City, IA
- Kelly J. Kelleher, MD, MPH, FAAP
- Kelly J. Kelleher, MD, MPH, FAAP
- Director, Center for Innovation in Pediatric Practice
- Director, Center for Innovation in Pediatric Practice
- Nationwide Children’s Hospital
- Nationwide Children’s Hospital
- Professor of Pediatrics
- Professor of Pediatrics
- Ohio State University
- Ohio State University
- Columbus, OH
- Columbus, OH
- Michael R. Lardieri, MSW
- Michael R. Lardieri, MSW
- Vice President, Health Information Technology
- Vice President, Health Information Technology
- National Council for Behavioral Health
- National Council for Behavioral Health
- Washington, DC
- Washington, DC
- Virna Little, PsyD, LCSW
- Virna Little, PsyD, LCSW
- Senior Vice President for Psychosocial Services and Community Affairs
- Senior Vice President for Psychosocial Services and Community Affairs
- The Institute for Family Health
- The Institute for Family Health
- New York, NY
- New York, NY
- Amy Brock Martin, DrPH
- Amy Brock Martin, DrPH
- Deputy Director
- Deputy Director
- SC Rural Health Research Center
- SC Rural Health Research Center
- University of South Carolina School of Public Health
- University of South Carolina School of Public Health
- Columbia, SC
- Columbia, SC
- Dennis McCarty, PhD
- Dennis McCarty, PhD
- Professor
- Professor
- Department of Public Health and Preventive Medicine
- Department of Public Health and Preventive Medicine
- Oregon Health & Science University
- Oregon Health & Science University
- Portland, OR
- Portland, OR
- Mimi McFaul, PsyD
- Mimi McFaul, PsyD
- Deputy Director, Mental Health Program
- Deputy Director, Mental Health Program
- Western Interstate Commission on Higher Education (WICHE)
- Western Interstate Commission on Higher Education (WICHE)
- Boulder, CO
- Boulder, CO
- Bill McFeature, PhD
- Bill McFeature, PhD
- Director of Integrative Behavioral Health
- Director of Integrative Behavioral Health
- Southwest Virginia Community Health Center
- Southwest Virginia Community Health Center
- Bristol, VA
- Bristol, VA
- Oscar Morgan, MHSA
- Oscar Morgan, MHSA
- Vice President
- Vice President
- Magna Systems, Inc.
- Magna Systems, Inc.
- Annapolis, MD
- Annapolis, MD
- Rich Munger, PhD
- Rich Munger, PhD
- Planner/Evaluator
- Planner/Evaluator
- Buncombe County Human Service Support Team
- Buncombe County Human Service Support Team
- Asheville, NC
- Asheville, NC
- Phyllis Panzano, PhD
- Phyllis Panzano, PhD
- Founder and President
- Founder and President
- Decision Support Services, Inc.
- Decision Support Services, Inc.
- Columbus, OH
- Columbus, OH
- Beth Phoenix, RN, PhD
- Beth Phoenix, RN, PhD
- Health Sciences Clinical Professor
- Health Sciences Clinical Professor
- Director, Psychiatric Nursing Graduate Program
- Director, Psychiatric Nursing Graduate Program
- UCSF School of Nursing
- UCSF School of Nursing
- San Francisco, CA
- San Francisco, CA
- Andrew Pomerantz, MD
- Andrew Pomerantz, MD
- National Mental Health Director for Integrated Care
- National Mental Health Director for Integrated Care
- Veterans Health Administration
- Veterans Health Administration
- White River Junction VA Medical Center
- White River Junction VA Medical Center
- White River Junction, VT
- White River Junction, VT
- Richard A. Rawson, PhD
- Richard A. Rawson, PhD
- Associate Director
- Associate Director
- UCLA Integrated Substance Abuse Programs
- UCLA Integrated Substance Abuse Programs
- Los Angeles, CA
- Los Angeles, CA
- Katherine Reynolds, MSW
- Katherine Reynolds, MSW
- Vice President, Health Integration and Wellness Promotion
- Vice President, Health Integration and Wellness Promotion
- National Council for Behavioral Health
- National Council for Behavioral Health
- Washington, DC
- Washington, DC
- Ruth Shim, MD
- Ruth Shim, MD
- Assistant Professor, Department of Psychiatry and Behavioral Sciences
- Assistant Professor, Department of Psychiatry and Behavioral Sciences
- Associate Director of Behavioral Health
- Associate Director of Behavioral Health
- National Center for Primary Care
- National Center for Primary Care
- Morehouse School of Medicine
- Morehouse School of Medicine
- Atlanta, GA
- Atlanta, GA
- Tony Salerno, PhD
- Tony Salerno, PhD
- Practice and Policy Scholar
- Practice and Policy Scholar
- McSilver Institute for Poverty Policy & Research
- McSilver Institute for Poverty Policy & Research
- Silver School of Social Work
- Silver School of Social Work
- New York University
- New York University
- Senior Consultant, CIHS
- Senior Consultant, CIHS
- New York, NY
- New York, NY
- Kim Schwartz, MSW
- Kim Schwartz, MSW
- CEO
- CEO
- Roanoke Chowan Community Health Center
- Roanoke Chowan Community Health Center
- Ahoskie, NC
- Ahoskie, NC
- Margaret Sharf, DNP
- Margaret Sharf, DNP
- PMHNP Program Director
- PMHNP Program Director
- Oregon Health & Science University
- Oregon Health & Science University
- School of Nursing
- School of Nursing
- Portland, OR
- Portland, OR
- Diane Snow, PhD, APRN, BC, CARN, PMHNP
- Diane Snow, PhD, APRN, BC, CARN, PMHNP
- Clinical Professor and Director
- Clinical Professor and Director
- PMHNP Program
- PMHNP Program
- University of Texas at Arlington
- University of Texas at Arlington
- Hurst, TX
- Hurst, TX
- Mark B. Snowden, MD, MPH
- Mark B. Snowden, MD, MPH
- Associate Professor
- Associate Professor
- University of Washington
- University of Washington
- Seattle, WA
- Seattle, WA
- Gail Stern, MSN, PMHCNS-BS
- Gail Stern, MSN, PMHCNS-BS
- Administrator
- Administrator
- Department of Psychiatry
- Department of Psychiatry
- Lehigh Valley Health Network
- Lehigh Valley Health Network
- Coopersburg, PA
- Coopersburg, PA
- Gail Stuart, PhD, RN, FAAN
- Gail Stuart, PhD, RN, FAAN
- Dean
- Dean
- College of Nursing
- College of Nursing
- Medical University of South Carolina
- Medical University of South Carolina
- Charleston, SC
- Charleston, SC
- Michael Terry, DNP, APRN-PMH/FNP
- Michael Terry, DNP, APRN-PMH/FNP
- Associate Clinical Professor
- Associate Clinical Professor
- Nurse Practitioner Program
- Nurse Practitioner Program
- University of San Diego
- University of San Diego
- Hahn School of Nursing & Health Sciences
- Hahn School of Nursing & Health Sciences
- San Diego, CA
- San Diego, CA
- Roberta Waite, EdD, APRN, CNS-BC, FAAN
- Roberta Waite, EdD, APRN, CNS-BC, FAAN
- Assistant Dean of Integration
- Assistant Dean of Integration
- Division of Graduate Nursing
- Division of Graduate Nursing
- Drexel University
- Drexel University
- Philadelphia, PA
- Philadelphia, PA
- Karen Williams, MS
- Karen Williams, MS
- VP for Programs
- VP for Programs
- West End Medical Centers
- West End Medical Centers
- Atlanta, GA
- Atlanta, GA
- Beth Wrobel
- Beth Wrobel
- CEO
- CEO
- Healthlinc Community Health Center,
- Healthlinc Community Health Center,
- Michigan City, IN
- Michigan City, IN
- APPENDIX II: DETAILED METHOD
- APPENDIX II: DETAILED METHOD
- APPENDIX II: DETAILED METHOD
- Overview
- Overview
- The method for arriving at the core set of competencies involved three major activities: (1) structured interviews with the key informants;
- The method for arriving at the core set of competencies involved three major activities: (1) structured interviews with the key informants;
- (2) review of the recent literature on integration; and (3) review and analysis of selected competency sets judged to have relevance to
- this process.
- Key Informants
- Key Informants
- The foundation of the core competencies rests on recommendations from 50 key informants who were selected because of their expertise
- The foundation of the core competencies rests on recommendations from 50 key informants who were selected because of their expertise
- on integrated care. They were identified in multiple ways, including: authorship of articles and other resources on the topic of integration,
- nomination by other experts, nomination by the SAMHSA-HRSA Center for Integrated Health Solutions, leadership within a HRSA-
- supported FQHC, leadership role in a community behavioral health organization that is a grantee within the SAMHSA-sponsored Primary
- and Behavioral Health Care Integration (PBHCI) program, and national leadership in peer support and recovery.
- Special efforts were made to ensure that the key informant pool included individuals whose expertise reflected knowledge of and practice
- Special efforts were made to ensure that the key informant pool included individuals whose expertise reflected knowledge of and practice
- in the following: integration of primary care and behavioral healthcare; development of professional competencies; the unique needs of
- children, adults, and older adults; urban and rural healthcare; cultural competence, diversity, and disparities; and healthcare financing
- and managed care. Experts were drawn from varied disciplines and specialties, including: internal medicine and family medicine, public
- health, addictions, psychiatry, social work, nursing and peer support and recovery. The list of key informants is contained in Appendix I.
- Key informants were interviewed by project team members using a semi-structured format. With respect to integration, they were asked to
- Key informants were interviewed by project team members using a semi-structured format. With respect to integration, they were asked to
- identify published works, other resources, and additional key informants. Their most important task was to recommend specific competencies
- for inclusion in the competency set. All recommended competencies were distilled into a single set, condensed to eliminate redundancy, and
- organized into categories in an iterative qualitative process managed by the project team.
- Literature Review
- Literature Review
- A review of the relevant literature pertaining to workforce factors in integrated health care from 2008 through 2011 was conducted
- A review of the relevant literature pertaining to workforce factors in integrated health care from 2008 through 2011 was conducted
- using a dozen databases. In addition, bibliographies in selected articles and reports were reviewed to identify other articles that may
- not have surfaced in the electronic subject search or that were not catalogued in the bibliographic databases. Titles and abstracts
- from the various database searches were reviewed and full articles were retrieved for those that met inclusion criteria. A total of 120
- resources were retrieved, including: published articles; federal, state, and non-governmental reports; and book chapters. These works
- were supplemented through the key informant process, which identified new resources recommended by informants that were not
- covered in the initial search.
- The literature on integration is predominantly composed of journal articles that represent opinion papers, literature reviews, and
- The literature on integration is predominantly composed of journal articles that represent opinion papers, literature reviews, and
- research reports, as well as a number of government and private sector documents, guides, books, and “tool kits.” Most of this literature
- focuses on the U.S. health care system, although there are significant contributions from several international sources. Regardless of
- the country of origin of these works, there was agreement within them that, in integrated settings, practitioner roles and responsibilities
- are often dramatically different from the content of what is currently taught across traditional educational programs or the nature of
- the roles and responsibilities in traditional clinical settings (see, for example: O’Donohue, Cummings, & Cummings, 2009; Pomerantz,
- Corson & Detzer, 2009).
- The literature reviewed was, by and large, very descriptive and very general about the nature of integration. A very small portion of the literature
- The literature reviewed was, by and large, very descriptive and very general about the nature of integration. A very small portion of the literature
- specifically discussed workforce competencies, which were distilled and added to the list identified through the key informant process.
- Review of Other Competency Sets
- Review of Other Competency Sets
- While there are no widely recognized competency sets on integrated care, the project team members reviewed general competency sets
- While there are no widely recognized competency sets on integrated care, the project team members reviewed general competency sets
- to gather additional input regarding the structure and content of the set of competencies under development. This review generated
- information regarding the most common approaches to identifying categories of competencies and yielded suggestions for content
- related to integration. The competency sets reviewed and analyzed were:
- Center for Substance Abuse Treatment. (2006).
- Center for Substance Abuse Treatment. (2006).
- Addiction counseling competencies: The knowledge, skills, & attitudes of professional
- practice
- (DHHS Publication No. (SMA) 06-4171). Technical Assistance Publication (TAP) Series 21. Rockville, MD.
- The original version of this document was authored by the National Addiction Technology Transfer Center (ATTC) and was updated
- The original version of this document was authored by the National Addiction Technology Transfer Center (ATTC) and was updated
- in 2005 through the work of a committee of experts.
- Psychiatric, Mental Health and Substance Abuse Essential Competencies Task Force. (2012). Essential psychiatric, mental health and
- Psychiatric, Mental Health and Substance Abuse Essential Competencies Task Force. (2012). Essential psychiatric, mental health and
- substance use competencies for the registered nurse.
- Archives of Psychiatric Nursing
- , 26(2), 80-110.
- National Panel for Psychiatric-Mental Health NP Competencies, National Organization of Nurse Practitioner Faculties. (2003,
- National Panel for Psychiatric-Mental Health NP Competencies, National Organization of Nurse Practitioner Faculties. (2003,
- September).
- Psychiatric-mental health nurse practitioner competencies
- . Retrieved from www.aacn.nche.edu/leading-initiatives/
- education-resources/PMHNP.pdf
- This document is currently under revision.
- This document is currently under revision.
- Note that this competency project is distinct from another federally sponsored effort funded by the Agency for Healthcare Research and
- Note that this competency project is distinct from another federally sponsored effort funded by the Agency for Healthcare Research and
- Quality (AHRQ). The two projects could be viewed as complementary since the competencies described in this report are drawn principally
- from expert opinion, while the competencies in the AHRQ-funded project are drawn largely from observation of providers delivering integrated
- care. Both works will contribute useful information to the ongoing effort to define competencies for integration.
- Development of the Competency Set
- Development of the Competency Set
- Three senior project team members, working independently, reviewed the comprehensive list of potential competencies identified through
- Three senior project team members, working independently, reviewed the comprehensive list of potential competencies identified through
- the three sources listed above and identified proposed competency categories. Differences were resolved through a consensus process
- that produced a working set of competency categories and tentative titles for the categories. A senior project team member placed
- individual competencies from the comprehensive list into competency categories. Other team members then proposed modifications
- to the placement and organization of competencies and achieved a complete set through a consensus process. Category titles were
- modified to fit the content of competencies within the categories.
- The resulting competency set was circulated electronically to the senior content experts and all key informants. They were asked to
- The resulting competency set was circulated electronically to the senior content experts and all key informants. They were asked to
- respond to the set and recommend any additions or edits to the proposed competency categories or individual competencies. The
- competency sets were revised based on the recommendations received, some of which were contradictory in nature. Approximately 80%
- of recommended changes were incorporated into a revised competency set. The revised competency set was reviewed and approved by
- the Senior Content Advisors.
