Providing increased access to mental health resources has long been a key concern for the nation’s healthcare system. While obstacles remain — including issues of adequate insurance coverage, overcoming stigmas, and provider accessibility — the conversation has turned in recent years. Behavioral health treatment is now widely viewed as a critical component to solve a wide variety of societal ills such as opioid abuse, youth suicide, and violence.
One of the simplest — yet most effective — methods to increase the number of patients receiving behavioral health treatment is to increase the number of patients who are screened for behavioral health issues. This can be achieved with an integrated care model that incorporates behavioral health into primary care treatment.
Integrated care is defined as the practice of incorporating mental health care into primary care settings and incorporating primary care into mental health care settings. For example, a pediatrician may screen patients for anxiety and depression while treating a patient with chronic disease. Conversely, a patient already diagnosed with behavioral health needs may prioritize seeing a behavioral health provider while ignoring primary care. In this situation, the behavioral health provider can provide basic primary care such as checking height, weight, blood pressure, and other vital stats during a behavioral care visit.
Integrated care takes many forms, with no right or wrong method. Differences result from organizational philosophy, provider preferences, geographical circumstances, and other factors. More important than the precise type of integration model followed is a commitment by all parties to provide integrated care.
The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) has defined six different collaboration levels. Here is a breakdown:
- At the lowest level, Coordinated Care, providers practice in separate facilities but communicate to coordinate care.
- At the next level, Co-located Care, providers are housed in the same facility and may share some of the same systems.
- At the highest level, Integrated Care, providers share the same space in the same facility and actively seek to reduce barriers to integrated care, with consistent communication and collaboration throughout the course of care.
Methods such as SBIRT (Screening, Brief Intervention, Referral to Treatment) have proven to be an effective integrated approach to addressing behavioral health issues. SBIRT emphasizes detection and intervention across the spectrum of care encounters, with virtually any encounter setting qualifying as a potential screening location. Care settings as diverse as primary care providers, hospital emergency rooms, trauma centers, and community-based providers can provide early intervention for at-risk substance users. Patient needs are quickly identified, addressed, and referred to the most appropriate level of care. Depending on the level of integration, that care may be provided at the same location, perhaps even by the same care provider.
Integrated care delivery models are demonstrating impressive results. In a two-year study of 1,800 adults with depression, the IMPACT model (Improving Mood, Promoting Access to Collaborative Treatment) more than doubled the effectiveness of depression treatment for adults in primary care settings. In the control group, 20 percent of patients reported significant improvement after one year, while half of the patients in the IMPACT group reported significant improvement.
IMPACT emphasizes a collaborative, integrated approach to behavioral health treatment, with a shared care plan across providers, population-based care management, a treat-to-target approach with clearly defined outcomes, and shared accountability among all providers. These key principles of provider collaboration, joint decision-making, patient involvement, and shared accountability are hallmarks of integrated care delivery.
Eccovia Solutions supports the goals of the integrated care movement and assists the integrated care model by providing the tools necessary to enable provider-to-provider collaboration, comprehensive care plans, patient engagement, clearly defined outcomes, and consistent evaluation of patient progress. Through the ClientTrack Care Coordination platform, providers have access to all essential patient information regardless of care setting, thus ensuring informed, integrated treatment across all providers and care locations.