Integrated Behavioral Health Care

Integrated behavioral health care is one of the emerging fields of coordinated and integrated health care. Simply stated, it means that behavioral health and medical providers work together. Due to this integration, “a patient experiences high quality care from primary care and behavioral health clinicians who work with not only their clients but their families using a systematic and cost effective approach in order to provide person centered care to a defined population”.

The integrated care approach addresses mental health and substance abuse conditions, multiple health behaviors that lead to chronic medical illnesses, life stressors and crises, stress related physical symptoms, and ineffective patterns of the use of health care. Of the 10 people waiting to see their primary care physician at their doctor’s office, seven of them are seeking care for issues related to behavioral health. They need to change behaviors to manage chronic diseases such as diabetes, cardiac conditions, and obesity. They have a drinking or drug use problem affecting their health and relationship; they want to lose weight or quit smoking.

Our behaviors have a connection between them and the health and well-being of body, mind and spirit. This includes behaviors such as eating habits, drinking or exercising. There are of course broader factors such as we live in an area with high pollution or experience high level of stress at work. 70% of our primary care visits stem from psycho-social issues. While we typically present with a physical health complaint, the underlying mental health or substance abuse issues are often triggering these visits. Unfortunately, most primary care doctors lack time to fully address the wide range of psychosocial issues that are presented by their patients. frequently, physical health and mental health issues occur together. people with diabetes or cardiac conditions often develop depression as well.

It has, therefore, been proposed to implement an integrated behavioral health care approach. Our “defined population” includes persons with severe mental illness and individuals who are dually diagnosed with Intellectual disability and Mental Disorders. They are the key stakeholders of this integrated care. There is partnership among practitioners, patients, families to ensure “person-centered care” that accounts for the person’s wants, needs, and preferences to make decisions and make them participate in their own care to improve their health outcome. There is ample evidence that poor physical health will lead to poor behavioral health, and vice versa. Therefore, it is necessary to have integration of behavioral health care to dealing with the “whole” person with severe mental illness.

Integrated behavioral health care  teams do not have to be physically present in one location and services do not have to be delivered in the same physical location to meet the integrated care criteria. There are advantages to bringing behavioral health services on site , but there can be acceptable variation as long as the care  team can fulfill the required functions of integrated behavioral health care in a collaborative model.  If the patient’s visit to his/her primary care doctor results in the screening and treatment of mental health and substance abuse problems in the primary care setting, and in a similar manner, if the behavioral health setting improves the medical care of individuals with serious mental health problems, there will be combination of integration and collaboration.

A full integration approach means- being part of the same team for the individual, regular meetings, coordinating prescribing activities, shared systems including electronic data through an EMR/EHR. The integrative model integrates behavioral health treatment as part of regular primary care. it is a key path to health care reform in the next decade. Our redundancies in health care administrative and service delivery structures will certainly call for an integrated care approach. Behavioral health system is encouraged to work with primary care to support and enhance the role of primary care providers in delivering mental health care.

The integrated approach assures quality of all programs and services. QA goals are set up, clearly defined, measured and quantitatively analyzed where possible. Program goals are aligned with the mission and objectives of the company and will utilize standardized industry tools and techniques to insure the quality.

The current approach of bio-psycho-social treatments, interventions and support services are evidence-based and outcomes-driven. Behavior interventions are based on a Functional Behavioral Assessment and interventions that are clearly individualized and built specific to persons with intellectual and developmental disabilities and co-occurring behavioral health diagnoses.

Finally, for this approach, there is successful collaboration between Intellectual disabilities and mental health systems. To avoid fragmented and inadequate services to ‘the other dually diagnosed’ individuals from both systems, ACIDD Maryland programs will coordinate the care between ID/DD and BH systems and reduce the barriers that interfere with successful practices identified by the treatment team, family and persons being served. Thus, our approach to service provision, that is, the total needs of the person being served and family become an important consideration in the planning and provision of services across systems of care.

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