Recipients of AcademyHealth's Presidential Scholarship for New Health Services Researchers were invited to blog about select sessions during the 2012 Annual Research Meeting. The following session summary is written by Evelyn Chang, M.D., M.S.H.S., VA Health Services Research Fellow, VA Greater Los Angeles Health System. During the session "Innovative Models for Integrating Behavioral Health into Medical Homes," speakers introduced three different integrated models of behavioral health care: IMPACT, behavioral health homes, and a pediatric model using “common elements.” IMPACT is a well-established model that integrates mental health (MH) into the primary care (PC) setting. Each PC practice includes a behavioral health professional (e.g., psychologist, nurse, social worker) who works with primary care providers (PCPs) to manage MH problems. To effectively treat MH disorders, the clinic measures outcomes, adjusts treatments until clinical goals are achieved using evidence-based treatment protocols, tracks outcomes using a population registry, and refers patients to psychiatrists when there is no clinical improvement. Through randomized controlled trials, the IMPACT model has demonstrated an improvement in depression and functional outcomes and cost-effectiveness. Now the model is in dissemination phase. More than 5,000 providers in >600 PC clinics have been trained in IMPACT, and it has been implemented throughout the entire state of Washington. The behavioral health home is theoretically a patient-centered medical home (PCMH) that provides medical care for patients with serious mental illnesses (SMI), such as schizophrenia and bipolar disease, or substance use disorder. These patients traditionally have poor quality of medical care and premature mortality due to medical problems. Besides the target population, these behavioral health homes differ from PC-based health homes. This population can be complex given social disadvantage and poverty, which requires a broader range of services (e.g., housing, employment support) and staff, including peers. In addition, behavioral health homes have a “recovery” orientation, seeing physical health as a part of a larger set of goals including relationships, stable housing, and meaningful life activities. Challenges include the development of IT systems, since MH providers generally have less access to electronic health records and registry tools. A few community MH clinics (i.e., Cherokee Health System) have begun experimenting with this model. Mathematica is developing a new integrated pediatric behavioral health model using “common elements.” The majority of children with MH problems have clusters of symptoms that defy a single diagnosis. Subsequently, PCPs are uncertain which treatment protocol to select. In this new model, pediatricians develop the capacity to manage undiagnosed MH disorders using “common elements” and “common factors.” “Common elements” represents a finite set of brief psychotherapeutic and behavioral interventions that spans diagnoses, such as psychoeducation and stress reduction. PCPs are also trained in “common factors,” skills that improve the provider-patient relationship and promote change in patient behavior. PCPs are also trained to prescribe a small formulary of well-studied psychotropics. This type of model can be easily implemented through the team-based approach of PCMH, as different team members can utilize common factors and common elements skills. Some literature suggests that this approach helps in symptom improvement. Promising approaches such as these can provide much needed integration to improve the quality of care for vulnerable populations. Presentation slides are available from this session:

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