Behavioral Consultation and Primary Care: A Guide to Integrating Services, Second Edition

Book Title: Behavioral Consultation and Primary Care: A Guide to Integrating Services, Second Edition

Authors: Patricia J. Robinson and Jeffrey T. Reiter

Publication Information: Cham, Switzerland, Springer International Publishing, 2016, 347 pp., $79.99, hardcover

From introducing the concept of the Primary Care Behavioral Health (PCBH) model, to practical evaluative and practice tools, this text serves as a helpful handbook of implementation of integration. It provides valuable resources for administrators, primary care providers (PCP), behavioral health consultants (BHC) and support staff. The authors begin by presenting a compelling discussion of the ways in which integration increases provider, staff, and patient satisfaction while improving overall quality of care and health of populations served. The PCBH model presented in this book is one in which the BHC works as a consultant to the PCP and a member of the care team, rather than a colocated therapist.

Behavioral health integration has been an interest of mine for several years. In my previous leadership role at a community health center, before having the chance to read this book, I had the responsibility of leading the implementation of an integrated behavioral health program. The path was bumpy and at times trying. I found that this text addresses many of the challenges we faced with practical solutions.

Robinson and Reiter have organized the book into five parts with 15 chapters. Each chapter concludes with a helpful summary and relevant web links. In addition to the physical textbook, the authors have placed supplemental materials online and have linked these materials to relevant passages in the book.

Part I introduces the reader to the concept of behavioral health in the context of primary care and the benefits of integration to PCPs, BHCs, support staff, individual patients and to the health of the population. Part I emphasizes that while behavioral health integration can be beneficial in many ways and can be implemented in a financially sustainable way, the PCBH model will not be highly profitable monetarily. In my past experience, I found that getting buy-in for integration from key stakeholders was sometimes time consuming and difficult. This chapter shares vital information in a concise way that could be referenced to help obtain this buy-in, and could help save time and effort for the implementation team.

Part II provides important guidance on building the behavioral health team with specific tools to aide in designing, training, and evaluating the integration. This section includes a discussion about the importance of including behavioral health documentation in the general medical record and not in a separate location as is done in traditional mental health models. The last section of Part II discusses the important role of training PCPs and RNs to effectively work with the BHCs to truly transform the practice.

Part III shares information on the practice of behavioral health care. This part is especially helpful for the PCP who is new to integration. Part III explains the differences between and the benefits of the medical model and behavioral health models of addressing health. Rather than eliminate illness as the medical model aims to do, the behavioral health model broadly helps patients positively adapt to changes in the context of health and the context of their lives in general. Working through the basic concepts of various therapeutic approaches within the behavioral health model, the authors give a helpful resource to PCPs who may otherwise be unfamiliar with these concepts. The last chapter of Part III provides useful metrics for assessing the quality and effectiveness of the program within the health center and in the context of population health.

Part IV provides detailed descriptions of day-to-day activities for a BHC and gives examples of how the day of a BHC can be used most effectively. The authors share tools that the BHC can use to introduce the model and even a checklist of activities for a new BHC to complete in the first 4 weeks of initiating integrated care. From my experience in integration, effective use of the BHCs time was a difficult challenge, and is key to the sustainability of the model. I would have appreciated this detailed example to walk me through how it can be done well.

Part V features a helpful discussion of the issues and challenges that can arise with implementation of an integrated system, including a primer on the growing opioid abuse epidemic and the role of behavioral health in this issue.

In today’s health care environment, PCP burnout has become an important issue that needs to be addressed, and the authors show throughout the book how the PCBH model can help to improve patient care and help to alleviate this growing issue.