• Research Opportunities

• Key Reports and Articles

• Mental Health Disparities

• Wellness

• Substance Use Conditions
  

• Outcomes and Evaluation

   

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Research Opportunities  

Integrating Mental Health Treatment into the Patient Centered Medical Home
This paper from the Agency for Healthcare Research and Quality (AHRQ) identifies the conceptual similarities in and differences between the PCMH and current strategies used to deliver mental health treatment in primary care. Even though adoption of the PCMH has the potential to enhance delivery of mental health treatment in primary care, several programmatic and policy actions are needed to facilitate integration of high-quality mental health treatment within a PCMH.

Collaborative Care Research Network
The purpose of the CCRN is to develop and implement a national, practice based research agenda to evaluate the effectiveness of collaboration between behavioral health, psychology and substance abuse intervention and primary medical care. The objectives of the CCRN are to support, conduct, and disseminate practice-based primary care effectiveness research that examines the clinical, financial, and operational impact of behavioral health on primary care and health outcomes. For further information about the CCRN, contact Ben Miller, CCRN Administrative Director.

Webinar-Primary Care/Behavioral Health Integration: Outcomes and Evaluation
Presentation materials and a recording of the National Council's webinar on Integration: Outcomes and Evaluations is available online.

Key Reports and Articles

A Model for Addressing Mental Health Disparities Among Latinos
Medical Family Therapy: A Model for Addressing Mental Health Disparities Among Latinos Researchers suggests that an effective method of reaching and treating mental health issues among Latinos is through medical family therapy and suggests that family therapists wishing to work with Latinos in a medical setting must be competent in two cultures: (a) Latino culture and (b) the culture of medicine.

A New Role for Peers
Wellness Coaching: A new Role for Peers, Published by Psychiatric Rehabilitation Journal, M. Swarbrick, et al. This report brief highlights how  wellness coaching represents an intervention that can help individuals persist in the pursuit of individually chosen health and wellness goals. 

Fourth revolution in psychiatry – Addressing comorbidity with chronic physical disorders
This journal article provides data on co-morbidity and suggests that addressing comorbidities of mental illnesses with chronic physical illnesses will be the fourth revolution in psychiatry.

Psychiatric Rehabilitation Journal
The spring issue of Psychiatric Rehabilitation Journal is devoted to Promoting Integrated Healthcare for People Living with Psychiatric Disabilities. Click this link to view these and other articles: The New Health Care Reform Act and Medicaid: New Opportunities for Psychiatric Rehabilitation by Allison A. Wishon Siegwarth & Chris Koyanagi, A Qualitative Study: Barriers and Facilitators to Health Care Access for Individuals with Psychiatric Disabilities by Marie Mesidor, Vasudha Gidugu, E. Sally Rogers, V. Megan Kash-MacDonald & Judith B. Boardman, and Healthy Eating in Persons with Serious Mental Illnesses: Understanding and Barriers Laura K. Barre, Joelle C. Ferron, Kristin E. Davis & Rob Whitley.

Realizing Health Reform’s Potential: How the Affordable Care Act Will Strengthen Primary Care and Benefit Patients, Providers, and Payers
Although primary care is fundamental to health system performance, the United States has undervalued and underinvested in primary care for decades. This brief describes how the Affordable Care Act will begin to address the neglect of America’s primary care system and, wherever possible, estimates the potential impact these efforts will have on patients, providers, and payers.

Medical Homes Led By Nurses
Health Affairs dedicated an issue to reinventing primary care (May 2010). This issue issue devoted space to the potential of medical homes, it did not tackle a topic of considerable debate: the role of nurse-led medical homes. What is needed is a balanced discussion of the potential increased access, improved quality, and cost savings that could be realized if nurse-led medical homes were fully recognized.

Collaboration among Payers Presents Opportunities for Health Care Reform, but Challenges Remain
This Fund report assesses the opportunities and challenges for multipayer collaborations to be critical agents of reform in health care delivery.

New AHRQ White Paper Covers Integrating Mental Health into the Medical Home
As part of the new Center for Primary Care, Prevention, and Clinical Partnerships, the Agency on Health Research and Quality features three foundational white papers on Patient Centered Medical Homes.

New AHRQ white paper
A new AHRQ white paper explores how the HITECH legislation could be harnessed to help practices operationalize and implement health information technology and support key principles of the patient-centered medical home (PCMH) to improve health care quality and efficiency.

Mental Disorders and Medical Comorbidity
This synthesis presents the evidence of comorbid mental and medical conditions and addresses the following questions: 1. What is the rate of comorbidity between medical and mental conditions and why is it so common? 2. What are the associated mortality, quality of care, and cost burdens of co morbidity? 3. What are the current evidence-based approaches for addressing comorbidity?

Evolving Models of Behavioral Health Integration in Primary Care
The Milbank Memorial Fund has just published an important report that summarizes the available evidence and states’ experiences around integration as a means for delivering quality, effective physical and mental health care. It provides eight models that represent qualitatively different ways of integrating/coordinating care across a continuum—from minimal collaboration to partial integration to full integration—according to stakeholder needs, resources, and practice patterns.

Literature Search for Integrated Health Care. Completed by Dawn Worley, MSW, intern Washtenaw County, Michigan

Integrated Health Studies. Completed by Dawn Worley, MSW, intern Washtenaw County, Michigan

Morbidity and Mortality in People with Serious Mental Illness
This report from the National Association of State Mental Health Program Directors Medical Directors Council reveals that persons with mental illnesses die 25 years younger than the general population, largely due to chronic medical conditions. The findings clearly point to the need for increased public funding and support to give mental health centers the capacity to identify physical illnesses and ensure that patients have access to lifesaving treatments.

Integration of Mental Health/Substance Abuse and Primary Care
This report from the Agency for Healthcare Research and Quality describes models of integrated care used in the United States; assesses how integration of mental health services into primary care settings, or primary health care into specialty outpatient settings impacts patient outcomes; and describes barriers to sustainable programs, use of health information technology, and reimbursement structures of integrated care programs within the United States.
 
Compendium of Primary Care and Mental Health Integration Activities across Various Participating Federal Agencies
The compendium highlights a variety of integration activities funded by various federal agencies and provides contact information for staff active on the integration workgroup.

Improving the Quality of Healthcare for Mental and Substance-Use Conditions
This Institute of Medicine report examines the distinctive characteristics of healthcare for mental and substance-use conditions and describes the actions required to achieve those ends-actions required of clinicians; healthcare organizations; health plans; purchasers; state, local, and federal governments; and all parties involved in health care for mental and substance-use conditions.

Initial Lessons From the First National Demonstration Project on Practice Transformation to a Patient-Centered Medical Home
Nutting, Paul, et al. (2009). Ann Fam Med 2009; 7: 254-260.
The article describes six early lessons from the National Demonstration Project and offers four recommendations for assisting the transformation of primary care practices.

Issue Brief: Medical Homes and Integration of Mental Health
One of a series of issue briefs by the Bazelon Center on the integration of mental health in healthcare reform. They offer a number of policy recommendations including the need to incorporate mental health expertise within medical homes.

California Integrated Policy Initiative Report
The Integration Policy Initiative intends to improve general healthcare, primary care, and the integration of mental health and substance use services with primary care. The IPI's new report covers a wide range of issues including delivery system design, financing and regulation, and recommendations for future actions.

Care Management Improves Physical Health of Patients with Mental Illness
Connecting mental health patients with care managers responsible for coordinating their health care significantly improves their overall health and wellbeing, according to a study by Benjamin Druss and other public health researchers at Emory University. Study findings suggest that care management is a promising approach for improving quality and outcomes of medical care for patients with serious mental illnesses.

View The National Council’s Collaborative Care Policy page

Mental Health Disparities

Why Do the Mentally Ill Die Younger?
Article in Time magazine examines why the mentally ill die 25 years younger than the rest of the population.

Mental Health in the Context of Health Disparities
Jeanne Miranda; Thomas G McGuire; David R Williams; Philip Wang
The American Journal of Psychiatry; Sep 2008; 165, 9; pg 1102

Integrating Physical and Mental Health Care to Reduce Health Disparities for People with Severe Mental Illness
Published by the Health Foundation of Greater Cincinnati, this publication discusses the health disparities of people with severe mental illnesses, using integrated care to reduce disparities, and offers individual, provider, and system level steps that can be taken to integrate physical and mental healthcare.

An Unhealthy America: The Economic Burden of Chronic Disease
This interactive map provides useful statistics on the economic burden of chronic disease by state, including emotional disorders.

Wellness

A Wellness Approach
Swarbrick, M. (2006). Psychiatric Rehabilitation Journal, 29, (4) 311- 314.
There is a significant paradigm in the field of public mental health practice that encompasses a wellness approach. This paper will present a wellness approach by comparing it to the traditional medical model. A personal application of the wellness approach will be discussed.

A Scientific Agenda for the Concept of Recovery as it Applies to Schizophrenia
Silverstein, Steven. (2008). Clinical Psychology Review, 28, (7) 1108-1124.
Recovery is now a widely discussed concept in the field of research, treatment, and public policy regarding schizophrenia. As it has increasingly become a focus in mainstream psychiatry, however, it has also become clear both that the concept is often used in multiple ways, and that it lacks a strong scientific basis. This article argues that such a scientific basis is necessary for the concept of recovery to have a significant long-term impact on the way that schizophrenia is understood and treated.

Obesity Reduction & Prevention Strategies for Individuals with Serious Mental Illness
This National Association of State Mental Health Program Directors report makes specific recommendations that, when implemented, should substantially reduce the weight and improve the overall health of a population with serious mental illness.

Percentage of Youth Initiating Alcohol or Tobacco Use Prior to Age 13 Declined in Last Decade
The percentage of high school students who first tried alcohol or cigarettes before the age of 13 has declined considerably over the last decade. In 1997, 31% of high school students reported drinking more than a few sips of alcohol before age 13, compared to 24% in 2007. The percentage reporting smoking a whole cigarette for the first time before age 13 also declined, from 25% in 1997 to 14% in 2007. Marijuana initiation before age 13, however, did not change significantly over the same period. This data was collected through the national Youth Risk Behavior Survey.

Substance Use Conditions

Integrating Appropriate Services for Substance Use Conditions in Health Care Settings:  An Issue Brief on Lessons Learned and Challenges Ahead
"Integrating Appropriate Services for Substance Use Conditions in Health Care Settings:  An Issue Brief on Lessons Learned and Challenges Ahead" is a summary of an April 22 meeting of the TRI-led (and SAMHSA/CSAT funded) Forum on Integration where numerous leaders of integration projects were invited to briefly describe their models and summarize the barriers they had encountered and recommendations for overcoming them. Four themes emerged from the April 22 meeting and are summarized in the September white paper: Better integration of screening, treatment or intervention for substance use conditions in general health care is of critical importance.  "These and other recommendations summarized in the document are not just from experts in the field," said Mady Chalk, Ph.D., Director of the TRI Center that led the project.  "They come from leaders with experience implementing integration projects in their systems of care - people the fields can (and will) learn a lot from as we move this model forward."

Benefits of Linking Primary Medical Care and Substance Abuse Services
Samet, Jeffrey H. Arch Intern Med. 161 (January 2001) 85.

Integrating Primary Medical Care With Addiction Treatment: A Randomized Controlled Trial
Weisner, Constance. JAMA. 2001; 286 (14): 1715-1723

Medical and Psychosocial Services in Drug Abuse Treatment: Do Stronger Linkages Promote Client Utilization?
Freidmann, Peter D. et al. HSR: Health Services Research 35:1 (June 2000)

Behavioral Counseling Interventions in Primary Care To Reduce Risky/Harmful Alcohol Use by Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force
Whitlock, Evelyn. Ann Intern Med. 2004; 140: 557-568.

Home Buprenorphine/Naloxone Induction in Primary Care
Lee, Grossman, DiRocco, Gourevitch. JGIM November 2008.  

  Outcomes and Evaluation 

Evaluation Report on ICARE
A study of North Carolina’s Integrated Care Collaborative (ICARE) sites found that staff and patients reported improved access to mental health services and greater coordination between primary care and mental health providers during the ICARE integrated care demonstration.

Outcomes, performance, and quality-What's the difference?
This article provides operational definitions of the terms used in discussing quality, performance, and outcomes. While focused on addiction treatments, it has broader use as we reduce confusion and build a common understanding among providers and policymakers.

Evaluation of Mountain Health Choices: Implementation, Challenges, and Recommendations
A policy report prepared by Mathematica and the Institue for Health Policy Research, West Virginia University, evaluates West Virginia's attempt to promote personal responsibility among targeted populations in the state's Mountain Health Choices Medicaid program.

A Process and Outcome Evaluation of Two Integrated Behavioral Health Care Models: People's Community Clinic and Lone Star Circle of Care
This report examines process and outcomes of  the second year of an integrated behavioral health model of health care at People’s Community Clinic and Lone Star Circle of Care-Georgetown, a model for which St. David’s Community Health Foundation helped to fund mental health care to be provided in conjunction with primary care for patients at those clinics.

Measuring Patient Outcomes
A new journal article addresses the identification, selection, and application of the most appropriate instruments to measure the quality of integrated chronic care by patient survey.

Integrated Primary Care: An Inclusive Three-World View Through Process Metrics and Empirical Discrimination
Miller, Mendenhall, & Malik. J Clin Psychol Med Settings. 2009. 16:21-30
This journal article address measurement in integrated settings and suggest a standardized nomenclature that will support broad based research on primary and behavioral health integration and collaboration.