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Dale Jarvis

Dale Jarvis and Associates

Synchronicity and Health Reform

April 29, 2014 | Community Impact | Comments
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Next week, the National Council for Mental Wellbeing will host its 2014 Annual Conference, which will be peppered with talk about behavioral health centers of excellence (BHCOE) and Certified Community Behavioral Health Clinics. During the conference we will introduce an added dimension to BHCOEs – Integrated Behavioral Health Teams (IBHTs).

Well, actually, I’m introducing the concept with this blog post…

Last fall, Michael Porter’s Harvard Business Review article, The Strategy that Will Fix Healthcare, generated a national discussion about the need to restructure healthcare around patient needs and away from specific specialties. This paper greatly influenced my thinking about BHCOEs and started other behavioral health leaders’ brains spinning.

One person in particular, Dick Dougherty, a psychologist and consulting colleague from Michael Porter’s hometown, Boston, asked himself a simple question: What would this restructuring look like in behavioral health? What he came up with is an important contribution to the BHCOE conversation – crowdsourcing at its best.

While I have been focusing on a BHCOE definition (great place to get care and great place to work) and teasing out the BHCOE elements (access, customer service, comprehensive care, outcomes, and value), Dick has dug down a layer deeper. Let me quote from a soon to be published white paper:

A key limitation in our current delivery system is the generalized approach taken to treat the vast array of specific and complex diagnoses which fall beneath the mental illness umbrella. While some areas of mental health are organized to treat consumers with specific disorders, such as eating disorders; most of the professionals in the field working in community behavioral health organizations operate as “generalists” and little is done outside of some academic medical centers and hospitals to market specialty services for specific conditions.

Dick goes on to describe a solution, which I’ll attempt to paraphrase.

Community Behavioral Health Organizations (CBHOs) ought to be focusing on the behavioral bealth center of excellence effort on two levels. The first level is building the foundation, achieving a high level of proficiency at the five elements. If a CBHO reaches this bar, it has become an excellent general practice for treating behavioral health disorders (my words). The second task is for CBHOs to develop one or more centers within their organization focused on specific populations. Again, let me quote Dick:

CBHOs should provide an organized team of ambulatory behavioral health clinicians, people with lived experience and support staff who provide integrated, diagnosis-specific, and evidence-based services. These IBHTs (Integrated Behavioral Health Teams) should specialize in treatment and support strategies within clinic settings for diagnoses, or clusters or diagnoses, such as schizophrenia, bipolar disorder, major depression, ADHD, conduct disorder, and anxiety disorders. They will have providers or programs that they partner with to provide an array of vertically integrated services including primary care, lab and radiology, peer psychosocial supports, respite and other employment and housing supports for those that need these supports.  Most importantly they need to organize their services with a consistent set of protocols backed by clear evidence. Recruiting and training clinical leadership to deliver a more standardized and evidence based approach is essential.

To me, this two part construct is very powerful. It is also quite different from how much of the community behavioral health ecosystem looks today. We will explore these ideas in several sessions next week at the National Council’s Conference ‘14 in D.C. Be sure to look in the final program, or search the Conference ’14 mobile app for “Dougherty” and “Jarvis”.

Today’s questions…

There are a number of CBHOs that have already developed integrated, condition-specific services and teams. Are you one of those organizations? Tell us about it.

Is it possible to achieve excellent outcomes (BHCOE element 4) for individuals with complex behavioral health disorders and comorbid chronic health conditions without an IBHT?

Is there a place in the future health delivery ecosystem for an excellent general practice for treating behavioral health disorders that doesn’t also have one or IBHTs?


Regardless of whether you’re attending the National Council’s Conference, be on the lookout finalized BHCOE Concept Paper.