Behavioral Consultation and Primary Care: A Guide to Integrating Services

Robinson, P.J., & Reiter, J. T. (2007)
New York: Springer

Reader Targets

Professors and Teachers in Undergraduate and Graduate School Programs, Physicians, Nurse Practitioners, Physician Assistants, Nurses, Social Workers, Psychologists, Counselors, Family Therapists

Description

Behavioral Consultation and Primary CareBehavioral Consultation and Primary Care provides an overview of the primary care behavioral health model of integration. It begins with a review of the literature pertinent to why primary health care needs to be reconfigured. The reader learns about the primary care milieu and the roles and responsibilities of various primary care staff members. The book describes the mission of primary care behavioral health model and provides a job description for the “behavioral health consultant,” or BHC, along with a comprehensive list of competencies required for successful BHC work.

Behavioral Consultation and Primary Care also provides a variety of tools for clinical practice, as well as for training primary care providers to partner with the BHC. Four clinical chapters offer a variety of case examples of providing care to children, youth, and families, adults, and older adults, as well as unique approaches to providing group services in primary care. In the last section of the book, the reader is invited to ponder ethical issues and program evaluation strategies for this new approach to care. The book comes with a CD that contains patient education materials, as well as clinical practice tools for influencing primary care providers.

About My Co-Author

Jeff Reiter, PhD, ABAP, is a psychologist who lives in Seattle and works at Health Point Health Care System. He has a great deal of experience in providing behavioral health services in primary care. Dr. Reiter also has expertise in start-up and on-going program evaluation of primary care behavioral health services. He has trained numerous psychology interns to work as behavioral health consultants. Dr. Reiter also works as a consultant to health care systems and provides workshops to professional audiences.

Acknowledgements / Awards / Review

» See Behavioral Consultation PDF for book review

This book has been used as a primary resource for program development in United States Air Force medical treatment facilities all over the world, in several European countries, and in numerous federally qualified health care systems and public health departments in the United States.

Increasingly, Behavioral Consultation and Primary Care is being used as a primary text in graduate social work and psychology programs.

Table of Contents

PART I. THE PERFECT STORM OF PRIMARY CARE

1. AN OVERVIEW OF PRIMARY CARE BEHAVIORAL HEALTH CONSULTATION
The Nature of Behavior Problems in Primary Care 4
Barriers to Recognizing and Treating Behavioral Problems in Primary Care 7
The Effects on Primary Care . 9
The Effects on Patients 10
Calming the Storm: The Move to Integrate Behavioral Health and Primary Care 11
The Primary Care Behavioral Health Model 15
Summary 19
2. A PRIMER ON PRIMARY CARE
The Primary Care Mission 22
Providers and Management in Primary Care 23
Support Staff in Primary Care 28
Summary 31

PART II. YOUR MISSION, SHOULD YOU CHOOSE TO ACCEPT IT

3. A MISSION AND A JOB DESCRIPTION
The Core Competencies 35
Job Description 58
Suggestions for Recruiting and Interviewing 58
Job Performance Evaluation 63
Training 66
Supervision 67
Summary 68
4. SERVICES, LOCATION, AND SUPPORT
Location, Location, Location 69
Common Expenses to Include in the Budget 73
Primary Care Behavioral Health Assistant Services 74
BHC Services 80
Billing 83
Summary 94

PART III. A HORIZON AND A COMPASS

5. THEORETICAL MODELS AND THERAPEUTIC APPROACHES FOR INTEGRATED CARE
Current Dilemmas in Health 98
Theories and Therapies Recommended for the BHC 106
Summary 124
6. MEASURES FOR A PRIMARY CARE BEHAVIORAL HEALTH PRACTICE
Planning Screening and Assessment Activities 127
Screening to Detect Specific Problems 132
Methods for Screening 158
Assessment for Treatment Planning and Evaluation 160
Tips for Teaching PCPs to Use Behavioral Measures 168
Summary 169

PART IV. THE ADVENTURE BEGINS

7. PRACTICE TOOLS FOR THE BHC
Initial Consults 172
Follow-up Consults 193
Charting and Medical Records 201
Summary 203
8. START-UP: WHAT TO DO AND HOW TO INFLUENCE PCPS
A Start-Up Checklist 205
Educating Providers about the BHC Service 218
Responding to Common Administrator and Staff Requests 231
Assessing and Overcoming Referral Barriers 235
Summary 242

PART V. THE HEART OF THE MATTER: CONSULTING WITH PATIENTS AND PCPS

9. EXAMPLES OF CONSULTATION WITH YOUTH AND THEIR FAMILIES
Young Children with Behavior Problems 250
Overweight and Obese Children 258
Children with Aches and Pains 265
Children with Social Problems 273
Children Recovering from Trauma 279
Children with ADHD 285
Summary 292
10. EXAMPLES OF CONSULTATIONS WITH ADULTS
Vague Pain Complaints and Domestic Violence 297
Patients with Chronic Pain 305
Medical Adherence 316
Somatization 321
Chest Pain (Panic) 325
Patients with Chronic Conditions 331
Learning Disabilities 336
Symptoms of Depression and Traumatic Stress 341
Suicidal Ideation 349
Drug and Alcohol Problems 356
Serious Mental Illness 362
Summary 368
11. EXAMPLES OF CONSULTATIONS WITH OLDER ADULT
Demoralization 373
Medical Adherence 381
Stresses Related to Caregiving (and other Problems) 389
Dementia 396
Loss and Preparation for Death 401
Preparing to Care for More Older Adults in Primary Care 409
Summary 411
12. MORE THAN ONE PATIENT AT A TIME: GROUP VISITS IN PRIMARY CARE
Adapting Group Visits for Primary Care 413
Primary Care Group Models and Examples 430
Suggestions for Starting Group Services 446
Summary 448

PART VI. UNCHARTED TERRITORY

13. CHALLENGING MOMENTS
Prescription Medication Misuse and Dependence 452
The “Biomedical” Provider 472
Handling Psychiatric Emergencies 479
Miscellaneous Challenges 483
Summary 489
14. COMMON ETHICAL ISSUES
Competence: The Case of Dr. Feelgood 492
Confidentiality:The Case of Ms. B. Healthy, M.S.W. 500
Informed Consent: The Case of Mr. Sufferless, M.F.T. 504
Summary 509
15. EVALUATING YOUR SERVICE
Productivity 512
Model Fidelity 518
Customer (Patient and PCP) Satisfaction 523
Clinical Effectiveness 526
Suggestions for Future Program Evaluation and Research Activities 527
Summary 529
References 531
Appendix A: Theories and Therapies: Recommended Reading for the BHC 566
Appendix B: Recommended Reading for Children, Parents, PCPs, and BHCs 569
Appendix C: Recommended Reading for BHCs and PCPs Concerning Adult Patients 573
Appendix D: Patient Education Handouts and Practice Tools (Compact Disc) 577
Index
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