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2019 Jun 24;21(6):e13300. We will include descriptive reports of integration programs that exist or existed, but will exclude proposed, hypothetical, and simulated approaches. 2021 national healthcare quality and disparities report. The Substance Abuse and Mental Health Services Administration (SAMHSA), in close collaboration with the Drug Enforcement Agency (DEA), recently announced new training requirements for practitioners with prescriptive authority treating substance use disorder (SUD). We will involve the TEP, Partners and TOO in the selection of the outcome for SOE after the included studies are identified. Children (aged 0-20 years) and adults (aged 21 years) with behavioral health needsClinical focus/conditions including but not limited to patients with. AHRQ's Focus on Integrating Behavioral Health and Primary Care (BH/PC) AHRQ published a comprehensive review ("Integration of Mental Health/Substance Abuse and Primary Care") of the available evidence on integrated BH/PC in 2008 AHRQ funded a research agenda conference grant in 2009 which resulted in an early Lexicon draft Princeton, NJ: Robert Wood Johnson Foundation; 2017. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html. Cochrane Database of Systematic Reviews. Behavioral health is an umbrella term that includes mental health and substance use, life stressors and crises, stress-related physical symptoms, and health behaviors. Practices create workflows, protocols, and procedures for screening, brief intervention, and referral to treatment (SBIRT) for patients with mental health and substance use disorders. About the AHRQ Academy | The Academy However, we will assess and consider the quality of studies identified for the remaining questions. Patients like the convenience of one-stop shopping. Whether their problem is stress, mental health, substance use, health behaviors, or all of the above, there is no wrong door. For Question 4, our working definition for our search for valid and reliable studies will limit inclusion to measures that have been used and evaluated. 11. 53. Families, Systems, & Health. How effective are approaches to integrating behavioral health and primary care? 96. JAMA Netw Open. Integrating behavioral health and primary care: a qualitative analysis Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Efforts to integrate behavioral health and primary care are rooted in growing recognition that perpetuating separate systems is no longer tenable. 12. Full text for all abstracts deemed appropriate for consideration by at least one of the reviewers will be retrieved. 34. 2020 Mar;38(1):6-15. https://doi.org/10.1037/fsh0000474. Questions 1, 3, 4, and 5. This If a small number of studies are identified, we will describe their strengths and limitations. AHRQ seeks to build a centralized resource hub to provide the tools and materials to advance the field of integration, and to promote a collaborative environment for dialogue and discussion among leaders across behavioral health, and primary healthcare arenas. County Health Rankings & Roadmaps. Waliany S. Health professionals with disabilities: Motivating inclusiveness and representation. 6. 20. 2017 Mar 1;174(3):246-55. https://doi.org/10.1176/appi.ajp.2016.16050507. 83. Accessed September 23, 2022. 92. 75. The search for this question will require an augmented strategy. https://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/county-health-rankings-model. 5600 Fishers Lane Learn about the following topic areas as they relate to integrated behavioral health: Integrating Behavioral Health & Primary Care, Integrating Behavioral Health and Primary Care Playbook, Medication-Assisted Treatment for Opioid Use Disorder Playbook, Usefulness of Behavioral Health Apps in Primary Care, EvidenceNOW: Managing Unhealthy Alcohol Use, HHS 2012 May;42(5):525-38. https://doi.org/10.1016/j.amepre.2012.01.019. Questions 2 and 5a. Report GAO-22-104597. 15 exp health status/ or exp health education/ 2012(10). The AHRQ Task Order Officer (TOO) and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. HighVery confident that the estimate of effect lies close to the true effect for this outcome. 2020 Aug 1;59(2):293-5. https://doi.org/10.1016/j.amepre.2020.01.009. This project was funded under Contract No. As such, we will assess risk of bias for Questions 2 and 5a. The Evidence-based Practice Center (EPC) refined and finalized them after reviewing of the public comments and seeking input from Key Informants and the Technical Expert Panel (TEP). 2018;36(4):513-517. https://doi.org/10.1037/fsh0000374. Ongoing collaboration and coordination of care are required; activities may include screening and diagnosis, acute and long-term interventions, and followup and maintenance. 2008 Nov 1;30(6):546-51. https://doi.org/10.1016/j.genhosppsych.2008.09.004. Subst Abuse Rehabil. Druss BG, von Esenwein SA, Glick GE, Deubler E, Lally C, Ward MC, Rask KJ. I J K L M N O P Q R S U Behavioral Health Behavioral health problems, which include mental health and substance use disorders, are among the most common conditions seen in primary care settings. Rockville, MD 20857 Accessed September 23, 2022. American Journal of Psychiatry. The Ansbach Military Community is spread . Key Informants IX. Accessed September 23, 2022. Format. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/co-occurring-disorders. NAM Perspectives. clinicians and staff" 3 or "the experience of providing care." 4 Provider satisfaction is a demonstrated outcome of integrated behavioral health. 2018 Jul 1;53:1-1. https://doi.org/10.1016/j.genhosppsych.2018.04.002. PDF Key Principles for Making Integrated Care Successful Across Settings Within the EPC program, the Key Informant role is to provide input into the decisional dilemmas and help keep the focus on Key Questions that will inform health care decisions. Data synthesis will differ across the three categories of questions (Scan, Key, and Contextual). Contacting Author. Integrating behavioral health into primary care addresses fragmentation and lack of coordination. Accessed September 23, 2022. To sign up for updates or to access your subscriberpreferences, please enter your email address below. Searches will be peer reviewed by a second librarian. 78. Katon W, UNutzer J, Fan MY, Williams Jr JW, Schoenbaum M, Lin EH, Hunkeler EM. Trauma and violence. Does patient educational level affect office visits to family physicians? 99. 64. https://www.samhsa.gov/trauma-violence. 2017 Jul;22(6):727-735. https://doi.org/10.1080%2F13548506.2016.1227855. Accessed September 23, 2022. This training, sponsored by Boston Medical Center Grayken Center for Addiction TTA and the Department of Public Health, Bureau of Substance Addiction Services (DPH/BSAS), will cover evidence-based strategies for initiating buprenorphine treatment within ambulatory care practices. ), and employers across the United States. Willems S, De Maesschalck S, Deveugele M, Derese A, De Maeseneer J. Socio-economic status of the patient and doctor-patient communication: Does it make a difference? Integration of mental health/substance abuse and primary care. Question 3 (Contextual). Centers for Disease Control and Prevention. Medical and behavioral health clinicians work together as a team to address a patients concerns. Technical Experts X. People with multiple chronic conditions have poorer health outcomes, use more health services, and spend more on healthcare.16,17Integrating behavioral health into primary care can provide the collaborative, patient-centered, and whole-person care needed to address biopsychosocial factors that affect health, well-being, and quality of life and reduce disparities in health and healthcare.17,18,19. Cherokee Health Systems Model (AHRQ) - Cherokee Health Systems is Health Center Program award recipient and a community mental health center, and is a national leader in integrating primary and behavioral/mental health care. Advancing patient-centered care for people living with multiple chronic conditions. 29 27 or 28, Internet Citation: https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/. https://www.cdc.gov/policy/polaris/healthtopics/ace/index.html. 2021 Sep 1;15:100847. https://doi.org/10.1016/j.ssmph.2021.100847. . Role of the Funder XIII. How are care team member roles and their work flows defined in different approaches to integrating behavioral health and primary care? InsufficientNo evidence. Cambridge University Press; 2019;20:e48. The studies for Question 5 will focus on care team member roles, integration, and training. 65. Contextual Questions. What is Integrated Behavioral Health? - University of Maryland, Baltimore 31. 23. Journal of Clinical Psychology in Medical Settings. Accessed September 23, 2022. 18. 60. 2012 May 1;42(5):539-49. https://doi.org/10.1016/j.amepre.2012.01.011. Academic Psychiatry. Registration I. Outcomes of interest include but not limited to:PATIENT LEVELHealth outcomes: CLINICIAN AND PRACTICE LEVELClinician Outcomes. According to the Agency for Healthcare Research and Quality (AHRQ) Academy (a part of the US Department of Health & Human Services attempting to universalize the language and conception of IBH), the definition of IBH includes a team of primary and mental health clinicians working together with patients and their families. Date: 12/25/2021 . 2017 Jul;22(6):727-735. https://doi.org/10.1080%2F13548506.2016.1227855. 38. Washington, DC: American Hospital Association; 2019 Dec. https://www.aha.org/issue-brief/2019-12-11-integrated-behavioral-health-high-value-care. ASAM Virtual Review Course in Addiction Medicine | The Academy Any disagreements will be resolved by consensus among investigators. HHS Roadmap for Behavioral Health Integration | HHS.gov 91. Am J Prev Med. 25. Office of Disease Prevention and Health Promotion. Washington, DC: United States Government Accountability Office; 2022 Mar. Therefore, study questions, design, and methodological approaches do not necessarily represent the views of individual technical and content experts. Accessed September 23, 2022. resources and infrastructure required, such as staffing, financing, payment models, and technology. https://www.gao.gov/products/gao-19-274. 81. Grant Number 21 (((behav* adj3 (health* or care or cares or caring or cared) adj5 (integrat* or collaborat* or comprehensiv* or coordinat* or implement* or initiat* or launch* or establish* or introduc* or strateg* or philosoph* or approach*)) or (BHI or IBH) or (integrat* adj5 (team* adj2 (base or based or focus* or align*) adj2 (health* or care or cares or caring or cared))) or (whole person* adj2 (care or cares or caring or cared))) adj10 ((nurs* adj (home* or facility or facilities)) or (assist* adj living) or p?ediatrics or p?ediatrician* or (p?ediatric* adj3 (care or caring or cares or cared or practice*)) or obstetrics or obstetrician* or ((obstetric* or maternal* or prenatal* or antenatal*) adj3 (care or caring or cares or cared or practice*)) or geriatrics or geriatrician* or gerontologist or ((geriatric or gerontolog* or elder*) adj3 (care or caring or cares or cared or practice*)) or (integrat* adj (healthcare* or (health* adj (care or cares or caring or cared)))) or ((primar* adj2 (practi* or care*)) or (family adj2 (medic* or practi* or physician*)) or (general adj2 practi*)))).mp. Nondiscrimination Notice, U.S. Department of Health & Human Services, Background - Foundational Information on Disparities in Health and healthcare, What We Know - The Role of Behavioral Health Integration in Reducing Disparities, Assemble a planning and implementation team for this initiative and provide appropriate training, such as, Assess the organizations readiness to make changes - you can use a tool such as, Implement changes - you can use an implementation tool such as, Assess current workplace culture - you can, Develop and implement strategies, activities, and tactics to recruit, support, affirm, and recognize staff and stakeholders from groups that are underrepresented, such as. 2015 Apr;16(4):319-26. https://doi.org/10.1111%2Fobr.12266. 82. Background: Multiple sclerosis (MS) is a chronic autoimmune inflammatory disease of the central nervous system, affecting more than 2.3 million people worldwide. https://doi.org/10.1017/S1463423618000403. 2. Telephone: (301) 427-1364, AHRQ Publishing and Communications Guidelines, Evidence-based Practice Center (EPC) Reports, National Healthcare Quality and Disparities Reports, National Healthcare Quality and Disparities Report, Healthcare Cost and Utilization Project (HCUP), AHRQ Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase (USHIK), AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, National Action Alliance To Advance Patient Safety, Academy for Integrating Behavioral Health and Primary Care (the Academy), Medication-Assisted Treatment (MAT) for OUD Playbook, Integrating Behavioral Health and Primary Care Playbook, Collection of Unhealthy Alcohol Use Tools and Resources, Collection of MAT for OUD Tools and Resources, Resources for Nursing Home Staff and Resident Well-Being, AHRQ's Nursing Home COVID-19 Action Network, Consumer Assessment of Healthcare Provider and Systems (CAHPS) Mental Healthcare Surveys, The Healthcare Cost and Utilization Project (HCUP), HCUP Data Visualization on Inpatient Trends in COVID-19 and Other Conditions, HCUP Fast Stats: Opioid-Related Hospital Use, HCUP Fast Stats: Neonatal Abstinence Syndrome (NAS) Among Newborn Hospitalizations, Geographic Variation in Inpatient Stays for Five Leading Substance Use Disorders, 2016-2018, Geographic Variation in Inpatient Stays for Five Leading Mental Disorders, 2016-2018, Opioid-Related and Stimulant-Related Adult Inpatient Stays, 2012-2018, Emergency Department Visits Related to Suicidal Ideation or Suicide Attempt, 2008-2017, Hospital Burden of Opioid-Related Inpatient Stays: Metropolitan and Rural Hospitals, 2016, Costs of Emergency Department Visits for Mental and Substance Use Disorders in the United States, 2017, County-Level Determinants of High Opioid-Related Hospitalization Rates, Distribution and Correlates of Neonatal Abstinence Syndrome Across US Counties, 2016, Any Use and Frequent Use of Opioids among Non-Elderly Adults in 2018-2019, by Socioeconomic Characteristics, Any Use and Frequent Use of Opioids among Elderly Adults in 2018-2019, by Socioeconomic Characteristics, Healthcare Expenditures for Treatment of Mental Disorders: Estimates for Adults Ages 18 and Older, U.S. Substance Abuse and Mental Health Services Administration. Finally, the Academy helps those who are trying to integrate . https://bipartisanpolicy.org/report/behavioral-health-2021/. Drug Alcohol Depend. Accessed September 23, 2022. Who is most burdened in health care? Comparators not applicable to other questions. Chicago, IL: Health Research & Educational Trust; 2014 Feb). Accessed September 23, 2022. Merrick MT, Ford DC, Ports KA, Guinn AS. This Center is the home of the newest evidence-based resources, tools and support for organizations working to integrate primary and behavioral health care. AHRQ Pub. The populations, interventions, comparators, outcomes, and settings (PICOS) are described in Table 1. Health Equity and Behavioral Health Integration | The Academy Our approach to describing the quality of the included studies will be driven by the volume of studies identified and the study designs. Accessed September 23, 2022. 41. https://doi.org/10.1001/jamanetworkopen.2020.29650. The inclusion and exclusion criteria for the overall review are specified in Table 1. The Journal of the American Board of Family Medicine. AHRQ Research Studies Database is searchable and includes AHRQ-authored and AHRQ-funded research studies on burnout. Balasubramanian BA, Cohen DJ, Jetelina KK, Dickinson LM, Davis M, Gunn R, Gowen K, DeGruy FV, Miller BF, Green LA. These disparities are reflected in differences in health outcomes such as life expectancy, quality of life, and morbidity and mortality rates based on gender, race, socioeconomic status, sexual orientation and gender identity, physical ability, age, weight, geographic region, housing status, and immigration status.1,2, Disparities in health and healthcare disproportionately impact people who are racial and ethnic minorities; have disabilities; reside in rural communities; are lesbian, gay, bisexual, transgender, and queer (LGBTQ); are women; experience homelessness; have behavioral health conditions; are immigrants; and have lower incomes.1,2 People that fall within multiple social, economic, or other classifications commonly cope with intersecting inequities and compounding disparities in health and healthcare - referred to as intersectionality.3, Mental health, substance use, and physical health have mutually influencing interactions, and all correlate with histories of trauma and with lower income.10,11 People with mental health and substance use disorders have a higher prevalence of other chronic conditions, such as cardiovascular disease, stroke, high blood pressure, diabetes, cancer, HIV and hepatitis, and vice versa.10,11,12,13,14,15, Fragmented and uncoordinated healthcare and social service systems compound underlying social, economic, and environmental inequities and make it difficult to fully address the entire array of biological, psychological, and social problems and illnesses that people bring into the healthcare system. Technical Experts do not do analysis of any kind; neither do they contribute to the writing of the report. 63. J Med Internet Res. Primary care clinicians evaluate integrated and referral models of behavioral health care for older adults: Results from a multisite effectiveness trial (PRISM-e). 8. Upstream strategies include to improve community conditions. 2012 Aug;169(8):790-804. https://doi.org/10.1176/appi.ajp.2012.11111616. New resources from AHRQ can help practices integrate care more effectively. Bombard Y, Baker GR, Orlando E, Fancott C, Bhatia P, Casalino S, Onate K, Denis JL, Pomey MP. HHSA29032013T. Integrating Behavioral Health & Primary Care| AHRQ Academy What approaches have been used to integrate behavioral health and primary care? Statements in the report should not be construed as endorsement by either the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services. The resource is provided by AHRQ's Academy for Integrating Behavioral Health and Primary Care (https://integrationacademy.ahrq.gov), which promotes the integration of behavioral health into primary and ambulatory care settings with a focus on care for patients using substances and those with mental health conditions. What is health equity and what difference does a definition make? What training interventions (e.g., mode and content, trainee credentials, dose and timing of training) are effective in facilitating integrated care team functioning? 2015 Jan 1;2:615-21. https://doi.org/10.1016/j.pmedr.2015.07.006. Key Question (2) and Sub-question 5a. Arch Gen Psychiatry. 12 exp behavioral medicine/ or exp Behavior therapy/ 89. Gain a practical definition of behavioral health integration as implemented in actual practice settings and develop shared language that helps communication and collaboration across sites, disciplines, and time. If meta-analysis is performed, randomized controlled trials will be analyzed separately from observational studies. Short inertial sensor-based gait tests reflect perceived state fatigue Integrating behavioral health across the continuum of care. Physicians' perceptions of people with disability and their health care. Find out how practices are successfully integrating care and explore the set of competencies that practices, providers, and staff need to advance integration efforts. INTRODUCTION In 2008, the Agency for Health Research and Quality (AHRQ) Behavioral Health Integration Evidence report observed that we do not know what elements of integrating medical and behavioral care contribute most to improvements in patient care [ 1 ]. To sign up for updates or to access your subscriberpreferences, please enter your email address below. The mission of the AHRQ Academy is to promote and support the integration of behavioral health into primary and ambulatory care settings with a key focus on providing care for patients using substances, particularly opioids, and for those with mental health conditions. Reference lists of included articles, selected excluded articles (e.g., narrative reviews), and systematic reviews will be reviewed for additional includable literature. Accessed September 23, 2022. https://doi.org/10.1080/00918369.2011.614902. What reliable, valid, clinically meaningful, and/or patient-centered measures and metrics are available to monitor and evaluate integration approaches? Strategies for Integrating Behavioral Health and Primary Care. Social determinants and social needs: Moving beyond midstream; p. 2. https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2021-03/HSTP%20Social%20Determinants%20of%20Health%20Investment%20Strategy_Final.pdf (PDF -- 378 KB). Washington, DC: U.S. Bureau of Labor Statistics; 2019 Dec. Report 1084: Table 18, Median usual weekly earnings of full-time wage and salary workers, by detailed occupation and gender, 2018 annual averages (numbers in thousands). 98. Accessed September 23, 2022. Engaging patients to improve quality of care: A systematic review. Dissemination of Integrated Care Within Adult Primary Care Settings: The Collaborative Care Model American Hospital Association. 62. Thota AB, Sipe TA, Byard GJ, Zometa CS, Hahn RA, McKnight-Eily LR, Chapman DP, Abraido-Lanza AF, Pearson JL, Anderson CW, Gelenberg AJ, Hennessy KD, Duffy FF, Vernon-Smiley ME, Nease DE Jr, Williams SP; Community Preventive Services Task Force. This is supported by the fact that individuals diagnosed with behavioral health disorders have significantly higher prevalence of chronic diseases, higher healthcare costs, reduced quality of life, and shorter life expectancies compared with those without behavioral health disorders.1 In an ideal system, primary and behavioral healthcare would be provided without artificial distinctions, and in an inclusive context. For the effectiveness questions, we will use the approach described in the Methods Guide for Effectiveness and Comparative Effectiveness Reviews.46 To ensure reliability and validity of the evaluation, the body of evidence will be assessed for the following criteria as they are defined in the Methods Guide: The strength of evidence will be assigned an overall grade of high, moderate, low, or insufficient according to a four-level scale by evaluating and weighing the combined results of the included domains.