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Dimensions

In assessing levels of integrated care, Karen W. Linkins, PhD et al. (“Conceptualizing and Measuring Dimensions of Integration in Service Models Delivering Mental Health Care to Primary Care Patients”, 2006) identified five dimensions in service models for delivering mental health care to primary care patients:

  • Physical proximity of mental health care to the primary care setting;
  • Temporal proximity (timing) of mental health care relative to the original primary care visit;
  • Communication among primary care and mental health providers;
  • Expertise and services available within the primary care setting; and
  • Degree of stigma associated with receiving mental health care.

Barbara Mauer and Kathleen Reynolds identified three dimensions important in achieving and measuring integration and cautioned that, while they are all interrelated, success in one area does not assure success in the others:

  • Clinical integration
  • Financial Integration
  • Structural Integration

Kirk Stroshal, Ph.D., in a 2007 presentation at the Collaborative Family Healthcare Association conference, delineated the dimensions of integration thusly:

  • Mission Integration – The extent to which the behavioral and general medical service systems are pointing toward the same health objectives, goals and strategies. [Rule: The goal is to improve the “health of the entire population, not just to treat the sick.]
  • Clinical Service Integration – The degree to which general medical and behavioral providers seamlessly engage in coordinated assessment, intervention, and follow-up activities. [Rule: the more co-management processes, protocols and assessment tools, the better.]
  • Physical Integration – The degree to which the general medical and behavioral health providers work in the same space, allowing for instantaneous access to care. [Rule: Co-location is NOT the same as integration.]
  • Operations Integration – The degree to which the general medical and behavioral health providers work off the same clinic “platform”. {Rule: The more operations processes are shared (scheduling, reception, QI, support staff), the better.]
  • Information Integration – The degree to which the general medical and behavioral health provider can access real time client care information. [Rule: Separate charts and sequestered information hamper collaboration.]
  • Financial Integration – The degree to which general medical and behavioral health services are funded as a “basic” form of health care. {Rule: Integrative behavioral care should be financed as a “core primary care service.]

At the behest of IBHP and CiMH, Dale Jarvis prepared The Primary Care, Mental Health and Substance Use Disorder Provider Readiness Assessment (2011).  The assessment tool describes 21 competencies and strategies likely to be needed in the new “healthcare ecosystem”.  This tool is divided into sections addressing different operational dimensions: relationship building; access and outcomes; person-centered healthcare home participation; business infrastructure; and consumer advocacy.

Integrated Primary Care and Behavioral Services: Can the Model Succeed: A Literature Review (2011) by Alaina Dall and Nicole Howard explores the efficacy and approaches of various integrated models of care.  The review concludes that “in general, individuals who were part of an integrated care program saw their symptoms reduced more than in the groups that received usual care.  However, improvements were seen regardless of the degree to which the approaches were integrated.”

Evolving Models of Behavioral Health Integration in Primary Care, a paper sponsored by the Milbank Memorial Fund, describes models of integrated care and cites examples of how they are being implemented throughout the country.

CIHS’s 2013 Standard Framework for Levels of Integrated Healthcare helps primary and behavioral health providers understand where they are on the integration continuum.

The Agency for Healthcare Research and Quality (AHRQ) has developed an Atlas of Integrated Behavioral Healthcare Quality  Measures for practices that wish to understand if they are providing, or are preparing to implement, integrated care.

SAMHSA-HRSA Center for Integrated Health Solutions has more assessment tools for organizations integrating physical and behavioral health.