Behavioral Health Integration

As the largest and most widely distributed of primary care physicians, family physicians have an important role in providing mental health care, especially in rural and underserved areas. The integration of behavioral health services with primary care is designed to improve the detection, diagnosis, and treatment of mental disorders in patients seen in primary care settings. Addressing mental health and physical problems in a comprehensive, coordinated, and collaborative manner can improve the quality of care and patient health. Through a partnership with the University of Denver, the Graham Center’s Behavioral Health Integration portfolio is expanding.

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  • Characteristics of Primary Care Physicians Working in the Same Practice as Behavioral Health Providers24 page PDF

    Presentations | May 01, 2015 | Stephen Petterson, PhD; Tracey Henry, MD, MOH; Benjamin Miller, PsyD; and Larry Green, MD

    2015 American Association of Medical Colleges Health Workforce Research Conference

  • Mental Health Treatment in the Primary Care Setting: Patterns and Pathways.

    Articles | Jun 09, 2014 | Stephen Petterson, PhD; Benjamin Miller, PsyD; Jessica Payne-Murphy, MA; Robert Phillips, MD, MSPH

    The redesign of primary care through the patient-centered medical home offers an opportunity to assess the role of primary care in treating mental health relative to the rest of the health care system. Better understanding the patterns of care between primary care and mental health providers helps guide necessary policy changes. This article reports the findings from 109,593 respondents to the 2002–2009 Medical Expenditure Panel Surveys (MEPS).

  • Proximity of Providers: Colocating Behavioral Health and Primary Care and the Prospects for an Integrated Workforce

    Articles | May 16, 2014 | Benjamin Miller, PsyD; Stephen Petterson, PhD; Bridget Teevan Burke, MPH; Robert Phillips, MD, MSPH; Larry Green, MD

    Integrated behavioral health and primary care is emerging as a superior means by which to address the needs of the whole person, but we know neither the extent nor the distribution of integration. Using the Centers for Medicare and Medicaid Services’ National Plan and Provider Enumeration System (NPPES) Downloadable File, this study reports where colocation exists for (a) primary care providers and any behavioral health provider and (b) primary care providers and psychologists specifically

  • Primary Care, Behavioral Health, Provider Colocation and Rurality

    Articles | May 01, 2014 | Benjamin Miller ,PsyD; Stephen Petterson, PhD; Shandra Levrey, PhD; Jessica Payne-Murphy, MA; Miranda Moore, PhD; and Andrew Bazemore, MD, MPH

    Purpose: The purpose of this study was to characterize the proximity of primary care and behavioral health service delivery sites in the United States and factors influencing their colocation.

  • A Needs-Based Method for Estimating the Behavioral Health Staff Needs of Community Health Centers

    Articles | Jul 15, 2013 | Bridget Teevan Burke, Benjamin F Miller, Michelle Proser, Stephen M Petterson, Andrew W Bazemore, Eric Goplerud and Robert L Phillips.

    Federally Qualified Health Centers are expanding to increase access for millions of more Americans with a goal of doubling capacity to serve 40 million people. Health centers provide a lot of behavioral health services but many have difficulty accessing mental health and substance use professionals for their patients. To meet the needs of the underserved and newly insured it is important to better estimate how many behavioral health professionals are needed.

  • Family Physicians Are Essential for Mental Health Care Delivery

    Articles | Apr 15, 2013 | Imam M. Xierali, PhD, Sebastian T. Tong, MD, MPH, Stephen M. Petterson, PhD, James C. Puffer, MD, Robert L. Phillips Jr., MD, MSPH and Andrew W. Bazemore, MD, MPH

    As the largest and most widely distributed of primary care physicians, family physicians have an important role in providing mental health care, especially in rural and underserved areas. However, the proportion of family physicians who report providing mental health care is low. Policy barriers such as payment for mental health services should be explored to ensure access to mental health care for patients across the urban to rural continuum.

  • Better Integration of Mental Health Care Improves Depression Screening and Treatment in Primary Care

    One Pagers | Nov 01, 2011 | Robert L. Phillips, Jr., MD, MSPH; Benjamin F. Miller, PsyD; Stephen M. Petterson, PhD; and Bridget Teevan, MS

    Improving screening and treatment for depression in primary care will require better mental health care integration. Depression is common in primary care, yet screening for the condition remains low. Enhanced, coordinated financial support for the integration of mental health care into primary care could improve identification and treatment of depression.

  • The Importance of Time in Treating Mental Health in Primary Care

    Articles | Jun 15, 2011 | Benjamin F. Miller; Bridget Teevan; Robert L. Phillips, Jr.; Stephen M. Petterson; and Andrew W. Bazemore.

    Primary care plays a critical role in treating mental health conditions, but caring for patients with comorbid mental health and medical conditions increases visit length. Lack of appropriate reimbursement mechanisms and competing priorities make it difficult to integrate mental health into primary care. Caring for patients with mental health comorbidities requires time not now affordable in the primary care setting and demands a new payment policy to promote team-based, integrated care for mental and physical illness in a patient-centered medical home.

  • Race and Ethnicity and Rural Mental Health Treatment

    Articles | Aug 15, 2009 | S Petterson, PhD; IC Williams, PhD; EJ Hauenstein, PhD, LCP, MSN, RN; V Rovnyak, PhD; E Merwin, PhD, RN, FAAN

    Objective: Research has shown that there is less use of mental health services in rural areas even when availability, accessibility, demographic, and need factors are controlled. This study examined mental health treatment disparities by determining treatment rates across different racial/ethnic groups. Methods: Data from the first four panels of the Medical Expenditure Panel Survey (MEPS) were used for these analyses. The sample consisted of 36,288 respondents yielding 75,347 person-year observations. The Economic Research Service’s Rural-Urban Continuum was used as a measure of rurality. Results: Findings show that rural residence does little to contribute to existing treatment disparities for racial/ethnic minorities living in these areas. Conclusions: Findings suggest that characteristics of the rural environment may disadvantage all residents with respect to mental health treatment. In more populated areas where mental health services are more plentiful, complex racial and service system factors may play a greater role in evident ethnic/racial treatment disparities.

  • Changing Patient Health-Risk Behavior Requires New Investment in Primary Care

    One Pagers | Oct 15, 2008 | Martey S. Dodoo, PhD; Lenard I. Lesser, Robert L. Phillips Jr, Andrew W. Bazemore, Stephen M. Petterson, and Imam Xierali

    Evidence supports the effectiveness of primary care interventions to improve nutrition, increase physical activity levels, reduce alcohol intake, and stop tobacco use. However, implementing these interventions requires considerable practice expense. If we hope to change behavior to reduce chronic illness, the way we pay for primary care services must be modified to incorporate these expenses.

  • Why There Must be Room for Mental Health in the Medical Home

    One Pagers | Mar 15, 2008 | Stephen Petterson, PhD, Bob Phillips, MD MSPH, Andrew Bazemore, MD MPH, Martey Dodoo, PhD, Xingyou Zhang, PhD, and Larry A. Green, MD

    Most people with poor mental health are cared for in primary care settings, despite many barriers. Efforts to provide everyone a medical home will require the inclusion of mental health care if it is to succeed in improving care and reducing costs.

  • Behavioral Change Counseling in the Medical Home

    One Pagers | Nov 15, 2007 | Bijal A. Balasubramanian, MBBS, MPH; Deborah J. Cohen, PhD; Martey S. Dodoo, PhD; Andrew W. Bazemore, MD, MPH; and Larry A. Green, MD

    Health-related behavioral counseling can and should be a central offering in the medical home. Primary care practices currently address unhealthy behaviors with their patients, but most practices lack the integrated approaches needed to effectively change these behaviors. Revisions in practice and financing are necessary to fully realize this capacity, which could affect the millions of patients served by the largest health care delivery platform in the United States.

  • Family Physicians Are an Important Source of Mental Health Care

    One Pagers | Apr 01, 2003 | Anu Subramanian PhD; Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH

    While comprising about 15 percent of the physician workforce, family physicians provided approximately 20 percent of physician office-based mental health visits in the United States between 1980 and 1999. This proportion has remained stable over the past two decades despite a decline in many other types of office visits to family physicians. Family physicians remain an important source of mental health care for Americans.

  • Shortchanging Adolescents: Room for Improvement in Preventive Care by Physicians

    Articles | Feb 15, 2001 | Merenstein D, Green LA, Fryer GE, Dovey SM

    BACKGROUND AND OBJECTIVES: Behaviors developed in adolescence influence health later in life. Adolescents seldom visit physicians to discuss health-related behaviors. Instead, physicians must incorporate health counseling into the exams for which the adolescents do come. We studied the frequency and duration of adolescents' consultations with family physicians and pediatricians involving counseling about diet and nutrition, exercise, weight reduction, cholesterol reduction, HIV transmission, injury prevention, and tobacco use. METHODS: Data were analyzed from the National Ambulatory Medical Care Survey for the 3-year period from 1995 through 1997. This survey uses a multistate national probability sample of patient visits to nonfederal, office-based physicians. We described patterns of counseling provided to adolescents and compared patterns for family physicians/general practitioners and pediatricians. RESULTS: Of 91,395 physician-reported visits analyzed, 4,242 (4.6%) were by adolescents ages 12-19. Visits to family physicians and pediatricians accounted for 1,846 (43.5%) of these visits. Counseling about any of the seven areas studied was included in 15.8% of family physician visits and 21.6% of pediatrician visits. The length of consultation increased from 13.8 to 17.6 minutes if counseling was included. CONCLUSION: Adolescents visit physicians infrequently. When they do, few receive counseling on critical adolescent health issues. Both family physicians and pediatricians have room for improvement.