behavioral health integration · collaborative care · Integrated Care

Top Ten Useful Measures, Assessments, and Tools for Collaborative Practices

(This blog post is a reprint of a piece in the CFHA Blog from January 15th, 2015. Click here for the original post. Reprinted with permission.)

In primary care, more than half of the office visits are for somatic complaints, which are often associated with depression and anxiety. These conditions often go undetected and can have a significant impact on health outcomes. As providers adopt a collaborative approach to care, many have incorporated the use of assessments for screening and early detection of symptoms of mental health and substance use conditions.

With an abundance of assessments, measures, and tools available for use, many collaborative care practices are challenged with determining which are most effective for use in the limited time available during a routine office visit. Screenings are important for all age groups. Below is a list of the top ten tools for use in practices. These ten were selected based on a number of factors, including reliability, validity, sensitivity, efficiency, and cost. In most cases, the tools are available for use at no cost. Most are also available in multiple languages as well.

  1. PHQ-9: The Patient Health Questionnaire (9) is widely used among primary care providers to identify depression. With only nine questions, this tool is easy to use and has been validated for early detection.
  2. AUDIT: The Alcohol Use Disorders Identification Test is a 10-item questionnaire developed by the World Health Organization and is found to be very effective in primary care settings.
  3. GAD-7: The seven-item General Anxiety Disorder screening identifies whether a more complete assessment is needed.
  4. DAST-10: The Drug Abuse Screen Test is a brief 10-item self-report tool that is effect for screening adults and adolescents for drug abuse.
  5. PC-PTSD: This four-item screen is effective for detecting post-traumatic stress disorder in primary care settings.
  6. Pediatric Symptoms Checklist: The 17-item version is easy to use in family practices for detecting developmental and behavioral problems.
  7. SBQ-R: The Suicide Behaviors Questionnaire is a four-question scale for assessing suicide-related thoughts and behaviors.
  8. Brief Pain Inventory: The tool is widely used in medical settings for assessing pain, and is available in 23 languages.
  9. Insomnia Severity Scale: This seven-question screening assessment is effective in identifying problems with sleeping.
  10. MDQ: The Mood Disorder Questionnaire (MDQ) is a 13-item questionnaire used to screen for bipolar disorder symptoms.

In order to limit the list to ten, there are many excellent tools that did not make this list. For example, some providers prefer the CAGE-AID to the AUDIT-7 for alcohol screening. In addition, many will find it very useful to have additional tools on hang to screen for additional conditions, such as:

  • Geriatric depression
  • Eating disorders
  • Postpartum depression
  • Intimate partner violence
  • ADHD
  • Autism

Integrating these tools into your electronic health record, including them in patient kiosks, and/or instructing support staff to make select tools available for completion while in the reception area are ways in which these cools have been included in practices. With routine use of many of these screening tools, collaborative care practices will efficiently and effectively detect signs and symptoms of behavioral health conditions. This enables earlier intervention, resulting in better health outcomes.

What is on your top ten list?

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behavioral health integration · behavioral health primary care integration · collaborative care · healthcare integration · primary care behavioral health integration

The Partnership: Choosing the Right Model for Your Integrated Healthcare Services

Determining the Model

How do partnering Community Behavioral Health Centers (CBHC) and  Community Health Centers (CHC) determine the ideal model for their foray into integration? There are many factors to consider such as:

  • What are the needs of the individuals served by the partnering organizations?
  • What are the needs of the community?
  • What resources do the organizations bring to the partnership?

Now that the partners have a solid foundation and clear vision for their collaboration, it is time for the careful planning that is necessary to make it a reality.  There are effective tools available to assist organizations in working through this very important process. (Please note that these suggestions and resources are not limited to community providers.) 

The MH/Primary Care Integration Options scale  is available on the SAMHSA-HRSA Center for Integrated Health Solution website. This is very helpful for leading the discussion among the members of the implementation team. The scale assists the partners not only in determining the current reality but also mutually deciding on the desired level of integration: Minimal Collaboration, Basic Collaboration from a Distance, Basic Collaboration On-Site, Close Collaboration/Partly Integrated, and Fully Integrated/Merged in each of these key functional areas:

  1. Access: How do individuals access services?
  2. Services: Are the services separate and distinct or are the primary care and behavioral health services seamless? Or perhaps somewhere in between.
  3. Funding: Do the partners share resources or are they separate?
  4. Governance: Are there separate boards of directors for each organization?
  5. Evidence-based Practices: Do the organizations administer the PHQ-9 or disease registries, for example, and share the results?
  6. Data: Do the partners share information? Do the providers have access to the partner’s EHR?

This assessment process is most effective when stakeholders from each organization are included. Ideally, representatives are included from clinical, management, and administrative departments, as well as a few individuals who use the services. It’s very helpful to have frontline staff and board members to take part as well.  Call center and reception staff offer a unique perspective that leadership frequently finds enlightening.

Other useful tools available include the National Council’s Success in the New Healthcare Ecosystem: Mental Health & Substance Use Provider Readiness Assessment prepared by Dale Jarvis.   This allows provider organization management teams to assess their organization’s readiness for engaging in the changing healthcare system.

Another tool to consider is the COMPASS-PH/BH  created by Zia Partners.  This self-assessment tool is used for primary care/behavioral health integration for implementation of a Comprehensive Continuous Integrated System of Care.

Making the Vision into a Reality

Once the ideal model of integration has been determined, the journey begins to make it a reality. Be sure to stop by for the next installment in the series.

What tools or methods have you found to be helpful when selecting a model for your healthcare integration endeavor?

I would love to hear from you! Please email your suggestions to me at behavioralhealthintegration@gmail.com for inclusion in a future post.