Integrated Care in Psychiatry [recurso electrónico] Redefining the Role of Mental Health Professionals in the Medical Setting

Front Matter....Pages i-xv A Vision of Integrated Psychiatric and Medical Care for 2023....Pages 1-4 Prevalence of Psychiatric Symptoms/Syndromes in Medical Settings....Pages 5-27 Access to and Engagement in Evidence-Based Integrated Care....Pages 29-53 Payment Barriers and Potential Solutions to Psychiatric Service Delivery in the Medical Setting....Pages 55-68 Psychiatrist’s Changing Role in a Reformed Delivery System: Adding Value in Accountable Care Organizations....Pages 69-85 Working with Integrated Case Managers to Improve Health Outcomes and Reduce High Cost in Patients with Health Complexity....Pages 87-102 Building Value-Added Teams to Care for Behavioral Health Needs in Primary Care....Pages 103-126 Integrating Care in the Public Sector....Pages 127-141 Integrating Child Psychiatric Care....Pages 143-156 Proactive Psychiatric Consultation Services for the General Hospital of the Future....Pages 157-181 Transitioning to Psychiatric Service Delivery in the Medical Setting....Pages 183-196 Training the Next Generation of Psychiatrists in Integrated Medical–Psychiatric Care....Pages 197-210 Research in Integrated Psychiatric Care....Pages 211-227 Back Matter....Pages 229-235 Foreword 6 Preface 8 Contents 12 Contributors 14 Chapter 1: A Vision of Integrated Psychiatric and Medical Care for 2023 17 Chapter 2: Prevalence of Psychiatric Symptoms/Syndromes in Medical Settings 21 Introduction 21 BH Comorbidity by Service Location 22 Primary Care 22 Emergency Departments 26 General Hospital Inpatient 27 Intensive Care Units 28 BH Comorbidity by Organ System 29 Neurology 29 Epilepsy 29 Cerebrovascular Disease 30 Movement Disorders 30 Multiple Sclerosis 31 Traumatic Brain Injury 31 Headache 31 Cardiac 31 Oncology 33 Infectious Diseases 35 HIV–AIDS 35 Hepatitis C 35 Endocrine 36 Diabetes Mellitus 36 Thyroid Dysfunction 36 Obstetric-Gynecology and Women’s Health 37 Conclusion 38 References 38 Chapter 3: Access to and Engagement in Evidence-Based Integrated Care 44 Background 45 Integrated Care Models and Engagement Strategies 47 Primary Care 48 Models for Detecting Mental Health Problems in Primary Care 48 Models for Coordinating Care 48 More Promising Primary Care Models 50 Summary 52 Obstetrics/Gynecology 52 Summary 53 Pediatric and Adolescent Primary Care 53 Increasing Behavioral Health Treatment Capacity 54 Technology to Improve Attention Deficit Hyperactivity Disorder Care 54 Advancing Adolescent Depression Care 55 Summary 55 Patient-Centered Medical Home 56 Summary 57 Emergency Departments/Trauma Centers 57 Improving Quality of PTSD Care in Trauma Centers 57 Improving Quality of Behavioral Health Care in Emergency Departments 57 Suicide Prevention in Emergency Departments 59 Summary 59 The Vision 59 Barriers to Implementation 61 Structural Barriers 61 Practice Level Barriers 62 Workforce and Training Barriers 62 Health IT Barriers 62 Financing Barriers 63 Knowledge Barriers 63 Recommendations 63 Conclusion 64 References 65 Chapter 4: Payment Barriers and Potential Solutions to Psychiatric Service Delivery in the Medical Setting 69 Background 69 Integrated Care: Collaboration and Economics 74 Working with Primary Care Practices 76 Transitioning to a Global Payment System 78 References 80 Chapter 5: Psychiatrist’s Changing Role in a Reformed Delivery System: Adding Value in Accountable Care Organizations 83 ACO Elements in Earlier Health Care Initiatives 84 ACOS Under ACA 86 ACO Model 86 Needed Elements in an ACO 86 Identifying Target Populations 88 Role of Psychiatry in Models of Collaborative, Integrative and Stepped Care 89 Barriers to Coordinated Behavioral Health Care 92 Montefiore Medical center’s ACO Initiatives 93 Conclusion 96 References 97 Chapter 6: Working with Integrated Case Managers to Improve Health Outcomes and Reduce High Cost in Patients with Health Complexity 100 The Doctor–Patient Relationship 101 Defining Health Complexity 102 Traditional Case Management to Integrated Case Management 106 Understanding Case Management Support Programs and the Case Manager 111 Integrated Case Management as a Part of Needed Changes in Psychiatric Practice 113 References 114 Chapter 7: Building Value-Added Teams to Care for Behavioral Health Needs in Primary Care 116 Fundamentals of Collaborative Care 116 Core Team Members 119 PCPs 119 Care Manager 120 Other Behavioral Health Providers 120 Psychiatric Consultant 121 Building the Team 122 Overview 122 Preparing for Team Building 124 Program Vision 125 Current Workflow, Staff Self-Assessment, and Gap Assessment 126 Collaborative Care Workflow 128 Implementation Plan 128 Supporting Implementation by Addressing Common Barriers 130 Beyond Implementation 136 Conclusion: Working Well Together 137 References 138 Chapter 8: Integrating Care in the Public Sector 140 Introduction 140 The Public Sector: Populations, History, and Current State 141 The Public Health and BH System 141 Community Health Centers 141 Community Mental Health Centers 143 Mending the Safety Net: Models for Collaboration Between CMHCS and FQHCS 145 Core Clinical Features of Public Sector Integrated Care Models 147 Roles for Psychiatrists in Emerging Public Sector Models 149 Conclusion 151 References 151 Chapter 9: Integrating Child Psychiatric Care 155 Background 156 Where We Are Now 158 Readiness of Health Care Professionals 158 Models of Integration 159 Remote Consultation Model 159 Advantages 160 Limitations 160 Co-located Model 160 Advantages 160 Limitations 161 Vision for Integrated Service Delivery 161 Barriers 163 Risks and Benefits 164 Effecting Change 165 Coalition Building 166 Payment Reform 166 Training 166 References 167 Chapter 10: Proactive Psychiatric Consultation Services for the General Hospital of the Future 169 Background 171 Psychiatric Consultation and LOS 171 Geriatrics Consultation and LOS 178 Disease-Specific Consultation and LOS 182 Current State 184 A First Model 184 A Second Model 186 Vision 187 Barriers 188 Risks, Benefits, and Costs 190 Recommendations 190 References 191 Chapter 11: Transitioning to Psychiatric Service Delivery in the Medical Setting 194 Where We Are 195 Where We Are Going 197 How We Get from Here to There 199 Example of a Psychiatry Primary Care Collaboration Pilot 200 Specific Recommendations for Change 201 Strategies to Build New Models in Medical Settings 202 Key Skills for Psychiatrists in Integrated Care Settings 203 Conclusion 205 References 206 Chapter 12: Training the Next Generation of Psychiatrists in Integrated Medical–Psychiatric Care 208 Psychiatry Training and Evolving Systems of Behavioral Health Care 209 The Affordable Care Act and Psychiatric Training 210 An Overview of Integrated Care 211 Specific Training Models 214 Combined Training 214 Cross-Training in General Medicine 215 Recommendations for an Integrated Psychiatry Residency Curriculum 216 Train New Trainers (TNT) in Primary Care Psychiatry 217 Conclusion 220 References 221 Chapter 13: Research in Integrated Psychiatric Care 222 Background 222 Prevalence of Disorders 223 Use of Services 224 Current Models 224 Research Findings 228 Outpatient Primary Care Setting 228 Outpatient Mental Health Setting 231 Inpatient Setting 231 Evidence for Specific Interventions 232 Limitations of Research 232 Future Needs 234 Implications for Health Care Practice and Policy 235 References 237 Index 239 "Integrated Care in Psychiatry: Redefining the Role of Mental Health Professionals in the Medical Setting is a landmark title in the field, offering a clear, detailed, and cohesive call by leading experts for coordinated care for patients with concurrent psychiatric and medical conditions. The renowned editors and authors argue that what is slowly occurring, and greatly needed at a faster pace, is nothing less than a sea change in the way that psychiatric care will be delivered. The current, mostly segregated, medical and psychiatric model of care has led to the development of competing medical and psychiatric subcultures that have resulted in a lack of dialog among health providers, administrators, and payers -- and thus in less than optimal patient outcomes. To remedy this problem, the book offers a practical, insightful road map to achieving the central tenet of health reform truly coordinated, patient-centered care where the care experience for the patient, the medical care itself, and the cost outcomes improve as the system changes from fee-for-service to population-based health. An invaluable reference for all clinicians, policy makers, payers, administrators, and others interested in the debate surrounding healthcare systems, Integrated Care in Psychiatry: Redefining the Role of Mental Health Professionals in the Medical Setting is a major contribution to the literature and a gold standard resource"--Provided by publisher __Integrated Care in Psychiatry: Redefining the Role of Mental Health Professionals in the Medical Setting__ is a landmark title in the field, offering a clear, detailed, and cohesive call by leading experts for coordinated care for patients with concurrent psychiatric and medical conditions. The renowned editors and authors argue that what is slowly occurring, and greatly needed at a faster pace, is nothing less than a sea change in the way that psychiatric care will be delivered. The current, mostly segregated, medical and psychiatric model of care has led to the development of competing medical and psychiatric subcultures that have resulted in a lack of dialog among health providers, administrators, and payers – and thus in less than optimal patient outcomes. To remedy this problem, the book offers a practical, insightful road map to achieving the central tenet of health reform – truly coordinated, patient-centered care where the care experience for the patient, the medical care itself, and the cost outcomes improve as the system changes from fee-for-service to population-based health. An invaluable reference for all clinicians, policy makers, payers, administrators, and others interested in the debate surrounding healthcare systems, __Integrated Care in Psychiatry: Redefining the Role of Mental Health Professionals in the Medical Setting__ is a major contribution to the literature and a gold standard resource.