How Integrated Care Can Integrate Person-Centered Care
SAMHSA/CMHS Consumer Affairs; Laura M. Galbreath, 2/7/2014
The integration of primary and behavioral health care is taking hold across the country, providing an opportunity for providers in both settings to bring full attention to the individual client and fully realize recovery principles of patient-centered care.
Primary and behavioral healthcare integration requires significant practice change, including new ways of running day-to-day operations, identifying how to pay for new services, and workforce training. Patient-centeredness is embedded in these major practice change initiatives, but change isn’t easy. When working to integrate care, organizations often face ambiguity when they try to define what it means to be person centered or recovery oriented. Often, in a fast-paced clinical setting, this vague understanding can lead to inaction.
Similar to the recovery transformation occurring in the behavioral health field, primary care providers are moving to person-centered approaches to care. The Patient-Centered Primary Care Collaborative, a leading organization in the movement to transform primary care providers into patient-centered medical homes, defines patient-centeredness as a partnership among practitioners, patients, and their families to ensure that decisions are made in full consideration of patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care. Similar to recovery-oriented practices, this is an opportunity to fully embed collaboration as the norm in primary care as practices move toward a person-centered medical or health home.
For primary care providers, the integration of behavioral health professionals as part of the clinical team brings greater capacity to provide direct services to individuals with a range of mental health and substance use needs. In addition, the behavioral health professionals on the clinical team, including peer providers who emphasize strength-based recovery and resiliency, are also dispelling common misconceptions, bringing creative ideas for engaging staff and families, and helping their colleagues understand what recovery looks like.
Specifically, in an integrated primary care setting, behavioral health providers can
- Demonstrate how recovery-oriented approaches for persons with mental illnesses and addictions help meet patient-centered medical or health home standards of care.
- Help the entire team recognize the possibility that anyone accessing services may have unresolved trauma underlying his or her distress.
- Provide skills training on Mental Health First Aid or focused psychological skills training, such as motivational interviewing.
- Embed the behavioral health goals agreed to by the person and any actions the person will need to take in his or her own self-care into the care plan.
- Acknowledge the strengths and learning derived from a person’s lived experience.
- Promote a culture and language of hope and optimism, which leads to people feeling valued, welcome, and safe.
For behavioral health providers, the challenge is to ensure that recovery principles make their way into newly embedded primary care clinics and wellness programs in the same way that they are being incorporated across mental health and addiction services. Providers can start to make this shift in the following actionable ways:
- During physical exams, in addition to discussing people’s medical concerns, ask them about their health goals.
- Offer training to primary care staff and, if possible, arrange for embedded primary care staff to shadow a behavioral health team to observe recovery-oriented services so that they can see them firsthand.
- Put in place peer-based supports, such as Whole Health Action Management (or WHAM) training, to empower people to achieve their wellness goals.
- Make sure wellness programs are strength-based instead of illness-based (healthy eating versus diabetes management).
- People and families are supported in taking advantage of community resources like the YMCA, or parks and recreation programs.
- Use patient surveys and focus groups to determine which health education and services individuals would be most in interested in accessing.
The SAMHSA–HRSA Center for Integrated Health Solutions and others are developing a growing number of resources to help providers address the clinical, operational, and administrative challenges faced in integrating primary and behavioral health. Taking the time to examine whether new integrated services are person centered, using resources such as self-assessment tools, is just as important as the other operational considerations if providers are to achieve the full potential of integration.
Person-centered and recovery-oriented approaches are critical to the success of primary and behavioral health integration. Together, we can ensure that integration, no matter the setting, includes a set of capabilities that support people in being at the center of their whole health and recovery.
Laura is the director of the SAMHSA–HRSA Center for Integrated Health Solutions. You can reach her at laurag@thenationalcouncil.org
The SAMHSA–HRSA Center for Integrated Health Solutions is dedicated to supporting the bidirectional integration of primary and behavioral health care for those with serious mental illness and/or substance use disorders and physical health conditions, whether seen in specialty mental health or primary care safety net provider settings across the country. We work directly with more than a hundred behavioral health sites implementing integrated care, and share what they learn with providers nationwide.