1. Behavioral Health Integration
Behavioral Health Integration 1
Presented by Terry L. Dunlop, D. BH

2. What is behavioral health integration?
 It is a systematic coordination of integrating mental health,
substance abuse, and primary care services through a team
approach, utilizing evidence based practices.
 Research has proven this integration to be the most effective
approach towards achieving a greater efficacy for people
with multiple healthcare needs.
(SAMHSA-HRSA, 2012)
Behavioral Health Integration
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Presented by Terry L. Dunlop, D. BH

3. For doctors and other health care professionals, integrated care will
provide resources to monitor all health conditions a person may have and
to coordinate treatments so they don’t interfere with each other.
SAMHSA-HRSA Center for Integrated Health. (2012).
A research survey was conducted by Spectrum Health, Inc. in Bellevue,
WA with the Seattle area primary care physicians. The results were:
 71% of office visits were for follow-up to chronic conditions.
 Over 70% stated the preferred mode of treating chronic pain would
include lifestyle management.
 Over 70% stated the preferred mode of treatment for asthma would
include lifestyle management.
(American Medical Association, 1999, Mauer, 2003)
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How will integrating behavioral health benefit
patients, physicians, & the medical community?
Presented by Terry L. Dunlop, D. BH

4. How will integrating behavioral health benefit
patients, physicians, & the medical community?
Cont.
 Almost 90% stated preferred mode for treating diabetes would include
lifestyle management.
 Well over 80% stated the preferred mode for treating hypertension would
include lifestyle management.
 Less than 30% of the time in all follow-up visits were patients suffering
these disorders seen by anyone other than a physician.
 People with chronic conditions as well as many of those with behavioral
problems often need to make lifestyle changes that a structured
psychoeducational program can facilitate. (Mauer, 2003)
 One provider can bill and treat multiple patients at the same time.
(Dyer, Levy, & Dyer, 2005, pp. 71-86)
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Presented by Terry L. Dunlop, D. BH

5. The Benefits of Integrated Behavioral Health
1. Integrating Behavioral Health Care providers into existing
medical facilities provides a “1 stop shop” for medical/mental
health services for patients.
2. Integrated health care benefits patients, caregivers, and providers
by augmenting services, improve quality of care, and lower
overall health care expenditures.
3. Integrated behavioral health care is less costly. (Typical savings
range between 20 and 40%, called the “medical cost offset.”)
4. Patients with behavioral problems or mood disorders such as
sleep disorders, depression, or anxiety can benefit from short
behavioral interventions from the BCP.
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(Dyer, Levy, & Dyer, 2005, pp. 71-86)
(Tovian, 2009; Hunter, Goodie, Oordt, & Dobmeyer, 2009)
Presented by Terry L. Dunlop, D. BH

6. How behavioral health interventions assist in
the management of disease.
 30 years of research suggests medical non-compliance rates with
prescriptions exceed 50% across many diverse syndromes for diet
and activity prescriptions.
 60% non-compliance with antidepressant medication within six
months of initial prescription.
 Patients with chronic conditions are difficult to present a lifestyle
change in the typical 12-minute primary care physician (PCP)-
patient interaction. A BCP will work with patients creating
treatment goals that include lifestyle changes, such as in diet,
smoking cessation, medication compliance, diabetes monitoring
and implementing exercise regimens attending sessions with BCP.
(Dyer, Levy, & Dyer, 2005, pp. 71-86)
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(Katon, et.al., 1992).
Presented by Terry L. Dunlop, D. BH

7. How behavioral health interventions assist in
the management of substance abuse.
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 Group treatment has been found to be superior to individual
treatment for substance abuse, when treatment lasted for ten or
fewer total sessions
(McRoberts, Burlingame, & Hoag, 1998).
 This will improve patient care and outcomes, and also ease the
burden for the PCP. (Dyer, Levy, & Dyer, 2005, pp. 71-86)
 Integrated treatment produces better outcomes for individuals
with co-occurring mental and substance use disorders. By
providing the clinical services , the PCP and BCP will be able to
meet the individual's substance abuse, mental health, and other
needs. (SAMSHA, 2012)
Presented by Terry L. Dunlop, D. BH

8. How behavioral health interventions assist in
the management of mental health disorders.
 Individuals with serious mental illness have a 25 year shorter
lifespan with the primary cause of death being cardiovascular
disease.
 Integrated health care for mental health disorders will augment
services by improving the quality of care at one location, monitor
medications regularly and again lower overall health care
expenditures.
 This will improve patient care and outcomes, and also ease the
burden for the PCP.
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National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006).
Presented by Terry L. Dunlop, D. BH

9. How to integrate behavioral health into an
existing clinic or hospital setting.
1. One way to better serve these patients is to integrate a behavioral
health practitioner down the hall from the PCP; into the primary
care practice.
2. Offer psychoeducation for groups. (Literature supports improved
clinical outcomes from group health encounters and group
encounters are billed with same E&M codes as individual
encounters.)
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Presented by Terry L. Dunlop, D. BH

10. Behavioral Health Integration Final Comments
 Marc Braman, American College of Lifestyle Medicine (ACLM) Past
President notes: “With this new kind of professional that is so skilled
with the heart of Lifestyle Medicine entering the healthcare arena, it will
be exciting to see how they become an important part of Lifestyle
Medicine specialty practice.”
 The Air Force has had a large integration project under way for several
years that follows a behavioral health consultant model (referral) using
clinical psychologists and social workers (Oordt, 2004).
 The SAMHSA Prime-E Study (Primary Care Research in Substance Abuse
and Mental Health for the Elderly) Preliminary results:
1. Increased engagement by 72% in the collocated services vs. 48% for
specialty care.
2. Alcohol related abuse, 72% vs. 29%, respectively
(Quijano, 2004).
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Presented by Terry L. Dunlop, D. BH

11. References
American Medical Association. (1999). Social and demographic characteristics of Physicians
in America. Washington, D.C.: AMA.
Cummings, N., Cummings, J, & Johnson, J. (1997). Behavioral health in primary care: A
guide to clinical integration. Madison, CN: Psychosocial Press.
Dyer, J. R., Levy, R., & Dyer, R. L. (2005). An integrated model for changing patient
behavior in primary care. In N. Cummings, W. O'Donahue, & E. Naylor (Eds.),
Psychological approaches to chronic disease management (pp. 71-86). Reno, NV: Context
Press.
Hunter, C.L., Goodie, J.L., Oordt, M.S., & Dobmeyer, A.C. (2009). Integrated behavioral
health in primary care. Washington, D.C.: American Psychological Association.
Katon, W. (2001). A randomized trial of relapse prevention of depression in primary
care. General Psychiatry, 58, 241-247.
Katon, W. (1999). Stepped collaborative care for primary care patients with persistent
symptoms of depression. General Psychiatry, 56, 1109-1115.
Mauer, B. J. (2003). Behavioral health/primary care integration models, competencies,
and infrastructure [Special issue]. National Council for Community Behavioral
Healthcare.
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Presented by Terry L. Dunlop, D. BH

12. References
McRoberts, C., Burlingame, G. M., & Hoag, M. (1998). Comparative efficacy of
individual and group psychotherapy: A meta-analytic perspective. Group
Dynamics: Theory, Research, and Practice, 2, 101-117.
Oordt, M.S. (2004). Behavioral health optimization: An update on integrated primary
care in the Air Force medical system. Society of Behavioral Medicine, Baltimore.
O'Donohue, W.T., Cummings, N.A., Cucciare, M.A., Runyan, C.N., & Cummings, J.L.
(2006). Integrated behavioral health care: A guide to effective intervention. Amhurst,
N.Y.: Humanity Books.
Quijano, L.M. (2004). Preliminary results: PRIME-E study. National Council for
Community Behavioral Healthcare, New Orleans.
SAMHSA-HRSA Center for Integrated Health. (2012). What is integrated care. Retrieved
from http://www.integration.samhsa.gov/about-us/what-is-integrated-care.
SAMSHA. (2012). Integrating mental health and substance abuse treatment. Retrieved from
http://www.samhsa.gov/co-occurring/topics/healthcare-integration/index.aspx
Tovian, S. M. (2009). Five questions for Steven Tovian PhD. American Psychological
Association. Retrieved January 16, 2013 from
http://www.newswise.com/articles/five-questions-for-steven-tovian-phd.
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Presented by Terry L. Dunlop, D. BH