KEY ACTIVITY #12A:
Foster Collaborative Teamwork with a Focus on Power Sharing Among Disciplines
This key activity involves the following elements of person-centered population-based care: behavioral health integration.
Overview
A commitment to integrated behavioral health includes a biopsychosocial orientation to patient care. Moving away from the biomedical model of care necessitates new ways of working that equally value psychological health and wellness. Staffing and care team structures should reflect this orientation to whole-person care with power sharing between professions. Optimizing participation of all care team members through effective power sharing provides the basis of truly integrated care.
Integrated behavioral health provides crucial behavioral health support in the primary care setting, effectively multiplying access to behavioral healthcare. Barriers to achieving integrated behavioral health include: competing health needs of historically marginalized populations (e.g., mental health is a secondary concern when treating children with HIV); severe shortages of licensed BH providers, especially a lack of congruent therapists for patients of color and non-English-speaking patients; comorbidities; factors related to medical culture (e.g., transactional vs. relational care); and organizational issues (e.g., frequent staff turnover). This activity cannot address those factors external to the health center but offers practical steps to mitigate organizational barriers to integration.
Behavioral health integration is fundamentally about intentionally building and supporting an integrated care team whose collective experiences represent a greater diversity of knowledge and expertise to support patient care.
The use of tools, such as messaging platforms, support team communication and warm handoffs, and thus collaboration. Pre-visit planning provides an opportunity to strategize across the care team to engage patients with behavioral health needs. Organizational vetting of clinical guidelines and protocols support a unified approach to patient care.
Understanding the prevalence of behavioral health conditions assists in program and resource development to track the impact on health outcomes.
Action steps and roles
1. Center integration methods that foster power sharing among the integrated care team.
This may look like:
- A behavioral health lead representative on the senior leadership team, ultimately leading to a position that has parity with the CMO.
- BH and medical clinicians regularly and actively exchange information about patient care through one-on-one conversations, curbside consults, etc.
- Training activities held annually, semi-annually or more frequently include BH and medical clinicians together.
- Regular multidisciplinary team huddles.
For additional recommendations regarding strategies for promoting a culture of IBH and operational integration, see Key Activity 2: Enhance the culture of Integrated Behavioral Healthcare and Key Activity 3: Enhance Operational Integration of Behavioral Health.
2. Design for workspace arrangement and infrastructure.
- For BH and medical clinician's physical workspace, consider opportunities for the BH staff to be embedded in or proximate to healthcare teams, allowing for greater frequency of warm handoffs, curbside consultations, etc. See Figure 2 in this article for a visual representation.
- Ensure BH staff and clinicians have treatment rooms consistent with evidence-based care guidelines.
- If care team members are working in a hybrid model, plan and develop a culture that additionally makes time for teaming across virtual and on-site staff.
- Document shared treatment plans in a single medical record.
Implementation tips
- Consider identifying shared goals among the care team (e.g., standing up a medication-assisted treatment (MAT) program) with the integrated team as a facilitator of the shared goal.
- Look for continual opportunities to champion and spread the story of the value of IBH. Consider patient stories as well as staff reflections on how their experiences working in an integrated team have enriched and supported their professional lives.
Resources
Evidence base for this activity
Grazier KL, Smith JE, Song J, Smiley ML. Integration of Depression and Primary Care. Journal of Primary Care & Community Health. 2013 Jun 3;5(1):67–73.
Mullin DJ, Hargreaves L, Auxier A, Brennhofer SA, Hitt JR, Kessler RS, et al. Measuring the integration of primary care and behavioral health services. Health Services Research. 2019 Feb 6.