Integrating Behavioral Healthcare and Primary Care, Appropriate Balance on What Model is Driving Care, and, the Whole Sp
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Integrating Behavioral Healthcare and Primary Care, Appropriate Balance on What Model is Driving Care, and, the Whole Spectrum of Individuals are Coming Through the Door… Michael R. Bütz1 · W. Douglas Tynan2
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract With the integration of behavioral health services into primary care and other medical specialties, the community of providers and the public must address a number of questions, including: What models of care are there for these services? What kinds of providers supply these services? Are these providers trained behavioral health providers or extenders in some form? And, as these systems of care are constructed, who makes use of them? The purpose of this study is to address these questions as well as to consider some of the challenges of attending to the spectrum of needs that will arise as integrated healthcare services expand. Consideration of these questions may serve to clarify the impact that these models of healthcare will have in ways that may be readily apparent and, at the same time, in ways that may be subtler and less comprehensible. Addressing these questions is also intended to facilitate discussions within healthcare systems and among providers concerning which models of care best respond to specific populations. In turn, proactively answering these questions will, for the foreseeable future, shape not only behavioral healthcare, in perhaps small or large ways, but also healthcare in general. Keywords Integrated behavioral health · Vertical integration · Horizontal integration · Physician extender · Spectrum of disorders
Introduction: What is the Model of Care, Are There Concerns About Extenders, and, Consequently, Who Continues to Come Through the Clinic’s Doors? With the integration of behavioral health services into primary care and other medical specialties, the community of providers and healthcare organizations must address a number of naturally arising questions. First of all, what are the models of care for these services? There are several that will be discussed below that represent a continuum of efficacy
* Michael R. Bütz [email protected] W. Douglas Tynan [email protected] 1
Aspen Practice, P.C., and St. Vincent Healthcare, 2900 12th Avenue North, Suite 280 W, Billings, MT 59101, USA
Office of Integrated Health Care, American Psychological Association Center for Psychology and Health, Washington, DC, USA
2
and models. Second, what kinds of providers are supplying these services, and are these providers trained behavioral health providers or extenders of some type? As described in 1976 by Glenn and Goldman as well as others at these earlier times (Morris & Smith, 1977; Schneider & Foley, 1977), descriptions of physician extenders have been in the literature for over 40 years and included the following providers (p. 64). Over the past ten years, two principal types of physician extenders have been developed. The first type would include physician assistants, exemplified by the Duke Universi
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