Integrated Care

Creating Effective Mental and Primary Health Care Teams provides the practical information, skills, and clinical approaches needed to implement an integrated collaborative care program and support the members of the care team as they learn this new, evidence-based, legislatively mandated care delivery system. Unique in presenting information specifically designed to be used in an integrated, collaborative care workflow, this book provides specific guidance for each member of the team. Care managers, consulting psychiatrists, primary care providers, and administrators alike can finally get on the same page in regard to patient care by referring to the same resource and employing a common framework. Written by recognized experts with broad research, clinical, implementation, and training experience, this book provides a complete solution to the problem of fragmented care.

Escalating costs and federal legislation expanding access to healthcare are forcing the industry to transition to a new model of health care delivery. This book provides guidance on navigating the changes as a team to provide the best possible patient care.

• Integrate physical and behavioral care
• Use evidence-based treatments for both
• Exploit leading-edge technology for patient management
• Support each member of the collaborative care team

Strong evidence has demonstrated the efficacy of a collaborative care approach for delivering mental health care to patients in a primary care setting. The field is rapidly growing, but few resources are available and working models are limited. This book provides a roadmap for transitioning from traditional methods of health care to the new integrated model. Providers ready to move to the next level of care will find Creating Effective Mental and Primary Health Care Teams an invaluable resource.

Preface ix

Acknowledgments xv

Chapter 1 Working as a Team to Provide Collaborative Care 1
Anna Ratzliff, Joseph Cerimele, Wayne Katon, and Jürgen Unützer

Part 1 Collaborative Care for Common Primary Care Presentations

Chapter 2 Mood Disorders—Major Depression 27
Amy Bauer and Patricia Areán

Chapter 3 Bipolar Disorder 55
Joseph Cerimele, Lydia Chwastiak, and Evette Ludman

Chapter 4 Anxiety and Trauma Disorders 78
David A. Harrison, Kari A. Stephens, Anna Ratzliff, and Jennifer Sexton

Chapter 5 Psychotic Disorders 101
Carolyn Brenner

Chapter 6 Substance Use Disorders: Alcohol Stimulants and Opioids 124
Susan E. Collins, Mark H. Duncan, Andrew J. Saxon, Joseph O. Merrill, and Richard K. Ries

Chapter 7 Chronic Pain 153
Catherine Q. Howe and Kari A. Stephens

Chapter 8 Attention Deficit Hyperactivity Disorder (ADHD) 181
Jennifer Sexton, Ryan Kimmel, William French, David A. Harrison, and Kim Kensington

Part 2 Collaborative Care Interventions

Chapter 9 Challenging Clinical Situations 207
Kyl Dinsio, Anna Ratzliff, and Kari A. Stephens

Chapter 10 Evidence-Based Behavioral Interventions for the Collaborative Care Team 226
Kari A. Stephens and Stacy Shaw Welch

Chapter 11 Evidence-Based Psychopharmacology for the Collaborative Care Team 238
David A. Harrison and Anna Ratzliff

Appendix: Resources 292

About the Authors and Contributors 295

Index 299

ANNA RATZLIFF, MD, PHD, is Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington.

JÜRGEN UNÜTZER, MD, MA, MPH, is Professor and Chair in the Department of Psychiatry and Behavioral Sciences at the University of Washington.

WAYNE KATON, MD, was Professor, Director of the Division of Health Services and Epidemiology, and Vice Chair in the Department of Psychiatry and Behavioral Sciences at the University of Washington.

KARI A. STEPHENS, PHD, is a clinical psychologist and Assistant Professor in Psychiatry and Behavioral Sciences at the University of Washington.

A New, Effective Model for Integrated Care Delivery!

Creating Effective Mental and Primary Health Care Teams is an essential resource written for every member of a Collaborative Care team—social workers, nurses, psychologists, licensed counselors, psychiatrists, primary care providers, and administrators. The authors are recognized experts in the field and show how to access the information, develop the skills, and apply the clinical approaches needed to implement an effective collaborative approach.

Filled with illustrative examples, this comprehensive text is designed to make it easy for a clinical team to combine their efforts to better assess and treat patients. The authors highlight and explore in-depth the five principles of Collaborative Care:

• Patient Centered Team Care:
Collaborate effectively as a team using shared care plans that incorporate patient goals.
• Population-Based Care:
Share a defined group of patients tracked in a registry to make sure that no one falls through the cracks.
• Measurement-Based Treatment to Target:
Track clinical outcomes and actively adjust treatments until goals are achieved.
• Evidence-Based Care:
Use biopsychosocial treatments that are evidence-based.
• Accountable Care:
Become accountable for improved outcomes at the individual patient and population level.

Providers ready to move to the next level of care will find Creating Effective Mental and Primary Health Care Teams an invaluable resource.