Figure 1. Family tree of terms in use in the field of collaborative care
The definitions are:
Mental Health Care
"Broad array of services & treatments to help people with mental illnesses & those at particular risk of developing them—to suffer less emotional pain and disability and live healthier, longer, more productive lives. A variety of caregivers in diverse, independent, loosely coordinated facilities & services—public and private—often referred to collectively as the de facto MH service system (Regier et al., 1978; Regier et al., 1993).
Specialty MH sector: MH professionals trained specifically to treat people with mental disorders in public or private practices, psychiatric units, general hospitals or tx centers.
General medical/PC sector: Health care professionals such as physicians and NPs in clinics, hospitals, nursing homes.
Human services sector: Social services, school-based counseling, residential rehab, vocational rehab, criminal justice/prison-based services, religious professional counselors.
Voluntary support network sector: Self-help groups such as 12-step programs, peer counselors"
Chemical Dependency/SA Care
Services, treatments, and supports to help people with addictions and substance abuse problems suffer less emotional pain, family and vocational disturbance, physical risks, and live healthier, longer, more productive lives.
Provided by (1) specialty addictions or substance abuse clinicians or counselors in SA tx clinics or settings, (2) clinicians or counselors in general medical or hospital settings, and (3) human services contexts such as schools, rehabilitation centers, criminal justice system or religious-based counseling and (4) the voluntary support networks such as 12-step programs and peer counselors.
(Adapted from SAMHSA def. for MH Care)
Behavioral Health Care
Care that addresses a client's behavioral issues bearing on health (not only mental illnesses) via clinicians such as psychiatrists, psychologists, social workers, psychiatric nurse practitioners, marriage & family counselors, professional clinical counselors, licensed drug/alcohol abuse counselors & other MH professionals. (McGraw-Hill Concise Dictionary of Modern Medicine, 2002)
BH and PC providers (i.e., physicians, NPs) delivering care in same practice; describes where services are provided rather than being a specific service. However, co-location employs a referral process, which may begin as medical cases are transferred to BH. (Blount 2003)
Predominately Canadian usage—PC & MH professionals (typically psychiatrists) working together in a shared system, maintaining 1 treatment plan addressing all patient health needs in a shared med record. (e.g., Craven & Bland, 2006)
Activities of psychiatry, psychology, or nursing that specialize in the interface between medicine & MH, usually in a hospital or medical setting. Role is to see patients in medical settings by request of medical clinicians as a "consult." (Adapted from Wikipedia)
BH providers and PCPs practice separately within their respective systems. Info regarding mutual patients exchanged as needed, and collaboration is limited outside of the initial referral. (Blount 2003)
An overarching term describing ongoing relationships between clinicians (e.g., BH and PC) over time (Doherty, McDaniel, & Baird, 1996). Not a fixed model, but a larger construct consisting of various components which when combined create models of collaborative care. (Craven & Bland, 2006; Peek, 2007).
Primary Care Behavioral Health
"...Recent term for new relationships emerging between specialty MH services and PC. Primary behavioral health care refers to at least three related activities: (1) behavioral health care delivered by PC clinicians, (2) specialty behavioral health care delivered in the PC setting, and (3) innovative programs that integrate elements of PC and specialty behavioral health care into new formats..."
(Sabin JE & Borus JF; 2009. Changing Roles in Primary Behavioral Healthcare, Chap in "Textbook of administrative psychiatry: New concepts for a changing behavioral health system"; JA Talbott & RE Hales, Eds)
Integrated Primary Care
Combines medical & BH services for the spectrum of problems that patients bring to primary medical care. Because most patients in PC have a physical ailment affected by stress, problems maintaining healthy lifestyles, or a psychological disorder, it is clinically effective & cost-effective to make BH providers part of PC. Patients can feel that for any problem they bring, they have come to the right place. Teamwork of MH & medical providers is an embodiment of the biopsychosocial model. (Blount; www.integratedprimarycare.com)
Tightly integrated on-site teamwork with unified care plan. Often connotes organizational integration as well, perhaps involving social & other services (Blount, 2003; Blount et al. 2007).
"Altitudes" of integration (SAMHSA):
Integrated treatment: Interactions between clinicians to address pt needs combining interventions for MH disorders in a primary treatment relationship or service setting.
Integrated program: An organizational structure that ensures staff & linkages with other programs to address all patient needs.
Integrated system: Organizational structure that supports array of programs for individuals with different needs through funding, credentialing, licensing, data collection/reporting, needs assessment, planning, and other operational functions.
Specific type of service, often disease specific (e.g., depression, congestive heart failure) whereby a BH clinician, usually a nurse or other non-physician, provides assessment, intervention, care facilitation, and followup (e.g., Belnap et al., 2006).
Patient-Centered Medical Home
"An approach to providing comprehensive PC for children, youth, and adults—a health care setting that facilitates partnerships between individual patients and their personal physicians, and when appropriate, the patient's family." (Joint Principles of PCMH, 2007)
Family-Centered Medical Home
Family-centered version of "medical home"; emphasize parents and families who play a large role in child health and mental health and who are also "the client" in child/pediatric settings.
"Care that is respectful of and responsive to individual patient preferences, needs, and guides all clinical decisions." (Institute of Medicine, 2001)
* A special case or subset of a much larger concept in use across the larger field of healthcare.
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