Services and Tools for Integration

Services Delivered in Behavioral Health Integration

A range of services can be offered by integration or coordinating behavioral health into the PCMH. From addressing the psychosocial determinants of health to severe mental illness, having a behavioral health professional within the PCMH team leads to new opportunities to provide comprehensive care. The following are resources that can help make this integration possible.

Implementation of Behavioral Health Integration - Tools and Considerations

The Behavioral Health Integration website is designed to give you the latest information about behavioral health integration and to let you dialogue with your peers about important questions and issues in this area. You can download and upload recent theory or research articles, and you can download tools that will help you design and implement a successful behavioral health integration program. (Membership to this website is required in order to access these free resources.)

The MacArthur Foundation Initiative on Depression and Primary Care has created a Depression Tool Kit, which is intended to help primary care clinicians recognize and manage depression. The Tool Kit includes easy to use instruments and information sources to assist with:

  • Recognizing and diagnosing depression;
  • Educating patients about depression, assessing treatment preferences, engaging their participation and explaining the process of care;
  • Using evidence-based guidelines and management tools for treating depression; and
  • Monitoring patient response to treatment.

DIAMOND Depression Care Toolkit offers primary care physicians (PCP’s) with the resources and support they need to provide patients with adequate mental health care including, access to psychiatrists who can review/consult on patient cases, a care team, detailed medical guide, checklists and tools.

Plan and Implement Integrated Care Programs

The Advancing Integrated Mental Health Solutions (AIMS) Center and IMPACT Implementation Center offer tools designed to help health care organizations plan and implement successful integrated care programs, such as the IMPACT program. Tools offered include implementation planning and team building worksheets, patient education materials, and treatment manuals.

Depression Care Improvement Study (APA, AAFP, ACP): Making use of the PHQ-9: Measurement-based Depression Treatment: The APA, AAFP, and ACP agreed on using the nine-question Patient Health Questionnaire (PHQ-9) for this project. The PHQ-9 covers nine criteria for depression, consistent with the DSM-IV. It assesses symptoms and allows the physician to track each component using a metric for determining if the patient is responding to treatment being treated to remission. The tool assesses the patient's suicide risk/ideation, which may help address physician concerns about potential liability regarding the recently highlighted issue of antidepressant use and suicide risk. The PHQ-9 is being combined with other interventions that assist primary care physicians in treating depression, including regular monitoring, medication management, and psychiatric consultation.

The following is additional information on the topic of PHQ-9: 

Partners in Health: Primary Care/County Mental Health Tool Kit - Designed to help primary care clinics and government mental health agencies forge collaborative relationships. Though the focus is on California counties, much of the IBHP Collaborative Tool Kit information can be generalized to other locales. Included are sample formal agreements and contracts reached between primary care agencies and county mental health agencies, advice from those who have established these working relationships, checklists for MOU and contract content, issues to consider when brokering agreements, mutual role descriptions, and much more.

American Psychiatric Association (APA) Practice Guidelines provide evidence-based recommendations for the assessment and treatment of psychiatric disorders.

The Hogg Foundation promotes improved mental health for the people of Texas through the support of effective mental health services, research, policies, and education, and works in partnership with communities, service providers, advocates, policy-makers, researchers and educators.

Cognitive Behavioral Therapy

How can behavioral health be integrated into the medical home team?

  • Policy Maker's Booklet (p.15) provides some valuable quotes on the primary care experience for individuals with mental illness.
  • “Brief introduction to Integrating Behavioral Health into Primary Care”, Dr. Alexander Blount presentation to PCPCC's Center to Promote Public Payer Implementation on May 5, 2009 (Presentation and other materials)