Integrated Care

Health reform represents great potential for changes in the delivery of health care. Integrated care as one component is a developing theme embracing increasing segments of mental health care/general health. It can improve treatment of patients with various mixtures of mental health/substance abuse and non-behavioral health care. There is considerable evidence pointing to improved outcomes due to integrated care. Its value is being increasingly accepted and implemented in care systems around the country. Dr. Raney has done a superb job dealing with the array of issues ranging from mechanisms of delivery to education and development of an adequate workforce to questions of liability. For all interested in the broad sweep of mental health care and its evolution in conjunction with health reform, this superb text brings comprehensive information and helps signal a dramatic movement in the history of mental health care. Herbert Pardes, M.D., Executive Vice Chairman of the Board of Trustees, New York-Presbyterian Dr. Raney has assembled the best available talent from a wide array of disciplines to build the definitive text of integrated behavioral health, with particular relevance to the roles and contributions of psychiatrists. From the first page to the last it is clear that her level of expertise and experience informs a practical yet thoroughly scientific treatment of this ever-evolving model of practice. The liberal use of graphics and case examples brings to life the unique skills and capabilities necessary for optimal implementation of integrated behavioral health care in the primary care setting. This text is a remarkable achievement that will become the standard referral resource for clinicians in new and established integrated behavioral health programs. James R. Rundell, M.D., Department of Psychiatry, Veterans Administration Medical Center, Minneapolis, MN Integrated Care is a well-edited, authoritative resource for clinicians working at the interface of primary care and behavioral health. Lori Raney, an acknowledged expert in integrated care, has edited chapters from an outstanding array of the leading voices in the field, who present the evidence for integrated care and provide guidance for psychiatric practice in general medical settings. The book is an essential tool for psychiatrists who wish to expand their practice opportunities in the future. Howard H. Goldman, M.D., PhD, Professor of Psychiatry, U Maryland School of Medicine, Baltimore, MD Integrated care is no longer a research subject, waiting for data to support its use. In this book, written by an all-star group of authors, Dr. Raney has assembled a guide to operationalizing a new way for psychiatrists to function in both primary and behavioral health care settings. The Affordable Care Act has the potential to provide care to many people who now have no such access. That goal will require we learn how to integrate care and collaborate with our colleagues in a variety of settings. This book is required reading for those who will participate in 21st century psychiatry. Philip R. Muskin, M.D., Professor of Psychiatry at CUMC, Chief of Service: Consultation-Liaison Psychiatry, New York-Presbyterian Hospital/Columbia Univ. Medical Center Bravo! Raney and her coauthors have written a brilliant book about psychiatrists practicing collaboratively with primary care clinicians to bring integrated, whole person care to the people of this nation. Here psychiatrists can find the best thinking and evidence about why this is important, what this kind of care looks like in practice, how to do it, and how to train for it. This is a beautiful and important piece of work that I will be recommending to my primary care and psychiatrist colleagues alike. Frank Verloin deGruy III, M.D., MSFM, Woodward-Chisholm Professor and Chair, Department of Family Medicine, University of Colorado School of Medicine As a psychiatrist who has spent most of his career training public psychiatrists, I found the chapter on Training Psychiatrists for Integrated Care particularly informative. The authors emphasize that psychiatrists working in integrated career need to focus on indirect care with much of the communication occurring via telephone, tele-video or electronic forms such as e-mail, text and electronic medical records. The approach utilizes population-based care and measurement-based treatment with regular use of screening instruments: depending on electronic data bases to track key clinical and quality of care outcomes of a specific population of patients to determine which patients need "step up" care; 'ruling-out' high risk conditions and trusting the team to initiate a preliminary treatment plan even in the absence of a 'perfect' diagnosis; delivering brief behavioral interventions that have been proven effective in primary care settings, such as motivational interviewing, behavioral activation, problem solving therapy, and health behavior change intervention such as smoking cessation. Jules M. Ranz, M.D., Clinical Professor of Psychiatry, Director, Public Psychiatry Fellowship, NYS Psychiatric Institute/Columbia, University Medical Center Lori Raney has produced an outstanding guide to providing comprehensive medical and psychiatric care in primary care and in community psychiatric settings. As experienced clinicians, she and her collaborators have produced a text that will prove helpful to practitioners and trainees alike. Paul Summergrad, M.D., Dr. Frances S. Arkin Professor and Chairman, Department of Psychiatry, Professor of Medicine, Tufts University School of Medicine; Psychiatrist-in-Chief, Tufts Medical Center Dr. Lori Raney's, Integrated Care: Working at the Interface of Primary Care and Behavioral Health is an invaluable and catalytic tool for psychiatric physicians, primary care colleagues and the collaborative primary care/behavioral health team to seize the opportunities stimulated by the Affordable Care Act and the evolving new models of populations' health and team based care. It is well grounded on Dr. Raney's, hands on clinical experience with primary care/behavioral health collaboration in the state of Colorado and it offers a clear, concise and pragmatic path for its adoption and implementation in other settings. I highly recommend it to all interested in better navigating and engaging in the evolving American health system. Eliot Sorel, M.D., Clinical Professor of Global Health & Psychiatry, The George Washington University, APA Board of Trustees Work Group on Health Reform, APA Council on Health Systems & Financing This book is much needed. It introduces a crucial member of the team, the consulting psychiatrist, to the collaborative care process in integrated primary care. It does a first rate job of introducing psychiatrists to both the routines of practice and to the spirit of multi-disciplinary team work on which the success of primary care behavioral health integration depends. -- Alexander Blount, EdD, Director, Center for Integrated Primary Care, Professor of Family Medicine and Psychiatry, University of Massachusetts Medical School, Director of Behavioral Science, Department of Family Medicine and Community Health Alexander Blount, EdD, Director, Center for Integrated Primary Care, Professor of Family Medicine and Psychiatry, University of Massachusetts Medical School Lori Raney's edited volume is the answer to the question we are all asking -- how do we effectively integrate psychiatric practice with primary care? The experts in this book describe a critical new role for psychiatrists, show us the data, describe the core principles, and detail the new attitudes, skills and behaviors needed to collaborate effectively with primary care providers. This will be an essential resource for the next generation of residents and other psychiatrists ready to step into the future. -- Richard F. Summers, M.D., Clinical Professor of Psychiatry, Co-Director of Residency Training, Perelman School of Medicine of the University of Pennsylvania, Past-President, American Association of Directors of Psychiatry Residency Training, Chair, Council on Medical Education and Lifelong Learning, American Psychiatric Association Richard F. Summers, M.D., Clinical Professor of Psychiatry, Co-Director of Residency Training, Perelman School of Medicine University of Pennsylvania, Past-President, AADPRT This valuable and well-written book provides a comprehensive overview of integrated care, including both integration of behavioral health into primary care and of medical care into settings serving the chronically and seriously mentally ill. Chapters address overall "big picture" public health and policy issues, the unmet health care needs met by integrated care, the practical nuts and bolts of working as a psychiatrist in integrated care settings, important legal and liability issues, key issues for workforce development, and ways in which educational experiences in integrated care address ACGME competencies and Psychiatry milestones. This volume, with its clear and easy-to-read description of the background and rationale for integrated care, as well as its specific case examples, guidelines, tables, and resources will be very helpful to any clinician, educator, or health care administrator interested in establishing, working in, or educating young psychiatrists for this novel type of practice. Deborah S. Cowley, M.D., Professor and Vice Chair for Education Director, Psychiatry Residency, Program Department of Psychiatry and Behavioral Sciences Integrated Care: Working at the Interface of Primary Care and Behavioral Health is an excellent and timely book. Its depiction of team based care, roles for Behavioral Health Professionals, Primary Care Physicians and Psychiatrists and changes necessary for training and practice is comprehensive and impressive. The book contains an outstanding chapter on integration in Pediatrics and child mental health. If you believe that integrated care is best for our patients and our practice as I do, this book will help you transform your care of your patients. John Sargent, M.D., Director, Division of Child and Adolescent Psychiatry, Tufts Medical School, Professor of Psychiatry and Pediatrics, Tufts University School of Medicine. Teamwork is essential for us to treat patients as whole people, with heart and mind, body and soul, all connected. This book provides a strong evidence-base for the bidirectional integration of primary care and behavioral health in a collaborative care model, with practical strategies for implementing these models and for training a new generation of professionals to practice psychiatry as a team sport in the 21st century. George Rust, M.D., MPH, FAAFP, FACPM, Professor of Family Medicine, Co-Director, National Center for Primary Care, Morehouse School of Medicine Dr. Raney and her colleagues have been able to distill technique and evidential knowledge into a highly practical, eminently readable, as well as clearly groundbreaking book that assists clinicians and administrators as they move into psychiatry's future. It will be read, read again, and then again, as an essential guide to plan, implement, and practice in collaborative care settings. Primary care providers will also find Integrated Care very helpful as they themselves orient their own work in new collaborative contexts. Hunter L. McQuistion, M.D., Clinical Associate Professor of Psychiatry, New York University School of Medicine, Immediate Past President, American Association of Community Psychiatrists In the rapidly changing world of health care this book provides a road map in a critical area of need, the role of the psychiatrists and other prescribers in these integrated systems of care. Dr. Raney and her colleagues represent the leaders in this transforming part of medicine and this book is must reading for anyone leading these emerging systems of care. It covers the full continuum of integration and is an essential guide for practice and also potential research directions. Joan Kenerson King, APRN, BC, Senior Integration Consultant, The National Council for Behavioral Health Integrated Care: Working at the Interface of Primary Care and Behavioral Health is sure to be a bedrock resource in what is one of the most rapidly growing and integral aspects of healthcare today. It is clear that our current 'dis-integrated' healthcare system is broken, driving us bankrupt, and leaves millions to suffer with untreated mental illness. There is no viable path forward without integration. Regardless of where you live in the healthcare ecosystem. Dr. Raney leverages her proven track record of 'on the ground' system transformation and calls on her friends - who also happen to be the best of the best - to assemble a map that points the way forward and shows us all how to catch up. This book is a must-have for leaders, administrators and clinicians alike. John Santopietro, M.D., FAPA, Chief Clinical Officer With the advent of health care reform, collaborative care is fast becoming an extremely important mental health service delivery model. Psychiatrists must have a seat at the table in developing and implementing integrated care models across a variety of health care settings. Integrated Care: Working at the Interface of Primary Care and Behavioral Health is prerequisite reading for any psychiatrist hoping to make a significant contribution to the discussion and practice of integrated care. Ruth Shim, M.D., M.P.H., Associate Professor, Department of Psychiatry and Behavioral Sciences Associate Director of Behavioral Health, National Center for Primary Care Morehouse School of Medicine

This text thoroughly reviews the evidence base and core principles that support integrated care models. The book includes full coverage of key concepts such as population-based care, measurement-based care, and stepped care and emphasizes how health reform initiatives are stimulating rapid dissemination of these models.