INTEGRATED BEHAVIORAL n n
HEALTH MANUAL n
EVERYTHING YOU NEED TO KNOW TO START,
n n n n n n n
GROW, OR ENHANCE BEHAVIORAL HEALTH S
n n n n n
ERVICES IN PRIMARY CARE
n n n
SecondnEdition,nSeptembern2018
EMnConsulting
Elizabethn Morrison,n LCSW,n MACnwww.emorrisonconsulting.com
, IntegratednBehavioralnHealthnManualn–nSeptembern2018
INTRODUCTION
Thisnmanualnisnintendedntonprovidensupportnfornbehavioralnhealthncliniciansnengagedninnthencomplexnworknofnpract
icingninnintegratednsettings,nasnwellnnasnoffernguidancenfornthennecessarynoperational, nleadershipnandnculturalnaspe
ctsnofnanwhole-personncarensystem.
AUTHOR
Elizabethn Morrisonn isnnan Licensedn Clinicaln Socialn Workern andn an MasternnAddictionsn Counselor.nnnShen hasn beennp
racticingninnintegratednsettingsnasnwellnasnassistingninnthendevelopmentnofnintegratednservicesninnsafetynnetnorgani
zationsninnCalifornianfornovern13nyears.n FornmorenonnElizabeth, nseenwww.emorrisonconsulting.com.
ACKNOWLEDGEMENTS
Firstnandnforemost,nInwouldnlikentonthanknEricanPalmer,nMSW,nwhonskillfullyneditednthisnentirenmanualnandncontribu
tednoriginalnwritingnandninsightsntonmanynofnthenarticles.nInwouldnalsonlikentonacknowledge nthenAlamedanHealthnCo
nsortium, nasnthenbonesnofnthisnmanualnwerenoriginallynwrittennfornthemnandnfollowednannoutlinenthoughtfullyndeve
lopednbynSaleenanGupte,nDrPH.nFinally, nInwouldnlikentonthanknNancynFacher,nLCSWnfornhernthoughtfulnreadingnandn
editsnofnthenclinicalnsections,nasnwellnasnfornallowingnmentonincludenhernwonderfulnarticlenonnclinicalnsupervisionninn
integrated nsettingsninnthisnmanual.
NOTICE
Pleasenfeelnfreentoncopynorndistributenthisn entirenmanualnornanynindividualnpartnofnit.nAttributionntonEMnConsultingni
snappreciated.
1
, IntegratednBehavioralnHealthnManualn–nSeptembern2018
TABLE OF CONTENTS n n
Introduction ...................................................................................................................................................................................... 4
BackgroundnandnPurpose ...................................................................................................................................................................................................... 4
TypicalnDifferencesnBetweennBehavioralnHealthnServicesnInnanTraditionalnSettingnvs.nanMedicalnSetting ....................................... 6
CommonnConcernsnofnBehavioralnHealthnCliniciansninnIntegratednSettings ................................................................................................... 9
IntegratednBehavioralnHealthnLeadership .................................................................................................................................................................. 11
PatientnExperience ...................................................................................................................................................................... 13
EnvironmentnofnCare ............................................................................................................................................................................................................ 13
ImprovingnPatientnExperience ......................................................................................................................................................................................... 15
Comfortn andnAccommodationnforn PatientsnWithn Mentaln Healthn Conditions:n Howntonincreasen mentalnnhealthn culturalnco
mpetencyninnthentraditionalnmedicalnsetting ............................................................................................................................................................. 16
PatientnCarenOfficesninnIntegratednBehavioralnHealthnSettings ......................................................................................................................... 18
ComputersnandnElectronicnHealthnRecordsninnthenBehavioralnHealthnVisit................................................................................................. 19
CollaborationnandnTeamwork ................................................................................................................................................. 21
ThenManynRolesnofnanClinicianninnIntegratednBehavioralnHealthnSettings .................................................................................................... 21
ThenRolenofnthenPsychiatristnandnthenBehavioralnHealthnClinician .................................................................................................................. 22
CommonnIntersectionsnofnBehavioralnHealthnandnPhysicalnHealth ................................................................................................................. 24
FornMedicalnProviders ............................................................................................................................................................... 26
WhatnDoesnanTherapistnActuallynDo? ............................................................................................................................................................................ 26
TipsnfornMedicalnProvidersnWorkingnonnanTeamnWithnBehavioralnHealthnProviders ............................................................................. 29
CommunicationnandnthenHealthcarenTeam ........................................................................................................................ 31
CommunicatingnwithnMedicalnProfessionalsnandnthenHealthcarenTeam ....................................................................................................... 31
WarmnHand-Offs,nCoolnHand-Offs,nandnStep-Ins:nPhilosophy,nProcedures,nandnRelatednCommunication .................................... 36
SamplenScriptsnfornBehavioralnHealthnCliniciansnReferringnPatientsntonPrimarynCare........................................................................... 42
CliniciannRelationshipsnwithnEmployees ..................................................................................................................................................................... 44
OperationalnIntegration ............................................................................................................................................................ 47
AnnIntroductionntonOperationalnIntegration .............................................................................................................................................................. 47
Multi-LevelnIntegrationnDepthnAssessment ............................................................................................................................................................... 50
BehavioralnHealthnStaffingnRatios ................................................................................................................................................................................... 57
RecruitmentnandnHiringnofnBehavioralnHealthnProviders .................................................................................................................................... 59
BehavioralnHealthnProvidernProductivityninnIntegratednSettings ..................................................................................................................... 63
DocumentationnandnBilling ................................................................................................................................................................................................ 66
PatientnPaperworknGuidelinesnfornBehavioralnHealthnProviders ..................................................................................................................... 71
Confidentiality ......................................................................................................................................................................................................................... 73
PrivatenMedicalnPractices ......................................................................................................................................................... 76
BehavioralnHealthnIntegrationninnPrivatenMedicalnOrganizationsnandnPractices ...................................................................................... 76
ScreeningnandnAssessment....................................................................................................................................................... 80
PrinciplesnofnScreeningnandnAssessment ..................................................................................................................................................................... 80
ScreeningnandnAssessmentnTools ................................................................................................................................................................................... 82
ClinicalnInterventions ................................................................................................................................................................. 84
EstablishingnannEffectivenTherapeuticnAlliance ........................................................................................................................................................ 84
2
, IntegratednBehavioralnHealthnManualn–nSeptembern2018
DifficultnRelationshipsnBetweennthenMedicalnTeamnandnPatients ................................................................................................................... 87
ThenBehavioralnHealthnClinician’snRoleninnChronicnDiseasenManagement .................................................................................................. 90
AddictivenDisordersnIntervention ................................................................................................................................................................................... 92
TraumanandnTraumanRelatednDisorders....................................................................................................................................................................101
CrisisnIntervention ...............................................................................................................................................................................................................105
De-Escalation .........................................................................................................................................................................................................................107
MotivationalnInterviewing ...............................................................................................................................................................................................114
CognitivenBehavioralnTherapy .......................................................................................................................................................................................117
DialecticalnBehavioralnTherapy......................................................................................................................................................................................119
SeekingnSafety ........................................................................................................................................................................................................................121
ProblemnSolvingnTherapy .................................................................................................................................................................................................123
BehavioralnActivation .........................................................................................................................................................................................................124
CliniciannSupport .......................................................................................................................................................................125
CliniciannSelfnCarenandnWell-Being ...............................................................................................................................................................................125
ClinicalnSupervision.............................................................................................................................................................................................................128
Conclusion ....................................................................................................................................................................................131
Summary ..................................................................................................................................................................................................................................131
ResourcesnfornFurthernExploration ..............................................................................................................................................................................132
Bibliography ................................................................................................................................................................................133
Appendix .......................................................................................................................................................................................134
3
HEALTH MANUAL n
EVERYTHING YOU NEED TO KNOW TO START,
n n n n n n n
GROW, OR ENHANCE BEHAVIORAL HEALTH S
n n n n n
ERVICES IN PRIMARY CARE
n n n
SecondnEdition,nSeptembern2018
EMnConsulting
Elizabethn Morrison,n LCSW,n MACnwww.emorrisonconsulting.com
, IntegratednBehavioralnHealthnManualn–nSeptembern2018
INTRODUCTION
Thisnmanualnisnintendedntonprovidensupportnfornbehavioralnhealthncliniciansnengagedninnthencomplexnworknofnpract
icingninnintegratednsettings,nasnwellnnasnoffernguidancenfornthennecessarynoperational, nleadershipnandnculturalnaspe
ctsnofnanwhole-personncarensystem.
AUTHOR
Elizabethn Morrisonn isnnan Licensedn Clinicaln Socialn Workern andn an MasternnAddictionsn Counselor.nnnShen hasn beennp
racticingninnintegratednsettingsnasnwellnasnassistingninnthendevelopmentnofnintegratednservicesninnsafetynnetnorgani
zationsninnCalifornianfornovern13nyears.n FornmorenonnElizabeth, nseenwww.emorrisonconsulting.com.
ACKNOWLEDGEMENTS
Firstnandnforemost,nInwouldnlikentonthanknEricanPalmer,nMSW,nwhonskillfullyneditednthisnentirenmanualnandncontribu
tednoriginalnwritingnandninsightsntonmanynofnthenarticles.nInwouldnalsonlikentonacknowledge nthenAlamedanHealthnCo
nsortium, nasnthenbonesnofnthisnmanualnwerenoriginallynwrittennfornthemnandnfollowednannoutlinenthoughtfullyndeve
lopednbynSaleenanGupte,nDrPH.nFinally, nInwouldnlikentonthanknNancynFacher,nLCSWnfornhernthoughtfulnreadingnandn
editsnofnthenclinicalnsections,nasnwellnasnfornallowingnmentonincludenhernwonderfulnarticlenonnclinicalnsupervisionninn
integrated nsettingsninnthisnmanual.
NOTICE
Pleasenfeelnfreentoncopynorndistributenthisn entirenmanualnornanynindividualnpartnofnit.nAttributionntonEMnConsultingni
snappreciated.
1
, IntegratednBehavioralnHealthnManualn–nSeptembern2018
TABLE OF CONTENTS n n
Introduction ...................................................................................................................................................................................... 4
BackgroundnandnPurpose ...................................................................................................................................................................................................... 4
TypicalnDifferencesnBetweennBehavioralnHealthnServicesnInnanTraditionalnSettingnvs.nanMedicalnSetting ....................................... 6
CommonnConcernsnofnBehavioralnHealthnCliniciansninnIntegratednSettings ................................................................................................... 9
IntegratednBehavioralnHealthnLeadership .................................................................................................................................................................. 11
PatientnExperience ...................................................................................................................................................................... 13
EnvironmentnofnCare ............................................................................................................................................................................................................ 13
ImprovingnPatientnExperience ......................................................................................................................................................................................... 15
Comfortn andnAccommodationnforn PatientsnWithn Mentaln Healthn Conditions:n Howntonincreasen mentalnnhealthn culturalnco
mpetencyninnthentraditionalnmedicalnsetting ............................................................................................................................................................. 16
PatientnCarenOfficesninnIntegratednBehavioralnHealthnSettings ......................................................................................................................... 18
ComputersnandnElectronicnHealthnRecordsninnthenBehavioralnHealthnVisit................................................................................................. 19
CollaborationnandnTeamwork ................................................................................................................................................. 21
ThenManynRolesnofnanClinicianninnIntegratednBehavioralnHealthnSettings .................................................................................................... 21
ThenRolenofnthenPsychiatristnandnthenBehavioralnHealthnClinician .................................................................................................................. 22
CommonnIntersectionsnofnBehavioralnHealthnandnPhysicalnHealth ................................................................................................................. 24
FornMedicalnProviders ............................................................................................................................................................... 26
WhatnDoesnanTherapistnActuallynDo? ............................................................................................................................................................................ 26
TipsnfornMedicalnProvidersnWorkingnonnanTeamnWithnBehavioralnHealthnProviders ............................................................................. 29
CommunicationnandnthenHealthcarenTeam ........................................................................................................................ 31
CommunicatingnwithnMedicalnProfessionalsnandnthenHealthcarenTeam ....................................................................................................... 31
WarmnHand-Offs,nCoolnHand-Offs,nandnStep-Ins:nPhilosophy,nProcedures,nandnRelatednCommunication .................................... 36
SamplenScriptsnfornBehavioralnHealthnCliniciansnReferringnPatientsntonPrimarynCare........................................................................... 42
CliniciannRelationshipsnwithnEmployees ..................................................................................................................................................................... 44
OperationalnIntegration ............................................................................................................................................................ 47
AnnIntroductionntonOperationalnIntegration .............................................................................................................................................................. 47
Multi-LevelnIntegrationnDepthnAssessment ............................................................................................................................................................... 50
BehavioralnHealthnStaffingnRatios ................................................................................................................................................................................... 57
RecruitmentnandnHiringnofnBehavioralnHealthnProviders .................................................................................................................................... 59
BehavioralnHealthnProvidernProductivityninnIntegratednSettings ..................................................................................................................... 63
DocumentationnandnBilling ................................................................................................................................................................................................ 66
PatientnPaperworknGuidelinesnfornBehavioralnHealthnProviders ..................................................................................................................... 71
Confidentiality ......................................................................................................................................................................................................................... 73
PrivatenMedicalnPractices ......................................................................................................................................................... 76
BehavioralnHealthnIntegrationninnPrivatenMedicalnOrganizationsnandnPractices ...................................................................................... 76
ScreeningnandnAssessment....................................................................................................................................................... 80
PrinciplesnofnScreeningnandnAssessment ..................................................................................................................................................................... 80
ScreeningnandnAssessmentnTools ................................................................................................................................................................................... 82
ClinicalnInterventions ................................................................................................................................................................. 84
EstablishingnannEffectivenTherapeuticnAlliance ........................................................................................................................................................ 84
2
, IntegratednBehavioralnHealthnManualn–nSeptembern2018
DifficultnRelationshipsnBetweennthenMedicalnTeamnandnPatients ................................................................................................................... 87
ThenBehavioralnHealthnClinician’snRoleninnChronicnDiseasenManagement .................................................................................................. 90
AddictivenDisordersnIntervention ................................................................................................................................................................................... 92
TraumanandnTraumanRelatednDisorders....................................................................................................................................................................101
CrisisnIntervention ...............................................................................................................................................................................................................105
De-Escalation .........................................................................................................................................................................................................................107
MotivationalnInterviewing ...............................................................................................................................................................................................114
CognitivenBehavioralnTherapy .......................................................................................................................................................................................117
DialecticalnBehavioralnTherapy......................................................................................................................................................................................119
SeekingnSafety ........................................................................................................................................................................................................................121
ProblemnSolvingnTherapy .................................................................................................................................................................................................123
BehavioralnActivation .........................................................................................................................................................................................................124
CliniciannSupport .......................................................................................................................................................................125
CliniciannSelfnCarenandnWell-Being ...............................................................................................................................................................................125
ClinicalnSupervision.............................................................................................................................................................................................................128
Conclusion ....................................................................................................................................................................................131
Summary ..................................................................................................................................................................................................................................131
ResourcesnfornFurthernExploration ..............................................................................................................................................................................132
Bibliography ................................................................................................................................................................................133
Appendix .......................................................................................................................................................................................134
3
