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Introduction: This paper is a report on a study exploring a potential typology of primary care patients referred for integrated behavioral health care (IBHC) services. We considered whether primary care patients could be grouped into meaningful clusters based on perceived need for behavioral health services, barriers to accessing care, and past-year service utilization. We also described the development of a working partnership between our university-based research team and a federally qualified health center (FQHC).Method: A total of 105 adult primary care patients referred for same-day behavioral health appointments completed a brief self-report questionnaire assessing past-year behavioral health concerns, service utilization, and perceived barriers to utilization.Results: Hierarchical and k-means cluster analyses revealed 3 groups: (a) Well-Served patients, characterized by high perceived need for services, high service use, and low barriers to service use (40%); (b) Underserved patients, characterized by high perceived need, low service utilization, and high barriers to service use (20%); and (c) Subclinical patients, characterized by low perceived need, low service use, and low barriers to service use (20%). Clusters were reliably differentiated by age, primary language, insurance status, and global functioning.Discussion: We found primary care patients could be grouped into 3 categories and that 60% (Underserved and Subclinical) represented groups less commonly seen in traditional mental health (MH) settings. IBHC may be a promising approach for extending the reach of MH care, and partnerships between FQHCs and university-based research teams may be a promising approach for conducting research on the IBHC service-delivery model. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

Introduction: A practice embarks on a radical reformulation of how care is designed and delivered when it decides to integrate medical and behavioral health care for its patients and success depends on managing complex change in a complex system. We examined the ways change is managed when integrating behavioral health and medical care.Method: Observational cross-case comparative study of 19 primary care and community mental health practices. We collected mixed methods data through practice surveys, observation, and semistructured interviews. We analyzed data using a data-driven, emergent approach.Results: The change management strategies that leadership employed to manage the changes of integrating behavioral health and medical care included: (a) advocating for a mission and vision focused on integrated care; (b) fostering collaboration, with a focus on population care and a team-based approaches; (c) attending to learning, which includes viewing the change process as continuous, and creating a culture that promoted reflection and continual improvement; (d) using data to manage change, and (e) developing approaches to finance integration.Discussion: This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. We offer an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care. (PsycINFO Database Record [ABSTRACT FROM AUTHOR]

In their paper, Burge et al. (2014) describe an innovative methodology for studying real-time antecedents to intimate partner violence (IPV), as well as the methods employed to ensure the safety of research participants. Over a 12-week timespan, 200 women in moderately violent relationships were asked to make daily phone calls, using a password-protected, interactive voice response system, to provide information about new violence and abuse, and the circumstances that surrounded it. The article details the many safety procedures employed. The authors report that only 2 women were withdrawn from the study for safety reasons. In addition, in post-participation interviews, many participants reported on the increased safety they experienced as a result of participating in the study. These results are discussed in the commentary as part of a growing trend that shows that studies that have well-designed safety procedures in place may actually constitute a kind of inadvertent but effective intervention for abuse survivors in healthcare settings. Implications of such procedures for continued research development in this area, as well as for designing and evaluating innovative health care-based IPV interventions are discussed. [ABSTRACT FROM AUTHOR]

In this commentary, I summarize and embellish responses to the papers presented at the Festschrift by Drs. Tienari, O'Connor, and Rolland at the University of Rochester, September 2005. I do this under the rubric of ‘lessons learned’ attributed to Dr. Wynne (indicated in this article by italic type). My remarks include ideas from the designated responders to this session, Drs. Tom Campbell, Jeri Hepworth, and Susan McDaniel, as well as key points raised by attendees during the ensuing discussions. If the data and the theory are in conflict, the data win and the theory has to go. [ABSTRACT FROM AUTHOR]