Anne C. Dobmeyer

Provider practices in the primary care behavioral health (PCBH) model: an initial examination in the Veterans Health Administration and United States Air Force.

The goals of this study were to identify characteristics of both behavioral health providers (BHPs) and the patients seen in a primary care behavioral health (PCBH) model of service delivery using prospective data obtained from BHPs. A secondary objective was to explore similarities and differences between these variables within the Veterans Health Administration (VHA) and United States Air Force (USAF) primary care clinics. A total of 159 VHA and 23 USAF BHPs, representing almost every state in the United States, completed the study, yielding data from 403 patient appointments. BHPs completed a web-based questionnaire that assessed BHP and setting characteristics, and a separate questionnaire after each patient seen on one day of clinical service. Data demonstrated that there are many similarities between the VHA and USAF BHPs and practices. Both systems tend to use well-trained psychologists as BHPs, had systems that support the BHP being in close proximity to the primary care providers, and have seamless operational elements (i.e., shared record, one waiting room, same-day appointments, and administrative support for BHPs). Comorbid anxiety and depression was the most common presenting problem in both systems, but overall rates were higher in VHA clinics, and patients were significantly more likely to meet diagnostic criteria for mental health conditions. This study provides the first systematic, prospective examination of BHPs and practices within a PCBH model of service delivery in two large health systems with well over 5 years of experience with behavioral health integration. Many elements of the PCBH model were implemented in a manner consistent with the model, although some variability exists within both settings. These data can help guide future implementation and training efforts.

Tipping points in the Department of Defense's experience with psychologists in primary care.

Psychologists played a crucial role in the successful implementation of integrated behavioral health care services in Department of Defense (DoD) primary care clinics. On the front lines of policy development, training programs, clinical care, and program evaluations, psychologists successfully promoted integrated care as a core component of the DoD patient-centered medical home. We review the development of integrated care and discuss the roles of psychologists in the DoD to provide an exemplar of the impact psychologists can have on the implementation and sustainment of integrated care.

Military and veteran health behavior research and practice: challenges and opportunities

There are 2.1 million current military servicemembers and 21 million living veterans in the United States. Although they were healthier upon entering military service compared to the general U.S. population, in the longer term veterans tend to be of equivalent or worse health than civilians. One primary explanation for the veterans’ health disparity is poorer health behaviors during or after military service, especially areas of physical activity, nutrition, tobacco, and alcohol. In response, the Department of Defense and Department of Veterans Affairs continue to develop, evaluate, and improve health promotion programs and healthcare services for military and veteran health behavior in an integrated approach. Future research and practice is needed to better understand and promote positive health behavior during key transition periods in the military and veteran life course. Also paramount is implementation and evaluation of existing interventions, programs, and policies across the population using an integrated and person centered approach.

Primary care behavioral health: ethical issues in military settings.

The rapid expansion of integrated behavioral health care in primary care medical settings introduces a number of ethical challenges faced by teams of health professionals from different disciplines. As military health care settings have increasingly implemented primary care behavioral health models of service delivery, distinct ethical dilemmas have emerged. This article examines two of these ethical issues, competence and multiple relationships, through presentation of clinical scenarios in military integrated primary care settings. Relevant professional ethical guidelines for psychologists, social workers, and physicians are examined. Recommendations for the ethical practice of primary care behavioral health, as well as suggestions for future development of professional ethical guidelines, are discussed.

The Right Book at the Right Time

Perhaps the best way to summarize the new book from Christopher Hunter, Jeff Goodie, Mark Oordt, and Anne Dobmeyer, Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention, is to label it the right book at the right time. This important addition to the growing library of primary care behavioral health (PCBH) texts does more than inform and assist those mental health professionals working in primary care. It also, by its very nature, represents the evolution of the PCBH field.