Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention by Christopher Hunter, Jeffrey Goodie, Mark Oordt, and Anne Dobmeyer Washington, DC: American Psychological Association, 2009, 289 pp., $99.95
There are an increasing number of books and articles focused on integration theory, models, and instruction in program design. There are also publications about health psychology and behavioral medicine, research summaries, and protocols for evidence-supported treatments. But when I am thinking about a particular patient with a particular set of complex medical or behavioral issues, a specific resource about assessing and treating primary care patients within an integrated model has been elusive. Further, when trainees, residents, or colleagues want to know what I do to be collaborative and integrate care, it has not felt like I could turn to an adequate reference.
Hunter, Goodie, Oordt, and Dobmeyer's volume provides such a resource. All books are imperfect--this one is also. But that said, this book is now my 'go to' volume when thinking about specific patient issues. It is also one of the resources I suggest to anyone wanting to get a sense of what do you do in the room with a patient from a collaborative framework.
The volume is divided into two parts. Part 1, chapters 1-4, focus on broad issues: building the service; conducting the initial consultation appointment; common interventions in primary care behavioral health; and an important chapter focused on cultural competence.
Part 2, chapters 5-16, is what makes this book outstanding. As a health psychologist and a research geek, I have been concerned that collaborative care and health psychology/behavioral medicine have not always developed in tandem. Specifically, I have not seen the integration of the rich research base of clinical behavioral medicine in the writings and conversations of collaborative care. These authors have done a good job of bridging that gap in accomplishing the stated purpose of their book--a focus on assessment and intervention within primary care.
Each chapter in Part 2 focuses on a particular clinical content area. Starting with depression and anxiety, the majority of chapters focus on a medical problem and the psychological and behavioral contributors to both medical status and the medical treatment of the problem. Each content area begins with a review of key empirical findings. There is then a discussion of the usual response in specialty mental health. This is followed by a discussion of how the issues are different in primary care behavioral health, as well as specific strategies, often drawn from evidence-supported guidelines for both assessment and intervention.
Specific assessment tools, forms, and procedures are offered in the text. The Five A approach (Whitlock, Orleans, Pender, & Allan, 2002), consisting of assess, advise, agree, assist, and arrange, is adapted for each content area as a focus of assessment and intervention. The authors suggest that this approach's focus on health behavior change is readily integrated into the patient's overall healthcare plan and is then available for monitoring and management by the entire healthcare team. Of additional utility is an excellent list of figures and tables at the beginning of the volume, including worksheets and handouts for each of the content areas. This list and its contents are available to purchasers with a supplied online link.
Two areas of omission concern me and modestly limit the breadth and importance of this volume. It was noted earlier that strength of this book bridges the collaborative care and empirical behavioral medicine worlds. An additional bridge would have been to include strategies for assessing the outcomes of the interventions described. In the healthcare world in which we operate, regularly assessing the outcomes of our efforts is crucial to move collaborative care from an interesting effort to a regular partner in healthcare. Similarly, what does it cost a practice to mount such an effort? Is it sustainable? What is the impact on bending the cost curve? Again, to generate mainstream healthcare acceptability, these are crucial questions, and responding to them would have strengthened the usefulness of the book.
That said, the authors have made a contemporary and important contribution to the field. It is of value to us all, particularly to students, interns, residents, and those making a shift of focus into collaborative care.
DOI: 10.1037/a0021712
REFERENCE
Whitlock, E. P., Orleans, C. T., Pender, N., & Allan, J. (2002). Evaluating primary care behavioral counseling interventions: An evidence-based approach. American Journal of Preventive Medicine, 22, 267-284.
Rodger Kessler, PhD, ABPP
Department of Family Medicine, University of Vermont College of Medicine, and Research Director, Collaborative Care Research Network, Kansas City, MO
