Over the past years, the paradigm shifted from the traditional counseling setting to integrated behavioral health services. This shift provides professional health care counselors with new opportunities and challenges in assuming their present roles and responsibilities. Primary care is initially focused on the prevention of injury and illness, health issues treatment, early detection, and comprehensive and coordinated care. It also considers unhealthy behaviors such as overeating, smoking, substance abuse, unsafe sexual practices, sedentary lifestyles, and violence. These factors significantly contribute to diverse physical and mental illnesses. Moreover, the psychological component is often a defining one in such medical disorders as headaches, hypertension, and chronic pains. Therefore, efficient treatment requires an integrated approach to consider all the relevant conditions and causes of different health states.
Integrated behavioral health might be defined in many different ways, but still, the term “integrated care” has more definitions in current studies. The main reason is the terminology newness, as its age is approximately one decade. Additionally, this terminology is primarily used for the description of different care models. However, integrated medical services and behavioral health may currently be considered an accepted care philosophy. Improving patient experience, reducing healthcare costs, improving the population’s health, and healthcare professionals’ experience makes integrated care competitive with the Quadruple Aim (Morrison, 2018). There are many pieces of research proving its efficiency and clear evidence on the patient’s preference.
The behavioral primary care services operate at a different level and clip comparative to traditional counseling. Behavioral counseling is cognitively oriented, fast-paced, and short-term, whereas regular clinics are characterized by longer-term and more in-depth treatment approaches (“Primary care,” n.d.). In other words, there is an evident contrast in the professional and operational cultures of these two approaches to health care. Integrated care is assumed as a holistic treatment modality enhancing collaboration of primary care mental health providers.
There is evident support for the integrated care approach; nevertheless, the counselors development in its terms is still limited. Behavioral health is considered an umbrella term covering life stressors, mental health, life crises, substance abuse conditions, health behaviors, and stress-related symptoms (“What is,”, n.d.). Current studies consider the students experiences, doubts about their work, and useful skills in different integrated care settings. The researchers state that students obtain the “encouraging perceived competencies” (Asempapa, 2019). Nevertheless, there are still several contextual-specific challenges requiring telic integrated care training.
Comparison of Integrated Behavioral Setting and Traditional Counseling Setting
The historical ground of primary health care is defined as the traditional biomedical model focusing on the medical diagnosis of illness, physical symptomology, medication, and disease. Hence, the biomedical model’s approach is dualistic and based on the philosophy that the human mind and the physical body are separately-viewed concepts. In turn, the integrated behavioral healthcare system is a one-setting blend of medical terms and the relevant behavioral health factors affecting well-being and health state in general. It is typically viewed as an essential component of “whole-person care” and a core aim of the advanced patient-oriented medical home. Integrated behavioral health is also referred to as integrated care, behavioral health integration, collaborative care, or primary care behavioral health (“What is,” n.d.). Regardless of the applied term, the goal remains the same: health and whole-person care.
Professionals practicing integrated care recognize that both behavioral and medical health factors are a critical part of each individual’s overall health. Hence, the patient’s concerns are better and more efficiently addresses by the team of behavioral health and medical clinicians. Such integrated teams deliver services in the settings of primary care unless a patient requires and requests specialty services. Better communication and coordination are the main advantages requiring work towards a standard set of health goals.
The body of research related to the topic is continuously growing, revealing how integrated behavior health positively influences the patients health and experience. Additionally, it results in unnecessary costs decrease in delays, money, and time. There are many benefits of an integrated behavioral health system worthy of being mentioned. In terms of chronic health conditions, patients are likely to suffer from the accompanying behavioral health problems. Therefore, they feel more comfortable when these problems are also addressed while improving their chronic conditions.
Integrated behavior health might be compared with one-stop shopping in terms of convenience. There is no need to seek help in different settings, no matter what the problem is: for instance, substance use, mental health, or stress. In the treatment of such issues, it is more socially more comfortable and acceptable to seek behavioral care treatment in an institution the patients are already familiar with.
Most medical providers recognize the benefit of behavioral health partners presence, as they concentrate on the issues the medical team has no training or time to address. Additionally, the cost of integrated behavioral health care often offsets one of the primary medical care services due to the “right time approach” (“What is,” n.d.). In terms of session structure, the “cost” is also different: primary medical care is characterized by the variable number of approximately 50-minute sessions, depending on the patient’s condition. In turn, the behavioral health care system assumes that 1-3 visits lasting from fifteen to thirty minutes are enough (“Primary care,” n.d.). Moreover, medical services providers consider their collaboration with the integration of behavioral health specialists as a significant chance to get the needed support and learn from each other. Finally, health care reform supports the relevant changes in payment and reimbursement systems and the clinical delivery systems. Health care shifts from the “fee-for-service models to bundled/global payments for populations of patients” (Jolly et al., 2016). All the involved providers get compensations based on the combined performance through receiving or bundling global payments.
Integration steadily continues to be gaining momentum, but its combination with primary care still creates many challenges. They include but are not limited to, organizational or systemic change, funding, healthcare policy, and others. Nevertheless, the philosophical difference between primary and behavioral care still poses the most significant challenge and makes behavioral care providers feel alienating while working within the traditional primary care culture. Moreover, primary care often causes burnout through overwork. It is also characterized by the lack of partnership with patients and, hence, person-oriented concern. As a result, it often fails to adequately provide the needed empathy for the struggles and experiences of the patients.
The vast majority of integrated health care providers doubt that collaboration with primary counseling settings poses a threat to subsuming the culture of behavioral health. Hence, they might be chronically overwhelmed and, therefore, concerned about the provided quality of care. Nevertheless, these reasons are not sufficient background for avoiding the integration. On the contrary, these issues are pointing out the importance of a conscious approach to primary care and behavioral health integration but not behavioral health intervention in the primary care system.
Asempapa, B. (2019). An exploratory investigation about graduate counseling students’ perceived competencies in integrated care. The Journal of Counselor Preparation and Supervision, 12(3). Web.
Jolly, J. B., Fluet, N. R., Reis, M. D., Stern, C. H., Thompson, A. W., & Jolly, G. A. (2016). Review of behavioral health integration in primary care at Baylor Scott and White Healthcare, Central Region. Proc (Bayl Univ Med Cent), 29(2): 131–136.
Morrison, E. (2018). Integrated behavior health manual. (2nd ed.). EM Consulting.
Primary Care and Specialty Mental Health. (n.d.). IBHP. 2020, Web.
What is integrated behavioral health? (n.d.). AHRQ. 2020, Web.