Advancing the integration of mental and physical health care : overcoming barriers, demonstrating outcomes with vulnerable populations, and understanding implementation

The objective of this dissertation is to describe a systematic approach to effectively treat common mental health disorders, which involves integrating care managers and mental health specialists into the primary care treatment team. Despite an extensive body of evidence demonstrating the effectiveness of collaborative care, implementation in various “real world” settings presents a number of barriers. Successful clinical trials have failed to result in widespread changes in practice. Gaps in the literature persist as to what the clinical, organizational and financial barriers to integration are. As a result, dissemination of the model lags far behind. This dissertation sought to contribute new information to the literature on integrated health care by examining various elements of dissemination efforts. The first article examined the experience among a group of health care providers in Texas who were attempting to integrate physical and behavioral health care. This article identified the barriers that they have encountered in addition to the strategies they have used to integrate mental and physical health services, and to determine whether the strategies reflect an evidence-based model of care delivery. In addition, the perceived clinical, organizational and financial barriers to integration were evaluated. The second article for this dissertation examined quantitative clinical outcomes of an integrated health care program in a community-based clinic with a low-income, uninsured population of Hispanics, a portion of which were Spanish-speaking. A socio-culturally adapted model for the provision of comprehensive health services may have a significant impact on the health and mental health outcomes of minority, non-English speaking populations. The third article offers an in-depth case study of an interdisciplinary collaborative care treatment team. Understanding the details of program implementation and the elements of the model that community based providers found useful, and those they found challenging, has implications for widespread implementation efforts. This qualitative article offered an analysis of how the treatment team organized itself to perform as a coordinated, high functioning effort that fit well with the needs of patients, and had each professional doing what they do best.