title: Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals.
abstract: OBJECTIVE
  This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions.
  
  
  METHODS
  This was a comparative case study in which a multidisciplinary team used an immersion-crystallization approach to analyze data from observations of practice operations, interviews with practice members, and implementation diaries. The observed practices were drawn from 2 studies: Advancing Care Together, a demonstration project of 11 practices located in Colorado; and the Integration Workforce Study, consisting of 8 practices located across the United States.
  
  
  RESULTS
  Primary care and behavioral health clinicians used 3 interpersonal strategies to work together in integrated settings: consulting, coordinating, and collaborating (3Cs). Consulting occurred when clinicians sought advice, validated care plans, or corroborated perceptions of a patient's needs with another professional. Coordinating involved 2 professionals working in a parallel or in a back-and-forth fashion to achieve a common patient care goal, while delivering care separately. Collaborating involved 2 or more professionals interacting in real time to discuss a patient's presenting symptoms, describe their views on treatment, and jointly develop a care plan. Collaborative behavior emerged when a patient's care or situation was complex or novel. We identified contextual factors shaping use of the 3Cs, including: time to plan patient care, staffing, employing brief therapeutic approaches, proximity of clinical team members, and electronic health record documenting behavior.
  
  
  CONCLUSIONS
  Primary care and behavioral health clinicians, through their interactions, consult, coordinate, and collaborate with each other to solve patients' problems. Organizations can create integrated care environments that support these collaborations and health professions training programs should equip clinicians to execute all 3Cs routinely in practice.
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland. cohendj@ohsu.edu.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: Melinda
authors.initials: M
authors.lastname: Davis
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: Bijal A
authors.initials: BA
authors.lastname: Balasubramanian
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: Rose
authors.initials: R
authors.lastname: Gunn
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hall
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: Frank V
authors.initials: FV
authors.lastname: deGruy
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: C J
authors.initials: CJ
authors.lastname: Peek
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Green
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: Carla
authors.initials: C
authors.lastname: Pallares
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Levy
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: David
authors.initials: D
authors.lastname: Pollack
authors.affiliation: From the Department of Family Medicine (D.C., M.D., R.G., J.H., S.L.) and Department of Medical Informatics and Clinical Epidemiology (D.C.), Oregon Health & Science University, Portland; Oregon Rural Practice-based Research Network (M.D.), Portland; Department of Epidemiology, Human Genetics, and Environmental Sciences (B.B.), University of Texas Health Science Center Houston School of Public Health, Dallas; Harold Simmons Comprehensive Cancer Center (B.B.), UT Southwestern Medical Center, Dallas, TX; Department of Family Medicine (F.V.Dg., L.A.G., B.F.M.), University of Colorado School of Medicine, Aurora; Department of Family Medicine and Community Health (C.J.P.), University of Minnesota Medical School, Minneapolis; Departments of Family Medicine, Epidemiology & Biostatistics, Sociology, and the Case Comprehensive Cancer Center and Clinical & Translational Science Collaborative (K.S.), Case Western Reserve University, Cleveland, OH; Plan de Salud del Valle, Inc. (C.P.), Brighton, CO; Department of Psychiatry (D.P.), Oregon Health & Science University, Portland.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Miller
mesh_terms: D000066491:Clinical Decision-Making; D003156:Community Mental Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D001523:Mental Disorders / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration; D011216:Practice Management, Medical / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration; D014481:United States
keywords: Behavioral Medicine; Communication; Delivery of Health Care; Integrated; Interdisciplinary Health Team