A Systemic Approach to Behavioral Healthcare Integration

This book provides clinicians, consultants, and healthcare administrators with a roadmap to establishing a systemic, patient-centered, family-oriented behavioral health service that is integrated into a healthcare setting.

Healthcare that goes beyond biomedical issues to address our whole biopsychosocial selves, produces better outcomes for patients and families. Integrating behavioral health into medical settings requires an understanding of the interplay of multiple systemic layers in American healthcare. The existing literature on integration largely fails to address the "big picture" of integrated services and systems, including operations, clinical processes, and financial sustainability elements.

A Systemic Approach to Behavioral Healthcare Integration summarizes the literature on the impact of integrating behavioral health care into medical settings, on the role of families in health maintenance and chronic disease management, and on team science and applying family systems theory/relational science to the teams that are now essential to healthcare.

Foreword

Preface

Acknowledgements

Prologue

Introduction: Why a Systemic Lens Is Critical for Integrated Care

Part 1: Overview: The Systemic Evolution of Integrated Care

• Chapter 1: Models of Integrated Care and Beyond
• Chapter 2: The Rise of Integrated Clinical Approaches
• Chapter 3: Healthcare Reform and Emerging Models of Research

Part II: Overview: Systemic Integrated Care Implementation

• Chapter 4: Healthcare Education, Financing, and Equity
• Chapter 5: Organization and Practice Level Integration
• Chapter 6: Shifting Practice Behaviors of Clinicals, Staff, and Administrators

Part III Overview: A Systemic Lens for Integrated Clinical Services

• Chapter 7: Clinical Theory, Strategies, and Research
• Chapter 8: The Developing Evidence Base for Systemic Interventions
• Chapter 9: Adult Healthcare
• Chapter 10: Pediatrics
• Chapter 11: Women’s Health
• Chapter 12: Conclusion: Envisioning an Integrated Healthcare Home

Epilogue

References

Index

About the Authors

Nancy Ruddy, PhD, currently serves as an internal program quality and accreditation consultant to graduate medical training programs at Stanford Healthcare in Palo Alto, CA. Over the last 30 years, she has served in various roles in training both medical and mental health professionals to provide integrated behavioral health including medical residency faculty, psychology postdoctoral fellowship director, postgraduate training program faculty, and curriculum design expert. Dr. Ruddy is a licensed psychologist and medical family therapist, having obtained both clinical member and approved supervisor status in the American Association of Marriage and Family Therapy. Dr. Ruddy has served as the chair of the Integrated Primary Care Group in The Society for Health Psychology and is currently the past president of the Society as a whole.

Dr. Ruddy was recognized for her contributions to the field of health psychology with the Timothy B. Jeffrey Memorial Award for Outstanding Contributions to Clinical Health Psychology in 2013. In addition, Dr. Ruddy has consulted to dozens of health care systems to facilitate the integration of behavioral health services into medical settings. Dr. Ruddy has published numerous book chapters and articles on integrated health care, as well as the 2008 APA book, The Collaborative Psychotherapist: Creating Reciprocal Relationships with Medical Professionals.

Susan H. McDaniel, PhD, ABPP, is the Dr. Laurie Sands distinguished professor of Families & Health and vice chair of the Department of Family Medicine at the University of Rochester Medical Center (URMC); in the Department of Psychiatry, she is the director of the Institute for the Family and the academic chief of the Division of Collaborative Care & Wellness. She is also director of the URMC Physician Communication Coaching Program. Dr. McDaniel's career is dedicated to integrating psychological and relational science and practice into health care.

She has won many awards and is the author of well over 100 journal articles and 17 books, translated into 10 languages, including 5 by APA, including Medical Family Therapy and Integrated Care, Family Therapy, Primary Care Psychology, Integrating Family Therapy, and A Casebook for Integrating Family Therapy, as well as 2 special issues of the American Psychologist on psychology and primary care, and the science of teamwork. Dr. McDaniel served as coeditor, with Thomas Campbell, MD, of the Families, Systems & Health journal for 12 years, and as associate editor for the American Psychologist for 10 years. She is a frequent speaker at national and international medical and mental health meetings. Dr. McDaniel has served in many leadership positions in mental health and primary care. She was the 2016 president of APA.

Ruddy and McDaniel have the collective experience and persuasive  examples to convince their readers why integrated care represents the best  care available. Context matters. No matter whether joining people to  guide their journey toward health or creating change in organizations, we  need to understand the perspective of others and the forces that shape their choices. Whether new or experienced to a systems lens, this accessible text will transform your care of patients.
—Catherine L. Gilliss, PhD, RN, FAAN; Dean and Styles Professor of Nursing, UCSF, San Francisco, CA

Complete with theory, policy, and practice evidence to manage the  complexities of integrated behavioral health more effectively, Ruddy and  McDaniel offer a comprehensive overview of behavioral healthcare  integration. Regardless of readers’ familiarity with integrated models of  care at the clinical-, population-, and system-levels, this book will deepen  practice knowledge and understanding.
—Lisa De Saxe Zerden, MSW, PhD, UNC Chapel Hill School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC; & Brianna M. Lombardi, MSW, PHD, UNC Chapel Hill School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC

Written by two highly successful forerunners in the field of integrated  healthcare, this book describes the challenges implementing integrated  models of care and provides a pathway to addressing those barriers. The strong focus on navigating systems effectively makes it a unique resource. The collective wisdom of the authors shines through, making it a must-read for anyone who wants to thrive in integrated primary and specialty  care settings.
—Barbara Cubic, PhD, Professor, Director of Behavioral Health, West Virginia University School of Medicine, Department of Family Medicine, Morgantown, WV

Ruddy and McDaniel offer us a work that is encyclopedic in scope, balanced and authoritative in its content, and, finally ground-breaking for the field of integrated care. It serves as a manual for making integrated behavioral health the standard of care in medical settings, as relevant to clinicians entering the field as to policy makers and organizational leaders on the lead edges of innovation.
—Alexander Blount, EdD, Professor Emeritus of family medicine and Community Health, UMass Chan Medical School, Worcester, MA; President, Integrated Primary Care, Inc.

For the first time we have a clear and comprehensive account of the field of integrated clinical care—the elements from which it draws, the sociopolitical and economic crucible in which it is forged, the powerful tools that have emerged, and the most promising directions for the future. Drs. Ruddy and McDaniel are two distinguished clinician-scholars who have been there from the beginning, working in and shaping this field, and this volume is a brilliant culmination of decades of work. Well done!
—Frank Degruy, MD, MSFM. Professor, Department of Family Medicine, University of Colorado, Boulder, CO

With a focus on systems, this text is a must-read for healthcare professionals who wish to have a sophisticated, yet practical understanding of current health conditions and why integrated care models are our best hope for achieving better health outcomes.
—Terry Stancin, PhD, ABPP, Pediatric/Clinical Child & Adolescent Psychologist, Professor, Case Western Reserve University, Cleveland, OH; Fellow, American Psychological Association