Models of Practice

Levels of Integration

One seemingly logical model for integration is the Four Quadrant model of Barbara Mauer. It was developed, among other reasons, to clarify the role for community mental health centers in a larger collaborative care system. The problem with the model is that two of the quadrants have most of the patients. There are lots of low medical/low behavioral health need patients and lots of high medical/high behavioral health need folks. The low medical/high behavioral health population and the high medical, low behavioral health populations are very small. Generally, the sicker you are (in one dimension), the sicker you are (in the other).

Some people like levels in describing models, and no one does levels as well as Bill Doherty and his colleagues. Five Levels of Primary Care/Behavioral Healthcare Collaboration .

The Agency for Healthcare Research and Quality on commissioned an expert report on models of integration of mental health and substance abuse into primary care.

A little over the top in number of models it distinguishes, but otherwise very solid and current is the Milbank Report.

There are the distinctions in models we need to make to organize the evidence. (Blount, 2003)

And the needs of pediatric practices are somewhat different. A 2009 issue paper from the Foundation of the National Institute for Health Care Management Strategies to Support the Integration of Mental Health into Pediatric Primary Care (PDF – 200KB). There is a movement to train the pediatrician to do the whole job, just as was originally envisioned for Family Medicine. This is the premise of the Johns Hopkins Center for Mental Health Services in Pediatric Primary Care.