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Flashcards in Integrated Care Deck (24):

Stages of chronic pain

1. Injury
2. Initial distress
3. Exacerbation of psychological and social problems
4. Acceptance of sick role


Integrated Care

integration of behavioral health into behavioral medicine and biomedicine creating integrated, team-based healthcare delivery system
- comprehensive and systemic interpretation
- bridges between medical and mental health worlds


Where are behavioral health consultants?

Inpatient care facilities
Outpatient care facilities
Research institutes
Faculty of schools
Private Practice Providers


Core components of integrated care

Biopyschosocial Spiritual Model (BPSS)
Collaboration -> mutual respect
Three world view -> clinician, administration, financial aspect



all problems are at once biological, psychological, and social
- works from systems model and encourages collaboration



system of interaction that is created when health care providers, mental health care providers, and patients with their families work together over time to treat illnesses
- all participants play vital roles


Barriers to effective collaboration

Disciplinary centrism
Differences between disciplines
Lack of effective collaboration -> common goals not identified


Three World View

Clinical -> quality of care, patient driven
Financial -> reimbursement, coding, billing
Operational -> systems, organization, communication, process improvement


Why are they called worlds?

People are trained in ONE discipline
- speak different languages, ask different questions, seek different outcomes, employ different values/principles


If 1 world fails, all fail

All 3 worlds must work together
- clinical fails -> poor quality
- operationally fails -> poor service, disappointment, waste
- financially fails -> lose money, out of business


Why integrate the services?

1. compromised physical health --> behavioral problems
2. compromised behavioral health -> physical problems
3. Stigma of behavioral services
4. compartmentalized understanding of health
5. Insurance/cost offset


Compromised physical health --> behavioral

chronic medical illness increases likelihood of depression 2 to 3 fold


Factors underlying link

1. Lack of self-care
2. Sleep problems
3. Obesity
4. Blood vessel changes
5. Stress


Compromised behavioral --> physical

- psychologically distressed patients experience increased physical symptoms
- 2/3 of primary care patients with psychiatric diagnosis have significant physical illness


Stigma of behavioral services

- Majority of patients with significant symptoms of depression and anxiety seek treatment solely from primary care provider
- MUCH less likely to see a psychotherapist --> some even refuse referral


Family Constellation

all members of current household, extended family, key people who patient feels is family


Impact of chronic illness on family

1. Family structural/organizational patterns
2. Communication processes
3. Culturally specific multigenerational patterns
4. Family belief systems


Chronic illness affect relationship health

- Relationship quality affects partners' health
- physical health affects relationship quality
* cyclical process --> keeps getting worse


Couple/family based interventions

1. Reduce denial and increase acceptance
2. Improve perceptions of illness manageability
3. Improving compliance with medical regimens


Chronic pain in relational context

uncertainty about cause of pain takes significant toll on relationship
- significantly associated with
- poor relationship satisfaction
- poor dyadic adjustment
- depressive symptoms
- Major Depressive Disorder


Spousal involvement in chronic pain

involvement through facilitative communication, responsiveness, and support is strongly associated with
- decreased intensity in pain
- less depressive symptoms
- increased relationship satisfaction


Focused assessment

quick assessment and practical recommendations
- use assessment tools


Attend to Culture

Racial and sexual minorities
1. Suffer more illness
2. Receive less treatment
3. Receive worse treatment
4. Receive treatment that devalues belief system
5. Experience racism in health contexts


4 C's of culturally appropriate assessments

1. What do you CALL your problem?
2. What do you think CAUSED the problem?
3. How do you COPE with your condition?
4. What CONCERNS do you have regarding your problem?