The ACT initiative has been on the front lines of behavioral health and primary care integration in the United States. In 2010, the University of Colorado School of Medicine, in conjunction with the Colorado Health Foundation, invited care sites to devise and implement multifaceted, actionable strategies to better integrate behavioral health and primary care interventions within their practices. Ultimately, 11 care sites were selected to participate in the 4-year ACT program, and each site was provided modest funding to help offset the costs of its integrated care endeavors.
Interventions shared across the 11 community mental health and primary care sites included:1
- Developing and utilizing comprehensive, systematic mental health screening tools
- Integrating and facilitating interoperability between medical and behavioral electronic health records
- Introducing and co-locating primary care providers (eg, physicians or mid-level practitioners), mental health care providers (eg, psychologists), and ancillary staff (eg, counselors, social workers, and medical assistants) across both primary care and mental health care clinics
Analyses regarding the effectiveness of ACT interventions have been conducted and results related to best practices in behavioral health screening have been reported. According to Balasubramanian et al, practices that implemented systematic protocols to identify patients needing integrated care had significantly higher reach (ie, extent to which the respective interventions were delivered to the target population) (mean=70% reach, 95% confidence interval [CI] 46.6–93.4%) than did practices that used practitioner discretion to identify patients needing integrated care (mean=7.9% reach, 95% CI 0.6–15.1, P=0.0014).2 These data suggest that utilization of validated, systematic screening tools are necessary to identify patients and populations requiring coordinated behavioral health and primary health services.
Furthermore, Frank deGruy III, MD, chair of the family medicine department at the University of Colorado School of Medicine, has commented on the successes of the ACT program. “All 11 of them succeeded, and they're still doing it,” Dr. deGruy said. “That demonstration project was such a success that we now have a statewide project in Colorado. We just enrolled 100 primary care practices to transform to integrated care, and over the next five years, we're going to increase that number up to 500 primary care practices.”3
To learn more about the ACT program, click below:
- Davis M, Balasubramanian B, Waller E, Miller B, Green L, Cohen D. Integrating behavioral and physical health care in the real world: early lessons from advancing care together. JABFM. 2013;26(5):588–602.
- Balasubramanian B, Fernald D, Dickinson L, et al. REACH of interventions integrating primary care and behavioral health. Journal of the American Board of Family Medicine: JABFM. 2015;28.
- American Academy of Family Physicians. Campaign Highlights Integration of Primary Care, Mental Health. http://www.aafp.org/news/family-medicine-americas-health/20160531hip-mentalhealth.html. Accessed May 10, 2018.
The NAVIGATE program is a comprehensive, multidisciplinary team-based treatment approach for first-episode psychosis. It was analyzed in the Early Treatment Program (ETP) study, which was part of the National Institute of Mental Health’s (NIMH) Recovery After an Initial Schizophrenia Episode (RAISE) initiative.1
The NAVIGATE team includes the following members:2
- Program Director, who educates the community about the program, recruits individuals who have begun to experience symptoms of psychosis, and leads the NAVIGATE team
- Prescriber, who is trained in using low doses of medications and addressing special issues of clients with first-episode psychosis
- Individual Resiliency Trainer (IRT), who helps patients identify and work toward their goals, teaching them strategies and skills to build their resiliency in coping with psychosis while staying on track with their lives
- Family Education (FE) Clinician, who helps the entire family learn about psychosis and its management, and techniques to support each other and build family resiliency
- Supported Employment and Education (SEE) Specialist, who helps patients identify and achieve their educational and/or employment goals
- Case Management, provided either by a separate case manager or by a specified NAVIGATE team member
In the study, 34 community health treatment centers from 21 different states were included and were randomly assigned to either the NAVIGATE program or to standard care. The sample included 404 patients with schizophrenia and related disorders, and each subject was followed for least 2 years.1
The results of the study proved that a team-based approach to first-episode psychosis produced greater improvement in clinical and functional outcomes compared to standard care. Participants assigned to NAVIGATE remained in treatment longer, had a greater improvement in quality of life and psychopathology, and were more involved in work and school compared to patients who received community care. The results showed that the effects of comprehensive care were more pronounced in patients with a shorter duration of untreated psychosis.
To learn more about the Navigate program, click below:
NAVIGATE - Team Guide Manual
- Kane JM, et al. Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE Early Treatment Program. Am J Psychiatry. 2016;173:362-372.
- NAVIGATE Consultants. Here’s How NAVIGATE Works. http://navigateconsultants.org/how-it-works/. Published 2014. Accessed May 10, 2018.