Stages of chronic pain
- Injury
- Initial distress
- Exacerbation of psychological and social problems
- 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
BPSS
all problems are at once biological, psychological, and social
- works from systems model and encourages collaboration
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
- NEED FLEXIBILITY
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?
- compromised physical health –> behavioral problems
- compromised behavioral health -> physical problems
- Stigma of behavioral services
- compartmentalized understanding of health
- Insurance/cost offset
Compromised physical health –> behavioral
chronic medical illness increases likelihood of depression 2 to 3 fold
Factors underlying link
- Lack of self-care
- Sleep problems
- Obesity
- Blood vessel changes
- 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
- Family structural/organizational patterns
- Communication processes
- Culturally specific multigenerational patterns
- 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
- Reduce denial and increase acceptance
- Improve perceptions of illness manageability
- 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
- Suffer more illness
- Receive less treatment
- Receive worse treatment
- Receive treatment that devalues belief system
- Experience racism in health contexts
4 C’s of culturally appropriate assessments
- What do you CALL your problem?
- What do you think CAUSED the problem?
- How do you COPE with your condition?
- What CONCERNS do you have regarding your problem?
