“Is there a Lexicon in the House?” 2012 CFHA Annual Meeting

1. “Is there a Lexicon in the House?” 2012 CFHA Annual Meeting C.J. Peek, PhD; University of Minnesota Normal confusion in a new field • “Are you saying integrated behavioral health and collaborative care are the same?” • “Is that the same as co-located mental health or primary care behavioral health?” • “What functions define the genuine article? What can be different from practice to practice?” • “How can we implement, ask research questions (or write a book) if we can’t even get through a phone call without stumbling over the basic concepts in our field? The archetypal experience: “We already do that. . .” “. . . No you don’t”

2. Communities this lexicon intends to unite: • Patients & families: • What do I want and expect as a standard of practice? • How would I recognize it if I saw it? • How would I know if what I see is up to standard? • Clinician & system implementers: • What exactly do I implement? • What are the core functions and what do I locally adapt? • Purchasers/plans: • What exactly am I buying? • What do I tell employees or members what to expect for the cost? • Policymakers & business modelers: • If asked to change rules of the game or business models, what functions need to be supported? • Says who? • Researchers: • What comparisons of effectiveness? • What terms for asking consistently understood questions across PBRN’s? 2

3. Requirements for lexicon development method: • Consensual but analytic (a disciplined process--not a political campaign) • Involving “native speakers”(in this case, 24 diverse) (implementers and users) • Focused on what functionalities look like in practice (not just principles, values, abstractions) • Amenable to gathering an expanding circle of “owners” and contributors (not just an elite group coming with a declaration) Method: Paradigm Case Formulation and Parametric Analysis Ossorio(2006); The Behavior of Persons. Descriptive Psychology Press, Ann Arbor

4. Defining clauses for genuine integrated BH: A. The “What”—a two-sentence definition; a glossary at the end B. The “How”: • A practice team tailored to the needs of each patient and situation (spelled out in 3 sub-clauses) • With a shared population and mission—with responsibility for total health outcomes • Using a systematic clinical approach (spelled out in 5 sub-clauses) • C. “Supported by”: • A community or population expecting that BH and PC will be appropriately integrated as a standard of care • Supported by office practice, leadership alignment, and business model (spelled out in 3 sub-clauses) • And ongoing QI and measurement of effectiveness • (spelled out in 2 sub-clauses) Based on Peek, C.J. and the National Integration Academy Council (AHRQ—in press). A consensus lexicon or operational definition: Integrated behavioral health and primary care. 2011 version available at:http://www.ahrq.gov/research/collaborativecare/ 4

5. Parameters—how practices might differ (examples)

6. Implementation: Lexicon Applications (Behavioral health integrated in primary care) 6 6

7. Lexicon Applications (Behavioral health integrated in primary care) 7 7