Integrated Behavioral Health Practice

Preface
Acknowledgments
Contents
About the Author
Chapter 1: Integrated Behavioral Health Service Models and Core Competencies
	1.1 Introduction to Integrated Behavioral Health Practice
	1.2 Defining Integrated Behavioral Health Practice
		1.2.1 The Need for Integrated Behavioral Health Practice
			1.2.1.1 Comorbidity of Health and Behavioral Health Issues
			1.2.1.2 Health care System Fragmentation
			1.2.1.3 Health Inequity and Social Determinants of Health
	1.3 Behavioral Health Care Integration
		1.3.1 Common Integrated Behavioral Health Practices and Models
		1.3.2 Two Integrative Practice Models: Health Homes and Collaborative Care
			1.3.2.1 Health Homes
			1.3.2.2 Collaborative Care
	1.4 Developing Integrated Behavioral Health Professionals
		1.4.1 Core Competencies for Integrated Behavioral Health Practice
		1.4.2 Developing an Integrated Behavioral Health Workforce
	1.5 Summary and Conclusion
	References
Chapter 2: The Intersections of Social, Behavioral, and Physical Health
	2.1 Overview of Health and Behavioral Health Intersections
	2.2 Prevalence of Behavioral Health Conditions in the United States
		2.2.1 Substance Use
		2.2.2 Mental Illness and Treatment
		2.2.3 Suicide
		2.2.4 Depression
		2.2.5 Anxiety
		2.2.6 Post-Traumatic Stress Disorder (PTSD)
		2.2.7 Comorbid Mental Health and Substance Use
		2.2.8 Comorbid Health and Behavioral Health Conditions
	2.3 Models of Health and Human Behavior
		2.3.1 Ecological Systems Theory
		2.3.2 Stress–Vulnerability Models
		2.3.3 Risk and Resilience from a Bio-Psycho-Social Framework
		2.3.4 Common Risk and Protective Factors for Behavioral Health Disorders
			2.3.4.1 Protective Factors
	2.4 Social Determinants of Health and Health Equity
		2.4.1 Integrated Behavioral Health Practice and Social Determinants of Health
	2.5 Summary and Conclusions
	References
Chapter 3: Models of Change and Well-Being from Behavioral Health Disorders
	3.1 Overview to Theories of Change and Well-Being
	3.2 Theories of Recovery and Well-Being
		3.2.1 The Recovery Model
			3.2.1.1 Recovery Overview
			3.2.1.2 Factors That Facilitate and Hinder Recovery
			3.2.1.3 Recovery-Oriented Practices That Promote Wellness
		3.2.2 Theories of Well-Being
			3.2.2.1 Well-Being Overview
			3.2.2.2 Psychological Well-Being
			3.2.2.3 Subjective Well-Being
			3.2.2.4 PERMA and Flourishing
	3.3 Model of Health Behavior Change
		3.3.1 Transtheoretical Model of Change
		3.3.2 Health Belief Model of Change
		3.3.3 Theory of Reasoned Action
	3.4 Summary and Conclusion
	References
Chapter 4: Behavioral Health Screening and Assessment
	4.1 An Orientation to Behavioral Health Assessment
	4.2 Setting the Stage: Engaging Clients and Building Rapport
	4.3 Assessing for Strengths and Resources
	4.4 Screening Areas for Common Behavioral Health Issues
		4.4.1 Screening for Depression and Anxious Distress
		4.4.2 Screening for Substance Use
		4.4.3 Adverse Childhood Events (ACEs) and Trauma
		4.4.4 Perceived Stress
		4.4.5 Interpersonal Violence
	4.5 Behavioral Health Assessment Areas
	4.6 Social Environmental Domains of Assessment
	4.7 Common Components of the Behavioral Health Assessment
	4.8 Summary and Conclusion
	References
Chapter 5: Person-Centered Treatment Planning
	5.1 An Overview of Person-Centered Treatment Planning
	5.2 Formulating Case Conceptualizations and Treatment Plans
		5.2.1 The Case Conceptualization
		5.2.2 The Treatment Plan
	5.3 Selecting Interventions
	5.4 Documenting Progress
	5.5 Summary and Conclusion
	References
Chapter 6: Integrated Behavioral Health Approaches to Interpersonal Violence
	6.1 An Overview of Violence and Health
	6.2 Epidemiological Impact of Violence on the Population
		6.2.1 Ecological Factors that Impact Violence
		6.2.2 Impact of Violence on Health
	6.3 Integrated Behavioral Health Practices to Address Violence
		6.3.1 Universal Prevention Programs
		6.3.2 Trauma-Informed Care Approaches
		6.3.3 Hospital-Based Violence Intervention Programs (HVIP)
		6.3.4 Law Enforcement Strategies
	6.4 Assessment and Interventions for Intimate Partner Violence
		6.4.1 Overview of Intimate Partner Violence
			6.4.1.1 Epidemiology of Intimate Partner Violence
			6.4.1.2 The Impact of Intimate Partner Violence on Health and Well-Being
		6.4.2 Implementing Approaches to Address IPV in Integrated Behavioral Healthcare Settings
			6.4.2.1 Mandated Reporting of IPV
		6.4.3 Common Screening and Assessment Practice for Intimate Partner Violence
		6.4.4 Brief Interventions for IPV in Integrated Behavioral Health Settings
			6.4.4.1 Confidentiality
			6.4.4.2 Providing Universal Education About Healthy Relationships and Empowering Clients
			6.4.4.3 Supporting Clients: Be Ready to Help
			6.4.4.4 A Systems Approach to IPV
	6.5 Hospital-Based Violence Intervention Programs for Community-Based Violence
	6.6 Summary and Conclusions
	References
Chapter 7: Trauma-Informed Behavioral Health Practice
	7.1 Chapter Overview
		7.1.1 Trauma-Related Definitions and Terms
			7.1.1.1 Traumatic Events
			7.1.1.2 Adverse Childhood Events
			7.1.1.3 Post-Traumatic Stress Disorder
			7.1.1.4 Trauma-Informed Care
		7.1.2 The Epidemiology of Trauma
			7.1.2.1 PTSD and Health
			7.1.2.2 Prevalence of Trauma and PTSD
			7.1.2.3 Adverse Childhood Experiences and Health
	7.2 Trauma-Informed Care
		7.2.1 Trauma-Informed Care Definition and Assumptions
		7.2.2 Principles of Trauma-Informed Care
		7.2.3 Implementation of Trauma-Informed Care Practice and Policies
	7.3 Post-Traumatic Stress Disorder (PTSD) Diagnostic Criteria
		7.3.1 Criteria A: Exposure to a Traumatic Event
		7.3.2 Criteria B: At Least One Intrusion or Re-experiencing Symptom
		7.3.3 Criteria C: Persistent Avoidance of Reminders Related to the Event
		7.3.4 Criteria D: At Least Two Negative Alterations in Cognitions and Mood Symptoms
		7.3.5 Criteria E: At Least Two Alterations in Reactivity and Arousal Symptoms
	7.4 Screening and Assessment for Traumatic Stress and PTSD
		7.4.1 Adverse Childhood Experiences
		7.4.2 Traumatic Events
		7.4.3 Post-Traumatic Stress Disorder
	7.5 Treatment Guidelines for PTSD (NICE Guidelines 2005)
	7.6 Treatment Approaches for Post-Traumatic Stress Disorder
		7.6.1 Theoretical Orientation
		7.6.2 Prolonged Exposure
		7.6.3 Psychoeducation
		7.6.4 Exposure
		7.6.5 Emotional Processing
		7.6.6 Eye Movement Desensitization and Reprocessing (EMDR)
		7.6.7 Cognitive Processing Therapy (CPT)
		7.6.8 Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
		7.6.9 Cognitive Behavioral Intervention for Trauma in Schools (C-BITS)
	7.7 Summary and Conclusions
	References
Chapter 8: Screening and Assessment for Depression and Anxiety Disorders
	8.1 Overview of Screening and Assessment of Depressive and Anxiety Problems
	8.2 Major Depressive Disorder Overview
		8.2.1 Screening and Assessment of Major Depressive Disorder
		8.2.2 Differential Diagnosis of Depression
		8.2.3 Depression and Suicide
	8.3 Anxiety Disorders Overview
	8.4 Screening and Assessment for Anxiety Disorders
		8.4.1 Differential Assessment of Anxiety Disorders
	8.5 Summary and Conclusions
	References
Chapter 9: Brief Approaches to Treating Depression and Anxiety
	9.1 Overview of Anxiety and Depression Treatment
	9.2 Cognitive Behavioral Therapy
		9.2.1 The Cognitive Model of Depression
		9.2.2 Cognitive Model of Anxiety
		9.2.3 Common Cognitive Distortions
			9.2.3.1 Selective Abstraction (Negative Filtering)
			9.2.3.2 Emotional Reasoning (False Alarms)
			9.2.3.3 Arbitrary Inference
			9.2.3.4 Overgeneralization
			9.2.3.5 Magnification/Minimization
			9.2.3.6 Personification
			9.2.3.7 Absolutistic (All-or-Nothing) Thinking
			9.2.3.8 Mind Reading/Fortune Telling/Catastrophizing
		9.2.4 Basic Skills of Cognitive Behavioral Therapy
			9.2.4.1 Use of the Case Conceptualization
			9.2.4.2 Psychoeducation
			9.2.4.3 Behavioral Experiments
			9.2.4.4 Agenda Setting and Mood Checks
			9.2.4.5 Socratic Questioning
			9.2.4.6 Addressing Maladaptive Thoughts
			9.2.4.7 Behavioral Activities
			9.2.4.8 Skill Building
	9.3 Behavioral Approaches
		9.3.1 Behavioral Activation
			9.3.1.1 The Act “As if…” Exercise
		9.3.2 Relaxation and Mindfulness Skills
			9.3.2.1 Relaxation Skills and Breathing Retraining
			9.3.2.2 Mindfulness-Based Approaches
	9.4 Exposure-Based Therapies
		9.4.1 In-Vivo Exposure and Fear Hierarchies
			9.4.1.1 Imaginal Exposure
	9.5 Cognitive Approaches
		9.5.1 Identifying and Changing Maladaptive Thinking Patterns
			9.5.1.1 Using Thought Change Records to Identify and Reframe Maladaptive Thoughts
			9.5.1.2 Eliciting Automatic Thoughts from Clients
			9.5.1.3 Evaluating the Evidence for the Thought (e.g., the Defense Attorney)
			9.5.1.4 Reattribution
			9.5.1.5 Decatastrophizing
			9.5.1.6 Coping Cards
	9.6 Coping Skill Development
		9.6.1 Problem-Solving Skills
		9.6.2 Assertiveness Skills
		9.6.3 Anger Management Skills
	9.7 Psychoeducation Approaches: Illness Management and Family Psychoeducation
		9.7.1 Illness Management Strategies
			9.7.1.1 Illness Self-Management and Recovery
			9.7.1.2 Wellness Recovery Action Plan (WRAP)
		9.7.2 Family Psychoeducation
	9.8 Summary and Conclusion
	References
Chapter 10: Screening, Assessment, and Brief Interventions for Substance Use
	10.1 Overview of Alcohol and Substance Use
	10.2 Screening and Assessment for Substance Misuse and Substance Use Disorders
	10.3 Screening, Brief Intervention, and Referral to Treatment (S-BIRT)
	10.4 Brief Motivational Interventions
	10.5 Summary and Conclusion
	References
Chapter 11: Stage-Based Treatment Approaches for Substance Use Disorders
	11.1 Overview of Stage-Based Approaches to Treatment
	11.2 Harm Reduction Approaches
		11.2.1 Overview and Definition
		11.2.2 Harm Reduction History
		11.2.3 Harm Reduction Principles
		11.2.4 Harm Reduction Programs
		11.2.5 Intensive Case Management
	11.3 Motivational Interviewing
		11.3.1 Motivational Interviewing: Philosophy, Basic Skills, and Techniques
		11.3.2 Motivational Interviewing Practices
			11.3.2.1 Avoiding Traps
			11.3.2.2 Common Practice Skills for Motivational Interviewing: OARS
			11.3.2.3 Eliciting Change Talk
			11.3.2.4 Using Rulers to Assess Readiness, Importance, and Confidence
			11.3.2.5 Decisional Balance Exercises
	11.4 Brief Cognitive Behavioral Treatment Approaches
		11.4.1 Cognitive Behavioral Model of Substance Use Disorder
		11.4.2 Functional Analysis
		11.4.3 Craving Management
		11.4.4 Coping Skills Training
		11.4.5 Relapse Prevention
	11.5 Summary and Conclusions
	References