Rodger Kessler and Dale Stafford This book is intended to foster thinking and dialogue about behavioral health clinicians providing psychological treatments as part of medical practice. Since medical sites evaluate and treat more mental health and substance abuse problems than the specialty behavioral health system and because many acute and chronic medical presentations have significant psychological components, on-site collaboration between medicine and behavioral health is a logical, feasible, and important evolution of medical care. The majority of this book is the presentation of medical cases in which psychological dimensions are important components of the problem, or cases that are primarily mental health diagnoses that were treated in primary care or specialty medical settings. The feature common to each of the cases is that they rep- sent some form of collaborative treatment between medicine and behavioral health. Conversations about the issues raised in this volume will hopefully be held by those who participate in providing health care, who do not often think and talk about these issues together. The intended audience is physicians, psychologists, behavioral health providers, health care administrators, health care financers, and health care policy makers. Each has both a role and an impact on patient care and patient outcomes although each has a different perspective on achieving the goal. Because of new clinical advancements and administrative and cost pressures, the goals of medicine have shifted to achieving the right care for patients.
Practical and applied—discusses economic and administrative issues alongside evidence-based clinical issues
In-depth case studies, co-written by psychologists and physicians
Collaborative Medicine Case Studies
Evidence in Practice
Edited by Rodger Kessler and Dale Stafford, Berlin Family Health, Montpelier, Vermont and Department of Family Medicine University of Vermont College of Medicine
Just as the mind and body collaborate in maintaining one’s health, collaboration between primary and behavioral health care can bring patients more efficacious treatment and better long-term results, from better compliance with or less dependence on medication to more effective use of health care services.
Collaborative Medicine Case Studies shows physicians and mental health practitioners working together across a variety of settings to assess and treat entrenched illnesses, combined physical and psychological conditions (back pain/panic attacks, diabetes/bipolar disorder), and cases that defy straightforward diagnosis. At the same time, the cases reflect the economic and financial realities of contemporary health care.
The cases discussed generate creative solutions using different levels of collaboration depending on patient need and site variables, but all share important similarities: close communication, careful follow-up by physician and behavioral health collaborators, and patients who would not have been treated as effectively without collaborative care. Blending research evidence, clinical insight, welcome humor, and realistic optimism, these cases demonstrate impressive successes, instructive setbacks, and comparative viewpoints while shedding light on the logistical, financial, and training challenges of integrative practice.
A sampling of the three dozen cases:
- The head and the brain: migraines, orofacial pain, tinnitus.
- Comorbid PTSD and persistent pain.
- Individuals and couples with complex medical/emotional problems.
- Chronic illnesses: obesity, spina bifida, cardiovascular disease.
- A Hmong woman’s post-immigration depression.
- A physician with anorexia
- Burn patients who keep coming back without treatment success.
Collaborative Medicine Case Studies is a blueprint for a vanguard in care, not only for physicians and psychologists but also for professionals and graduate students in health psychology and health care administration and finance.
Background.- Primary Care Is the De Facto Mental Health System.- Organizing Collaborative Care in Medical Settings.- Planning Care in the Clinical, Operational, and Financial Worlds.- How I Learned About Integrated Care by Failing Miserably: The Deadly Sins of Integration.- Tailoring Collaborative Care to Fit the Need: Two Contrasting Case Studies.- Managing Chronic Pain Through Collaborative Care: Two Patients, Two Programs, Two Dramatically Different Outcomes.- Integrating Mental Health Services into Primary Care: The Hamilton FHT Mental Health Program.- Primary Care Life.- The Primary Care Behavioral Health Model: Applications to Prevention, Acute Care and Chronic Condition Management.- A Collaborative Approach to Somatization.- Improved Health Status and Decreased Utilization of an Anxious Phobic Man.- The Train Wreck: Assessment and Management of a Complex Medical Patient.- Collaborative Medical and Behavioral Health Treatment of Patients with Migraine Headache.- Collaborative Care for an Immigrant Couple.- Assessment and Management of Somatoform and Conversion Symptoms.- Women’s Health.- Chronic Pelvic Pain: A Case for an Interdisciplinary Evaluation and Treatment Approach.- Biobehavioral Management of Hot Flashes in a 48-Year-Old Breast Cancer Survivor.- Preserving a Life and a Career: How a Partnership Between Medicine and Psychology Saved a Physician with Anorexia Nervosa.- Collaborative Care to Heal Gender Relations Across Generations: A Couple of Trainees Watch a Couple of Experts Treat a Couple of Couples.- Specialty Mental Health Care to Medical Patients.- The Complex Orofacial Pain Patient: A Case for Collaboration Between the Orofacial Pain Dentist and the Clinical Health Psychologist.- Integrated Care in a Cardiac Rehabilitation Program: Benefits and Challenges.- Collaborative Treatment in Behavioral Medicine: Treatment of a Young Single Mother with Psoriasis and Generalized Anxiety Disorder.- Hypnotic Amplification–Attenuation Technique for Tinnitus Management.- Chronic Medical Illness.- An Integrative Approach to Treating Obesity and Comorbid Medical Disorders.- A Case of Medically Unexplained Chronic Cough.- Walking the Tightrope Without a Net: Integrated Care for the Patient with Diabetes, Cardiovascular Disease, and Bipolar Disorder…and No Insurance.- Healing Through Relationships: The Impact of Collaborative Care on a Patient with Spina Bifida.- Psychiatric and Comorbid Disorders in Primary Care.- Overcoming Depression in a Strange Land: A Hmong Woman’s Journey in the World of Western Medicine.- Seven Years in a Young Man’s Life: Collaborative Care in Rural Vermont.- Bringing the Family into Focus: Collaborative Inpatient Psychiatric Care.- Pain.- Complexity and Collaboration.- A Bad Situation Made Worse.- Innovations in the Treatment of Comorbid Persistent Pain and Posttraumatic Stress Disorder.- What Goes Up Must Come Down: The Complexity of Managing Chronic Pain and Bipolar Disorder.- Pediatric Burns: They Are Not Always What They Appear.- A Man with Chronic Back Pain and Panic Attacks: A Collaborative Multisystem Intervention.- Conclusion.- Summary.