Health care systems are facing challenges in achieving therapeutic goals for their clients. Therefore, a support system and services within the organization must be established. It is essential for professionals to collaborate, communicate, and work as a team.  In an effort to achieve therapeutic goals, health care and organizations are moving toward the integration of behavioral health (Funderburk, Fielder, DeMartini & Flynn, 2012). The integration of behavioral health consists of various levels of service for implementation. Achieving therapeutic goals is based on a four-level model as described in Establishing an integrated care practice in a community health center (Auxier, Farley & Siefert, 2011). An essential first step is to assess the patient based on four levels of severity. Depending on various factors including geographical location and patient needs, implementation of approach may vary. The integrative care practice may consist of screening, consultation, psychotherapy, and psychological testing. The implementation of services should consist of best evidence based practice using their best professional knowledge and implement strategies with an open mind. The implementation of IC/CC aims at improving the quality of care for patients, which increases patient satisfaction. In addition, improving mental and physical health while increasing patient functioning aims at increasing the patient’s overall health and well-being. This approach addresses various components of an individual’s health including physical, emotional, mental, social, spiritual, and environmental issues affecting overall health and well-being of clients. According to Runyan (2011) models of successful integration are typically seen with stepped care within larger organizations that includes a variety of specialty areas and services. There are no one size fits all models, but implementing essential components of care services based on needs will assist in achieving individual client’s therapeutic goals.

• How does this support health literacy?

Health literacy are essential skills in order to manage the health and well-being of individuals. Ensuring individuals understand detailed information related to their health is essential. Effective communication between the professional and patient assists in reducing misunderstanding and aids in a complete understanding of the various aspects related to their health. From start to finish, individual’s must have a clear understanding. In addition, patients must be able to easily navigate technological systems and understand written communication. Establishing appropriate health literacy helps individuals develop a clear understanding and gain knowledge related to their health that will assist in achieving health goals and satisfaction.  

• What factors might lead to the failure of the CC/IC delivery model?

There are various factors that might lead to the failure of the CC/IC delivery model. The organizational setting and lack of services may influence the failure of the model. Professionals who lack knowledge or have not been trained in specific areas may cause the model to fail. In addition, there may be a lack of professionals or services available. The patient’s lack of knowledge may also contribute to the failure of the model. With technology on the rise, individuals may lack navigation and lack knowledge of the system. Technology can be costly, thus lack of funds may affect the model as organizations are unable to implement most current and effective strategies. Organizations may not implement the best model for the client population, thus not targeting and meeting the needs of the patient population.

• How might lack of acceptance of the value or viability of the CC/IC model by stakeholders, lack of awareness of the clinical competencies of various members of the team, barriers to financial reimbursement for services, and lack of integration of support services within the practice cause a breakdown in efficacy?

Stakeholders may have difficulty accepting the value of CC/IC models for several reasons. These may include financial and regulation requirements of the model, sharing of information, development within the workforce, and technology. Stakeholders may lack understanding and knowledge of how CC/IC models work or not understand how to implement a successful model.  Lack of communication, collaboration, and professional interaction between team members are barriers that may cause a breakdown in efficacy (Soklaridis, Kelner, Love & Cassidy, 2009). In addition, a breakdown in efficacy may be due to lack of teamwork as well as lack of understanding of their scope of practice amongst professionals, thus causing confusion. In addition, contractual and payment issues may exist. Insurance policies have various financing and reimbursement structures due to the capitated care for patients (Kelly & Coons, 2012). In addition, contracting laws may vary from state to state, thus causing a breakdown in efficacy.    

• What supportive interventions within the CC/IC model address such issues? 

In addition, consider how successful health care models assume an understanding of each profession’s competencies and responsibilities. For example, primary care providers (PCPs) are sometimes unaware of the abilities and practice scope of psychology professionals. Gaining knowledge by engaging in team discussions and staff meetings. Setting clear guidelines and protocol within the organization, provide education and training for professionals, increase communication through patient charting in an organized manner (Soklaridis, Kelner, Love & Cassidy, 2009). Every individual has a specific role and brings their own knowledge, which is beneficial to function as a team. Contributing professional knowledge and understanding allows professionals to reflect on various view points and thoughts in order to effectively function as a team and implement best strategies that targets various needs. Finally, receiving legal advice from a health law attorney may assist in overcoming financial, reimbursement, and contracting issues (Kelly & Coons, 2012).

• Identify methods of targeted intervention and education for PCPs that might alleviate potential issues for the CC/IC model.

Patients may present PCP with psychological and medical illnesses, thus it is essential for PCP’s to have an understanding of proper assessments and best care for patients. Upon successfully evaluating patients, PCP’s can make a decision on how to best treat the patient. Best treatment may include referring the patient to mental health services that can provide additional or more in-depth care. London, Watson & Berger (2013) state that PCP’s are typically the first provider individuals consult for information and guidance, thus collaboration between PCP’s and mental health professionals is essential. The collaboration will assist in effectively treating patient’s based on their needs. Ongoing training and opportunities for professionals that target assessing, diagnosing, and basic treatment for frequent psychiatric issues will assist in alleviating problems within the CC/IC model and provide best practice for patients (London, Watson & Berger (2013).    

• Explain how the APA Ethical Code of Conduct can be used to guide decisions in these complex situations.

The APA Ethical Code of Conduct can be used as a guideline to address various situations. Section 10 discusses therapy services including obtaining informed consent and ensuring the client is able to ask questions as well as receive answers. In addition, taking appropriate steps to provide services and treatment for clients that is in the best interest of the client and reducing potential risk. Section 7 discusses education and training which relates to the importance of staying current with policies and procedures and spreading the information to appropriate parties. This can be applied to the IC/CC models as every individual has an obligation to stay current and up to date with changes and new discoveries and communicate this knowledge. Section 6 discusses record keeping and fees that provides assistance for professionals. Fees should be consistent with the law and records should be maintained and kept confidential. Protecting patient’s privacy and confidentiality is essential. Privacy and confidentiality may be difficult as professionals need to ensure they are not collaborating or providing information to a colleague who is not part of the services team for the patient. Finally, professionals must ensure they work within their boundaries of competence. Thus, ensuring individuals have a clear understanding of their duties, obligations, and services is essential.

• Evaluate and comment on the potential work settings where you might find the CC/IC model. In what ways might this model provide more job satisfaction? 

According to Kelly & Coons, 2012), CC/IC models may be found in public and private health delivery systems. This may include The Department of Veterans Affairs, Department of Defense, and Federally Qualified Health Centers in urban and rural communities as well as the Indian Health System. Kaiser Permanente and the Mayo Clinic are the largest, private health care companies who implement the CC/IC model (Kelly & Coons, 2012). The CC/IC model may provide more job satisfaction in a variety of ways. This integrated care increases patient’s satisfaction as their needs are being met which assists in the overall attitudes of patients and providers. In addition, professionals collaborate and communicate with other members of their team, which provides support for each other. Establishing guidelines and increasing collaboration amongst team members assists in reducing confusion amongst individuals. Finally, professionals who work within the scope of their boundaries helps to increase confidence, provides effective care, and assists in team building as various team members work together to achieve a common goal.