CU researchers offer framework to integrate behavioral health and primary care [News release]

From the 4 March 2014 EurkAlert

Excerpt

AURORA, Colo. (March 4, 2016) – – Researchers at the University of Colorado School of Medicine, along with experts from across the country, have developed a set of policy recommendations that would improve the quality of behavioral health care patients receive in clinical settings.

The Eugene S. Farley, Jr. Health Policy Center, with support from the Robert Wood Johnson Foundation, released recommendations in a report, “Creating a Culture of Whole Health,” that offers practical improvements that would eliminate the artificial separation of “mental health” from “physical health.” The report provides recommendations that call for creating a new approach to health care.

“The health care system differentiates physical and behavioral health care, patients don’t,” said Benjamin Miller, PsyD, director of the Eugene S. Farley, Jr. Health Policy Center and assistant professor of family medicine at the CU School of Medicine. “They seek care in a single setting with providers they trust in clinics that are convenient for them to visit. There should be no ‘wrong door’ preventing patients from accessing appropriate care.”

To improve the quality of care, Miller and the project team make several recommendations. Among them:

• policymakers and payers should establish payment methodologies that support team, not individual, providers;
• policymakers and payers should invest in a national technical assistance center focused on how to improve care by revising federal, state and local policy and regulatory barriers;
• providers should engage communities in service to advancing needs for behavioral health and assure consistency across care delivery;
• providers should share information on how to operationalize successful strategies, such as telehealth; and
• businesses and philanthropies could create resources and technical assistance strategies that improve access to data for patients and other providers.

[News release] Are temper, anxiety, homework trouble medical issues? Many parents don’t realize it

From the 18 May 2015 University of Michigan news release

Just half of parents of school-aged children would discuss anxiety or temper tantrums that seemed worse than peers

ANN ARBOR, Mich. — Parents often bring their school-aged children to check-ups or sick visits armed with questions. What should he put on that rash? What about her cough that won’t go away?

IntBehavioralHealth_050515.fw_.png

But when children’s temper tantrums or mood swings are beyond the norm, or they are overwhelmed by homework organization, do parents speak up?

Today’s University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health finds that many parents of children age 5-17 wouldn’t discuss behavioral or emotional issues that could be signs of potential health problems with their doctors. While more than 60 percent of parents definitely would talk to the doctor if their child was extremely sad for more than a month, only half would discuss temper tantrums that seemed worse than peers or if their child seemed more worried or anxious than normal. Just 37 percent would tell the doctor if their child had trouble organizing homework.

The most common reason for not sharing these details with their children’s doctors? Nearly half of parents believed that these simply were not medical problems. Another 40 percent of parents say they would rather handle it themselves and about 30 percent would rather speak to someone other than a doctor.

“Behavioral health and emotional health are closely tied to a child’s physical health, well-being and development, but our findings suggest that we are often missing the boat in catching issues early,” says Sarah J. Clark, M.P.H., associate director of the National Poll on Children’s Health and associate research scientist in the University of Michigan Department of Pediatrics.

…

[Press release] You are what you eat — How gut bacteria affect brain health | EurekAlert! Science News

You are what you eat — How gut bacteria affect brain health | EurekAlert! Science News.

From the 22 January 2015 press release

 

CAPTION
Journal of Medicinal Food is an authoritative, peer-reviewed, multidisciplinary journal published monthly in print and online. Led by Editors-in-Chief Sampath Parthasarathy, MBA, PhD, and Young-Eun Lee, PhD, Wonkwang University, Jeonbuk, Korea, this scientific journal publishes original scientific research on the bioactive substances of functional and medicinal foods, nutraceuticals, herbal substances, and other natural products. The Journal explores the chemistry and biochemistry of these substances, as well as the methods for their extraction and analysis, the use of biomarkers and other methods to assay their biological roles, and the development of bioactive substances for commercial use. Tables of content and a sample issue may be viewed on the Journal of Medicinal Food website.

CREDIT
©Mary Ann Liebert, Inc., publishers

 

New Rochelle, NY, January 21, 2015–The hundred trillion bacteria living in an adult human–mostly in the intestines, making up the gut microbiome–have a significant impact on behavior and brain health. The many ways gut bacteria can impact normal brain activity and development, affect sleep and stress responses, play a role in a variety of diseases, and be modified through diet for therapeutic use are described in a comprehensive Review article in Journal of Medicinal Food, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The paper is available free on the Journal of Medicinal Food website until February 21, 2015.

In “The Gut Microbiome and the Brain”, Leo Galland, Foundation for Integrated Medicine (New York, NY), presents the most up-to-date understanding of the relationship between the proteins produced by intestinal bacteria and the human central nervous system. The author explores the various mechanisms through which the microbiome can influence the brain: by stimulating and over-stimulating the immune system, producing neurotoxic agents, releasing hormones or neurotransmitters identical to those made by the human body, or through direct neuronal stimulation that sends signals to the brain.

“The microbiome has become a hot topic in many branches of medicine, from immune and inflammatory diseases, such as Crohn’s and IBD to cardiovascular diseases,” says Co-Editor-in-Chief Sampath Parthasarathy, MBA, PhD, Florida Hospital Chair in Cardiovascular Sciences, University of Central Florida, Orlando. “Scientists are not only aware of the ‘good’ and the ‘bad’ microbes in the gut but are becoming increasingly aware of how they could alter the metabolism beyond gut.”

 

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Behavioral Health United States 2012

From the US Substance Abuse and Mental Health Administration press release

Behavioral Health United States 2012

SAMHSA’s newly-released publication, Behavioral Health, United States, 2012, the latest in a series of publications issued by SAMHSA biannually since 1980, provides in-depth information regarding the current status of the mental health and substance abuse field. It includes behavioral health statistics at the national and State levels from 40 different data sources. The report includes three analytic chapters:

• Behavioral Health Disorders across the Life Span
• Mental Health and Substance Use Disorders: Impairment in Functioning
• Mental Health and Substance Use Disorders: Treatment Landscape

 

The volume also includes 172 tables, which are organized into four sections:

• Behavioral Health of the Population: the mental health status of the U.S. population and prevalence of mental illness;
• Behavioral Health Service Utilization: providers and settings for behavioral health services; types of behavioral health services provided; and rates of utilization;
• Behavioral Health Treatment Capacity: number of facilities providing mental health and substance abuse services; numbers of qualified specialty mental health and substance abuse providers; and
• Payer and Payment Mechanisms: expenditures and sources of funding for behavioral health services.

 

No other HHS publication provides this type of comprehensive information regarding behavioral health services delivery in the U.S. This publication is the only available comprehensive source of national-level statistical information on trends in both private and public sector behavioral health services, costs, and clients. Drawing on 40 different data sources, this publication also includes State-level data, and information on behavioral health treatment for special populations such as children, military personnel, nursing home residents, and incarcerated individuals.

 

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Incentivizing Healthy Behaviors in Low-Income Patient Populations

Incentivizing Healthy Behaviors in Low-Income Patient Populations.

From the 24 October 2013 blog item at Leavitt Partners

What works and 8 lessons other health care organizations learn

Data suggests costs can be better contained if all people are practicing healthy life behaviors.[i] State and Federal leaders, charged with holding down costs without sacrificing access to or quality of care, agree with this principal—and as a health insurance payer with one of the longest histories of serving low-income individuals, state Medicaid programs have explored many approaches to incentivizing positive health-related behaviors in its patient populations.

On January 1 2014, about half of the states will expand their Medicaid programs to newly eligible individuals with income below 133% FPL. Insurance subsidies will also be provided to individuals with income between 100% and 400% FPL, increasing access to commercial insurance to those with low- to moderate-incomes. As health care organizations begin managing the health and wellbeing of these newly insured groups, many will be looking for ways to control long-term costs by incentivizing healthy changes in behaviors.

In order to better understand which approaches are the most effective, Leavitt Partners analyzed case studies and program outcomes to answer the following questions:

What are the most effective approaches to motivate low-income adults to make positive changes in their behavior (for themselves and children)?

What are the most effective approaches to motivate low-i

– See more at: http://leavittpartners.com/2013/10/incentivizing-healthy-behaviors-low-income-patient-populations/#sthash.DyBTYRJG.dpuf

 

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Prisoners Doing Yoga May See Psychological Benefits

yoga (Photo credit: GO INTERACTIVE WELLNESS)

 

From the 11 July 2013 article at Science Daily

 

Yoga can improve mood and mental wellbeing among prisoners, an Oxford University study suggests, and may also have an effect on impulsive behaviour.

The researchers found that prisoners after a ten-week yoga course reported improved mood, reduced stress and were better at a task related to behaviour control than those who continued in their normal prison routine.

‘We found that the group that did the yoga course showed an improvement in positive mood, a decrease in stress and greater accuracy in a computer test of impulsivity and attention,’ say Dr Amy Bilderbeck and Dr Miguel Farias, who led the study at the Departments of Experimental Psychology and Psychiatry at Oxford University. ‘The suggestion is that yoga is helpful for these prisoners.’

Dr Bilderbeck adds: ‘This was only a preliminary study, but nothing has been done like this before. Offering yoga sessions in prisons is cheap, much cheaper than other mental health interventions. If yoga has any effect on addressing mental health problems in prisons, it could save significant amounts of public money.’

…

If yoga is associated with improving behaviour control, as suggested by the results of the computer test, there may be implications for managing aggression, antisocial or problem behaviour in prisons and on return to society, the researchers note — though this is not measured in this initial study.

Dr Bilderbeck, who practices yoga herself, cautions: ‘We’re not saying that organising a weekly yoga session in a prison is going to suddenly turn prisons into calm and serene places, stop all aggression and reduce reoffending rates. We’re not saying that yoga will replace standard treatment of mental health conditions in prison. But what we do see are indications that this relatively cheap, simple option might have multiple benefits for prisoners’ wellbeing and possibly aid in managing the burden of mental health problems in prisons.’

Sam Settle, director of the Prison Phoenix Trust, says: ‘Almost half of adult prisoners return to prison within a year, having created more victims of crime, so finding ways to offset the damaging effects of prison life is essential for us as a society. This research confirms what prisoners have been consistently telling the Prison Phoenix Trust for 25 years: yoga and meditation help them feel better, make better decisions and develop the capacity to think before acting — all essential in leading positive, crime-free lives once back in the community.’

 

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• Yoga Improves Mental Health Among Prisoners (medindia.net)
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We Can’t App Our Way Into Better Health or Healthcare – Health Is Social

We Can’t App Our Way Into Better Health or Healthcare

From the 9 March 2012 post at Health is Social

It’s cool and all that we can track our every step, our every weight, our every heartbeat, our every glucose reading.

Cooler still is to receive relevant feedback based on all the tracks.

Cooler yet is to gain proper interpretation of what the feedback means.

Even cooler is for us to get healthier and to deliver better care with all this tracking.

That last sentence – it’s not *just* cooler: it’s crux.

We can build all kinds of mobile applications. We can track all sorts of things.

But if we track the wrong things, we’ll simply railroad ourselves – or at least hop on the wrong train.

It’s not enough to track all those pushups and all those marathons.

In fact, how do you know that all those sweaty visits to the gym aren’t slowly making invisible tears in your muscles – how do you know that all those tears aren’t inducing a chronic state of tiny inflammatory processes that one day will lead to a myocardial infarction?

You see, the problems in front of you aren’t the problems in front of you: for an app that tracks your gym activity *might* be blinding you to some other problems.

Building and using more and more apps won’t convey us into better health or healthcare. Yes, they can help nudge and guide us – and that’s important as long as the contexts and processes into which those nudges and guides are the right ones.

An app is a module.

Health is a whole.

 

SAMHSA Announces A Working Definition Of “Recovery” From Mental Disorders And Substance Use Disorders

From the December 2011 news release

Date: 12/22/2011 10:00 AM
Media Contact: SAMHSA Press Office
Telephone: 240-276-2130

SAMHSA announces a working definition of “recovery” from mental disorders and substance use disorders

A new working definition of recovery from mental disorders and substance use disorders is being announced by the Substance Abuse and Mental Health Services Administration (SAMHSA). The definition is the product of a year-long effort by SAMHSA and a wide range of partners in the behavioral health care community and other fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders, along with major guiding principles that support the recovery definition. SAMHSA led this effort as part of its Recovery Support Strategic Initiative. The new working definition of Recovery from Mental Disorders and Substance Use Disorders is as follows: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. “Over the years it has become increasingly apparent that a practical, comprehensive working definition of recovery would enable policy makers, providers, and others to better design, deliver, and measure integrated and holistic services to those in need,” said SAMHSA Administrator Pamela S. Hyde. “By working with all elements of the behavioral health community and others to develop this definition, I believe SAMHSA has achieved a significant milestone in promoting greater public awareness and appreciation for the importance of recovery, and widespread support for the services that can make it a reality for millions of Americans.”… Through the Recovery Support Strategic Initiative, SAMHSA has also delineated four major dimensions that support a life in recovery: Health : overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way; Home:  a stable and safe place to live; Purpose:  meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and Community : relationships and social networks that provide support, friendship, love, and hope.   Guiding Principles of Recovery   Recovery emerges from hope:  The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.   Recovery is person-driven:  Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s).   Recovery occurs via many pathways:  Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds ? including trauma experiences ? that affect and determine their pathway(s) to recovery. Abstinence is the safest approach for those with substance use disorders.   Recovery is holistic:  Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. The array of services and supports available should be integrated and coordinated.   Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery   Recovery is supported through relationship and social networks:  An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.   Recovery is culturally-based and influenced : Culture and cultural background in all of its diverse representations ? including values, traditions, and beliefs ? are keys in determining a person’s journey and unique pathway to recovery.   Recovery is supported by addressing trauma : Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.   Recovery involves individual, family, and community strengths and responsibility:  Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.   Recovery is based on respect :  Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery. For further detailed information about the new working recovery definition or the guiding principles of recovery please visit:  http://www.samhsa.gov/recovery/ SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

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New definition of addiction: Addiction is a chronic brain disease, not just bad behavior or bad choices

From a 15 August 2011 Science Daily news article

The American Society of Addiction Medicine (ASAM) has released a new definition of addiction highlighting that addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling or sex. This the first time ASAM has taken an official position that addiction is not solely related to problematic substance use.

When people see compulsive and damaging behaviors in friends or family members — or public figures such as celebrities or politicians — they often focus only on the substance use or behaviors as the problem. However, these outward behaviors are actually manifestations of an underlying disease that involves various areas of the brain, according to the new definition by ASAM, the nation’s largest professional society of physicians dedicated to treating and preventing addiction…..

Read the article