Jennifer S Funderburk

Syracuse VA Medical Center, Syracuse, New York, United States

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Publications (28)40.62 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: There is little known regarding the typical trajectory of alcohol use following a positive screen for hazardous alcohol use. This information would help primary care providers as they attempt to determine the best use of patient visits that might include brief alcohol interventions versus other competing medical demands. This longitudinal observational study included 98 Veterans who screened positive on the Alcohol Use Disorders Identification Test-Consumption (>3) and were asked to report on their alcohol use every 3 months for 1 year. Using latent class growth modeling, we identified the best fitting latent class structure for each outcome of high-risk and heavy drinking, respectively. There was a class of participants with increased probability of having a high-risk week or episode of heavy drinking as well as a group of participants who appeared to maintain their current drinking pattern. Although the latent class growth modeling suggested that none of the groups of participants reduced the likelihood of occurrence of heavy drinking days, two groups did significantly reduce the probability of having a hazardous alcohol use week. These results suggest that there are specific classes of patients who are less likely to change their alcohol use following a positive screen, especially those patients who report engaging in heavy drinking.
    Military medicine. 11/2014; 179(11):1198-206.
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    ABSTRACT: Insomnia is common, but undertreated, among primary care patients. Within the Veterans Health Administration (VA), increasing attention has been given to the treatment of insomnia within primary care settings, but little research has examined Veterans' treatment preferences. We examined preferences for sleep treatment among VA primary care patients. Participants (N = 126: 98% male, 89% white; M age = 60 years) completed a brief survey. On the basis of Insomnia Severity Index scores, 22% reported subthreshold and 13% moderate insomnia. Fifty percent reported having issues with sleep (falling asleep, staying asleep, or sleeping too much) in the past 12 months; among these, only 44% reported any discussion of medication (34%) or other strategies (32%) to improve sleep with medical providers. The most preferred treatment approach was to work it out on one's own, followed by consulting the primary care provider (PCP). The most preferred modality was a one-on-one meeting with the PCP, followed by a one-on-one meeting with the behavioral health provider. In conclusion, VA primary care patients preferred handling sleep problems on their own, but if seeking help, they preferred working with PCPs over behavioral health providers. The majority of Veterans preferred individual treatment and strategies other than medication.
    Military medicine. 10/2014; 179(10):1072-1076.
  • Jennifer S Funderburk, Aileen Kenneson, Stephen A Maisto
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    ABSTRACT: As researchers examine the efficacy of interventions that simultaneously target more than 1 symptom, it is important to identify ways to help guide research and program development. This study used electronic medical record data to examine the covariation of multiple risk factors regularly assessed among primary care patients. It also examined the health care utilization of those patients identifying where the health care system came in contact with them to help identify the ideal locations these interventions may be most often used. We obtained data for six risk factors, as well as the number of primary care, mental health, and emergency department visits, from Veteran patients with a primary care visit. There were three main groups of primary care patients, identified using latent class analysis and regression. Although the smallest group, the "High Treatment Need" group, had an increased probability of screening positive for all four risk factors, the post-traumatic stress disorder screen was a significant discriminator of this group from the others. Results show that this group had the greatest number of encounters in all health care locations suggesting significant opportunities for intervention. However, future research is needed to examine the current interventions offered and potential avenues where risk factors may be addressed simultaneously.
    Military medicine. 10/2014; 179(10):1119-1126.
  • Jennifer S Funderburk, Robyn L Fielder
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    ABSTRACT: Reviews the website, The Academy: Integrating Behavioral Health and Primary Care http://integrationacademy.ahrq.gov. This website was created by the Agency for Healthcare Research and Quality. It was constructed and is maintained by a project team (Benjamin Miller, PsyD, Garrett Moran, PhD, and Deborah Cohen, PhD), who are advised by the National Integration Academy Council, which is a group of integrated health care experts that help direct strategic initiatives. The overall mission of this website is to serve as a centralized resource to allow easy access to tools and materials that advance the field of behavioral health and primary care integration. The review presented here provides an overall impression of the layout/structure of the website; a page guide and descriptions of the page structure and content. Overall, this website includes a wealth of information on integrated health care and can easily be seen as a great resource to a variety of professionals contemplating implementation of integrated health care or currently working within an integrated system. It is expertly formatted so that the information is all included, but each individual page is not too overwhelming. In addition, it is comprehensive, leaving very little that may be helpful to readers interested in integrated health care not discussed or at least identified as area that the project team is developing. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Families, systems & health : the journal of collaborative family healthcare. 09/2014; 32(3):357-360.
  • Robyn L Shepardson, Jennifer S Funderburk
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    ABSTRACT: Universal screening at university health centers can facilitate early identification and treatment of behavioral health problems common among college students. This article describes the (a) process of implementing behavioral health screening at a university health center and (b) results of universal screening for depression, suicidal ideation, alcohol misuse, tobacco use, and sleep problems. We discuss the decision points involved in screening, including what to screen for, whom to screen, how to implement the screening measure, and how to deal with patients who screen positive. During the Spring and Fall 2010 academic semesters, 4,126 screening questionnaires were completed by students (62 % female) accessing a university health center. Each semester, 9-13 % of students screened positive for depression, 2.5-3 % for suicidal ideation, and 33-38 % for alcohol misuse, while 10 % wanted help with smoking cessation and 12-13 % with sleep problems. The results suggest that behavioral health screening in a university health center can help identify students with behavioral health concerns to increase access to care.
    Journal of Clinical Psychology in Medical Settings 07/2014; · 1.49 Impact Factor
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    ABSTRACT: A significant number of military personnel report engaging in or experiencing intimate partner violence (IPV). To advance current research and understanding of this behavior, we conducted a methodological review of the literature on IPV in military personnel and veterans. Research from 1980 to the present, which consisted of 63 empirical studies, was objectively coded by two independent raters on a number of variables important to the methodological quality of research on IPV in the military. In addition, areas of importance to the future of IPV research are presented.
    Trauma Violence & Abuse 03/2014; · 3.27 Impact Factor
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    ABSTRACT: Overweight and obesity are growing problems for primary care. Although effective weight management programs exist, these programs experience significant attrition, which limits effectiveness. This study examined provider and staff perceptions of attrition from the Veterans Health Administration MOVE!® Weight Management Program as an initial step toward understanding attrition from primary care-based programs. Participants MOVE!® clinicians, primary care providers, and other staff members who interacted with patients about participating in MOVE!® (n=754) from Department of Veterans Affairs medical centers throughout the United States. Respondents were predominantly female (80.8%), Caucasian (79.2%), and trained as nurses (L.P.N., R.N., or N.P.; 50%). Measure Participants completed a web-mediated survey; items assessed agreement with personal and programmatic reasons for dropout, and allowed respondents to indicate the number one reason for dropout in an open-ended format. This survey was adapted from an existing tool designed to capture patient perceptions. Respondents indicated that veterans experienced practical barriers to attendance (eg, transportation and scheduling difficulties) and desire for additions to the program (eg, a live exercise component). Low motivation was the primary factor identified by respondents as associated with dropout, particularly as noted by MOVE!® clinicians (versus other providers/staff; P<0.01). These findings suggest that programmatic changes, such as adding additional meeting times or in-session exercise time, may be of benefit to MOVE!®. In addition, increasing the use of techniques such as Motivational Interviewing among providers who refer patients to MOVE!® may improve participant engagement in MOVE!® and other primary care-based weight management programs. Further research is needed to effectively identify those likely to withdraw from weight management programs before achieving their goals, and the reasons for withdrawal.
    Primary Health Care Research & Development 03/2014;
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    ABSTRACT: The goals of this study were to identify characteristics of both behavioral health providers (BHPs) and the patients seen in a primary care behavioral health (PCBH) model of service delivery using prospective data obtained from BHPs. A secondary objective was to explore similarities and differences between these variables within the Veterans Health Administration (VHA) and United States Air Force (USAF) primary care clinics. A total of 159 VHA and 23 USAF BHPs, representing almost every state in the United States, completed the study, yielding data from 403 patient appointments. BHPs completed a web-based questionnaire that assessed BHP and setting characteristics, and a separate questionnaire after each patient seen on one day of clinical service. Data demonstrated that there are many similarities between the VHA and USAF BHPs and practices. Both systems tend to use well-trained psychologists as BHPs, had systems that support the BHP being in close proximity to the primary care providers, and have seamless operational elements (i.e., shared record, one waiting room, same-day appointments, and administrative support for BHPs). Comorbid anxiety and depression was the most common presenting problem in both systems, but overall rates were higher in VHA clinics, and patients were significantly more likely to meet diagnostic criteria for mental health conditions. This study provides the first systematic, prospective examination of BHPs and practices within a PCBH model of service delivery in two large health systems with well over 5 years of experience with behavioral health integration. Many elements of the PCBH model were implemented in a manner consistent with the model, although some variability exists within both settings. These data can help guide future implementation and training efforts. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Families Systems & Health 12/2013; 31(4):341-53. · 1.74 Impact Factor
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    ABSTRACT: Adherence to protocol among behavioral health providers working in co-located, collaborative care or Primary Care Behavioral Health settings has rarely been assessed due to limited measurement options. Development of psychometrically sound measures of provider fidelity may improve the translation of these service delivery models into every day practice. One hundred seventy-three integrated behavioral health providers in VA primary care clinics responded to an online questionnaire to assess the reliability and validity of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ). Psychometric assessment resulted in a reliable 48-item measure with two subscales that specified essential and prohibited provider behaviors. The PPAQ demonstrated strong convergent and divergent validity when compared to another measure of health care integration. Known-group comparisons provided partial support for criterion validity. The PPAQ is a reliable and valid self-report of behavioral health provider fidelity with implications for improving provider training, program monitoring, and clinical research.
    Translational Behavioral Medicine. 12/2013;
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    ABSTRACT: What is already known about this subjectDepressive symptoms and obesity are highly prevalent in primary care settings.Depressive symptoms and obesity are positively related; as body weight increases, individuals are more likely to display depressive symptoms. What this study addsThis study examines the moderating roles of health behaviours (alcohol use, smoking status and vigorous exercise) on the relationship between body mass index and depressive symptoms.Exercise attenuates the relationship between depressive symptoms and obesity. Primary care patients often report multiple health risk behaviours and symptoms, including obesity and depressive symptomatology. This study examined the relationship between body mass index (BMI) and depressive symptomatology among primary care patients and tested its moderation by health behaviours. Primary care patients (n = 497) completed self-report questionnaires. Using three multilevel models, we tested the moderation of health behaviours on the BMI-depressive symptoms relationship. After controlling for relevant covariates, BMI was positively related to depressive symptoms. Smokers reported more depressive symptoms (P < 0.01), whereas vigorous exercisers reported fewer (P < 0.001). Alcohol consumption was not related to depressive symptoms (P > 0.05). Only vigorous exercise significantly moderated the BMI-depression relationship (P < 0.05). BMI is positively related to depressive symptoms among patients who do not participate in vigorous activity, suggesting that vigorous activity reduces the risk for depressive symptoms among patients with higher BMI.
    Clinical Obesity. 11/2013;
  • Jennifer S Funderburk, Stephen A Maisto, Allison K Labbe
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    ABSTRACT: It is important to find ways to identify prevalent co-occurring health risk factors to help facilitate treatment programming. One method is to use electronic medical record (EMR) data. Funderburk et al. (J Behav Med 31:525-535, 2008) used such data and latent class analysis to identify three classes of individuals based on standard health screens administered in Veterans Affairs primary care clinics. The present study extended these results by examining the health-related outcomes for each of these identified classes. Follow-up data were collected from a subgroup of the original sample (N = 4,132). Analyses showed that class assignment predicted number of diagnoses associated with the diseases that the health screens target and number of primary care behavioral health, and emergency room encounters. The findings illustrate one way an EMR can be used to identify clusters of individuals presenting with multiple health risk factors and where the healthcare system comes in contact with them.
    Journal of Clinical Psychology in Medical Settings 10/2013; · 1.49 Impact Factor
  • Jennifer S Funderburk, Kyle Possemato, Stephen A Maisto
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    ABSTRACT: The success of any secondary prevention effort in identifying those in need for further services depends on the primary care team following all positive screening results with additional assessment or intervention. Initial research suggests possible differences in primary care responses to positive screens for hazardous alcohol use compared to depression. Therefore, the purpose of this study was to examine current practices of Veterans Affairs healthcare providers following a positive screen for hazardous alcohol use or depression. Chart reviews were conducted for a random sample of 98 Veterans who screened positive for hazardous alcohol use using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) questions and a separate sample of 99 Veterans who screened positive for depression using the 2-item Patient Health Questionnaire (PHQ-2) over a 1-year period. Findings suggest multiple discrepancies in screening practices between the AUDIT-C and the PHQ-2. These include a higher likelihood of further depression assessment or referral after a positive PHQ-2 screen. Scores on the AUDIT-C that indicate heavier alcohol consumption were more likely to result in assessment or intervention than did lower but still positive AUDIT-C scores. Overall, these data suggest that many opportunities are missed, especially in regards to hazardous alcohol use, for prevention and intervention.
    Military medicine. 10/2013; 178(10):1071-1077.
  • Aileen Kenneson, Jennifer S Funderburk, Stephen A Maisto
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    ABSTRACT: There is a well-known association between mood disorders and substance use disorders (SUD), but little research has been conducted on SUDs as risk factors for the development of subsequent mood disorders. We analyzed data from the National Comorbidity Survey Replication study. Diagnoses were determined using DSM-IV criteria. Odds ratios (aORs) of subsequently developing mood disorders were adjusted for age, sex and race/ethnicity. Data from 5217 individuals were included (6.6% male; mean age 45.3 years; 72.6% White, 11.2% Black, 12.5% Hispanic and 3.7% other). Subsequent mood disorders developed in 26.4% of individuals with primary adolescent-onset SUD (12-17 years), 21.7% of those with SUD onset at 18-25 years, and 14.0% of those with SUD onset between the ages of 26 and 34 years. The mean lagtime between SUD onset and development of a mood disorder was about 11 years. Controlling for demographic variables, the aORs of developing a mood disorder in these three age groups were 2.44, 3.65, and 3.25. Substance dependence was associated with higher odds of mood disorders than was abuse. Among the specific mood disorders, the increased odds of developing bipolar disorder were particularly high among individuals with drug dependence. Individuals with adolescent and young adult-onset SUD had increased odds of developing a secondary mood disorder. This indicates that adolescents and young adults with SUD should be closely monitored for both positive and negative mood symptoms. SUD treatment and aftercare offer opportunities for the early identification of secondary mood disorders.
    Drug and alcohol dependence 07/2013; · 3.60 Impact Factor
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    ABSTRACT: BACKGROUND: The integration of behavioral health services into primary care is increasingly popular, yet fidelity of implementation in this area has been infrequently assessed due to the few measurement tools available. A sentinel indicator of fidelity of implementation is provider adherence, or utilization of prescribed procedures and engagement in model-specific behaviors. This study aimed to develop the first self-report measure of behavioral health provider adherence for co-located, collaborative care, a commonly adopted model of behavioral health service delivery in primary care. METHODS: A preliminary 56-item measure was developed by the research team to represent critical components of adherence among behavioral health providers. To ensure the content validity of the measure, a modified Delphi study was conducted using a panel of co-located, collaborative care model experts. During three rounds of emailed surveys, panel members provided qualitative feedback regarding item content while rating each item's relevance for behavioral health provider practice. Items with consensus ratings of 80% or greater were included in the final adherence measure. RESULTS: The panel consisted of 25 experts representing the Department of Veterans Affairs, the Department of Defense, and academic and community health centers (total study response rate of 76%). During the Delphi process, two new items were added to the measure, four items were eliminated, and a high level of consensus was achieved on the remaining 54 items. Experts identified 38 items essential for model adherence, six items compatible (although not essential) for model adherence, and 10 items that represented prohibited behaviors. Item content addressed several domains, but primarily focused on behaviors related to employing a time-limited, brief treatment model, the scope of patient concerns addressed, and interventions used by providers. CONCLUSIONS: This study yielded the first content valid self-report measure of critical components of collaborative care adherence for use by behavioral health providers in primary care. Although additional psychometric evaluation is necessary, this measure may assist implementation researchers in clarifying how provider behaviors contribute to clinical outcomes. This measure may also assist clinical stakeholders in monitoring implementation and identifying ways to support frontline providers in delivering high quality services.
    Implementation Science 02/2013; 8(1):19. · 2.37 Impact Factor
  • Aileen Kenneson, Jennifer S Funderburk, Stephen A Maisto
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    ABSTRACT: BACKGROUND: Compared to other mental illnesses, bipolar disorder is associated with a disproportionately high rate of substance use disorders (SUDs), and the co-occurrence is associated with significant morbidity and mortality. Early diagnosis of primary bipolar disorder may provide opportunities for SUD prevention, but little is known about the risk factors for secondary SUD among individuals with bipolar disorder. The purposes of this study were to describe the population of people with childhood and adolescent-onset primary bipolar disorder, and to identify risk factors for secondary SUD in this population. METHODS: Using data collected from the National Comorbidity Survey Replication study, we identified 158 individuals with childhood-onset (<13years) or adolescent-onset (13-18years) primary bipolar disorder (I, II or subthreshold). Survival analysis was used to identify risk factors for SUD. RESULTS: Compared to adolescent-onset, people with childhood-onset bipolar disorder had increased likelihoods of attention deficit hyperactivity disorder (ADHD) (adjusted odds ratio=2.81) and suicide attempt (aOR=3.61). Males were more likely than females to develop SUD, and did so at a faster rate. Hazard ratios of risk factors for SUD were: lifetime oppositional defiant disorder (2.048), any lifetime anxiety disorder (3.077), adolescent-onset bipolar disorder (1.653), and suicide attempt (15.424). SUD was not predicted by bipolar disorder type, family history of bipolar disorder, hospitalization for a mood episode, ADHD or conduct disorder. CONCLUSIONS: As clinicians struggle to help individuals with bipolar disorder, this study provides information that might be useful in identifying individuals at higher risk for SUD. Future research can examine whether targeting these risk factors may help prevent secondary SUD.
    Comprehensive psychiatry 01/2013; · 2.08 Impact Factor
  • Wilfred R. Pigeon, Jennifer Funderburk
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    ABSTRACT: Primary care is often the place where patients with depression and comorbid insomnia seek treatment. The experience of comorbid insomnia with depression can have a significant impact on the efficacy of other depression treatments and exacerbate depressive symptoms. Using the empirically based Cognitive-Behavioral Treatment for Insomnia (CBT-I) to target the comorbid experience of insomnia in patients with depression can help improve sleep and potentially modify some depressive symptoms. Additional rationale for such an approach includes that a positive therapeutic experience may enhance engagement with or adherence to other psychotherapeutic interventions. Although other brief CBT-I interventions have been developed for primary care, none of them were actually delivered to depressed patients or implemented in primary care. Therefore, this paper describes a brief CBT-I intervention that was designed to be delivered in 4 sessions lasting from 15 to 45 minutes each within a primary care setting to depressed veterans. A case study is provided along with sample materials used in this intervention. In addition, we share implementation tips based on our experiences and feedback from eight veterans who have completed the intervention to date. Overall, the intervention was generally well received and suggests that the intervention may be feasibly delivered in a primary care setting.
    Cognitive and Behavioral Practice 01/2013; · 1.33 Impact Factor
  • Jennifer S. Funderburk, Robyn L. Fielder
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    ABSTRACT: University health centers provide an opportune setting in which psychology graduate students can obtain training in integrated primary care (IPC). The purpose of this article is to describe an advanced practicum experience for psychology doctoral students, who serve as integrated behavioral health providers (BHPs) in a university primary care clinic. First, we describe aspects of our IPC practicum, including planning and development; the theoretical model; implementation of behavioral health screening; structure of patient visits; use of evidence-based practice; management of risky patients; communication with specialty mental health and primary care providers (PCPs); issues related to practicum eligibility, training, and supervision; evaluations; and program maintenance. Then we report on characteristics of 347 patients seen by BHPs over 3 semesters; the most common reasons for referral were sleep, depression, and anxiety. Lastly, we surveyed 7 graduate students who completed the practicum to obtain their views on aspects of the training experience; students reported that they developed new skills and would recommend the practicum to others. Our experience suggests that an IPC practicum in a university health center has the potential to benefit psychology graduate students, primary care providers (PCPs), and patients. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
    Training and Education in Professional Psychology 01/2013; 7(2):112. · 1.58 Impact Factor
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    ABSTRACT: The goals of this study were to (a) describe an Integrated Behavioral Health Care (IBHC) program within a university health center and (b) assess provider and patient acceptability and satisfaction with the IBHC program, including behavioral health screening and clinical services of integrated behavioral health providers (BHPs). Fifteen providers (nine primary care providers and six nurses) and 79 patients (75% female, 65% Caucasian) completed program ratings in 2010. Providers completed an anonymous web-based questionnaire that assessed satisfaction with and acceptability of behavioral health screening and the IBHC program featuring integrated BHPs. Patients completed an anonymous web-based questionnaire that assessed program satisfaction and comfort with BHPs. Providers reported that behavioral health screening stimulated new conversations about behavioral health concerns, the BHPs provided clinically useful services, and patients benefited from the IBHC program. Patients reported satisfaction with behavioral health services and reported a willingness to meet again with BHPs. Providers and patients found the IBHC program beneficial to clinical care. Use of integrated BHPs can help university health centers support regular screening for mental and behavioral health issues. Care integration increases access to needed mental health treatment.
    Families Systems & Health 05/2012; 30(2):130-40. · 1.74 Impact Factor
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    ABSTRACT: Sleep disturbance is a significant problem for adults presenting to primary care. Though it is recommended that primary care providers screen for sleep problems, a brief, effective screening tool is not available. The aim of this preliminary study was to test the utility of item three of the Patient Health Questionnaire-9-item (PHQ-9) as a self-report screening test for sleep disturbance in primary care. This was a cross-sectional survey of male VA primary care patients in Syracuse and Rochester, NY. Sensitivity and specificity statistics were calculated as well as positive and negative predictive value to determine both whether the PHQ-9 item-3 can be used as an effective sleep screen in primary care and at what PHQ item-3 cut score patients should be further assessed for sleep disturbance. One hundred and eleven male, VA primary care patients over the age of 18 and without gross neurological impairment participated in this one-session, in-person study. During the research session, patients completed several questionnaires, including a basic demographic questionnaire, the PHQ-9, and the Insomnia Severity Index (ISI). PHQ-9 item 3 significantly correlated with the total score on the ISI (r = 0.75, p < 0.0001). A cut score of 1 on the PHQ-9 item 3, indicating sleep disturbance at least several days in the last two weeks, showed the best balance of sensitivity (82.5%) and specificity (84.5%) as well as positive (78.4%) and negative (91%) predictive value. Item 3 of the PHQ-9 shows promise as a screener for sleep problems in primary care. Using this one-item of a popular screening measure for depression in primary care allows providers to easily screen for two important issues without unnecessarily adding significant burden.
    Journal of General Internal Medicine 09/2011; 27(3):339-44. · 3.28 Impact Factor
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    ABSTRACT: The integration of behavioral health and primary care has received much attention in the literature. Behavioral health providers (BHPs) in integrated settings are faced with different treatment constraints than those who work in specialty mental health. The existing literature focuses on what BHPs should do in primary care settings; however, little research exists specifying what BHPs are actually doing. This study provides a glimpse into what types of interventions BHPs are using, and what types of patients they are seeing, in primary care. A chart review was conducted of patients (N = 180) seen by BHPs in five Veterans Affairs primary care clinics. Depression was the most common diagnosis, while less common presenting problems included substance abuse/dependence, psychosis, and bipolar disorder. Common interventions used were medical management, psycho-education, elements of cognitive-behavioral therapy (CBT), and supportive psychotherapy. Future research should examine the efficacy of brief interventions in primary care settings.
    Journal of Clinical Psychology in Medical Settings 02/2011; 18(1):22-9. · 1.49 Impact Factor