Table 2 Item content, content domains, and consensus ratings of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)
Original Item | Content domain | Research team rating | Final item, if modified from original | Delphi rating |
|---|---|---|---|---|
1. During clinical encounters with patients, I see patients for 30 minutes or less. | Practice and Session Management | Essential | N/A | 83% Essential |
2. I manage patients reporting mild and moderate symptoms and refer those with more severe symptoms to other behavioral health services. | Practice and Session Management | Essential | 2. I manage patients reporting mild and moderate symptoms in primary care, and I refer those with more severe symptoms to specialty mental health services when possible. | 88% Essential |
3. During clinical encounters with a patient, I discuss barriers to implementing a plan or adhering to treatment recommendations. | Practice and Session Management | Essential | 3. During patient appointments, I discuss barriers to implementing a plan or adhering to treatment recommendations. | 80% Essential |
4. I collaborate with primary care team or PACT staff to provide group medical visits to patients | Consultation, Collaboration, and interprofessional communication | Compatible | 4. I collaborate with primary care team staff to provide group medical visits (or shared medical appointments) to patients. | 80% Compatible |
5. I accept referrals for patients with traditional mental health problems (i.e. depression, anxiety, PTSD, etc.). | Referral management and care continuity | Essential | 5. I accept referrals for patients with common mental health problems (i.e. depression, anxiety, etc.). | 80% Essential |
6. During clinical encounters with a patient, I implement behavioral and/or cognitive interventions. | Clinical scope and Interventions | Essential | N/A | 86% Essential |
7. In introducing my role in the clinic to patients, I explain that I want to get an idea of what is and what is not working for the patient and then together develop a plan to help them manage their concerns. | Practice and Session Management | Essential | 7. In introducing my role in the clinic to patients, I explain that I want to get an idea of what is and what is not working for the patient and then together develop a plan to help them manage their concerns. | 80% Essential |
8. During clinical encounters with patients, I triage patients to determine if they can be treated in primary care or should be referred to a specialty mental health or a community agency. | Practice and Session Management | Essential | N/A | 86% Essential |
9. I accept referrals for patients in need of behavioral health interventions for chronic pain. | Referral Management and Care Continuity | Essential | 9. I accept referrals for patients who might benefit from brief, targeted behavioral health interventions for chronic pain. | 80% Essential |
10. I accept referrals for patients in need of behavioral health interventions for adjustment to illness (i.e., diabetes, heart disease, spinal cord injury, TBI, etc.). | Referral Management and Care Continuity | Essential | 10. I accept referrals for patients who might benefit from brief, targeted behavioral health interventions for adjustment to illness (i.e., diabetes, heart disease, spinal cord injury, TBI, etc.). | 96% Essential |
11. My progress notes include focused recommendations for the PCP | Practice and Session Management | Essential | 11. My progress notes in the shared medical record include focused recommendations for the Primary Care Provider and/or primary care team. | 88% Essential |
12. I huddle with the primary care team or PACT staff to provide both a behavioral health perspective and behavioral data. | Consultation, Collaboration, and interprofessional communication | Essential | 12. I meet briefly with primary care staff as a team to provide both a behavioral health perspective and behavioral data. | 88% Essential |
13. My progress notes include focused recommendations for the patient. | Practice and Session Management | Essential | N/A | 86% Essential |
14. During clinical encounters with patients, I provide educational handouts to the majority of patients. | Clinical Scope and Interventions | Essential | 14. During patient appointments, I provide educational handouts when appropriate. | 72% Compatible |
15. I routinely consult with primary care team or PACT staff other than the PCP (i.e., pharmacist, dietician) about behavioral aspects of medical conditions (i.e., medications that cause nightmares.) | Consultation, Collaboration, and interprofessional communication | Essential | 15. I consult with various members of the primary care team (i.e., pharmacist, dietician) in addition to the Primary Care Provider about behavioral aspects of medical conditions (i.e., medications that cause nightmares.) | 80% Essential |
16. At follow-up encounters with patients, I inquire about progress on goals or action plans set at the previous appointment. | Practice and Session Management | Essential | N/A | 90% Essential |
17. During clinical encounters with patients, I routinely complete standardized measures for an initial screening (e.g., PHQ-9, PCL, or brief cognitive screening). | Practice and Session Management | Essential | 17. I administer one or more brief validated measures (e.g., Patient Health Questionnaire-9, or PHQ-9) for an initial screening of symptoms of interest, or I review these findings if measures were administered by other primary care staff. | 84% Essential |
18. I document a full-length treatment plan with multi-axial diagnosis after the initial encounter. | Practice and Session Management | Prohibited | 18. It takes 30 minutes or more for me to complete all documentation following the initial appointment. | 80% Prohibited |
19. During a clinical encounter with a patient, I use reflection of affect and silence to promote emotional exploration. | Clinical Scope and Interventions | Prohibited | 19. During patient appointments, I promote emotional exploration. | 88% Compatible |
20. Following clinical encounters with patients, I provide feedback to the PCP within 1 business day of initial patient contact. | Consultation, Collaboration, and interprofessional communication | Essential | 20. Following patient appointments, I provide feedback to Primary Care Providers (based on their preferred method of communication) within 1 business day of an initial appointment. | 96% Essential |
21. During clinical encounters with patients, I clarify, confirm, and discuss the patient’s concerns. | Practice and Session Management | Essential | N/A | 86% Essential |
22. My progress notes include a brief clinical conceptualization or impressions. | Practice and Session Management | Essential | 22. My progress notes include brief clinical impressions of the patient’s presenting problem(s). | 80% Essential |
23. During a clinical encounter with a patient, I provide full neuropsychological, cognitive, or personality assessments. | Clinical Scope and Interventions | Prohibited | N/A | 96% Prohibited |
24. I see patients for weekly, open-ended therapy. | Practice and Session Management | Prohibited | N/A | 86% Prohibited |
25. In introducing my role in the clinic to patients, I explain that our sessions will be less than 30 minutes. | Practice and Session Management | Essential | 25. In introducing my role in the clinic to patients, I explain that our appointments typically will be 30 minutes or less. | 84% Essential |
26. I provide behavioral health crisis or emergency intervention (i.e. suicide intervention) as the CCC BHP. | Clinical Scope and Interventions | Compatible | 26. I provide suicide risk assessment for primary care patients in crisis and refer to a higher level of care as indicated. | 84% Essential |
27. During clinical encounters with patients, I see patients for 50-minute appointment. | Practice and Session Management | Prohibited | 27. I typically see patients for 50-minute appointments. | 80% Prohibited |
28. During clinical encounters with patients, I use local community resources to assist me in meeting the behavioral health needs of patients. | Practice and Session Management | Essential | 28 During patient appointments, I use local community resources to assist me in meeting the behavioral health needs of patients. | 84% Essential |
29. I provide education to the primary care team or PACT staff on behavioral health issues (e.g., presentations and handouts). | Consultation, Collaboration, and interprofessional communication | Essential | N/A | 86% Essential |
30. I provide advice to primary care team or PACT staff about appropriate referrals to specialty behavioral health services. | Referral Management and Care Continuity | Essential | N/A | 86% Essential |
31. I conduct follow-up sessions via telephone. | Practice and Session Management | Compatible | 31. I conduct follow-up appointments via telephone when appropriate. | 88% Compatible |
32. During a clinical encounter with a patient, I provide traditional family therapy to patients and couples. | Clinical Scope and Interventions | Prohibited | 32. I provide family or couples therapy for 10 or more appointments per episode of care. | 84% Prohibited |
33. During a clinical encounter with a patient, I primarily use open-ended questions. | Clinical Scope and Interventions | Prohibited | 33. During patient appointments, I use open-ended questions. | 72% Compatible |
34. On average, I see patients for only 2–3 consultations. | Practice and Session Management | Essential | 34. I typically see patients for 6 or less appointments per episode of care. | 79% Essential |
35. My progress notes include findings from functional assessments and brief screening instruments. | Practice and Session Management | Essential | N/A | 96% Essential |
36. During clinical encounters with patients, I complete standardized measures for assessing change at follow up (e.g., PHQ-9, PCL, or brief cognitive screening). | Practice and Session Management | Essential | 36. I administer one or more brief validated measures (e.g., Patient Health Questionnaire-9, or PHQ-9) for follow up screening of symptoms of interest, or I review these findings if measures were administered by other primary care staff. | 84% Essential |
37. I routinely consult with PCPs to increase my knowledge about behavioral aspects of medical conditions, such as the role of anxiety in cardiac distress. | Consultation, Collaboration, and interprofessional communication | Essential | N/A | 83% Essential |
38. During a clinical encounter with a patient, I provide supportive interventions without addressing cognitive or behavioral change. | Clinical Scope and Interventions | Compatible | 38. During a patient appointment, I provide supportive interventions without addressing cognitive or behavioral change. | 84% Compatible |
39. During a clinical encounter with a patient, I provide full-length empirically supported treatments (ESTs), such as Prolonged Exposure or Cognitive Processing Therapy. | Clinical Scope and Interventions | Prohibited | 39. During a patient appointment, I provide full-length empirically supported treatments, such as Prolonged Exposure or Dialectical Behavior Therapy. | 88% Prohibited |
40. Following clinical encounters with patients, I continue to provide feedback to the PCP about follow-up appointments when needed. | Consultation, Collaboration, and interprofessional communication | Essential | N/A | 90% Essential |
41. During clinical encounters with patients, I work with the patient to develop a specific plan to address their presenting problem and document this plan. | Practice and Session Management | Essential | N/A | 83% Essential |
42. I accept referrals for patients who need lifestyle interventions (e.g., tobacco cessation, weight control, stress management). | Referral Management and Care Continuity | Essential | N/A | 97% Essential |
43. I accept referrals for patients in need of behavioral health interventions for medication issues (i.e., adherence). | Referral Management and Care Continuity | Essential | N/A | 86% Essential |
44. During a clinical encounter with a patient, I provide traditional psychotherapy and specialized behavioral interventions. | Clinical Scope and Interventions | Prohibited | 44. I typically see patients for 10 or more appointments per episode of care. | 88% Prohibited |
45. Following clinical encounters with patients, I schedule follow-ups at least two weeks apart. | Practice and session management | Essential | 45. Following patient appointments, I typically schedule follow-ups at least two weeks apart. | 84% Compatible |
46. I accept referrals for patients in need of behavioral health interventions for adjustment to aging and issues specific to older patients. | Referral Management and Care Continuity | Essential | 46. I accept referrals for patients in need of behavioral health interventions for adjustment to aging and issues specific to older patients. | 80% Essential |
47. During a clinical encounter with a patient, I provide a highly structured encounter to address functional assessment, focused intervention, and disposition. | Practice and Session Management | Essential | 47. During a patient appointment, I provide functional assessment, focused intervention, and address disposition. | 92% Essential |
48. I provide brief psycho-education and symptom management groups as part of my role as CCC BHP. | Clinical Scope and Interventions | Compatible | 48. I provide brief psycho-educational groups or classes on specific topics (such as mood management, stress reduction, etc.). | 80% Compatible |
49. During a clinical encounter with a patient, I provide brief consultation to couples or families. | Clinical Scope and Interventions | Compatible | 49. I have appointments with couples and families as appropriate. | 68% Compatible |
50. I accept referrals for patients from PCPs as a warm hand off (i.e., the PCP introduces me to the Veteran). | Referral management and Care continuity | Essential | N/A | 100% Essential |
51. In introducing my role in the clinic to patients, I explain that I work with the PCPs in situations where good healthcare involves paying attention to physical health, habits, behaviors, emotional health and how those things interact. | Practice and Session Management | Essential | N/A | 83% Essential |
52. I provide long-term (i.e., greater than 6 sessions) group psychotherapy, such as DBT, as part of my role as CCC BHP. | Clinical Scope and Interventions | Prohibited | 52. I provide long-term (i.e., greater than 8 sessions) group psychotherapy. | 80% Prohibited |
53. During a clinical encounter with a patient, I obtain a full psycho-social history. | Clinical scope and Interventions | Prohibited | 53. I meet with a patient for greater than 50 minutes to gather a full psycho-social history and comprehensive psychiatric interview. | 88% Prohibited |
54. During a clinical encounter with a patient, I provide medical social work services. | Clinical Scope and Interventions | Prohibited | 54. During a patient appointment, I typically provide medical social work services, including, but not limited to, assistance with disability claims, obtaining health insurance, and/or assisting with housing. | 88% Prohibited |
55. During clinical encounters with patients, I address the PCPs reason for referral. | Practice and Session Management | Essential | N/A | 93% Essential |
56. I employ strategies to identify and prevent exacerbation of at-risk, sub-syndromal behaviors and symptoms. | Clinical Scope and Interventions | Essential | N/A | 83% Essential |
57. Not included in Round 1 Survey | Consultation, Collaboration, and interprofessional communication |  | 57. I provide information regarding a patient’s symptoms and functioning to assist Primary Care Providers (and/or clinical pharmacists, primary care psychiatrists, psychiatric nurse practitioners) in initiating or modifying common psychotropic medications, such as antidepressants. | 84% Essential |
58. Not included in Round 1 Survey | Clinical Scope and Interventions | Â | 58. I participate in primary care based clinical pathways for common health conditions, such as chronic pain or comorbid depression and cardiovascular disease. A clinical pathway is an approach to managing patients with common conditions by utilizing empirically supported interventions in a pre-defined sequence among a multidisciplinary group of providers. | 80% Essential |