Primary Care Behavioral Health Clinical Pathways

Primary Care Behavioral Health Clinical Pathways

Primary Care Behavioral Health (PCBH) Clinical Pathways are designed to assist DoD Patient-Centered Medical Homes (PCMHs) in providing improved collaborative care for a number of specific mental health and chronic medical conditions frequently seen in PCMH settings. Each pathway contains guidelines for the provision of coordinated, collaborative care between the primary care manager (PCM) and the internal behavioral health consultant (IBHC), while making use of PCMH staff and data management tools available through the electronic medical record (EMR).

Each pathway contains detailed guidance on strategies for (1) identifying patients for pathway inclusion; (2) connecting the patient with the IBHC; (3) intervening with evidence-based approaches from the IBHC; (4) and monitoring outcomes of care.

Clinical pathways have been developed for depression, anxiety, obesity, diabetes, insomnia, tobacco use, chronic pain and alcohol misuse. IBHCs within DoD have access to this clinical pathway information.

Clinical Pathways

Identify

E.g., Screening, Provider History Exam, PCMH Data Pulls

Connect

E.g., To IBHC, BHCF, or Specialty Behavioral Health Services as appropriate

Intervene

E.g., Medication, IBHC Intervention, Care Facilitation

Monitor

E.g., Standard Assessment Tools, Symptoms, Vitals and Labs