ABSTRACT
Many primary care clinics struggle with rapid implementation and systematic expansion of primary care behavioral health (PCBH) services. Often, an uneven course of program development is due to lack of attention to preparing clinic leadership, addressing operational factors, and training primary care providers (PCPs) and nurses. This article offers competency tools for clinic leaders, PCPs, and nurses to use in assessing their status and setting change targets. These tools were developed by researchers working to disseminate evidence-based interventions in primary care clinics that included fully integrated behavioral health consultants and were then used by early adaptors of the PCBH model. By deploying these strategies, both practicing and teaching clinics will take a big step forward in developing the primary care workforce needed for primary care teams, where the behavioral health needs of a patient of any age can be addressed at the time of need.
Subject(s)
Behavioral Medicine/organization & administration , Delivery of Health Care, Integrated/organization & administration , Leadership , Patient Care Team/organization & administration , Physicians, Primary Care/organization & administration , Primary Care Nursing , Primary Health Care/organization & administration , Clinical Competence , Evidence-Based Medicine/organization & administration , Health Plan Implementation/organization & administration , Humans , Referral and Consultation/organization & administration , United StatesABSTRACT
Snowy owl chicks typically depart from nests at approximately 18 days of age, but 3 weeks before taking their first flight. High concentrations of corticosterone have been implicated in behavioral changes in many species, leading us to assess corticosterone's role in chick nest departure. Corticosterone titers in free-living chicks, however, do not predict this departure event. Baseline corticosterone concentrations decrease as chicks age. By 13 days, corticosterone concentrations are 50% of concentrations in 1-day-old chicks. Baseline concentrations, however, do not differ between departed and nest-bound chicks. Furthermore, corticosterone concentrations become significantly elevated 30min after collecting the baseline sample, indicating that chicks are able to mount a corticosterone response to handling. This stress-induced rise in corticosterone also did not differ between departed and nest-bound chicks. Brood sizes varied, possibly resulting in increased stress in chicks from larger broods. Although many chicks died before reaching departure age, brood sizes at time of nest departure ranged from 1 to 10 chicks. Brood size was not correlated with age of nest departure or individual corticosterone concentrations. These data indicate that it is unlikely that corticosterone plays a role in triggering nest departure in snowy owl chicks.