Innovations in disability care coordination organizations: integrating primary care and behavioral health clinical systems.

Specialized programs have emerged to coordinate care for Medicaid beneficiaries with disabilities who commonly have multiple, complex medical and psychosocial comorbidities. These specialized programs, disability care coordination organizations (DCCOs), center around nurse and social worker care managers who function largely in integrated or collaborative care management models. Two programs extended the traditional DCCO roles of care manager, colocating them in primary care and behavioral clinical settings with results beneficial to care managers, providers, and patients. These initiatives required overcoming the challenges found among differing specialty cultures, insufficient organizational supports, and consumer behaviors that commonly defeat their self-management of their health and life needs. The outcomes are encouraging to care management practice, to primary care and behavioral health providers, the systems in which they practice, and to DCCO beneficiaries. The nurse and social worker care managers and the providers in both systems built positive professional relationships, gained insights into the knowledge and practices of specialties different from their own, and leveraged each other's expertise to the benefit of patients. Organizational systems gained insights into the supports needed to achieve optimal integration and comprehensive care. Outcomes for patients were significant: enhanced abilities to manage their complex health and life situations and realize improved health states.

Patient self-management in the primary care treatment of depression.

Efforts to improve primary care treatment of depression incorporate elements of the chronic illness care model, including patient self-management strategies. Case studies, focus groups and the literature suggest six key components of depression self-management programs: (1) implement behavioral change interventions, (2) plan for crisis and relapse prevention, (3) re-establish personal meaning, (4) attend to patients' experience, context and community, (5) build a patient-clinician partnership and (6) create an integrated, self-management support structure. Successful implementation of these components is facilitated by (1) the care system's collective and empathic understanding of the disease itself; (2) sufficient time; (3) adequate funding and (4) robust clinical information systems.