271:) and problem-solving therapy, compared to usual care by PCP's (i.e. antidepressant medication, drug placebo, or unspecified control). The authors concluded that evidence-based psychotherapies adapted for the primary care setting are comparable to pharmacotherapy alone and superior to PCP's usual care. The use of brief evidence-based psychotherapies, such as those reviewed by Schulberg et al., 2002, are fundamental within the PCBH model. The PCBH model emphasizes a problem-focused and functional-contextual approach to assessment and treatment of behavioral health and mental disorders. Wolf and Hopko's (2008) recent review of treatments for depression in primary care concluded that adaptations of CBT for depression in primary care are "probably efficacious." Research also shows that providing basic training in CBT to PCPs is not enough to produce robust clinical outcomes (King et al., 2002); highlighting the importance of the BHC's integrated role in primary care. With respect to the impact of behavioral health consultation on pharmacological treatment of major and minor depression, compared to usual care Katon et al. (1995) found improved medication adherence, increased patient satisfaction with treatment, and overall greater improvements in mood over time for major depression. Inclusion of a behavioral health professional in the treatment of depression in primary care improves outcomes, patient and physician satisfaction, and costs less than usual care. The PCBH model prioritizes the usage of treatment algorithms based on scientific guidelines that include pharmacological and psychotherapeutic interventions. This approach seeks to ensure that patients receive the safest and most effective treatments available.
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treatment. Many experts believe this low completion rate is tied to the stigma that often surrounds mental health care, causing patients to deny or refuse to seek help for psychiatric needs. As a general rule, patients who do choose to address their mental health concerns express a preference for services in primary care likely due to its familiarity and less stigmatizing environment. However, as many medical providers will admit, their training has left them ill-prepared to appropriately treat the psychiatric sequalae that presents in their clinic. The PCBH model has sought to address this dilemma by providing access to mental health services on site to more effectively target the biological, psychological, and social aspects of patient care. Resulting from close collaboration between physicians and mental health providers, the patients' needs are more adequately met by care that is more comprehensive and collaborative between physicians and mental health providers. Furthermore, the patients are more likely to follow through with primary care services, with referral rates around 80–90%.
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to the enhanced-referral model. Another single-site study at an urban community health center found that embedding BHCs resulted in reduced referrals to specialty mental health (8% of depressed patients were referred) along with improved adherence to evidence-based guidelines for the care of depression and reduced prescriptions for antidepressants. Moreover, a recent literature review revealed that improved outcomes in mental health care were associated with several fundamental characteristics, including collaboration and co-location with PCP and mental health providers, as well as systematic follow-up, medication compliance, patient psycho-education, and patient input into treatment modality. In general the number of empirical investigations that have examined the clinical impact and cost-offset of the BHC model is still limited, although a growing body of evidence supports the utility of other integrated behavior health programs (with varying degrees of integration) in academic settings, Veterans
Affairs Medical Centers, and community health care settings. A 2011
220:. Thus, while it seems there are various "specialty" mental health clinics and psychiatrists alike, the primary care environment continues to lend itself to an array of psychiatric issues. One reason is that physical health problems can contribute to psychological dysfunction and vice versa. Examples of the frequent comorbity between medical and psychological problems include: chronic pain can cause depression; panic symptoms can lead to complaints of heart palpitations; and stress can contribute to irritable bowl syndrome. While these mind-body relationships may seem obvious, often the presenting problem is far less clear, with the physical health problem being masked by psychosocial concerns. In fact, of the 10 most common complaints in primary care, less than 16% had a diagnosable physical etiology. The psychosocial impact on primary care is tremendous (approximately 70% of all visits); however, it is curious that few mental health providers have traditionally placed themselves where the demand for their services is arguably the greatest.
371:, published in 2007, recommended "that early intervention efforts to protect and promote mental health, including screening and the promotion of mental health awareness, become an essential component of primary care visits and school health assessments.". This objective has been largely retained in the proposed objectives for Healthy People 2020. As Hass and deGruy pointed out, "The primary care patient may or may not believe that she has a mental problem, and may or may not be ready to agree to psychological treatment ... primary care psychologists make services accessible and understandable to patients…". Because of the difference in how patients, particularly those from underserved groups, may express their distress and respond to the stigma of mental illness providing Behavioral Health services through primary care will likely make services more psychologically and physically accessible.
391:, uncovered that 60% of physician visits were either individuals who were somatizing stress or whose physical condition was exacerbated by emotional factors. These findings prompted Kaiser to explore various strategies to better manage psychosocial complaints, with ultimate goal of cost reduction. Psychotherapy, which was offered as a prepaid benefit, was studied as a method to reduce primary care visits while also more properly (and less expensively) addressing the problem at hand. Studies revealed that by participating in brief psychotherapy, medical utilization reduced by 65%. The initiatives at Kaiser Permanente set in motion a large body of research on medical cost-offset, a term for the reduction in medical costs that occurs as a result of a patient receiving appropriately designed behavior health services in lieu of more expensive medical services. The
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health consultants (BHCs) work side-by-side with all members of the clinical care team (including primary care providers (PCPs) and nursing staff) to enhance preventive and clinical care for mental health problems that have traditionally been treated solely by physicians. The role of the BHC is to facilitate systemic change within primary care that facilitates a multidisciplinary approach both from a treatment and reimbursement standpoint. BHCs typically collaborate with physicians to develop treatment plans, monitor patient progress, and flexibly provide care to meet patients' changing needs. Moreover, the integrated care model increases behavioral health accessibility, fosters communication between patients and their primary care team, and improves patients' experiences receiving primary care.
402:(HCFA) sponsored the Hawaii Medicaid Project, a seven-year prospective study examining the impact of a new, collaborative behavioral health system among 36,000 Medicaid beneficiaries and 91,000 federal employees in Honolulu. This landmark trial compared the medical cost-offset among patients who received brief and targeted interventions, those who received a 52-session annual psychotherapy benefit, and those who received no treatment. The results showed that the brief, targeted interventions reduced saved $ 350 per patient per year while psychotherapy actually increased costs by $ 750 per year. The Hawaii Medicaid Project became the prototype for cost offset research and spawned future projects among managed care organizations, with goal of reducing costs. In 1987,
422:(VA) systems began to conduct research around the impact of primary care psychologists, beginning with the Healthcare Network of Upstate New York (VISN2). In the last decade, additional VA systems have followed suit with primary care behavioral health programs of their own to meet the increasing mental health demands of soldiers returning from war. More recently, federal support has begun to take hold by increasing funding for integrated behavioral health services for various federally qualified health centers (FQHCs) in the United States. Primary care behavioral health was seen as a solution in FQHCs to address the mental health needs of the Medicaid and uninsured populations, with the goal of better treatment and reduced overall costs.
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BHCs also provide support and management for patients with severe and persistent mental illness and tend to be familiar with psychopharmacological interventions. Paralleling general medicine, patients who require more extensive mental health treatment are typically referred to specialty care. BHC appointments are typically 15–30 minutes long with the goal of utilizing brief interventions to reduce functional impairment for the population as a whole. BHCs tend to provide focused feedback to PCPs with succinct, action oriented recommendations to help effectively manage patients' needs. BHC interventions tend to be more cost effective and offer increased access to care, with improved patient and provider satisfaction.
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Medicaid) is the prohibition of same-day billing. This makes it impossible for a PCBH program since the fundamental concept behind PCBH is the provision of services (medical and mental health visit) on the same day. Typically eligible professionals for
Medicaid reimbursement in federally qualified health centers include psychiatrists, psychologists and licensed clinical social workers. Access to care and payment tends to be less restrictive with Medicare, another federal program for persons without private insurance.
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Mexico. The changing population of the United States is generating a need to incorporate cultural competence into the way primary care services are delivered. These changes in the population are concurrent with increasing evidence of disparities in the quality of care that is provided to historically underserved populations within the United States. Underserved populations have low levels of access and utilization based on economic, cultural, and systemic barriers to care.
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packaged brief CBT with pharmacotherapy reduced disability, increased remitted symptoms, and decreased anxiety sensitivity for individuals diagnosed with panic disorder relative to usual care and demonstrated greater improvement in depression, anxiety, and disability measures at 6 month follow-up,. Further, clinical guidelines for the treatment of generalized anxiety disorder and panic disorder in primary care recommend behavior therapy and/or SSRI.
25:
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model of health and illness, Social and environmental factors affecting adherence, Fears and concerns about medication and side effects, Treatment understanding model of culturally competent practice". By adopting this kind of approach, Behavioral Health providers can help primary care providers meet the medical, psychological, and cultural needs of the patient.
395:(NIMH) funded several replications examining medical cost offset in the years to follow, with reductions of cost around 30 to 65%. One important trend that emerged in this literature was the greater the collaboration between primary care, the better the cost offset. Likewise, the more "traditional" the behavioral interventions, the less the medical cost offset.
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depending on the mental health concern. Typically, little contact occurs between therapists and patients' physicians or psychiatrists, and coordination of care may be difficult, time consuming, and expensive. The payment and access systems for specialty mental health are also usually distinct from and more cumbersome than that for primary care treatment.
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patient and the health provider may render medical care 'psychologically' inaccessible to ethnic minorities, resulting in poorer health outcomes for these populations (possibly via noncompliance)." Strategies that help bridge mismatches improve treatment outcomes and make care more accessible for underserved populations.
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In regard to other health behaviors, strict utilization of the BHC model has shown significant improvements in sleep difficulties, while less integrated models of behavioral health have produced favorable outcomes for smoking cessation, diabetes adherence, and pain disorders. Whitlock et al., suggest
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A comparison of an enhanced-referral system to a BHC model found that more than 80% of medical providers rated communication between themselves and the BHC as occurring "frequently," relative to less than 50% in an enhanced-referral model of care. Providers strongly preferred an integrated care model
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The PCBH model enables early identification and behavioral/medical intervention that can prevent some acute problems from becoming chronic health care problems (such as chronic pain, diabetes, COPD, hypertension, obesity), which are the cause of many medical visits to primary care clinics. Behavioral
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Providing culturally-competent, population based care can difficult to conceptualize, particularly in the context of the fast-paced environment of primary care. Hunter et al. propose "a patient-centered, culturally competent approach for effective communication and care…that includes the
Explanatory
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Funding has been a barrier to the implementation of the PCBH consultant model. The cost of treatment and lack of affordable health care has been a barrier for many people with mental illness to receive treatment. In the private sector insurance market mental health treatment is often segregated from
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Behavioral health providers in primary care settings have an opportunity to directly impact health care disparities by designing "…strategies to enhance cooperative or healthy behavior". "The premise is that mismatches in models (i.e., expectations about illness and health interactions) between the
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Behavioral health consultants are culturally competent generalists who provide treatment for a wide variety of mental health, psychosocial, motivational, and medical concerns, including management of anxiety, depression, substance abuse, smoking cessation, sleep hygiene, and diabetes among others.
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The other major issue impacting the development of the PCBH model is the dearth of well-trained mental health workers. At present professional training programs with an emphasis in primary care are limited in number which has led to the growth of internships of varying kinds to train students and
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found that counselling in primary care settings resulted in significantly greater clinical effectiveness in short term mental health outcomes compared to usual care but provided no longer term benefits. Since all of the studies reviewed were from the United
Kingdom, how well these findings can be
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This model uses databases or what are known as registries to track and monitor patients with certain conditions. Typical examples in primary care include diabetes and depression. Often the person managing the registry is a nurse or mental health professional who performs follow-up phone calls and
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Primary care practice has traditionally adopted a generalist approach whereby physicians are trained in the medical model and solutions to problems typically involve medications, procedures, and advice. Appointment times are short, with the goal of seeing a large number of patients in a day. Many
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Commonly called "specialty" care, traditional outpatient psychotherapy usually involves treatment of mental health concerns in an outpatient clinic or another setting independent of medical care. Sessions are usually 50 minutes in length and the duration of treatment may vary from weeks to years
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estimate that by the year 2042 White, non-Hispanic people will no longer be the majority of the population in the United States. According to the 2010 census, White, non-Hispanic people are no longer the majority of the population in Texas, California, the
District of Columbia, Hawaii, and New
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have identified integrated care as key targets for improved primary care, the PCBH model has been able to take root in these systems whereas only a few PCBH programs exist in private insurance environments. One major barrier in some states (states can set some of their own rules with regard to
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Although less empirical attention has been directed toward improving treatment of anxiety disorders in primary care, Stanley et al. found 8 sessions of CBT delivered in a co-located model, superior to usual care for generalized anxiety disorder. Additionally, a collaborative care approach that
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which provides insurance coverage for a large number of individuals with severe and persistent mental illness. The federal government provides money to each state to fund
Medicaid programs and provides general mandates on how the money must be spent. Because the federal government has special
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Despite the availability of outpatient mental health resources, research indicates that patients are still driven to the primary care setting. In fact, studies show that as little as 10% of patients actually follow through when being referred by a physician to receive outpatient mental health
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Provision of clinical mental health services through a population-based focus on the common problems confronting a majority of individuals. Such issues treated in primary care may include response to physical illness, stress, affective concerns, substance use and abuse, and developmental and
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followed suit by studying brief behavioral intervention among
Medicare recipients in Florida, with the intention of reducing medical utilization among recent widows and widowers. Known as the Bereavement Program, Humana learned after 2 years $ 1400 could be saved per patient via brief group
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Slay, J.D., & McCleod, C. (1997) Evolving an integration model: The
Healthcare Partners experience. In N.A. Cummings, J.L. Cummings, and J. Johnson (Eds.) Behavioral health in primary care: A guide for clinical integration (pp 121–144). New York: International Universities
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Behavioral health providers and PCPs practice within the same office or building but maintain separate care delivery systems, including records and treatment plans. However, behavioral health providers and PCPs may consult one another for enhanced treatment outcomes.
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clinic. The goal of PCBH is to improve and promote overall health within the general population. This approach is important because approximately half of all patients in primary care present with psychiatric comorbidities, and 60% of psychiatric illness is treated in
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Armstrong, T., & Swartzman, L. (2001), Cross-cultural differences in illness models and expectations for the health care provider-client/patient interaction. In S. Kazarian and D. Evans (Eds.), Cultural health psychology, (pp. 45–61). San Diego, CA: Academic
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National
Institute for Health and Clinical Excellence. (2001). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: management in primary, secondary and community care. (Clinical guideline 113.). Available from NICE
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patients present with behavioral health care needs that may overlap with medical disorders and that may exacerbate, complicate, or masquerade as physical symptoms. In addition, many medical problems present with associated psychological
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mental health system in the United States. Research shows that approximately half of all mental health care services are provided solely by primary care providers. Furthermore, primary care practitioners prescribe about 70% of all
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brief behavioral interventions have only a modest impact on health behavior change. However, they also suggested that within a population-based model of care modest changes in behavioral health "translate to significant effects."
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Ahles, T., Wasson, J., Seville, J. L., Johnson, D. J., Cole, B. F., Hanscom, B., et al. (2006). A controlled trial of methods for managing pain with or without co-occurring psychological problems. Annals of Family
Medicine, 3,
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Cummings, N.A. (1997). Approaches in prevention in the behavioral health of older adults. In P. Hartman-Stein (Eds.) Innovative behavioral healthcare for older adults: A guide-for changing times (pp. 1–23). San Francisco:
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Narrow, W.; Reiger, D.; Rae, D.; Manderscheid, R.; Locke, B. (1993). "Use of services by persons with mental and addictive disorders: Findings from the Institute of Mental Health Epidemiologic Catchment Area Program".
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Katon, W.; Korff, Von; Lin, E.; Walker, E.; Simon, G. E.; Bush, T.; Robinson, P.; et al. (1995). "Collaborative management to achieve treatment guidelines. Impact on depression in primary care ( No. 13)".
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Hunter, C.L., Goodie, J.L., Oordt, M.S., & Dobmeyer A.C., (2009), Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. Washington, DC: American Psychological
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Jones, K.R., & Vischi, T.R. (1980). The Bethesda Consensus Conference on Medical Offset. Alcohol, drug abuse, and mental health administration report. Rockville, MD: Alcohol, Drug Abuse, and Mental Health
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Ridgeway, N.; Harvill, D.; Harvill, L.; Falin, T.; Forester, G.; Gose, O. (1999). "Improved control of type 2 diabetes mellitus: a practical education/behavior modification program in a primary care clinic".
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Fiore, M., Bailey, W., Cohen, S., et al. (2000). Treating Tobacco Use and Dependence. A Clinical Practice Guideline. Rockville, MD: U.S. Dept. of Health and Human Services; AHRQ publication No. 00-0032.
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James, L.C. (2009) What administrators should know about the primary care setting. In L.C. James & W.T. O'Donohue (Eds.). The primary care toolkit (pp 13–19). N.Y.: Springer Science + Business Media
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intervention for bereavement. In the 1990s, other HMOs and regional group practices began to integrate behavioral health services into primary care, including Kaiser Permanente, Healthcare Partners,
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Haas, L.J., & deGruy, F.V. (2004). Primary care, psychology, and primary care psychology. In Haas, L.J. (Ed.), Handbook of Primary Care Psychology, (pp. 5–19). New York: Oxford University Press.
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Cummings, N.A., O'Donohue, W., Hays, S.C., & Follette, V. (2001). Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice. San Diego: Academic Press.
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Haley, W.E.; McDaniel, S.H.; Bray, J.H.; Frank, R.G.; Heldring, M.; Johnson, S.B.; Lu, E.G.; et al. (1998). "Psychological practice in primary care settings: Practical tips for clinicians".
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O'Donohue, W.T., Cummings, N.A., Cucciare, M.A., Runyan, C.N., & Cummings, J.L. (2006). Integrated behavioral health care: A guide to effective intervention. Amherst, NY: Humanities Books.
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other medical care, isolated in separate systems of care and payment. Typically this makes it more difficult for patients to access services readily, if at all. For uninsured patients the
150:(such as stress, emotional reactions, dysfunctional lifestyle behaviors), that are amenable to change through behavioral interventions that can improve outcomes for these health problems.
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Koehler, AN, et al. (2022). "Cost Analysis of Integrated Behavioral Health in a Large Primary Care Practice." Journal of Clinical Psychology in Medical Settings. Vol 29. Pages 446–452.
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may retain the traditional session length of specialty care or may adhere to a brief, consultative approach that is solution-focused. Primary care psychologists may often be trained in
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Schulberg, H. C.; Raue, P. J.; Rollman, B. L. (2002). "The effectiveness of psychotherapy in treating depressive disorders in primary care practice: clinical and cost perspectives".
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U.S. Department of Health and Human Services, Office of Disease Prevention & Health Promotion. (2009). Proposed Healthy People 2020 Objectives. Retrieved March 14, 2010, from
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Koehler, AN, et al. (2019). "Patient Views of Behavioral Health Providers in Primary Care: A Qualitative Study of 2 Southeastern Clinics." Journal of Patient Experience.
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assists the primary care team in following evidence-based protocols. There is often also a consulting psychiatrist who oversees the provision of care in primary care.
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Roy-Byrne, P.; Katon, W.; Cowley, D.; Russo, J. (2001). "A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care".
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collaborate within the same system. The behavioral health provider works as part of the medical team to meet the wide range of needs with which patients present.
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As the population of the United States becomes more diverse, the approach to population-based care must also adjust accordingly. Projections published by the
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situational issues among others. Primary care psychologists are co-located with primary care providers and usually share the same physical space in practice.
1191:"Moving an Innovative Depression Care Model from Research to Practice: A Conversation With IMPACT Implementation Center Director Jürgen Unützer, MD, MPH, MA"
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By establishing a role in primary care, the front-line of health-care delivery, behavioral health providers gain direct access to patients and providers.
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In the years to follow, behavioral health integration started to gain support from a federal level, as
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Bower, Peter; Knowles, Sarah; Coventry, Peter A.; Rowland, Nancy (2011-09-07).
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129:) consultation model is a psychological approach to population-based clinical
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that is simultaneously co-located, collaborative, and integrated within the
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263:(RCTs) that examined evidence-based treatments for major depression (
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Psychological approach to population-based clinical health care
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Roy-Byrne, P.; Craske, M.; Stein, M.; et al. (2005).
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Michael King, O. D. F. T. A. H. D. S.; Turner, R. (2002).
1551:"Healthy People 2020 - Improving the Health of Americans"
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of Puget Sound, Kaiser Group Health of Minnesota, and
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JAMA: The Journal of the American Medical Association
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Primary Care Companion Journal of Clinical Psychiatry
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retrain professionals (see training programs below).
259:, Schulberg, Raue, & Rollman (2002) reviewed 12
351:PCBH and health disparities in the United States
325:can provide (depending on eligibility criteria)
1514:Professional Psychology: Research and Practice
514:Professional Psychology: Research and Practice
1213:Journal of Consulting and Clinical Psychology
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1579:TopicArea=Mental+Health+and+Mental+Disorders
420:United States Department of Veterans Affairs
987:The Cochrane Database of Systematic Reviews
967:https://doi.org/10.1007/s10880-022-09866-9
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501:https://doi.org/10.1177/2374373519860357
1436:American Journal of Preventive Medicine
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205:Primary care has often been termed the
228:The behavioral health consultant model
45:Please improve this article by adding
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671:10.1001/archpsyc.1988.01800360065009
636:10.1001/archpsyc.1993.01820140017002
400:Health Care Financing Administration
298:Traditional outpatient psychotherapy
393:National Institute of Mental Health
1652:Mental health in the United States
1502:prod/cen2010/briefs/c2010br-02.pdf
336:federally qualified health centers
183:Behavioral health consultants and
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1332:http://guidance.nice.org.uk/CG113
175:programs, but not exclusively so.
1403:10.1097/00007611-199907000-00004
1168:10.1001/jama.1995.03520370068039
323:United States federal government
58:"Primary care behavioral health"
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763:10.1016/j.socscimed.2007.03.015
1480:http://mentalhealth.samhsa.gov
1346:Journal of Clinical Psychology
1297:Archives of General Psychiatry
1252:Archives of General Psychiatry
995:10.1002/14651858.CD001025.pub3
786:Journal of Behavioral Medicine
659:Archives of General Psychiatry
624:Archives of General Psychiatry
413:Duke University Medical Center
123:primary care behavioral health
1:
1458:10.1016/S0749-3797(02)00415-4
1048:10.1016/S0163-8343(02)00175-5
751:Social Science & Medicine
47:secondary or tertiary sources
715:10.1016/0002-9343(89)90293-3
703:American Journal of Medicine
261:randomized controlled trials
180:Behavioral health consultant
1036:General Hospital Psychiatry
574:10.1136/bmj.38683.710255.BE
265:interpersonal psychotherapy
1678:
1526:10.1037/0735-7028.29.3.237
1225:10.1037/0022-006X.71.2.309
1071:Clinical Psychology Review
526:10.1037/0735-7028.37.6.676
334:hospitals and clinics and
293:Alternative models of care
269:cognitive-behavior therapy
169:Primary care psychologists
1309:10.1001/archpsyc.58.9.869
1264:10.1001/archpsyc.62.3.290
1083:10.1016/j.cpr.2007.04.004
914:Wisconsin Medical Journal
869:Annals of Family Medicine
798:10.1007/s10865-005-9019-2
1391:Southern Medical Journal
1122:10.1136/bmj.324.7343.947
850:10.1177/0091217420951059
409:Group Health Cooperative
340:several federal agencies
332:Veteran's Administration
214:psychotropic medications
1500:https://www.census.gov/
1110:British Medical Journal
255:Specifically targeting
185:primary care physicians
163:Primary care psychology
1610:Managed Care Quarterly
284:Health behavior change
34:relies excessively on
947:(6 Suppl 1): 7S–72S.
307:Co-located care model
838:Int J Psychiatry Med
457:10.4088/PCC.v03n0501
383:In the early 1960s,
369:Healthy People 2010
330:relationships with
1657:Applied psychology
1485:2010-08-22 at the
1358:10.1002/jclp.20548
357:U.S. Census Bureau
192:Collaborative care
1162:(13): 1026–1031.
1116:(7343): 947–950.
665:(12): 1117–1119.
385:Kaiser Permanente
173:health psychology
119:
118:
111:
93:
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1626:
1625:
1605:
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1553:. Archived from
1546:
1540:
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698:
692:
689:
683:
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654:
648:
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618:
612:
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596:
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568:(7536): 259–63.
553:
547:
543:
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509:
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497:
491:
488:
479:
478:
468:
436:
158:Associated terms
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94:
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51:
27:
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1598:Administration.
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251:Depression care
244:Cochrane review
239:
230:
218:antidepressants
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40:primary sources
28:
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1520:(3): 237–244.
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1442:(4): 267–284.
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1077:(1): 131–161.
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1557:on 2012-08-02
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630:(2): 95–107.
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60: –
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54:Find sources:
48:
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32:This article
30:
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21:
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1662:Primary care
1635:Jossey-Bass.
1630:
1616:(2): 64–70.
1613:
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1555:the original
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1489:/cre/toc.asp
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1566:default.htm
387:, an early
216:and 80% of
131:health care
1646:Categories
1561:2011-06-23
1197:2013-09-24
426:References
257:depression
99:April 2015
69:newspapers
36:references
1444:CiteSeerX
1003:1469-493X
201:Rationale
1622:10134004
1483:Archived
1466:11988383
1411:10414474
1366:19152339
1317:11545671
1282:15753242
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327:Medicaid
208:de facto
148:sequelae
1273:1237029
1012:7050339
890:1466686
723:2919607
679:2904248
644:8381266
583:1360390
379:History
83:scholar
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316:Policy
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810:S2CID
90:JSTOR
76:books
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1362:PMID
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1278:PMID
1229:PMID
1136:PMID
1087:PMID
1052:PMID
1017:PMID
999:ISSN
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922:PMID
895:PMID
802:PMID
767:PMID
719:PMID
675:PMID
640:PMID
588:PMID
471:PMID
127:PCBH
121:The
62:news
1522:doi
1454:doi
1399:doi
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1305:doi
1268:PMC
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