Peter Fifield

Treating chronic illness is becoming increasingly team-based, yet most team building concepts relate to the team as a dichotomous unit: the medical team and the patient. Patients are expected to be “engaged” and “activated” members of the team, yet there is a gap in knowledge regarding how patients most effectively integrate into the team. Exacerbating the complexity of patient as team member is the multifaceted, ever-changing mood state of patients with cooccurring medical and mental health conditions. The medical field is well aware of the correlations between mental health and chronic illnesses. The purpose of this study is to investigate, from the patient’s perspective, what factors influence the patient’s sense of connectedness to the patient’s care team and how these factors mediate the patient’s positive health behaviors relative to self-care. Findings from a mixed-methods approach showed that the level of perceived confidence relative to self-care of chronic illness was medi...

This chapter explores the legal and ethical challenges one faces by providing behavioral health in a medical setting. The information presented is based on findings from ongoing research and analysis of current literature in addition to discussions with leaders in the field, communications with lawyers and administrators of advocacy and government agencies pertaining to integrated primary care (IPC). The authors propose standards of care that are established based on a myriad of factors, including professional codes of ethics, case law, state and federal laws, professional standards, existing best practices, current professional guidelines, administrative rules and regulations, and licensing board regulations. Regulations may differ for behavioral health and medical providers, posing challenges in IPC settings. This chapter provides a review of these regulations, particularly 42CFR Part 2, a federal law governing confidentiality for substance abuse programs, Health Insurance Portability and Accountability Act (HIPAA), and state laws relevant to patient care in IPC settings as they apply to common ethical issues that arise in an IPC setting. The authors present ethical quandaries through case studies to illustrate decision points and make recommendations related to patient care practices concerning informed consent and release of information procedures, and treatment protocols. These considerations are in light of existing practices and laws that lag behind the tenants of integration. The authors advocate for policy changes to be more compatible with collaboration in the primary care setting.