Configuring Health Care for Systematic Behavioral Screening and Intervention
Abstract
The United States Preventive Services Task Force recommends universal screening and intervention for tobacco use, excessive drinking, and depression. These services improve health outcomes, decrease health care costs, enhance public safety, and generate substantial return on investment. Given the prevalence rates of these behavioral conditions and the time necessary for evidence-based interventions, it will be challenging to integrate behavioral screening and intervention (BSI) into busy health care settings. Therefore, consistent with the principles of the medical home and the chronic care model, the health care team must be expanded to systematically provide BSI. A 2-tiered, stepped-care model is proposed. The first tier of services—consisting of assessment, intervention, and follow-up services—would address most mild-to-moderate behavioral risks or conditions. The second tier would include various specialty-based resources, which would be conserved for patients with greatest need and potential to benefit. With slight enhancement of their training, health educators would be excellent candidates to serve as cost-efficient providers of first-tier services. The proposed model would help the United States realize improved health outcomes and cost savings as health care benefits are expanded to a greater proportion of its population. ( Population Health Management 2011;14:299–305)
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
An effective healthcare system to improve cardiovascular health by fostering healthy lifestyle change may resemble a 2-tiered, stepped care model.
“An effective healthcare system to improve cardiovascular health by fostering healthy lifestyle change may resemble a 2-tiered, stepped care model.81”
From Better Population Health Through Behavior Change in Adults: A Call to Action (2013) · cites this paper as [81]
Cites
Actual Causes of Death in the United States, 2000
Mokdad, A. H. (2004) · JAMA · doi:10.1001/jama.291.10.1238 · Cited by 5,211 · see citing works
(1991) · Medical Entomology and Zoology · Cited by 4,438 · see citing works
Treating Tobacco Use and Dependence
(2008) · PEDIATRICS · doi:10.1542/peds.2008-1627 · Cited by 2,701 · see citing works
Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010) · JAMA · doi:10.1001/jama.2009.1943 · Cited by 2,009 · see citing works
Hettema, J., Steele, J., & Miller, W. R. (2005) · Annual Review of Clinical Psychology · doi:10.1146/annurev.clinpsy.1.102803.143833 · Cited by 1,803 · see citing works
Effectiveness of brief alcohol interventions in primary care populations
Kaner, E. F., Beyer, F. R., Muirhead, C., Campbell, F., Pienaar, E. D., Bertholet, N., Daeppen, J. B., Saunders, J. B., & Burnand, B. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004148.pub4 · Cited by 1,665 · see citing works
Primary Care: Is There Enough Time for Prevention?
Yarnall, K. S. H., Pollak, K. I., Østbye, T., Krause, K. M., & Michener, J. L. (2003) · American Journal of Public Health · doi:10.2105/ajph.93.4.635 · Cited by 1,641 · cited 1× · see citing works
“Indeed, to deliver all recommended prevention services to an average-size patient panel, primary care providers would have to spend more than 7 hours every day.(44) Consistent with the principles of the medical home(45) and the chronic care model as adopted for prevention,(46) the health care team must be expanded if…”
Relationship of Depression and Diabetes Self-Care, Medication Adherence, and Preventive Care
Lin, E. H. B., Katon, W., Von Korff, M., Rutter, C., Simon, G. E., Oliver, M., Ciechanowski, P., Ludman, E. J., Bush, T., & Young, B. (2004) · Diabetes Care · doi:10.2337/diacare.27.9.2154 · Cited by 1,146 · see citing works
Comparison of extended versus brief treatments for marijuana use.
Stephens, R. S., Roffman, R. A., & Curtin, L. (2000) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.68.5.898 · Cited by 711 · see citing works
Interventions for promoting physical activity
Foster, C., Hillsdon, M., Thorogood, M., Kaur, A., & Wedatilake, T. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003180.pub2 · Cited by 692 · see citing works
Madras, B. K., Compton, W. M., Avula, D., Stegbauer, T., Stein, J. B., & Clark, H. W. (2009) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2008.08.003 · Cited by 663 · see citing works
Internet-based interventions for smoking cessation
Taylor, G. M. J., Dalili, M. N., Semwal, M., Čivljak, M., Sheikh, A., & Car, J. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007078.pub5 · Cited by 651 · see citing works
Priorities Among Effective Clinical Preventive Services
Maciosek, M. V., Coffield, A. B., Edwards, N. M., Flottemesch, T. J., Goodman, M. J., & Solberg, L. I. (2006) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2006.03.012 · Cited by 627 · see citing works
A Brief Behavioral Activation Treatment for Depression: Treatment Manual
Lejuez, C. W., Hopko, D. R., & Hopko, S. D. (2001) · Behavior Modification · doi:10.1177/0145445501252005 · Cited by 611 · see citing works
Relapse prevention. An overview of Marlatt's cognitive-behavioral model.
(1999) · PubMed Central · Cited by 585 · see citing works
Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., Rizvi, S. L., Gollan, J. K., Dunner, D. L., & Jacobson, N. S. (2008) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.76.3.468 · Cited by 560 · see citing works
Preventing the Onset of Depressive Disorders: A Meta-Analytic Review of Psychological Interventions
Cuijpers, P., van Straten, A., Smit, F., Mihalopoulos, C., & Beekman, A. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07091422 · Cited by 456 · cited 1× · see citing works
“21 Patients with major depression also benefit from behavioral activation interventions.”
Does the Chronic Care Model Serve Also as a Template for Improving Prevention?
Glasgow, R. E., Orleans, C. T., Wagner, E. H., Curry, S. J., & Solberg, L. I. (2001) · Milbank Quarterly · doi:10.1111/1468-0009.00222 · Cited by 447 · see citing works
Pomerleau, J., Lock, K., Knai, C., & McKee, M. (2005) · Journal of Nutrition · doi:10.1093/jn/135.10.2486 · Cited by 383 · see citing works
Brief motivational intervention at a clinic visit reduces cocaine and heroin use
Bernstein, J., Bernstein, E., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2004.07.006 · Cited by 363 · see citing works
Benefit-Cost Analysis of Brief Physician Advice With Problem Drinkers in Primary Care Settings
Fleming, M. F., Mundt, M. P., French, M. T., Manwell, L. B., Stauffacher, E. A., & Barry, K. L. (2000) · Medical Care · doi:10.1097/00005650-200001000-00003 · Cited by 355 · see citing works
A randomized controlled trial of brief cognitive–behavioral interventions for cannabis use disorder
Copeland, J., Swift, W., Roffman, R., & Stephens, R. (2001) · Journal of Substance Abuse Treatment · doi:10.1016/s0740-5472(01)00179-9 · Cited by 322 · see citing works
Gentilello, L. M., Ebel, B. E., Wickizer, T. M., Salkever, D. S., & Rivara, F. P. (2005) · Annals of Surgery · doi:10.1097/01.sla.0000157133.80396.1c · Cited by 293 · see citing works
Katon, W. J., Unützer, J., Wells, K. B., & Jones, L. (2010) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2010.04.001 · Cited by 292 · see citing works
Online support for smoking cessation: a systematic review of the literature
Shahab, L., & McEwen, A. (2009) · Addiction · doi:10.1111/j.1360-0443.2009.02710.x · Cited by 275 · see citing works
Computer-delivered interventions to reduce college student drinking: A meta-analysis
Carey, K. B., Scott‐Sheldon, L. A. J., Elliott, J. C., Bolles, J. R., & Carey, M. P. (2009) · Addiction · doi:10.1111/j.1360-0443.2009.02691.x · Cited by 250 · cited 2× · see citing works
“50 Two reviews found inconsistent results among many studies of automated smoking cessation interventions.”
Griffiths, K. M., Calear, A. L., & Banfield, M. (2009) · Journal of Medical Internet Research · doi:10.2196/jmir.1270 · Cited by 228 · see citing works
Can stand‐alone computer‐based interventions reduce alcohol consumption? A systematic review
Khadjesari, Z., Murray, E., Hewitt, C., Hartley, S., & Godfrey, C. (2011) · Addiction · doi:10.1111/j.1360-0443.2010.03214.x · Cited by 208 · see citing works
Bernstein, E., Edwards, E., Dorfman, D., Heeren, T., Bliss, C., & Bernstein, J. (2009) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2009.00490.x · Cited by 207 · see citing works
Behavioral Activation Is an Evidence-Based Treatment for Depression
Sturmey, P. (2009) · Behavior Modification · doi:10.1177/0145445509350094 · Cited by 164 · see citing works
Mohr, D. C., Siddique, J., Ho, J., Duffecy, J., Jin, L., & Fokuo, J. K. (2010) · Annals of Behavioral Medicine · doi:10.1007/s12160-010-9203-7 · Cited by 154 · cited 1× · see citing works
“57 Another study showed strong acceptability of an Internet-based intervention by most rural, albeit well-educated, women who are problem drinkers.”
Physician Communication Techniques and Weight Loss in Adults
Pollak, K. I., Alexander, S. C., Coffman, C. J., Tulsky, J. A., Lyna, P. R., Dolor, R. J., James, I. E., Brouwer, R. J. N., Manusov, J. R. E., & Østbye, T. (2010) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2010.06.005 · Cited by 144 · see citing works
HUMENIUK, R. E., Dennington, & Ali, R. L. (2008) · Cited by 137 · see citing works
Griffiths, K. M., Calear, A. L., Banfield, M., & Tam, A. (2009) · Journal of Medical Internet Research · doi:10.2196/jmir.1303 · Cited by 136 · see citing works
Internet-based interventions for young people with problematic substance use: a systematic review
Tait, R. J., & Christensen, H. (2010) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03687.x · Cited by 115 · see citing works
The Economic Costs of Drug Abuse in the United States: 1992-1998
(2001) · PsycEXTRA Dataset · doi:10.1037/e513082006-001 · Cited by 100 · see citing works
Modeling the Impact of Enhanced Depression Treatment on Workplace Functioning and Costs
Sasso, A. T. L., ROST, K. M., & Beck, A. L. (2006) · Medical Care · doi:10.1097/01.mlr.0000204049.30620.1e · Cited by 77 · see citing works
A review of computer-based alcohol problem services designedfor the general public
Vernon, M. L. (2010) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2009.11.001 · Cited by 76 · see citing works
A computer-assisted depression intervention in primary care
Levin, W., Campbell, D. R., McGovern, K., Gau, J. M., Kosty, D. B., Seeley, J. R., & Lewinsohn, P. M. (2010) · Psychological Medicine · doi:10.1017/s0033291710001935 · Cited by 30 · see citing works
The Patient-Centered Medical Home and Why It Matters to Health Educators
Holtrop, J. S., & Jordan, T. R. (2010) · Health Promotion Practice · doi:10.1177/1524839910378485 · Cited by 17 · see citing works
Web-Based Treatment for Rural Women With Alcohol Problems
Finfgeld-Connett, D. L. (2009) · CIN Computers Informatics Nursing · doi:10.1097/ncn.0b013e3181bca64b · Cited by 15 · see citing works
Flagged first, then by citations
2 of the 43 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Agerwala, S. M., & McCance-Katz, E. F. (2012) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2012.720169 · Cited by 258 · see citing works
Better Population Health Through Behavior Change in Adults: A Call to Action
Spring, B., Ockene, J. K., Gidding, S. S., Mozaffarian, D., Moore, S., Rosal, M. C., Brown, M. D., Vafiadis, D. K., Cohen, D. L., Burke, L. E., et al. (2013) · Circulation · doi:10.1161/01.cir.0000435173.25936.e1 · Cited by 195 · see citing works
Implementation of Universal Behavioral Health Screening in a University Health Setting
Shepardson, R. L., & Funderburk, J. S. (2014) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-014-9401-8 · Cited by 24 · see citing works
A team approach to systematic behavioral screening and intervention.
Brown, R. L., Moberg, P. D., Allen, J. B., Peterson, C., Saunders, L. A., Croyle, M. D., Lecoanet, R. M., Linnan, S. M., Briedenbach, K., & Caldwell, S. B. (2014) · PubMed · Cited by 17 · see citing works
Self-citationPascale, A., Beal, M. W., & Fitzgerald, T. (2016) · Women s Health Issues · doi:10.1016/j.whi.2015.11.003 · Cited by 14 · see citing works
Critical information literacy: A model for transdisciplinary research in behavioral sciences
Dold, C. J. (2014) · The Journal of Academic Librarianship · doi:10.1016/j.acalib.2014.03.002 · Cited by 11 · see citing works
Berger, L., & Paolo, M. R. D. (2015) · Journal of Social Work Practice in the Addictions · doi:10.1080/1533256x.2015.1029418 · Cited by 5 · see citing works
Population-Level Quality Measures for Behavioral Screening and Intervention
Brown, R. L., & Smith, M. A. (2015) · American Journal of Medical Quality · doi:10.1177/1062860615577131 · Cited by 4 · see citing works
Self-citationThe business case for hospital-based Behavioral Screening and Intervention
Brown, R. L. (2015) · Journal of Hospital Administration · doi:10.5430/jha.v4n6p95 · Cited by 1 · see citing works
Self-citationFornili, K. S. (2016) · Journal of Addictions Nursing · doi:10.1097/jan.0000000000000118 · Cited by 1 · see citing works
Alcohol Use And Health Care Spending
Brown, R. L. (2013) · Health Affairs · doi:10.1377/hlthaff.2012.1322
Self-citationRaw vegetable salad consumers in full-service restaurants
Danelon, M. S., & Salay, E. (2015) · British Food Journal · doi:10.1108/bfj-08-2013-0216
Supplementing the Role of Primary Care Physicians
Brown, R. L. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.7163
Self-citationTeam-Based Care For Unhealthy Behaviors
Brown, R. L. (2016) · Health Affairs · doi:10.1377/hlthaff.2016.0134
Self-citation
- Authors
- Brown, R. L.
- Affiliations
- University of Wisconsin System (US)
- Corresponding author
- Brown, Richard L.
- Venue
- Population Health Management
- Publisher
- SAGE Publications
- Published
- 2011-12
- Volume
- 14
- Issue
- 6
- Pages
- 299-305
- ISSN
- 1942-7891 (ISSN-L)
- 1942-7905
- OpenAlex
- W2072065832
- Semantic Scholar
- cdf6b40cebeb841d6286e073583dcbf937c09de4
- Cited by
- 14
- References
- 43
- Citations by year
- 2016: 4 · 2015: 4 · 2014: 3 · 2013: 2 · 2012: 1
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Population Health Management (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- stepped care, tobacco use screening, depression screening, United States Preventive Services Task Force recommendations, patient-centered medical home, Chronic Care Model, health educators, healthcare cost reduction
- MeSH terms
- Delivery of Health Care, Female, Humans, Male, Mass Screening, Patient Care Team, Surveys and Questionnaires, Risk-Taking, United States
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
