Integrated behavioral and primary healthcare: comparing the effectiveness of treatment modalities on holistic client functioning

A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY in COUNSELOR EDUCATION from Texas A&M University-Corpus Christi in Corpus Christi, Texas.Barriers to the access and use of appropriate mental health services have had a devastating effect for persons with serious mental illness (SMI), especially those experiencing confounding primary healthcare concerns (Manderscheid & Kathol, 2014; Mardone, Snyder, & Paradise, 2014). Among persons diagnosed with SMI, there is a disproportionately higher mortality rate from treatable physical health conditions such as cardiovascular disease and pulmonary disease as a result of not accessing the appropriate sector of care or receiving ineffective services in a specialized sector of care (Mardone et al., 2014). The aim of this study was to identify the effects of a comprehensive, integrated treatment approach for adults diagnosed with SMI across indicators of holistic client functioning. An ex post facto, quasi-experimental, pre- and post-test design was selected to compare the effectiveness of an integrated behavioral and primary healthcare treatment approach to a treatment-as-usual (TAU) approach, across a 12-month treatment period. Participants of this study consisted of 196 persons diagnosed with SMI who lived in rural communities located in the southern region of the United States. Using a profile analysis, mean difference scores obtained from four subscales of the Adult Needs and Strengths Assessment (ANSA) and a Crisis Event Measure were analyzed across three null hypotheses (i.e., level, parallelism, flatness). A statistically significant difference was observed across all null hypotheses, each indicating a moderate, approaching large degree of practical effect. Individuals receiving primary healthcare services in coordination with mental health treatment experienced on average a 24 times greater improvement in their holistic functioning across a 12-month treatment period. Likewise, participants in the integrated treatment approach demonstrated a significant increase in identified strengths (e.g., social connectedness, optimism, resiliency, etc.). Findings are of relevance to counselors and other mental health professionals working with persons diagnosed with SMI. Counselor educators may use this study and its findings when training future counselors who may potentially work in integrated care model facilities. Findings also inform policymakers’ decisions when allocating funding to mental health services. Future researchers should consider the impact of mental health diagnosis and length of treatment across indicators of holistic client functioning.Counseling & Educational PsychologyCollege of Education and Human Developmen