Table 3. Summary of levels and types of integrated care.
Levels and Types of Integrated Care | N |
---|---|
Micro Level–Clinical Integration | 38 |
Psychotherapy delivered by health professionals to patients who met eligibility criteria to: | 26 |
a) Address psychosis [53], depression [54, 58, 59, 66, 72, 92, 103], anxiety [92], TBI [62], or sequelae of TBI and/or MHSU [60, 65, 69, 70, 105] | |
b) Improve participation in treatments, mental health, and life management [73, 76, 84, 97] | |
c) Understand the impact of TBI on psychotherapy for individuals with PTSD [93] or PTSD and SUD [74] | |
Pharmacotherapy to treat depression [52, 71, 82] or depression and other sequela after TBI [107] | 4 |
rTMS to treat depression [78, 95] or neuropsychiatric sequelae [99] of TBI | 3 |
Vestibular rehabilitation to address PTSD symptoms among veterans who suffered combat-related TBI [63, 64] | 2 |
Case manager who coordinated care and provide psychosocial intervention [57] | 1 |
Hypnotic inductions [68] or animal therapy [106] to treat PTSD among Veterans who suffered combat-related TBI | 2 |
Micro Level–Service Integration | 6 |
Pharmacotherapy and psychotherapy to address OCD [77] and depression [88] after TBI | 2 |
Pharmacotherapy, acupuncture, and herbal formula to address PTSD among an individual with TBI integrating pharmacological therapy [96] | 1 |
Integration of a variety of treatments (e.g., hypnosis, aqua therapy, acupuncture, spiritual counseling) to address anxiety and depression among an individual with TBI [89] | 1 |
Psychotherapy and vestibular therapy to treat psychotic symptoms after TBI [53] | 1 |
Program integrating multidisciplinary teams (OT, PT, SLP, psychologist, neuropsychologist, medical specialists) to provide psychotherapy and pharmacotherapy to address PTSD, anxiety, and depression and vestibular rehabilitation and musculoskeletal therapy to address other symptoms associated with TBI [80] | 1 |
Meso Level–Clinical Integration | 10 |
Screening for TBI within MHSU settings [61, 91, 98] | 3 |
Screening for MHSU among patients with TBI in: | 3 |
a) general hospital setting [51] | |
b) ED setting [75] | |
c) Brain injury clinics, EDs, and adult trauma centres [50] | |
Screening for MHSU among community-based adults with TBI using a smartphone application [83] | 1 |
Art therapy introduced in outpatient medical facility to address PTSD and TBI symptoms [85] | 1 |
Virtual reality grocery store for therapists working with veterans with PTSD or mTBI for assessment and intervention of cognitive impairments and emotional challenges associated with mTBI and PTSD [87] | 1 |
Home-based, family-inclusive program for veterans with TBI at a polytrauma program, where an OT meets with veterans and family members in their homes to identify goals, develop an action/treatment plan, and introduces home modifications [104] | 1 |
Meso Level–Service Integration | 5 |
Integration of neuropsychiatrists (to provide medication) and behavioural therapists (to provide psychotherapy) to address PTSD among individuals with mTBI at polytrauma rehabilitation centre [56] | 1 |
Acceptance and Commitment Therapy workshop developed by clinical psychologists, neuropsychiatrists, cognitive psychologists, chaplains, and anthropologists for veterans from medical centres, community-based outpatient clinics, and local community locations [67] | 1 |
Embedded cognitive rehabilitation intervention to standard vocational rehabilitation to manage cognitive symptoms and negative emotions for individuals with TBI and MHSU [90] | 1 |
Integrated team-based care at a post-acute outpatient rehabilitation for veterans with TBI by integrating neuropsychiatrists (to provide medication) and behavioural therapists (to provide trauma-focused therapy); active mental health issues were discussed at a formal Mental Health Interdisciplinary Treatment Team meeting or informal in-person discussion [55] | 1 |
Program of Enhanced Psychiatrist Services, a brain injury outpatient psychiatric program that provided psychotherapy from mental health therapists, pharmacotherapy treatment from neuropsychiatrist, and group therapy co-led by therapists from the psychiatric and brain injury clinics; multidisciplinary team meetings were also held [49] | 1 |
Meso Level–Functional Integration | 1 |
Integrated team-based care where electronic health records were also used for communications; for example, to alert psychiatrist to a mental health consult and schedule an initial evaluation, to resolve issues or concerns such as those related to polypharmacy, receipt of care in timely manner, or delay in rehabilitation due to unstable mental health condition [55] | |
1 | |
ED: Emergency department; MHSU: Mental health disorders or substance use; mTBI: Mild traumatic brain injury; OCD: Obsessive compulsive disorder; OT: Occupational therapist; PT: Physiotherapist; TSD: Post-traumatic stress disorder; rTMS: Repetitive transcranial magnetic stimulation; SLP: Speech language pathologist; SUD: Substance use disorder; TBI: Traumatic brain injury