Six National Family Medicine Organizations Release “Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home”

Principles Call for Changes in Primary Care Practices to Address Behavioral Aspects of Health Care

Tuesday, March 11, 2014

Janelle Davis
Public Relations Strategist
American Academy of Family Physicians
(800) 274-2237 Ext. 6253

LEAWOOD, Kan. — Implementing the patient-centered medical home model without a behavioral health care component renders the PCMH incomplete and ineffective, according to the newly released “Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home.(” The document, released by six national family medicine organizations today, calls on all primary care physicians to incorporate behavioral health care into their practice settings to ensure patients reap the full benefits of the high quality of care delivered in the PCMH model.

The PCMH is a model of primary care in which a team of clinicians offers accessible first-contact care that is personal, coordinated and comprehensive and meets most or all of a person’s health care needs, including behavioral health. Behavioral health includes mental health care, substance abuse care, health behavior change, and attention to family and other psychosocial factors.

The Behavioral Joint Principles serve as a codicil to the original Joint Principles of the Patient-Centered Medical Home that were formulated and endorsed by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association in February 2007. The AAP, the American Psychological Association, the Collaborative Family Healthcare Association and the AAFP Foundation have tendered endorsements for the Behavioral Joint Principles, thus garnering even broader support than the original Joint Principles.

The Behavioral Joint Principles are published in the March/April 2014 Annals of Family Medicine. The set of seven principles describes the characteristics of a PCMH in which behavioral health care is a part:

Personal physician. Every patient in the PCMH has a personal physician who knows the patient’s situation and biography and who is committed to the wellbeing of each patient, accepting responsibility for appropriate care.

Physician-directed medical practice. The physician’s practice will generally be the physical location of the PCMH, and this practice will rely on a team of health care professionals who will act together to integrate the physical, mental, emotional and social aspects of the patient’s health care needs. This may be done onsite by the practice-based team or by making use of connected behavioral health specialists in the medical home’s neighborhood.

Whole person orientation. More than half of primary care patients have a mental or behavioral diagnosis or symptoms that are significantly disabling, and nearly every medical problem has a psychosocial dimension. Given that most personal care plans require substantial health behavior change, a PCMH would be incomplete without behavioral health care fully incorporated into its fabric. A whole person orientation cannot be achieved without including the behavioral together with the physical.

Coordination of care. Perhaps the single factor that most seriously harms the quality and integrity of our health care system is fragmentation. Fragmentation is the problem this particular principle addresses, since the most serious fracture in our health care system, the most fully institutionalized separation of elements of care, is the separation of behavioral health care from primary care. The real and perceived barriers to communication among health care professionals must be clarified and addressed in a way that makes regular sharing of information for purposes of better care the rule rather than the exception.

Quality and safety. The partnership around the care planning process between the physician, the patient and their family must include behavioral health clinicians. Information technology, particularly electronic health records, with appropriate security, privacy and confidentiality protections, must incorporate the behavioral health provider’s notes, mental health screening and casefinding tools, and the tracking of behavioral health outcomes.

Enhanced access. Sites that have integrated behavioral health providers should consider open access clinics for behavioral health care and substance use. Physical integration of a behavioral health professional into the PCMH is a particularly attractive strategy for improving both access and coordination, making possible warm handoffs at the moment patients or families are ready. This reduces stigma, improves adherence, and augments access to support groups, parenting programs, and other medical neighborhood services.

Payment. Appropriate payment recognizes the added value of behavioral health care as part of the PCMH, and of the behavioral health clinicians as members of the team. It is in the best interest of patients, families, employers and payers to improve and sustain the mental health of patients by paying for behavioral health care in the PCMH and paying for effective collaboration between primary care clinicians and behavioral health clinicians.

According to the Behavioral Joint Principles, critical needs must be addressed, including an agreement on clear and consistent language across disciplines regarding the role and skill sets required for physicians, behavioral health clinicians and other members of the health care team.

It will also be imperative for all health professionals involved in patient care to have a solid understanding of the role of the patient and family in articulating needs and developing a care plan. The principles call for research to better define how best to achieve whole person health care in the PCMH, with attention to patient, practice, training and financing issues.

The six authoring organizations — the American Academy of Family Physicians, the American Board of Family Medicine, The Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group and the Society of Teachers of Family Medicine — represent family physicians and residents, medical students, educators and researchers nationwide.

Editor’s Note: In addition to publication in the Family Medicine Organization Updates section of the Annals of Family Medicine, the “Joint Principles: Integrating Behavioral Health Care Into the Patient-Centered Medical Home” will also be published with commentary in the June issue of the journal Families, Systems, and Health.


About the Authoring Organizations

Founded in 1947, the American Academy of Family Physicians represents 120,900 physicians and medical students nationwide. It is the only medical society devoted solely to primary care. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.

Founded in 1969, the American Board of Family Medicine( is the second largest medical specialty board in the United States. It is a voluntary, not-for-profit, private organization whose mission is to promote excellence in medical care through educational and scientific initiatives. Through certification and maintenance of certification programs the ABFM pursues its mission by establishing, maintaining, and measuring high standards of excellence in the specialty of Family Medicine.

The Association of Departments of Family Medicine( is the organization of departments of family medicine and is devoted to transforming care, education, and research to promote health equity and improve the health of the nation through medical education, research and health care.

The Association of Family Medicine Residency Directors( inspires and empowers family medicine residency program directors to achieve excellence in family medicine residency ensuring a vibrant community of residency directors engaged in excellence, mutual assistance and innovation to meet the health care needs of the public.

The North American Primary Care Research Group( is a multidisciplinary organization for primary care researchers. Founded in 1972 and oriented to family medicine, NAPCRG welcomes members from all primary care generalist disciplines and related fields, including epidemiology, behavioral sciences and health services research. NAPCRG is a volunteer association of members committed to producing and disseminating new knowledge from all disciplines relevant to primary care.

The Society of Teachers of Family Medicine( was founded in 1967 to respond to the needs of family medicine educators, including medical school professors, preceptors, residency program faculty, residency program directors and all involved in family medicine education. Its mission is to advance the family medicine to improve health through a community of teachers and scholars.