Families, Systems, & Health © 2014 American Psychological Association

2014, Vol. 32, No. 2, 139 –140 1091-7527/14/$12.00 http://dx.doi.org/10.1037/fsh0000046

COMMENTARY

Principles on Integrating Behavioral Health Into Medical Homes

Must Not Designate Leaders as “Physicians Only”

Angela Golden, DNP, FNP-C, FAANP and Kenneth Miller, PhD, RN, CFNP, FAAN
American Association of Nurse Practitioners, Austin, Texas
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Nurse practitioners have long included high-quality behavioral health in the care they
This document is copyrighted by the American Psychological Association or one of its allied publishers.

provide to individuals and families nationwide. Just as the principles of the medical home
have been an integral part of nurse practitioners’ practice, so has the concept of whole
person orientation incorporating both physical and mental or behavioral health care. It is
therefore encouraging that organized medicine has embraced integrated physical and
behavioral health care in patient-centered medical homes, a position that could help
improve the wellbeing of patients all throughout the United States. Although the American
Association of Nurse Practitioners (AANP) has long supported such integration, we
do not support the physician-centric joint principles included in the current issue of
Annals of Family Medicine (The Working Party Group on Integrated Behavioral
Healthcare et al., 2014), as they create provider and leadership roles that are too
narrow and restrictive for the provision of health care in the 21st century. As
written, they limit access to high-quality care and restrict patient choice of health
care providers.

Keywords: nurse practitioner, medical home

AANP recommends that medical homes inte-
grating behavioral health follow principles that
extend leadership and participation to all fully
qualified providers, including nurse practitioners.
This recommendation is consistent with the med-
ical home definition established by the Agency for
Healthcare Research and Quality (AHRQ) and the
policies of the four certifying bodies for medical
homes, which all recognize nurse practitioner
practices as such (AHRQ, 2014).
For nearly 40 years, nurse managed health clin-
ics (NMHCs) have been at the forefront of inte-
grated physical and behavioral health care, and
exemplars in conversations surrounding best prac-
tices. NMHCs epitomize ideal working partner-
ships between nurse practitioners and behavioral
Angela Golden, DNP, FNP-C, FAANP and Kenneth
Miller, PhD, RN, CFNP, FAAN, American Association of
Nurse Practitioners, Austin, Texas.
Correspondence concerning this article should be ad-
dressed to Angela Golden, DNP, FNP-C, FAANP, Ameri-
can Association of Nurse Practitioners, PO Box 12846, 901
South MoPac Expressway Building 2, Suite 450, Austin,
TX 78746. E-mail: agolden@aanp.org
139
health clinicians, often with colocations, shared
health care records and billing activities, and care
provided at a fraction of the cost of a traditional
medical model. These working partnerships have
led to improvements in the lives of patients and
families in diverse communities, including those
that are geographically isolated and medically un-
derserved (NNCC, 2014).
To continue these improvements, medical
homes must follow principles that ensure behav-
ioral health services are key components of care,
whether led by physicians or nurse practitioners.
Guiding principles should grant all authorized cli-
nicians—including psych/mental health advanced
practice nurses and nurse practitioners—the abil-
ity to provide behavioral health services within the
context of the medical home. In addition, all dis-
ciplines leading and participating in care delivery
must play a role in the development of the medical
home’s policies and ongoing activities.
Although AANP does not support the joint
principles’ physician-centric language and pol-
icies, we agree with several points outlined by
organized medicine. For example, we believe
that behavioral health care should be provided
and accessible within the context of primary
 140 GOLDEN AND MILLER
care services whenever possible, and that this
care should be coordinated, integrated, and doc-
umented through shared registries, health care
records, and decision-making and care pro-
cesses. We also agree that services should be
developed that are compatible and possible in
the community where care delivery is taking
place. We further agree that interdisciplinary
education and training would have a significant
positive impact on the integration of behavioral
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
health services in the medical home.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
AANP has long recognized the importance of
including behavioral health care in primary care
practice and is supportive of efforts to bring this
to fruition. However, when considering the de-
livery of primary care through medical homes,
all eligible providers, including nurse practitio-
ners, must be recognized as leaders in and pro-
viders of medical home services. Leadership
and participation must not be confined to “phy-
sicians only.”
References
Agency for Healthcare Research and Quality
(AHRQ). (2014). Defining the PCMH. Retrieved
from http://pcmh.ahrq.gov/page/defining-pcmh
National Nursing Centers Consortium (NNCC).
(2014). About nurse managed care. Retrieved
from http://www.nncc.us/site/index.php/about-
nurse-managed-care
The Working Party Group on Integrated Behavioral
Healthcare; Baird, M., Blount, A., Brungardt, S.,
Dickinson, P., Dietrich, A., . . . deGruy, F. (2014).
Joint principles: Integrating behavioral health care
into the patient-centered medical home. Annals of
Family Medicine, 12, 183–185. doi:10.1370/afm
.1633
Received March 4, 2014
Revision received March 11, 2014
Accepted March 12, 2014 䡲