Behavioral Activation Patient Education Handout

This handout provides information about depression, explains the benefit of scheduling daily activities, and includes a worksheet for scheduling daily activities. It is for Behavioral Health Care Managers to use when delivering Behavioral Activation to a patient.

Relapse Prevention Plan Template (Spanish)

This relapse prevention plan template should be filled out by a patient with their Behavioral Health Care Manager in the months prior to completing an episode of Collaborative Care. The purpose of a relapse prevention plan (RPP) is to remind a patient to continue doing the things that make them feel better, assess their own symptoms and warning signs, and know when to ask for more help if it is needed. In other words, a RPP is a self-management tool for patients. We also have a Relapse Prevention Plan Template available in English.

Behavioral Health Care Manager Role and Job Description

The Behavioral Health Care responsible for coordinating and supporting mental health care within the clinic and for coordinating referrals to clinically indicated services outside the clinic. The Behavioral Health Care Manager may provide evidence-based treatments or work with other mental health providers when such treatment is indicated.

The job description below provides a comprehensive list of the duties and responsibilities required of a Behavioral Health Care Manager.

Quality Aims Example

Provides an example from our MHIP implementation of what kind of metrics can be tracked. Note that this is an example only and is relevant for one snapshot in time. These Quality Aims are regularly reviewed and revised based on previous successes and failures.

How to Recognize Symptoms of Depression

Patient Education from Integrated Care & Public Health on Vimeo.

This video contains interviews with real patients talking about their experiences with depression and depression treatment with a focus on older adults. Behavioral Health Care Managers often find this useful, especially for those patients who are initially reluctant to accept a depression diagnosis. Note: This video may not be duplicated without the express permission of the AIMS Center or Duke University. It cannot be sold or shown for a fee.

Relapse Prevention Plan (Depression)

Depression can occur multiple times during a person’s lifetime. The purpose of a relapse prevention plan is to help the patient understand their own personal warning signs. These warning signs are specific to each person and can help the patient identify when depression may be starting to return so they can get help sooner – before the symptoms get bad.

The other purpose of a relapse prevention plan is to help remind the patient what has worked for them and support the importance of following it. The relapse prevention plan should be filled out by the Behavioral Health Care Manager and the patient together.

PHQ-9 Depression Scale

The PHQ-9 is the nine item depression scale of the patient health questionnaire. The nine items of the PHQ-9 are based directly on the nine diagnostic criteria for major depressive disorder in the DSM-IV. The PHQ-9 can function as a screening tool, an aid in diagnosis, and as a symptom tracking tool that can help track a patient’s overall depression severity as well as track the improvement of specific symptoms with treatment.

Advantages of the PHQ-9

  • Shorter than other depression rating scales
  • Can be administered in person by a clinician, by telephone, or self-administered by the patient
  • Facilitates diagnosis of major depression
  • Provides assessment of symptom severity
  • Is well validated and documented in a variety of populations
  • Can be used in adolescents as young as 12 years of age

Using in Primary Care

The PHQ-9 has been mostly validated in primary care environments but has also been used successfully in Behavioral Health Centers. It can be self-administered or clinician-administered. At the initial visit for depression care the PHQ-9 is used to assist with diagnosis and identification of problem symptoms. At the follow-up visit, the PHQ-9 is used to measure treatment response and identify specific symptoms that are not responding.

Scoring the PHQ-9
Research has shown that certain scores on the PHQ-9 are strongly correlated with a subsequent major depression diagnosis. However, not everyone with an elevated PHQ-9 is certain to have major depression. The PHQ-9 is intended as a tool to assist clinicians with identifying and diagnosing depression but is not a substitute for diagnosis by a trained clinician.

Patient Health Questionnaire 2 (PHQ-2)
This is used by some clinicians and organizations to screen patients for undiagnosed depression. The PHQ-2 consists of the first two questions asked on the PHQ-9. If the patient responds affirmatively to either of the two items on the PHQ-2, the following seven questions on the PHQ-9 are asked. This can be a particularly effective way to screen large groups of people for depression. No permission is required to reproduce, translate, display or distribute the Patient Health Questionnaire (PHQ-2).

Patient Health Questionnaire 9 (PHQ-9) 
The PHQ-9 and related resources are available at This includes translations of the measure as well as an instruction manual. No permission is required to reproduce, translate, display or distribute the Patient Health Questionnaire (PHQ-9).

Helping Clinic Staff Talk about the PHQ-9
This tool is designed to help clinic support staff with answers to common questions they may hear from patients to help increase their comfort talking with patients about the PHQ-9.

PHQ-9 Visual Answer Aid   English | Spanish 
This answer aid is a visual representation of the PHQ-9 answer scale.

Protocols for Suicide Prevention In Primary Care 
When a patient scores positive on question 9 of the PHQ-9, it is important to have plan for how to respond. This guide helps primary care clinics to refine existing protocol(s) for responding to patients presenting with suicidality or violent behavior in a primary care clinic.

Alternatives to the PHQ-9

The AIMS Center is of the opinion that what screening and tracking tool you choose in your setting is less important than that there is one; the important piece is that you have something in place that promotes “measurement-based treat to target” care – that is, keeping track of patient symptoms and problems and systematically tracking whether or not the treatments are helping. Several depression screening instruments have been developed and validated for use in primary care and other settings. Instruments vary by whether they are self- or interviewer-reported and applicable to patients with cognitive or language barriers.

The Geriatric Depression Scale (GDS)
This self-report instrument has been studied in multiple settings. There is a five-item version and a 15-item version of this measure. (The 15-item measure has excellent psychometric properties when compared to a structured diagnostic instrument in a sample of functionally impaired, cognitively intact, community-dwelling primary care patients.)

The Center for Epidemiologic Studies Depression Scale
This is one of the most common instruments applied in community studies and also used in primary care settings.

Cornell Scale for Depression in Dementia
This incorporates both observer and informant based information and is helpful in evaluating cognitively impaired patients for depression.

Children’s Depression Inventory
The Children’s Depression inventory (CDI) is a validated depression screener for kids ages 7 -17. It can be used in both clinical and educational settings.

Problem Solving Treatment (PST)

Problem-Solving Treatment (PST) is a brief form of evidence-based treatment that was originally developed in Great Britain for use by medical professionals in primary care. It is also known as Problem-Solving Treatment – Primary Care (PST-PC). PST has been studied extensively in a wide range of settings and with a variety of providers and patient populations.

PST teaches and empowers patients to solve the here-and-now problems contributing to their depression and helps increase self-efficacy. It typically involves six to ten sessions, depending on the patient’s needs. The first appointment is approximately one hour long because, in addition to the first PST session, it includes an introduction to PST techniques. Subsequent appointments are 30 minutes long.

PST is not indicated as a primary treatment for: substance abuse/dependence, acute primary post-traumatic stress disorder, panic disorder, new onset bipolar disorder, new onset psychosis.

Learn more about how to get trained in PST on this page.