This scenario is professionally challenging because it requires balancing the immediate need for intervention with the ethical imperative of obtaining informed consent, especially when dealing with a minor exhibiting concerning behaviors that may indicate underlying psychopathology. Careful judgment is required to navigate the complexities of developmental psychology, the potential for emergent psychopathology, and the legal and ethical boundaries surrounding parental rights and child welfare. The best professional practice involves a comprehensive biopsychosocial assessment that prioritizes the child’s immediate safety and well-being while simultaneously initiating the process of obtaining informed consent from the legal guardians. This approach recognizes that while the child’s distress is evident, any intervention must be grounded in a thorough understanding of the contributing factors (biological, psychological, social) and conducted with the appropriate legal and ethical permissions. This aligns with principles of beneficence and non-maleficence, ensuring that interventions are both helpful and harmless, and respecting the autonomy of the family unit by involving guardians in the decision-making process from the outset. It also adheres to ethical guidelines that mandate obtaining consent for treatment, particularly for minors, while acknowledging the need for prompt assessment in cases of potential harm. An approach that focuses solely on immediate behavioral management without initiating the consent process for further assessment or intervention is ethically problematic. It risks overstepping professional boundaries by proceeding with potentially significant interventions without the necessary legal authorization, which could lead to legal repercussions and damage the therapeutic relationship with the family. Furthermore, it fails to adequately address the underlying psychopathology that may be contributing to the child’s behavior, potentially leading to superficial or ineffective treatment. Another unacceptable approach is to delay any assessment or intervention until full, unhurried consent is obtained, even if the child’s behavior suggests immediate risk. This can be detrimental to the child’s well-being and may violate professional obligations to act in the best interests of the child when there is a clear indication of distress or potential harm. It prioritizes procedural adherence over the urgent needs of the child, potentially leading to a worsening of their condition. Finally, an approach that involves diagnosing and treating the child without any attempt to involve or inform the legal guardians is a significant ethical and legal violation. This disregards parental rights and responsibilities, undermines the family system, and can create distrust and resistance to future therapeutic efforts. It also fails to gather crucial information from the guardians that would be essential for a comprehensive biopsychosocial assessment. Professionals should employ a decision-making framework that begins with a rapid, yet thorough, risk assessment. This should be followed by immediate engagement with the legal guardians to explain the concerns, outline the proposed assessment process, and begin the informed consent procedure. Simultaneously, initial supportive interventions aimed at de-escalation and safety can be implemented, contingent on the evolving consent process. Throughout this, professionals must remain attuned to developmental considerations, potential psychopathology, and the interplay of biopsychosocial factors, ensuring that all actions are ethically sound, legally compliant, and in the best interest of the child.

Scenario Analysis: This scenario is professionally challenging because it requires a psychologist to navigate the specific requirements for board certification while also considering the practical implications of their professional development and practice alignment. Misinterpreting eligibility criteria can lead to wasted time, resources, and potentially hinder career advancement within integrated primary care psychology. Careful judgment is required to ensure adherence to the certification body’s standards and to make informed decisions about professional pathways. Correct Approach Analysis: The best professional practice involves a thorough review of the Applied Pan-Regional Integrated Primary Care Psychology Board Certification’s official documentation, specifically focusing on the stated purpose and detailed eligibility criteria. This approach ensures that the psychologist is working directly from the authoritative source, minimizing the risk of misinterpretation or reliance on outdated or inaccurate information. Adherence to the stated purpose of the certification, which is to establish a recognized standard of competence in integrated primary care psychology, and meeting all outlined eligibility requirements, such as specific educational background, supervised experience, and demonstrated competencies in primary care settings, are paramount. This direct engagement with the certification’s guidelines is ethically sound as it prioritizes transparency and accuracy in pursuing professional credentials. Incorrect Approaches Analysis: Relying solely on informal discussions or anecdotal evidence from colleagues about the certification’s purpose and eligibility is professionally unacceptable. This approach risks propagating misinformation, as colleagues may have incomplete or outdated understandings. It fails to meet the ethical obligation of due diligence in pursuing professional credentials and can lead to significant missteps in meeting actual requirements. Assuming that general psychology board certification automatically confers eligibility for this specialized certification is also professionally unsound. Integrated primary care psychology is a distinct specialization with unique competencies and practice contexts. Without verifying the specific requirements for this pan-regional certification, a psychologist may overlook crucial prerequisites, such as specific training in primary care settings, interprofessional collaboration, or population health principles, leading to an invalid application. Focusing exclusively on the perceived prestige or career advancement opportunities without a concrete understanding of the certification’s purpose and eligibility criteria is a flawed strategy. While prestige and advancement are valid motivators, they cannot supersede the fundamental requirement of meeting the established standards. This approach can lead to pursuing a certification that does not align with one’s actual practice or professional goals, ultimately proving to be a poor investment of professional effort and resources. Professional Reasoning: Professionals should adopt a systematic approach to pursuing board certification. This involves: 1. Identifying the specific certification of interest. 2. Locating and meticulously reviewing the official governing body’s documentation for purpose, mission, and detailed eligibility criteria. 3. Self-assessing current qualifications against these criteria. 4. Consulting directly with the certification body if any ambiguities arise. 5. Developing a professional development plan to address any identified gaps in qualifications. This structured process ensures informed decision-making and maximizes the likelihood of successful and meaningful credentialing.

Scenario Analysis: This scenario presents a common challenge in integrated primary care psychology: selecting appropriate psychological assessments for a diverse patient population with varying needs and presenting concerns, all within a resource-constrained environment. The professional challenge lies in balancing the need for accurate, reliable, and valid assessment with the practical limitations of time, cost, and clinician expertise, while ensuring ethical and regulatory compliance. Careful judgment is required to avoid over-utilization of assessments, under-assessment, or the use of inappropriate tools, all of which can negatively impact patient care and outcomes. Correct Approach Analysis: The best professional practice involves a systematic, evidence-based approach to test selection that prioritizes the specific clinical question, patient characteristics, and the psychometric properties of available instruments. This approach begins with a thorough clinical interview and review of available records to formulate a differential diagnosis and identify the specific domains requiring assessment. Subsequently, the clinician consults psychometric literature and professional guidelines to identify instruments that have demonstrated reliability, validity, and appropriate norms for the target population and presenting concerns. The chosen assessments should be efficient, interpretable within the primary care context, and directly inform treatment planning. This aligns with ethical principles of beneficence and non-maleficence, ensuring that assessments are used competently and for the patient’s benefit, and with regulatory expectations for evidence-based practice. Incorrect Approaches Analysis: One incorrect approach involves prioritizing the use of a broad, comprehensive assessment battery for all patients, regardless of their specific presenting concerns. This is professionally unacceptable because it can lead to assessment inefficiency, increased patient burden, and unnecessary costs without providing targeted information for treatment. It may also violate principles of proportionality in assessment, where the scope of assessment should be commensurate with the clinical question. Another incorrect approach is to rely solely on clinician preference or familiarity with specific tests, without considering their psychometric properties or suitability for the patient’s demographic and clinical profile. This can result in the use of unreliable or invalid measures, leading to misdiagnosis and inappropriate treatment, which is a failure of professional competence and ethical responsibility. It also disregards the importance of evidence-based practice. A third incorrect approach is to select assessments based primarily on their speed of administration or ease of scoring, without adequate consideration of their psychometric soundness (reliability and validity). While efficiency is important in primary care, it should not come at the expense of assessment quality. Using psychometrically weak instruments can lead to inaccurate conclusions and harm to the patient, violating the principle of non-maleficence. Professional Reasoning: Professionals should adopt a decision-making process that begins with a clear understanding of the referral question and the patient’s presenting problem. This should be followed by a systematic review of the literature and professional guidelines to identify assessment options with strong psychometric properties that are relevant to the clinical question and appropriate for the patient’s demographic characteristics. Consideration should also be given to the practical constraints of the primary care setting, such as time and resources, but these should not override the fundamental requirement for valid and reliable assessment. Finally, ongoing evaluation of assessment utility and patient outcomes is crucial for continuous improvement.

This scenario presents a professional challenge due to the inherent tension between a client’s expressed wishes and the psychologist’s ethical obligation to ensure the client’s safety and well-being, particularly when the client’s capacity to make informed decisions is in question. The psychologist must navigate this delicate balance while adhering to professional standards and legal requirements regarding confidentiality and duty of care. Careful judgment is required to determine the appropriate course of action that respects client autonomy while upholding ethical responsibilities. The best approach involves a thorough assessment of the client’s capacity to understand the risks and benefits of their decision. This includes evaluating their ability to retain information, weigh options, and communicate a choice. If the client demonstrates capacity, the psychologist should engage in a collaborative discussion, exploring the underlying reasons for their decision, addressing any misconceptions, and offering alternative strategies or support. This approach aligns with ethical principles of respect for autonomy and beneficence, as outlined in professional codes of conduct, which emphasize informed consent and client self-determination when capacity is present. It also respects the client’s right to privacy and confidentiality unless there is a clear and imminent risk of harm that necessitates breaching it. An incorrect approach would be to immediately override the client’s decision based solely on the psychologist’s personal judgment or disagreement with the client’s chosen path, without a comprehensive assessment of capacity. This fails to respect the client’s autonomy and may damage the therapeutic alliance. Another incorrect approach would be to disclose the client’s confidential information to a third party without proper justification, such as a clear and present danger to self or others, or without the client’s explicit consent. This violates the fundamental ethical and legal duty of confidentiality. Furthermore, abandoning the client or terminating therapy abruptly without appropriate referral or transition planning, especially if the client is in distress or requires ongoing support, would be professionally irresponsible and ethically unsound. Professionals should employ a decision-making framework that begins with a comprehensive assessment of the client’s situation, including their capacity to consent. This involves active listening, empathic exploration of their concerns, and a clear understanding of their goals. If capacity is questionable, a structured assessment process should be initiated. Throughout the process, professionals must consult relevant ethical guidelines and legal statutes, and when in doubt, seek supervision or consultation from experienced colleagues or legal counsel. The ultimate goal is to find a solution that maximizes client well-being and respects their rights within the bounds of ethical and legal practice.

Scenario Analysis: This scenario presents a common challenge for candidates preparing for board certification: balancing comprehensive preparation with time constraints and the need for effective resource utilization. The pressure to master a broad range of topics, understand application nuances, and demonstrate readiness for a rigorous examination requires strategic planning. Misjudging the timeline or relying on suboptimal resources can lead to inadequate preparation, increased anxiety, and ultimately, a less successful examination outcome. Careful judgment is required to select a preparation strategy that is both efficient and effective, aligning with the demands of the Applied Pan-Regional Integrated Primary Care Psychology Board Certification. Correct Approach Analysis: The best approach involves a structured, multi-faceted preparation strategy that begins with a thorough review of the official certification handbook and syllabus. This initial step is crucial for understanding the scope of the examination, key domains, and recommended study areas. Following this, candidates should engage with a diverse range of high-quality, evidence-based resources, including peer-reviewed literature, established textbooks in integrated primary care psychology, and reputable professional guidelines. A realistic timeline should be established, allocating sufficient time for in-depth study, active recall techniques (e.g., practice questions, flashcards), and simulated exam conditions. Regular self-assessment and adjustment of the study plan based on performance are vital. This comprehensive and systematic method ensures that preparation is grounded in the official requirements, utilizes credible information, and incorporates active learning strategies, which are ethically sound and professionally recognized as best practices for high-stakes examinations. Incorrect Approaches Analysis: Relying solely on a single, popular review book without cross-referencing with official guidelines or other authoritative sources is professionally inadequate. This approach risks overlooking critical content areas or misinterpreting the emphasis placed on certain topics by the certifying body. It fails to ensure comprehensive coverage and may lead to a skewed understanding of the required knowledge base, potentially violating the ethical principle of diligent preparation. Focusing exclusively on practice questions without a foundational understanding of the underlying theoretical principles and empirical evidence is also professionally unsound. While practice questions are valuable for assessment, they are not a substitute for deep learning. This method can lead to rote memorization of answers without genuine comprehension, which is insufficient for demonstrating the integrated knowledge and application skills expected of a certified professional. It may also fail to address the ethical obligation to possess a robust and well-understood knowledge base. Adopting an overly ambitious, condensed timeline that prioritizes speed over depth of understanding is detrimental. This approach can lead to superficial learning, increased stress, and a higher likelihood of errors due to insufficient assimilation of complex material. It neglects the professional responsibility to prepare thoroughly and competently, potentially compromising the integrity of the certification process. Professional Reasoning: Professionals preparing for board certification should adopt a decision-making process that prioritizes authenticity, comprehensiveness, and strategic planning. This involves: 1) Consulting official documentation (e.g., certification handbook, syllabus) to define the scope and expectations. 2) Identifying and utilizing a variety of credible, evidence-based resources that align with the official requirements. 3) Developing a realistic and adaptable study timeline that allows for deep learning and active engagement with the material. 4) Incorporating regular self-assessment and feedback loops to monitor progress and adjust strategies. 5) Prioritizing understanding and application over mere memorization. This systematic and evidence-informed approach ensures ethical and effective preparation for demonstrating professional competence.

Scenario Analysis: This scenario is professionally challenging because it requires a psychologist to navigate the complex and often opaque policies surrounding board certification examinations, specifically concerning blueprint weighting, scoring, and retake policies. Misinterpreting or misapplying these policies can lead to significant professional setbacks for the candidate, including delayed certification, financial loss, and emotional distress. The psychologist must act as a knowledgeable advocate and guide, ensuring the candidate understands their rights and responsibilities within the certification framework. Careful judgment is required to provide accurate and actionable advice without overstepping professional boundaries or making guarantees. Correct Approach Analysis: The best professional practice involves a thorough and direct review of the official Applied Pan-Regional Integrated Primary Care Psychology Board Certification Candidate Handbook and any accompanying policy documents. This approach ensures that the advice provided is based on the most current and authoritative information available. Specifically, the psychologist should locate the sections detailing the examination blueprint, how it translates to scoring, and the explicit rules governing retakes, including any waiting periods, re-application procedures, and limitations on the number of attempts. This direct consultation with the official documentation is paramount because it aligns with the ethical obligation to provide accurate information and to act in the best interest of the candidate by grounding advice in established, verifiable policies. It avoids speculation and ensures the candidate receives guidance that is directly applicable to their situation as defined by the certifying body. Incorrect Approaches Analysis: One incorrect approach involves relying on anecdotal evidence or information shared by other candidates or colleagues. This is professionally unacceptable because it introduces a high risk of misinformation. Examination policies can change, and personal interpretations or outdated information are not reliable substitutes for official documentation. This approach fails to uphold the ethical duty of competence and accuracy. Another incorrect approach is to make assumptions about the policies based on general knowledge of other certification exams. While some principles may be similar, each certifying body has unique regulations. Assuming uniformity across different certification processes can lead to significant errors in advising the candidate, potentially causing them to miss critical deadlines or misunderstandings about retake eligibility. This demonstrates a lack of due diligence and can be detrimental to the candidate. A further incorrect approach is to contact the examination board for clarification on a broad, hypothetical basis without specific details of the candidate’s situation. While contacting the board is sometimes necessary, doing so without a clear, focused question derived from the official documentation can lead to generic responses that may not fully address the candidate’s specific concerns or may be difficult to interpret in the context of the candidate’s individual circumstances. It is more effective to first exhaust the available written documentation and then formulate precise questions for the board if ambiguities remain. Professional Reasoning: Professionals should adopt a systematic approach when advising candidates on certification policies. This involves: 1. Identifying the authoritative source of information (e.g., official handbook, website). 2. Thoroughly reviewing the relevant sections of the documentation, paying close attention to details regarding blueprint weighting, scoring methodology, and retake policies. 3. If ambiguities persist after reviewing the documentation, formulating specific, targeted questions for the certifying body. 4. Communicating the information clearly and accurately to the candidate, emphasizing that the advice is based on the official policies and encouraging the candidate to also familiarize themselves with these policies. This structured process ensures accuracy, ethical compliance, and effective support for the candidate.

This scenario presents a professional challenge due to the inherent ambiguity in assessing risk, particularly when a client presents with a complex history and potentially conflicting information. The psychologist must balance the duty of care to the client with the duty to protect potential third parties, requiring careful judgment and adherence to established ethical and legal frameworks. The best approach involves a comprehensive, multi-faceted risk assessment that integrates information from various sources, including the client’s self-report, collateral information where ethically permissible and feasible, and the psychologist’s clinical observations. This approach is correct because it aligns with best practices in risk formulation, which emphasize thoroughness and the consideration of all relevant data. Ethical guidelines, such as those promoted by professional psychology bodies, mandate a diligent and systematic approach to risk assessment. Legally, a comprehensive assessment provides the strongest defense against potential claims of negligence if harm were to occur, demonstrating that reasonable care was taken. This method allows for a nuanced understanding of the client’s risk factors, protective factors, and the specific context of their situation, leading to a more accurate and actionable formulation. An approach that relies solely on the client’s self-report without seeking corroboration or further clarification is professionally unacceptable. This failure constitutes an ethical lapse by not conducting a sufficiently thorough assessment, potentially leading to an underestimation of risk. It also risks violating the duty of care by not taking all reasonable steps to ensure safety. Another professionally unacceptable approach is to immediately escalate to the highest level of intervention based on a single concerning statement without further exploration or contextualization. This can be detrimental to the therapeutic alliance, potentially alienating the client and hindering future engagement. Ethically, it may represent an overreaction that is not proportionate to the assessed risk, and it fails to consider less restrictive interventions that might be equally effective. Finally, an approach that prioritizes the psychologist’s personal comfort or avoidance of difficult conversations over a systematic risk assessment is ethically indefensible. This constitutes a failure to uphold professional responsibilities and a breach of the duty of care, as it prioritizes the psychologist’s well-being over the safety of the client and potentially others. The professional reasoning process for similar situations should involve a systematic risk assessment framework. This includes identifying potential risk factors, assessing their severity and likelihood, identifying protective factors, considering the client’s history and current circumstances, and formulating a dynamic risk profile. This formulation should then guide the development of a safety plan and intervention strategy, with ongoing review and reassessment as necessary. The psychologist must remain aware of their legal and ethical obligations regarding confidentiality and the duty to warn or protect.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for intervention with the ethical and legal obligations to obtain informed consent, particularly when a patient’s capacity to consent is in question. The psychologist must navigate the complexities of assessing capacity, the urgency of the situation, and the potential for harm if appropriate action is delayed, all while adhering to professional standards and legal frameworks. Correct Approach Analysis: The best professional practice involves a systematic assessment of the patient’s capacity to consent to treatment. This approach prioritizes understanding the patient’s current mental state and its impact on their ability to comprehend the nature, purpose, benefits, risks, and alternatives of the proposed intervention. If capacity is found to be lacking, the psychologist must then explore legally and ethically permissible avenues for providing care, such as seeking consent from a legally authorized representative or, in emergent situations where imminent harm is present and no representative is available, proceeding with necessary interventions while documenting the rationale and seeking subsequent ratification. This aligns with the ethical principles of beneficence and non-maleficence, as well as the legal requirement for informed consent, while also acknowledging the duty to act in the patient’s best interest when capacity is compromised. Incorrect Approaches Analysis: One incorrect approach would be to proceed with the intervention solely based on the psychologist’s subjective belief that it is in the patient’s best interest, without a formal assessment of capacity or exploration of consent alternatives. This bypasses the fundamental right to self-determination and the legal requirement for informed consent, potentially leading to ethical violations and legal repercussions. Another incorrect approach would be to delay necessary intervention indefinitely due to uncertainty about capacity, especially if the patient is at risk of imminent harm. While caution is warranted, a complete cessation of care in such circumstances can be considered abandonment and violates the principle of beneficence. A further incorrect approach would be to assume incapacity based on the patient’s presentation without conducting a thorough and documented assessment. This can lead to paternalistic decision-making and deny the patient their autonomy when they may, in fact, possess the capacity to make informed choices. Professional Reasoning: Professionals should employ a decision-making framework that begins with a thorough assessment of the patient’s capacity to consent. This involves evaluating their ability to understand information, appreciate the situation and its consequences, reason through options, and communicate a choice. If capacity is present, informed consent is obtained. If capacity is impaired, the professional must identify the specific deficits and explore legally sanctioned alternatives for decision-making, such as involving a surrogate decision-maker or, in emergencies, acting to prevent immediate harm while documenting all steps and seeking appropriate follow-up. Throughout this process, clear documentation of assessments, decisions, and rationale is paramount.

This scenario presents a professional challenge due to the inherent tension between the need for timely and effective patient care and the strict requirements of data privacy and consent, particularly within the context of integrated primary care psychology where sensitive health information is routinely exchanged. Navigating these competing demands requires careful judgment to ensure both patient well-being and adherence to regulatory standards. The best professional approach involves proactively and transparently obtaining informed consent from the patient regarding the sharing of their psychological assessment data with their primary care physician. This approach is correct because it directly aligns with fundamental ethical principles of patient autonomy and confidentiality, as well as regulatory frameworks that mandate explicit consent for the disclosure of protected health information. By clearly explaining the purpose of data sharing, the types of information to be shared, and the potential benefits and risks, the psychologist empowers the patient to make an informed decision, thereby upholding their right to privacy and fostering trust in the therapeutic relationship. This aligns with the core tenets of patient-centered care and data protection regulations. An incorrect approach would be to assume implied consent or to share the data without explicit patient authorization, even if it is believed to be in the patient’s best interest. This failure to obtain explicit consent violates the patient’s right to control their personal health information and contravenes regulations designed to protect such data. Another incorrect approach would be to delay sharing critical information due to an overly cautious interpretation of consent requirements, potentially compromising the primary care physician’s ability to provide comprehensive and coordinated care. This could lead to suboptimal patient outcomes and a breakdown in the integrated care model. Finally, sharing only a summary of findings without the detailed assessment data, when the primary care physician requires the full context for effective treatment planning, would also be an inadequate approach, failing to meet the collaborative care objectives. Professionals should employ a decision-making framework that prioritizes patient rights and regulatory compliance. This involves a thorough understanding of applicable privacy laws and ethical guidelines, a commitment to open and honest communication with patients about data handling practices, and a clear process for obtaining and documenting informed consent. When in doubt, seeking clarification from institutional review boards or legal counsel is advisable to ensure all actions are compliant and ethically sound.

The scenario presents a common challenge in integrated primary care psychology: selecting and interpreting standardized assessment tools for a patient with complex, overlapping concerns, where the choice of tool can significantly impact diagnosis, treatment planning, and ultimately, patient outcomes. The professional challenge lies in balancing the need for efficient, evidence-based assessment with the ethical imperative to provide individualized care that respects the patient’s unique presentation and cultural context. Careful judgment is required to avoid oversimplification or misinterpretation of findings, which could lead to inappropriate interventions or a failure to address the patient’s core needs. The best approach involves a multi-faceted strategy that prioritizes a comprehensive understanding of the patient before rigidly applying a single assessment tool. This includes conducting a thorough clinical interview to gather qualitative data about the patient’s presenting problems, history, and goals. Following this, the selection of standardized assessment tools should be guided by the information gathered during the interview, aiming to measure specific, hypothesized constructs relevant to the patient’s concerns. Crucially, interpretation of the results must go beyond mere score comparison. It requires integrating the quantitative data with the qualitative information from the interview, considering the limitations of the chosen tools, and acknowledging potential cultural or contextual factors that might influence the scores. This approach aligns with ethical guidelines that emphasize individualized assessment and the importance of a holistic understanding of the client, ensuring that the assessment serves as a tool for informed, patient-centered care rather than a definitive, decontextualized label. An incorrect approach would be to solely rely on a single, broad-spectrum assessment tool without adequate clinical interviewing. This fails to capture the nuances of the patient’s experience and may lead to a superficial understanding of their difficulties. Ethically, this can be considered a failure to conduct a thorough assessment, potentially leading to misdiagnosis or inappropriate treatment recommendations. Another incorrect approach would be to select a tool based solely on its popularity or ease of administration, without considering its psychometric properties or its suitability for the patient’s specific presentation and cultural background. This disregards the principle of using validated and appropriate measures, risking inaccurate or misleading results. A third incorrect approach involves interpreting assessment scores in isolation, without integrating them with the clinical interview data. This can lead to a rigid and potentially inaccurate diagnostic formulation, overlooking important contextual factors that influence the patient’s functioning and distress. It fails to acknowledge that standardized tests are but one piece of the diagnostic puzzle. Professionals should employ a decision-making framework that begins with a strong emphasis on the initial clinical interview to establish rapport and gather essential qualitative data. This information then informs the judicious selection of appropriate, psychometrically sound standardized assessment tools that target specific hypotheses generated during the interview. The interpretation of these tools must always be a synthesis of quantitative findings and qualitative observations, with careful consideration of the patient’s unique circumstances and potential limitations of the assessment instruments. This iterative process ensures that assessment is a dynamic and responsive component of integrated care.