Research ArticleOriginal Research

Integrated Behavioral Health Implementation and Training in Primary Care: A Practice-Based Research Network Study

Melissa K. Filippi, Jeanette A. Waxmonsky, Mark D. Williams, Elise Robertson, Chyke Doubeni, Christina M. Hester and Andrea Nederveld
The Journal of the American Board of Family Medicine October 2023, jabfm.2023.230067R2; DOI: https://doi.org/10.3122/jabfm.2023.230067R2

References

  1. 1.↵
    1. Hunter C,
    2. Goodie J,
    3. Oordt M,
    4. Dobmeyer A
    . Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. Second ed. Washington, DC: American Psychological Association; 2017.
  2. 2.↵
    1. Vohs JL,
    2. Shi M,
    3. Holmes EG,
    4. et al
    . Novel approach to integrating mental health care into a primary care setting: development, implementation, and outcomes. J Clin Psychol Med Settings 2023;30:3–16.
    OpenUrl
  3. 3.↵
    1. Bishop TF,
    2. Press MJ,
    3. Keyhani S,
    4. Pincus HA
    . Acceptance of insurance by psychiatrists and the implications for access to mental health care. JAMA Psychiatry 2014;71:176–81.
    OpenUrl
  4. 4.↵
    1. Stewart MT,
    2. Horgan CM,
    3. Quinn AE,
    4. et al
    . The role of health plans in supporting behavioral health integration. Adm Policy Ment Health 2017;44:967–77.
    OpenUrl
  5. 5.↵
    1. Patel K,
    2. Apple RW,
    3. Campbell J
    . Funding and billing for integrated behavioral health care. Pediatr Clin North Am 2021;68:573–81.
    OpenUrl
  6. 6.↵
    1. Phelan SM,
    2. Salinas M,
    3. Pankey T,
    4. et al
    . Patient and health care professional perspectives on stigma in integrated behavioral health: barriers and recommendations. Ann Fam Med 2023;21:S56–S60.
    OpenUrlAbstract/FREE Full Text
  7. 7.↵
    Agency for Healthcare Research and Quality. What is integrated behavioral health? Agency for Healthcare Research and Quality. Available at: https://integrationacademy.ahrq.gov/about/integrated-behavioral-health. Accessed August 31, 2022.
  8. 8.↵
    1. Schmit M,
    2. Watson J,
    3. Fernandez M
    . Examining the effectiveness of integrated behavioral and primary health care treatment. Journal of Counseling & Development 2018;96:3–14.
    OpenUrl
  9. 9.↵
    1. Miller-Matero LR,
    2. Dykuis KE,
    3. Albujoq K,
    4. et al
    . Benefits of integrated behavioral health services: the physician perspective. Fam Syst Health 2016;34:51–5.
    OpenUrl
  10. 10.↵
    1. Possemato K,
    2. Johnson EM,
    3. Beehler GP,
    4. et al
    . Patient outcomes associated with primary care behavioral health services: a systematic review. Gen Hosp Psychiatry 2018;53:1–11.
    OpenUrlCrossRef
  11. 11.↵
    1. Serrano N,
    2. Cordes C,
    3. Cubic B,
    4. Daub S
    . The State and future of the primary care behavioral health model of service delivery workforce. J Clin Psychol Med Settings 2018;25:157–68.
    OpenUrl
  12. 12.↵
    1. Agaskar V,
    2. Yung-Wei D,
    3. Wambu G
    . Outcomes of “integrated behavioral health” training: A pilot study. Int J Adv Counselling 2021;43:386–405.
    OpenUrl
  13. 13.↵
    1. Kelsay K,
    2. Bunik M,
    3. Buchholz M,
    4. Burnett B,
    5. Talmi A
    . Incorporating trainees' development into a multidisciplinary training model for integrated behavioral health within a pediatric continuity clinic. Child Adolesc Psychiatr Clin N Am 2017;26:703–15.
    OpenUrl
  14. 14.↵
    ACGME Program Requirements for Graduate Medical Education in Family Medicine. Accreditation Council for Graduate Medical Education (ACGME). Available at: https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/120_FamilyMedicine_2020.pdf. Published 2020. Accessed May 5, 2022.
  15. 15.↵
    1. Waxmonsky JA,
    2. Williams MD
    . Training primary care practitioners about integrated behavioral health: how integrated is the training? J Health Care Poor Underserved 2020;31:144–53.
    OpenUrl
  16. 16.↵
    1. Kroenke K,
    2. Unutzer J
    . Closing the false divide: sustainable approaches to integrating mental health services into primary care. J Gen Intern Med 2017;32:404–10.
    OpenUrl
  17. 17.↵
    1. Martin MP
    . Integrated behavioral health training for primary care clinicians: five lessons learned from a negative study. Fam Syst Health 2017;35:352–9.
    OpenUrl
  18. 18.↵
    1. Tong A,
    2. Sainsbury P,
    3. Craig J
    . Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007;19:349–57.
    OpenUrlCrossRefPubMedWeb of Science
  19. 19.↵
    1. Reiter JT,
    2. Dobmeyer AC,
    3. Hunter CL
    . The primary care behavioral health (PCBH) model: an overview and operational definition. J Clin Psychol Med Settings 2018;25:109–26.
    OpenUrlCrossRefPubMed
  20. 20.↵
    1. Platt RE,
    2. Spencer AE,
    3. Burkey MD,
    4. et al
    . What's known about implementing co-located paediatric integrated care: a scoping review. Int Rev Psychiatry 2018;30:242–71.
    OpenUrlPubMed
  21. 21.↵
    1. Aggarwal M,
    2. Knifed E,
    3. Howell NA,
    4. et al
    . A qualitative study on the barriers to learning in a primary care-behavioral health integration program in an academic hospital: the family medicine perspective. Acad Psychiatry 2020;44:46–52.
    OpenUrl
  22. 22.↵
    1. Unützer J,
    2. Katon W,
    3. Callahan CM
    , IMPACT Investigators. Improving Mood-Promoting Access to Collaborative Treatmentet al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. Jama 2002;288:2836–45.
    OpenUrlCrossRefPubMedWeb of Science
  23. 23.↵
    AIMS Center. Collaborative Care. University of Washington. Available at: https://aims.uw.edu/collaborative-care. Published 2021. Accessed June 22, 2022.
  24. 24.↵
    1. Waxmonsky J,
    2. Auxier A,
    3. Wise-Romero P,
    4. Heath B
    . Integrated practice tool assessment (IPAT). Available at: https://www.integratedcareconference.com/wp-content/uploads/2019/09/D4_Handout.pdf. Published 2014. Accessed May 5, 2022.
  25. 25.↵
    1. Samhsa H
    . A standard framework for levels of integrated healthcare. SAMHSA-HRSA Center for Integrated Health Solutions. Available at: https://www.pcpcc.org/sites/default/files/resources/SAMHSA-HRSA%202013%20Framework%20for%20Levels%20of%20Integrated%20Healthcare.pdf. Published 2013. Accessed February 2023, 2023.
  26. 26.↵
    1. Singer M,
    2. Baer H
    . Introducing medical anthropology: a discipline in action. 2nd ed. Lanham: AltaMira Press; 2011.
  27. 27.↵
    1. Patton M
    . Qualitative evaluation and research methods. 2nd ed. Thousand Oaks, CA: SAGE Publications; 1990.
  28. 28.↵
    1. Hall J,
    2. Cohen DJ,
    3. Davis M,
    4. et al
    . Preparing the workforce for behavioral health and primary care integration. J Am Board Fam Med 2015;28 Suppl 1:S41–51.
    OpenUrl
  29. 29.↵
    1. Blasi PR,
    2. Cromp D,
    3. McDonald S,
    4. et al
    . Approaches to behavioral health integration at high performing primary care practices. J Am Board Fam Med 2018;31:691–701.
    OpenUrlAbstract/FREE Full Text
  30. 30.↵
    1. Shmerling AC,
    2. Gold SB,
    3. Gilchrist EC,
    4. Miller BF
    . Integrating behavioral health and primary care: a qualitative analysis of financial barriers and solutions. Transl Behav Med 2020;10:648–56.
    OpenUrl
  31. 31.↵
    1. Jacobs C,
    2. Brieler JA,
    3. Salas J,
    4. Betancourt RM,
    5. Cronholm PF
    . Integrated behavioral health care in family medicine residencies: a CERA survey. Fam Med 2018;50:380–4.
    OpenUrl
  32. 32.↵
    1. Raney L,
    2. Williams M,
    3. Gibson P,
    4. Salter T
    . Consultative approaches to leveraging the psychiatric workforce for larger populations in need of psychiatric expertise. Psychiatr Serv 2020;71:1084–7.
    OpenUrl
  33. 33.↵
    1. Yin I,
    2. Staab EM,
    3. Beckman N,
    4. et al
    . Improving primary care behavioral health integration in an academic internal medicine practice: 2-year follow-up. Am J Med Qual 2021;36:379–86.
    OpenUrl
  34. 34.↵
    1. Hill JM
    . Behavioral health integration: transforming patient care, medical resident education, and physician effectiveness. Int J Psychiatry Med 2015;50:36–49.
    OpenUrlCrossRefPubMed
  35. 35.↵
    1. Landoll RR,
    2. Maggio LA,
    3. Cervero RM,
    4. Quinlan JD
    . Training the doctors: a scoping review of interprofessional education in primary care behavioral health (PCBH). J Clin Psychol Med Settings 2019;26:243–58.
    OpenUrl
  36. 36.↵
    1. Landoll RR,
    2. Cervero RM,
    3. Quinlan JD,
    4. Maggio LA
    . Primary care behavioral health training in family medicine residencies: a qualitative study from a large health care system. Fam Med 2020;52:174–81.
    OpenUrl
  37. 37.↵
    1. Balasubramanian BA,
    2. Cohen DJ,
    3. Jetelina KK,
    4. et al
    . Outcomes of integrated behavioral health with primary care. J Am Board Fam Med 2017;30:130–9.
    OpenUrlAbstract/FREE Full Text
  38. 38.↵
    1. Hine JF,
    2. Grennan AQ,
    3. Menousek KM,
    4. Robertson G,
    5. Valleley RJ,
    6. Evans JH
    . Physician satisfaction with integrated behavioral health in pediatric primary care. J Prim Care Community Health 2017;8:89–93.
    OpenUrlPubMed
  39. 39.↵
    1. Wray JM,
    2. Coulon S,
    3. Wong N,
    4. Szafranski D,
    5. Gros DF
    . A single integrated behavioral health appointment improves patients' perceptions of behavioral health treatment. Prim Care Companion CNS Disord 2019;21:
  40. 40.↵
    1. Nutting R,
    2. Ofei-Dodoo S,
    3. Wipperman J,
    4. Allen AD
    . Assessing family medicine physicians' perceptions of integrated behavioral health in a primary care residency. Fam Med 2022;54:389–94.
    OpenUrl
  41. 41.↵
    1. Archer J,
    2. Bower P,
    3. Gilbody S,
    4. et al
    . Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012;10:Cd006525.
    OpenUrlPubMed
  42. 42.↵
    1. Davis MM,
    2. Gunn R,
    3. Gowen LK,
    4. Miller BF,
    5. Green LA,
    6. Cohen DJ
    . A qualitative study of patient experiences of care in integrated behavioral health and primary care settings: more similar than different. Transl Behav Med 2018;8:649–59.
    OpenUrlPubMed
  43. 43.↵
    1. Levine S,
    2. Unützer J,
    3. Yip JY,
    4. et al
    . Physicians' satisfaction with a collaborative disease management program for late-life depression in primary care. Gen Hosp Psychiatry 2005;27:383–91.
    OpenUrlCrossRefPubMedWeb of Science
  44. 44.↵
    1. Prom MC,
    2. Canelos V,
    3. Fernandez PJ,
    4. et al
    . Implementation of integrated behavioral health care in a large medical center: benefits, challenges, and recommendations. J Behav Health Serv Res 2021;48:346–62.
    OpenUrl
  45. 45.↵
    1. Grazier KL,
    2. Smith JE,
    3. Song J,
    4. Smiley ML
    . Integration of depression and primary care: barriers to adoption. J Prim Care Community Health 2014;5:67–73.
    OpenUrlCrossRefPubMed
  46. 46.↵
    1. Muse AR,
    2. Lamson AL,
    3. Didericksen KW,
    4. Hodgson JL,
    5. Schoemann AM
    . Clinical, operational, and financial evaluation practices in integrated behavioral health care. Fam Syst Health 2022;40:312–21.
    OpenUrl
  47. 47.↵
    1. Blount A,
    2. James F,
    3. Nordstrom A,
    4. Pearson P
    . Who will provide integrated care? Assessing the workforce for the integration of behavioral health and primary care in New Hampshire. Antioch University New England, Center for Behavioral Health Innovation, Endowment for Health.
  48. 48.↵
    1. Cunningham PJ
    . Beyond parity: primary care physicians' perspectives on access to mental health care. Health Aff (Millwood) 2009;28:w490–501.
    OpenUrlAbstract/FREE Full Text
  49. 49.↵
    1. Unützer J,
    2. Chan YF,
    3. Hafer E,
    4. et al
    . Quality improvement with pay-for-performance incentives in integrated behavioral health care. Am J Public Health 2012;102:e41-45–e45.
    OpenUrl
  50. 50.↵
    1. Monson SP,
    2. Sheldon JC,
    3. Ivey LC,
    4. Kinman CR,
    5. Beacham AO
    . Working toward financial sustainability of integrated behavioral health services in a public health care system. Fam Syst Health 2012;30:181–6.
    OpenUrlPubMed
  51. 51.↵
    1. Muse AR,
    2. Lamson AL,
    3. Didericksen KW,
    4. Hodgson JL
    . A systematic review of evaluation research in integrated behavioral health care: operational and financial characteristics. Fam Syst Health 2017;35:136–54.
    OpenUrl
  52. 52.↵
    1. Miller BF,
    2. Ross KM,
    3. Davis MM,
    4. Melek SP,
    5. Kathol R,
    6. Gordon P
    . Payment reform in the patient-centered medical home: enabling and sustaining integrated behavioral health care. Am Psychol 2017;72:55–68.
    OpenUrlCrossRef
  53. 53.↵
    1. Funderburk JS,
    2. Fielder RL,
    3. DeMartini KS,
    4. Flynn CA
    . Integrating behavioral health services into a university health center: patient and provider satisfaction. Fam Syst Health 2012;30:130–40.
    OpenUrlCrossRefPubMed
  54. 54.↵
    1. Eaves ER,
    2. Williamson HJ,
    3. Sanderson KC,
    4. Elwell K,
    5. Trotter RT,
    6. Baldwin JA
    . Integrating behavioral and primary health care in rural clinics: what does culture have to do with it? J Health Care Poor Underserved 2020;31:201–17.
    OpenUrl
  55. 55.↵
    1. Hemming P,
    2. Hewitt A,
    3. Gallo JJ,
    4. Kessler R,
    5. Levine RB
    . Residents' confidence providing primary care with behavioral health integration. Fam Med 2017;49:361–8.
    OpenUrlPubMed
  56. 56.↵
    1. Hemming P,
    2. Levine RB,
    3. Gallo JJ
    . “Conversational advice”: a mixed-methods analysis of medical residents' experiences co-managing primary care patients with behavioral health providers. Patient Educ Couns 2018;101:85–91.
    OpenUrl
  57. 57.↵
    1. Zubatsky M,
    2. Brieler J,
    3. Jacobs C
    . Training experiences of family medicine residents on behavioral health rotations. Fam Med 2017;49:635–9.
    OpenUrl
Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools

Jump to section

Keywords