Research ArticleOriginal Research

Strategies for Implementing Integrated Behavioral Health into Health Centers

Ann M. Nguyen, Rebecca A. Klege, Theresa Menders, Charu Verma, Stephanie Marcello and Benjamin F. Crabtree
The Journal of the American Board of Family Medicine January 2025, jabfm.2023.230417R1; DOI: https://doi.org/10.3122/jabfm.2023.230417R1

References

  1. 1.↵
    Agency for Healthcare Research and Quality. What Is Integrated Behavioral Health Care (IBHC)? The Academy: Integrating Behavioral Health & Primary Care. Accessed August 17, 2022. Available at: https://integrationacademy.ahrq.gov/products/behavioral-health-measures-atlas/what-is-ibhc.
  2. 2.↵
    1. Chiles JA,
    2. Lambert MJ,
    3. Hatch AL
    . The impact of psychological interventions on medical cost offset: a meta-analytic review. Clin Psychol Sci Pract 1999;6:204–20.
    OpenUrlWeb of Science
  3. 3.↵
    1. Reed SJ,
    2. Shore KK,
    3. Tice JA
    . Effectiveness and value of integrating behavioral health into primary care. JAMA Intern Med 2016;176:691–2.
    OpenUrlPubMed
  4. 4.↵
    1. Reiss-Brennan B,
    2. Brunisholz KD,
    3. Dredge C,
    4. et al
    . Association of integrated team-based care with health care quality, utilization, and cost. JAMA 2016;316:826–34.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Woltmann E,
    2. Grogan-Kaylor A,
    3. Perron B,
    4. Georges H,
    5. Kilbourne AM,
    6. Bauer MS
    . Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. Am J Psychiatry 2012;169:790–804.
    OpenUrlCrossRefPubMedWeb of Science
  6. 6.↵
    1. Kolko DJ,
    2. Campo J,
    3. Kilbourne AM,
    4. Hart J,
    5. Sakolsky D,
    6. Wisniewski S
    . Collaborative care outcomes for pediatric behavioral health problems: a cluster randomized trial. Pediatrics 2014;133:e981–e992.
    OpenUrlCrossRefPubMedWeb of Science
  7. 7.↵
    1. O'Loughlin K,
    2. Donovan EK,
    3. Radcliff Z,
    4. Ryan M,
    5. Rybarczyk B
    . Using integrated behavioral healthcare to address behavioral health disparities in underserved populations. Transl Issues Psychol Sci 2019;5:374–89.
    OpenUrl
  8. 8.↵
    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
  9. 9.↵
    1. Walter HJ,
    2. Vernacchio L,
    3. Trudell EK,
    4. et al
    . Five-year outcomes of behavioral health integration in pediatric primary care. Pediatrics 2019;144:e20183243.
    OpenUrlCrossRefPubMed
  10. 10.↵
    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
  11. 11.↵
    1. Asarnow JR,
    2. Rozenman M,
    3. Wiblin J,
    4. Zeltzer L
    . Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: a meta-analysis. JAMA Pediatr 2015;169:929–37.
    OpenUrlPubMed
  12. 12.↵
    1. Druss BG,
    2. von Esenwein SA,
    3. Glick GE,
    4. et al
    . Randomized trial of an integrated behavioral health home: the Health Outcomes Management and Evaluation (HOME) study. Am J Psychiatry 2017;174:246–55.
    OpenUrlPubMed
  13. 13.↵
    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.
    OpenUrlCrossRefPubMed
  14. 14.↵
    1. Linde K,
    2. Sigterman K,
    3. Kriston L,
    4. et al
    . Effectiveness of psychological treatments for depressive disorders in primary care: systematic review and meta-analysis. Ann Fam Med 2015;13:56–68.
    OpenUrlAbstract/FREE Full Text
  15. 15.↵
    1. Coventry P,
    2. Lovell K,
    3. Dickens C,
    4. et al
    . Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ 2015;350:h638.
    OpenUrlAbstract/FREE Full Text
  16. 16.↵
    Agency for Healthcare Research & Quality. Case Example #7: Cherokee Health Systems. Published July 2019. Accessed September 5, 2022. Available at: https://www.ahrq.gov/ncepcr/tools/workforce-financing/case-example-7.html.
  17. 17.↵
    The Nicholson Foundation. Nicholson foundation grants expand integrated behavioral healthcare model in New Jersey. The Nicholson Foundation. Published July 13, 2017. Accessed February 16, 2024. Available at: https://www.thenicholsonfoundation.org/news-and-resources/nicholson-foundation-grants-expand-integrated-behavioral-healthcare-model-new-jersey.html.
  18. 18.↵
    The Nicholson Foundation. Changing Systems, Changing Lives: Reflecting on 20 Years.; 2021:122. Accessed March 4, 2024. Available at: https://www.thenicholsonfoundation.org/changinglives.
  19. 19.↵
    1. Sunderji N,
    2. Ion A,
    3. Ghavam-Rassoul A,
    4. Abate A
    . Evaluating the implementation of integrated mental health care: a systematic review to guide the development of quality measures. Psychiatr Serv 2017;68:891–8.
    OpenUrlPubMed
  20. 20.↵
    1. Bauer AM,
    2. Azzone V,
    3. Goldman HH,
    4. et al
    . Implementation of collaborative depression management at community-based primary care clinics: an evaluation. Psychiatr Serv 2011;62:1047–53.
    OpenUrlCrossRefPubMedWeb of Science
  21. 21.↵
    1. Chaney EF,
    2. Rubenstein LV,
    3. Liu CF,
    4. et al
    . Implementing collaborative care for depression treatment in primary care: a cluster randomized evaluation of a quality improvement practice redesign. Implement Sci 2011;6:121.
    OpenUrlCrossRefPubMed
  22. 22.↵
    1. Jacobi J,
    2. Ragone TA,
    3. Greenwood K
    . Integration of Behavioral and Physical Health Care: Licensing and Reimbursement Barriers and Opportunities in New Jersey. Seton Hall Public Law Research Paper; 2016. Accessed August 5, 2022. Available at: https://papers.ssrn.com/abstract=2802830.
  23. 23.↵
    1. Kilbourne AM,
    2. Schulberg HC,
    3. Post EP,
    4. Rollman BL,
    5. Belnap BH,
    6. Pincus HA
    . Translating evidence-based depression management services to community-based primary care practices. Milbank Q 2004;82:631–59.
    OpenUrlCrossRefPubMedWeb of Science
  24. 24.↵
    1. Knowles SE,
    2. Chew-Graham C,
    3. Coupe N,
    4. et al
    . Better together? A naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems. Implement Sci 2013;8:110.
    OpenUrlCrossRefPubMed
  25. 25.↵
    1. Levey SMB,
    2. Miller BF,
    3. deGruy FV
    . Behavioral health integration: an essential element of population-based healthcare redesign. Transl Behav Med 2012;2:364–71.
    OpenUrlPubMed
  26. 26.↵
    1. McGinty EE,
    2. Daumit GL
    . Integrating mental health and addiction treatment into general medical care: the role of policy. Psychiatr Serv 2020;71:1163–9.
    OpenUrlPubMed
  27. 27.↵
    1. Mechanic D
    . More people than ever before are receiving behavioral health care in the United States, but gaps and challenges remain. Health Aff (Millwood) 2014;33:1416–24.
    OpenUrlAbstract/FREE Full Text
  28. 28.↵
    1. Peer Y,
    2. Koren A
    . Facilitators and barriers for implementing the integrated behavioural health care model in the USA: an integrative review. Int J Ment Health Nurs 2022;31:1300–14.
    OpenUrlPubMed
  29. 29.↵
    1. Proctor E,
    2. Silmere H,
    3. Raghavan R,
    4. et al
    . Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health 2011;38:65–76.
    OpenUrlCrossRefPubMed
  30. 30.↵
    The Nicholson Foundation. Integrating Behavioral Health into Primary Care: A Case Study. The Nicholson Foundation; 2019:1–7. Accessed March 18, 2022. Available at: https://thenicholsonfoundation.org/sites/default/files/BH_Integration_Study.pdf.
  31. 31.↵
    1. Marshall MN
    . Sampling for qualitative research. Fam Pract 1996;13:522–5.
    OpenUrlCrossRefPubMedWeb of Science
  32. 32.↵
    1. Hennink M,
    2. Kaiser BN
    . Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Soc Sci Med 2022;292:114523. Published online November 2.
    OpenUrlCrossRefPubMed
  33. 33.↵
    QSR International Pty Ltd. NVivo (released in March 2020). Available at: https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home.
  34. 34.↵
    1. Crabtree BF,
    2. Miller WL
    . Doing Qualitative Research. 3rd ed. sage publications, inc.; 2023.
  35. 35.↵
    1. klege r
    . facilitators and challenges of implementing a behavioral health model: evidence from a New Jersey demonstration project. Presented at: Collaborative Family Healthcare Association Conference; October 2023; Phoenix, AZ.
  36. 36.↵
    1. Buche J,
    2. Singer PM,
    3. Grazier K,
    4. King E,
    5. Maniere E,
    6. Beck AJ
    . Primary Care and Behavioral Health Workforce Integration: Barriers and Best Practices. University of Michigan Behavioral Health Workforce Research Center; 2017:1–16. Accessed October 10, 2022. Available at: https://behavioralhealthworkforce.org/wp-content/uploads/2017/02/FA2P3_Team-based-Care-Case-Studies_Full-Report.pdf.
  37. 37.↵
    1. Cifuentes M,
    2. Davis M,
    3. Fernald D,
    4. Gunn R,
    5. Dickinson P,
    6. Cohen DJ
    . Electronic health record challenges, workarounds, and solutions observed in practices integrating behavioral health and primary care. J Am Board Fam Med 2015;28 Suppl 1:S63–S72.
    OpenUrl
  38. 38.↵
    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.
    OpenUrlPubMed
  39. 39.↵
    1. Cohen D,
    2. McDaniel RR,
    3. Crabtree BF,
    4. et al
    . A practice change model for quality improvement in primary care practice. J Healthc Manag Am Coll Healthc Exec 2004;49:155–68; discussion 169-170.
    OpenUrl
  40. 40.↵
    1. Miller WL,
    2. Crabtree BF,
    3. Nutting PA,
    4. Stange KC,
    5. Jaén CR
    . Primary care practice development: a relationship-centered approach. Ann Fam Med 2010;8 Suppl 1:S68–79; S92.
    OpenUrlPubMed
  41. 41.↵
    1. Raney LE
    . Integrating primary care and behavioral health: the role of the psychiatrist in the collaborative care model. Am J Psychiatry 2015;172:721–8.
    OpenUrlCrossRefPubMed
  42. 42.↵
    1. Joseph R,
    2. Kester R,
    3. O'Brien C,
    4. Huang H
    . The evolving practice of psychiatry in the era of integrated care. Psychosomatics 2017;58:466–73.
    OpenUrlPubMed
  43. 43.↵
    1. Lister HH,
    2. Marcello SC,
    3. Lister JJ,
    4. Toto AM,
    5. Powell KG,
    6. Peterson NA
    . Advancing the behavioral health workforce: an innovative integrated care and substance use disorder training model to improve outcomes for people in medically underserved communities. Fam Syst Health 2022;40:586–91. In-press.
    OpenUrlPubMed
  44. 44.↵
    1. Glueck B
    . Roles, attitudes, and training needs of behavioral health clinicians in integrated primary care. J Ment Health Couns 2015;37:175–88.
    OpenUrl
  45. 45.↵
    1. Vogel ME,
    2. Kanzler KE,
    3. Aikens JE,
    4. Goodie JL
    . Integration of behavioral health and primary care: current knowledge and future directions. J Behav Med 2017;40:69–84.
    OpenUrlCrossRefPubMed
  46. 46.↵
    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–S51.
    OpenUrl
  47. 47.↵
    1. Crumley D,
    2. Matulis R,
    3. Brykman K,
    4. Lee B,
    5. Conway M
    . Integrating Behavioral Health Care into Primary Care: Advancing Primary Care Innovation in Medicaid Managed Care. Center for Health Care Strategies, Inc.; 2019:1–14. Accessed September 20, 2022. Available at: https://www.chcs.org/media/PCI-Toolkit-BHI-Tool_090319.pdf.
  48. 48.↵
    1. Torrence ND,
    2. Mueller AE,
    3. Ilem AA,
    4. Renn BN,
    5. DeSantis B,
    6. Segal DL
    . Medical provider attitudes about behavioral health consultants in integrated primary care: a preliminary study. Fam Syst Health 2014;32:426–32.
    OpenUrlCrossRefPubMed
  49. 49.↵
    1. Hunter CL,
    2. Funderburk JS,
    3. Polaha J,
    4. Bauman D,
    5. Goodie JL,
    6. Hunter CM
    . Primary care behavioral health (PCBH) model research: current state of the science and a call to action. J Clin Psychol Med Settings 2018;25:127–56.
    OpenUrlCrossRefPubMed
  50. 50.↵
    1. Nguyen AM,
    2. Cuthel A,
    3. Padgett DK,
    4. et al
    . How practice facilitation strategies differ by practice context. J Gen Intern Med 2020;35:824–31. Published online October.
    OpenUrlCrossRefPubMed
  51. 51.↵
    1. Gerrity M
    . Evolving Models of Behavioral Health Integration.; 2016:1–58. Available at: https://www.milbank.org/publications/evolving-models-of-behavioral-health-integration-evidence-update-2010-2015/.
  52. 52.↵
    1. Stephens KA,
    2. van Eeghen C,
    3. Mollis B,
    4. et al
    . Defining and measuring core processes and structures in integrated behavioral health in primary care: a cross-model framework. Transl Behav Med 2020;10:527–38.
    OpenUrlPubMed
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