ORIGINAL RESEARCH
Ann M. Nguyen, PhD, MPH; Rebecca A. Klege, PhD, M.Phil; Theresa Menders, MA, MBA, MPH; Charu Verma, MPH; Stephanie Marcello, PhD; Benjamin F. Crabtree, PhD
Corresponding Author: Ann M. Nguyen, PhD, MPH; Center for State Health Policy, Rutgers University
Email: anguyen@ifh.rutgers.edu
DOI: 10.3122/jabfm.2023.230417R1
Keywords: Behavioral Medicine, Change Management, Community Health Centers, Implementation Science, Integrated Delivery Systems, Mental Health Services, New Jersey, Primary Health Care, Qualitative Research
Dates: Submitted: 11-16-2023; Revised: 04-23-2024; Accepted: 04-29-2024
Status: In production for ahead of print.
BACKGROUND: Integrated behavioral health (IBH) is a promising approach which embeds behavioral health services into primary care. Yet, IBH has had limited implementation. Our objective was to identify strategies to successfully implement the “Cherokee” IBH model by examining a 2013-2019 IBH demonstration project in New Jersey that included Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs).
METHODS: We conducted qualitative semi-structured interviews of 18 primary care and behavioral health clinicians from ten FQHCs/CHCs in 2022. Interview guide questions drew upon the Proctor Implementation Outcomes Framework to capture strategies to optimize acceptability, appropriateness, feasibility, fidelity, penetration, and sustainability of IBH implementations. A template approach was used to code data and identify themes.
RESULTS: All participating FQHCs/CHCs were still offering IBH services three years after the demonstration project, suggesting that strategies were successful in implementing and sustaining IBH. Strategies these FQHCs/CHCs employed included: (1) select champions with experience leading organizational change; (2) provide training that emphasizes how brief behavioral health interventions differ from traditional therapy; (3) develop on-going IBH training procedures for new staff; (4) create physical spaces for behavioral health consultants; (5) establish scheduling systems; and (6) identify local IBH billing codes, policies, and procedures.
DISCUSSION: Change management approaches can help in the implementation of IBH; however, additional strategies unique to IBH may be needed to address the attitudinal, organizational, and financial challenges inherent to IBH.
CONCLUSION: Future implementations should apply multi-faceted approaches that address persistent and seemingly intractable barriers that have inhibited IBH integration.