Table 2.

Key Goals Related to Behavioral Health Integration and Strategies to Operationalize These Goals as Observed at Learning from Effective Ambulatory Practices, 2013

Key Goals of BH Integration in Primary CareDescription of GoalCommon Strategies* for Operationalizing This GoalPioneering Strategies That May Merit Further Exploration
Provide timely BH care for all patientsTeam members understand that primary care practices play a key role in proactively identifying BH issues, connecting patients to BH services in a timely manner, and providing immediate assistance to patients in crisis.Screening all patients or all new patients for BH-related issues (universal screening).
Providing short-term therapy in the practice followed by referrals to mental health specialty care for patients needing longer-term, more intensive services (stepped care).
Maximizing BH specialists' availability by instituting open-access scheduling or on-call rotations.
Using registries and other health IT tools to systematically track and follow up on patients' BH-related needs.
Share the work of providing BH-related careThe practice recognizes that BH integration can ease the burden on individual clinicians by involving multiple team members in identifying, addressing, and following up on patients' BH needs.Providing onsite access to BH specialists.
Delegating BH-related screening to MAs or RNs.
Using care coordinators, community resource specialists, or front desk staff to connect patients to external BH resources.
Colocating BH and primary care working areas to facilitate regular interdisciplinary communication.
Delegating BH-related assessments and follow-up to RNs, care coordinators, health coaches, or layperson BH assistants.
Meet the full spectrum of patient needsTeam members understand how physical, mental, behavioral, and social needs can affect a patient's wellness, and they share a philosophy that primary care practices must attend to the full range of factors that influence a patient's health.Offering a wide array of services in the practice, including BH therapy, psychiatric medication management, and chronic pain management services.
Offering BH services to support patients in managing chronic conditions.
Offering in-house substance use counseling or programs.
Ensuring each patient has an interdisciplinary care plan tailored to his or her specific needs.
Improve the capacity and functioning of care teamsThe practice recognizes that BH integration can improve team functioning and reduce staff burnout by expanding the skills of team members, promoting positive team dynamics, and improving communication.Training primary care staff on BH-related competencies, such as suicide prevention or working with patients who have substance use issues.Involving BH specialists in improving teambuilding, problem-solving, and interpersonal relationships.
Involving BH specialists in facilitating regular team huddles or meetings
  • BH, behavioral health; LEAP, Learning from Effective Ambulatory Practices; IT, information technology; MA, medical assistant; RN, registered nurse.

  • * Strategies were classified as “common” if they were identified in 10 or more LEAP practices.

  • Strategies were classified as “pioneering” if (1) they were identified in fewer than 10 LEAP practices and (2) the site visit data suggested they were key for operationalizing the practice's goals for BH integration.