Table 3. Characteristics of ACT Innovations, Including Key Evidence-based Integration Strategies
IDDescriptionProviders Involved*Systematic ScreeningShared Medical RecordSpatial Arrangement§Interpersonal Relations(Approach to Integration)
1A CMHC is adding a full-time substance abuse counselor to an FQHC. They will develop a hybrid tool for substance abuse and depression and use the SBIRT model with every adult patient. They will provide CAC training to 3 staff members for dual credentialing.MD, DO, PA, NP MA, LAC Navigator, health coachYes (PHQ9 and 4 questions on substance use, including smoking, alcohol, drugs)NoCo-locatedReferral-triggered
2A postdoctoral psychology training program is partnering with an FQHC that serves seniors to implement enhanced, computerized cognitive and psychological screening. The team will implement and track clinical use of the screening, provide a summary report to clinicians, provide follow-up treatment as requested, and monitor care pathways.MD, NP PhD, PsyD, postdoctoral trainees (PhD, PsyD), student interns (MA)NoYesCo-locatedReferral-triggered Regular communication and coordination
3This privately owned primary care practice is automating behavioral health screening by implementing a kiosk and electronic tablets for use at check-in. This innovation expands current screening materials. The practice will work with information technology partners to develop coding necessary to integrate data into their EHR.MD, DO, PA, NP PhDYes (PHQ2; PHQ9 if PHQ2 is positive)NoMostly separateReferral-triggered
4A CMHC is developing a new integrated care clinic; this included building a new facility and bringing on a primary care team. They are using systematic screening and developing a Personal Health Profile (PHP) that extracts selected information from two separate behavioral health and medical EHRs to provided information about patients' behavioral and physical health needs at the point of care.MD, NP MD (psychiatry), PsyD, LPC, MSW, LCSWYes (PHQ9, GAD7, AUDIT, DAST)NoCo-locatedRegular communication and coordination Full collaboration and integration
5Three private practices—a pediatric practice, family medicine clinic, and behavioral health center—are collaborating on this project. The behavioral health center is expanding services into family practice by delivering trainings on integration, developing a collaborative care schedule to increase consultations and warm hand-offs, and implementing systematic screening.MD, NP PhD, PsyD, LMFT, LPC, LCSW, CACYes (PHQ2; PHQ9 if PHQ2 is positive)NoMostly separateReferral-triggered Regular communication and coordination
6A research team is working with an FQHC to develop a screening tool that assesses patients' behavioral health needs and treatment preferences. Clinic staff are implementing this tool in a practice with an onsite behavioral health provider and patient navigators, with the goal of establish consistent screening and referral of patients to their preferred treatment.MD, NPPhD, postdoctoral trainees (PsyD) NavigatorNoYesCo-locatedReferral-triggered Regular communication and coordination
7This privately owned primary care practice is partnering with a CMHC to hire, train, and supervise a co-located behavioral health provider. They are also expanding health coach services. The practice is exploring ways to finance and sustain these services. MD, DO, PA, chiropractic MSW, LSW Health coachYes (PHQ2; PHQ9 if PHQ2 is positive)YesCo-locatedReferral-triggered Regular communication and coordination Full collaboration and integration
8This is a partnership between an FQHC system, a substance abuse treatment center, and a CMHC. The CMHC is the site of the intervention. They are embedding a primary care team, including a physician's assistant, medical assistant, care coordinator, and substance abuse counselor, into 3 CMHC locations of care.PA MD (psychiatry), LSW, LPC, LCSW, BA, CAC, LAC Care managerYes (access to PC; brief screen for depression, anxiety, and substance use, including smoking, alcohol, drugs; if positive PHQ9, AUDIT, DAST, GAD7)NoCo-locatedReferral-triggered Regular communication and coordination Full collaboration and integration
9This system is co-locating behavioral health providers in primary care clinics to provide patients with solution-focused interventions and facilitate referral to other organizational resources (eg, long-term therapy, case management). These behavioral health providers also provide some consultations to medical clinicians upon request.MD, PA, NP PhDNoYesCo-locatedReferral-triggered Regular communication and coordination
10This solo, privately owned primary care practice is partnering with a nonprofit mental health center to embed a behavioral health provider into the practice. The practice will employ systematic screening and develop referral protocols. The behavioral health provider will provide therapy for patients with poorly controlled chronic diseases.MD, MSWYes (PHQ2; substance use, including smoking, alcohol, drugs; domestic violence)YesCo-locatedReferral-triggered Regular communication and coordination Full collaboration and integration
11This FQHC will increase screening and behavioral health services for newly identified pregnant women by adding a psychology fellow. The fellow will screen patients, offer brief therapy, and follow-up with patients, as needed. All eligible patients receive a follow-up screen at six weeks postpartum.MD, PA, NP PhD, Post-doctoral trainees (PhD, PsyD), student interns (MA)Yes (PHQ9, GAD7, AUDIT)YesFully sharedRegular communication and coordination Full collaboration and integration
  • * Types of providers involved included medical doctor (MD); doctor of osteopathy (DO); physician assistant (PA); nurse practitioner (NP); clinical psychologist (PhD); doctor of psychology (PsyD); masters-level psychologist (MA); bachelors-level therapist (BA); masters of social work (MSW); licensed social worker (LSW); licensed professional counselor (LPC); licensed clinical social worker (LCSW); licensed marriage and family therapist (LMFT); licensed addictions counselor (LAC); certified addictions counselor (CAC).

  • Uses a method to identify members of the clinic population who need or may benefit from behavioral health services. We report the behavioral health screenings used because 9 of the 11 innovations occurred in primary care settings that already had systematic protocols for detecting needs around common medical conditions (eg, diabetes). Behavioral health screenings included the 2-item Patient Health Questionnaire (PHQ2), and the 9-item Patient Health Questionnaire (PHQ9) (for depression); the Alcohol Use Disorders Identification Test (AUDIT); the Drug Abuse Screening Test (DAST); and the 7-item Generalized Anxiety Disorder Screen (GAD7).

  • One record was used to record both physical and behavioral health information.

  • § See Peek and colleagues5 for definitions.

  • See Figure 2 and Peek and colleagues5 for definitions. If an innovator uses multiple approaches, the predominant interpersonal relationship strategy is italicized.

  • ACT, Advancing Care Together; CMHC, community mental health center; EHR, electronic health record; FQHC, federally qualified health center; SBIRT, Screening, Brief Intervention, and Referral to Treatment.