Table 2. Integration Strategy Implemented by ACT practices
Site IDIntegration StrategyTarget PopulationMethod of AssessmentAssessment Measures Used
4This practice embedded psychology doctoral trainees in prenatal clinicPregnant patients seen at clinicIn waiting room by BHCsCompletion of PHQ9, GAD7, AUDIT, HbA1c
7This primary care practice automated screening for behavioral health needs using a tablet. A psychologist with a private, colocated practice became an employee who provided traditional mental health services in the practice.Patients ≥18 y seen at clinicIn waiting room using tablet devicesCompletion of PHQ2 followed by PHQ9, if PHQ2 positive
10This private primary care practice partnered with a CMHC to hire a BHC. The practice also expanded health coaching services.Patients ≥18 y seen at clinicIn waiting room using paper-based survey, then transition to tablet devicesCompletion of PHQ9, GAD7, AUDIT
9A small primary care practice added a traditional mental health therapist from a private mental health agency to provide colocated care and brief interventions.Patients ≥18 y seen at clinicIn waiting room using paper-based survey, then transition to tablet devicesCompletion of PHQ9, GAD7, AUDIT, and to assess tobacco use.
17An FQHC with a colocated mental health therapist added a colocated substance use counselor from a collaborating CMHC.Patients ≥18 y seen at clinicIn waiting or exam room by medical assistantsCompletion of PHQ9 and SBIRT
19This practice screened patients using a tablet device that was programmed to directly transfer entered data to an EHR-linked interface accessible to providers. Further, a PC clinician/MA team, and a BHC were embedded in the practice to provide primary care and BH services.Patients ≥18 y seen at clinicIn waiting room using handheld tablet devicesCompletion of PHQ9, GAD7, AUDIT, BMI, HbA1c
16This primary care practice expanded their existing integrated care model by working with a research team to develop and implement a screening form for patients to self identify behavioral health needs.English and Spanish-speaking patients ≥18 y seen at clinicIn waiting room using paper-based surveyCompletion of a newly developed “Improve your Health” survey
12A postdoctoral training program provides colocated mental health services in an FQHC serving seniors. A computerized cognitive and psychological screening program was developed and implemented.Patients ≥50 y seen for an annual wellness or medically necessary visitClinical discretion by primary care providersCompletion of a newly developed cognitive screening tool called CaPS
13This private primary care practice expanded their partnership with a private mental health agency to provide integrated care. First, an urgent consult schedule was created for BHC services. Over time, services expanded to enable full-time BHC coverage within the practice setting.Patients ≥18 y seen at clinic for an annual, diabetes, or hypertensive examaClinical discretion by primary care providers, then transitioned to systematic in waiting room using paper-based surveyCompletion of PHQ2
14A BHC was embedded in a primary care setting with multiple clinics (e.g., family medicine, pediatrics). BHC provides brief counseling and helps connect patients to specialty MH services within the large, integrated health system or to external resources.Patients ≥18 y seen at clinicClinical discretion by primary care providersReferral to a behavioral health counselor
18A primary care team (including PA, MA, care coordinator, and substance use counselor) were embedded in a CMHC.Clients without primary care physician on recordClinical discretion by mental health providersReferral to the primary care team
  • Abbreviations: BH, behavioral health; BHC, behavioral health clinician; CaPS, Cognitive and Psychological Screen; CMHC, community mental health center; FQHC, federally qualified health center; PC, primary care; AUDIT, Alcohol Use Disorders Identification Test; PHQ, patient health questionnaire; GAD, generalized anxiety disorder; HbA1c, glycosylated hemoglobin; BMI, body mass index; SBIRT, screening, brief intervention, and referral to treatment; PA, physician assistant; MA, medical assistant.

  • PHQ2 was used to screen for depression; PHQ9 was used to screen or monitor for depression; GAD7 was used to screen or monitor for anxiety disorder; AUDIT was used to screen or monitor for alcohol use; DAST was used to screen or monitor for substance use; BMI was used to screen or monitor for obesity; and HbA1c was measured to monitor for diabetes.

  • a Target population changed midstream.