Building Bridges: Primary Care and Mental Health Providers’ Perspectives on a Behavioral Health Collaborative Intervention Among Underserved Populations

Abstract

Background

Behavioral health interventions that support low-income children and their families in under-resourced communities have a positive impact on child development; however, few interventions exist that highlight approaches providers use to contribute to this positive development.

Objective

To identify key strategies used by pediatric primary care physicians (PCP) and specialty mental health providers to improve access to and engagement in mental health services for low-income children and their families engaged in behavioral health services.

Method

Using the inductive constant comparative approach, researchers conducted 11 semistructured interviews with six PCPs, one staff member from a federally qualified health center (FQHC), and three mental health providers and one staff member from two local mental health clinics.

Results

Three main themes were identified that were used by PCPs and specialty mental health providers to improve access to and engagement in mental health services for low-income children and their families.

Conclusions

These themes highlight how PCPs and specialty mental health providers engage in critical strategies to support their efforts to improve access to and engagement in mental health services for low-income children and their families. The present study offers evidence that identifying effective strategies for providers to improve access to and engagement in mental health services for low-income children and their families is an important step toward the national priority of integrating mental and behavioral health services into pediatric primary care.

Appendix A

Example of Coding Scheme.

Code	Definition	Example
Communication	Content shared between primary care and specialty provider that involves an exchange or transfer of information (e.g., such as letters, reports, key medical information, etc.) that includes the source (i.e., phone, grand rounds, fax, education session), frequency, direction (i.e., unidirectional or bidirectional), or quality (i.e., timeliness, reliability, accuracy, completeness, consistency)	With CHEC, it’s been good. I really appreciate the communication. Dr. Patel shared with me about my patients. I liked the educational sessions that we had. It helped... the experience was good because I felt that there was a connection. Like it wasn’t that I was just sending my patients out and I don’t know what was going on. I felt that I had resources like call or... it’s been good. We’ve got a lot done. I got the reports
Coordination	Primary care and specialty provider sharing information in order to carry out a plan of action—desired and/or actual. Gives insight into what the intervention really is and identifies the process, development, and implementation of a shared plan to help patients What this code does not focus on the processes, development, and implementation of a plan for patients	So, our referral coordinators are helpful with receiving the reports that they do receive and making sure that they get in front of the eyes of the provider and then being scanned in into our electronic health record. At the beginning of the referral process, our referral coordinators and our medical assistants are assisting with making sure that the provider completes the referral form and then they fax it over to the agencies. (CP)
Collaboration	Content shared between primary care and specialty provider that goes back and forth about what they are going to implement for the patient or discussions primary care and specialty provider have as it relates to a plan for the patient; this plan demonstrates structure, a process and a shared understanding about the plan that will be carried out together	So, when our colocation started happening it was lovely because the therapists had certain hours that she was there, is there at the site and we could make appointments with them and say I’ve met this person before and you can just come to our site at this time. She doesn’t work for us but she will help you. And so that already was an improvement and she would come by once every two weeks or and say, Hi I am here if you have anybody to refer to me just go ahead and fil out this form. Also she would come up to us and say I have a follow up, some follow up information on your patient. Lovely