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Implementation of Behavioral Health Integration in Small Primary Care Settings: Lessons Learned and Future Directions

Abstract

Primary care practices are in great need of practical guidance on the steps they can take to build behavioral health integration (BHI) capacities, particularly for smaller practice settings with fewer resources. 11 small primary care sites (≤ 5 providers) throughout New York State utilized a continuum framework of core components of BHI in combination with technical assistance. Surveys were collected at baseline, 6-months, and 12-months. Semi-structured interviews and focus groups were conducted during site visits, and a stakeholder roundtable was facilitated to address broader themes. Data were analyzed using qualitative thematic analysis. Practices reported successful engagement with the framework and actively participated in planning and advancing BHI operations. Greater success was observed in practices with existing on-site BHI services, identified champions for BHI, early and sustained training and involvement of providers and administrators, use of collaborative agreements with external behavioral health providers, and capacity to successfully receive reimbursements for BHI services. Advancing health information technologies was a challenge across sites. Financing and policy factors were viewed as critically important to advance integration efforts. The pilot of a continuum framework offers lessons for primary care practices and policymakers to advance integrated BH care.

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Funding

This study was funded by the United Hospital Fund [Grant Number 4126217] and the New York State Health Foundation [Grant Number 4126177], which were awarded to Dr. Henry Chung at the Montefiore Medical Center, and by the New York State Office of Mental Health Policy Scholars program [no grant number], which was awarded to Matthew L. Goldman, MD, MS.

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Correspondence to Matthew L. Goldman.

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This study was reviewed and met the waiver exemption of the Institutional Review Board of the Albert Einstein College of Medicine.

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Goldman, M.L., Smali, E., Richkin, T. et al. Implementation of Behavioral Health Integration in Small Primary Care Settings: Lessons Learned and Future Directions. Community Ment Health J (2021). https://doi.org/10.1007/s10597-021-00802-z

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Keywords

  • Behavioral health integration
  • Financial sustainability
  • Technology barriers
  • Qualitative evaluation
  • Implementation