Provider and Staff Perceptions and Experiences Implementing Behavioral Health Integration in Six Low-Income Health Care Organizations

  • Heather Farb
  • Katie Sacca
  • Margaret Variano
  • Lisa Gentry
  • Meagan Relle
  • Jane Bertrand
Article
  • 28 Downloads

Abstract

Behavioral health integration (BHI) is a proven, effective practice for addressing the joint behavioral health and medical health needs of vulnerable populations. As part of the New Orleans Charitable Health Fund (NOCHF) program, this study addressed a gap in literature to better understand factors that impact the implementation of BHI by analyzing perceptions and practices among staff at integrating organizations. Using a mixed-method design, quantitative results from the Levels of Integration Measure (LIM), a survey tool for assessing staff perceptions of BHI in primary care settings (n=86), were analyzed alongside qualitative results from in-depth interviews with staff (n=27). Findings highlighted the roles of strong leadership, training, and process changes on staff collaboration, relationships, and commitment to BHI. This study demonstrates the usefulness of the LIM in conjunction with in-depth interviews as an assessment tool for understanding perceptions and organizational readiness for BHI implementation.

Keywords

Behavioral health integration Integrated care Primary care Behavioral health Provider perceptions Measuring integration Program implementation Mixed methods evaluation 

References

  1. 1.
    National Alliance on Mental Illness (NAMI). Mental health by the numbers. NAMI. Available online at https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers. Accessed December 2, 2015.
  2. 2.
    Substance Abuse and Mental Health Services Administration. Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings. 2014. Substance Abuse and Mental Health Services Administration. Available online at http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf. Accessed December 2, 2015.
  3. 3.
    Robinson PJ, Reiter JT. Behavioral Consultation and Primary Care: A Guide to Integrating Services. New York: Springer, 2007.CrossRefGoogle Scholar
  4. 4.
    Roll JM, Kennedy J, Tran M, et al. Disparities in unmet need for mental health services in the United States, 1997–2010. Psychiatric Services. 2013;64(1):80–82.CrossRefPubMedGoogle Scholar
  5. 5.
    Carey, TA. Mental health: Integration is the key to the revolution. The Lancet. 2013;382(9902):1403–1404.CrossRefGoogle Scholar
  6. 6.
    Massa I, Miller BF, Kessler R. Collaboration between NCQA patient-centered medical homes and specialty behavioral health and medical services. Translational Behavioral Medicine. 2012;2(3):332–336.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Nielsen M. Behavioral health integration: A critical component of primary care and the patient-centered medical home. Drug and Alcohol Dependence. 2014;98(1–2):45–53.Google Scholar
  8. 8.
    Westheimer JM, Steinley-Bumgarner M, Brownson C. Primary care providers’ perceptions of and experiences with an integrated healthcare model. Journal of American College Health. 2008;57(1):101–108.CrossRefPubMedGoogle Scholar
  9. 9.
    Torrence ND, Mueller AE, Ilem AA, et al. Medical provider attitudes about behavioral health consultants in integrated primary care: A preliminary study. Families, Systems, & Health. 2014;32(4):426.CrossRefGoogle Scholar
  10. 10.
    New Orleans Health Department. Behavioral Health in New Orleans 2012: Recommendations for Systems Change. New Orleans Health Department. Available online at https://www.nola.gov/nola/media/Health-Department/Publications/Behavioral-Health-in-New-Orleans-2012-final-draft.pdf. Accessed December 2, 2015.
  11. 11.
    Camden Coalition of Healthcare Providers. Healthcare hotspotting. Available online at http://hotspotting.camdenhealth.org/. Accessed January 5, 2016.
  12. 12.
    University of Washington Psychiatry & Behavioral Sciences AIMS Center. IMPACT evidence-based depression care. AIMS Center. Available online at http://impact-uw.org/. Accessed January 5, 2016.
  13. 13.
    Collaborative Family Healthcare Association. PCBH FAQ – general definition. Collaborative Family Healthcare Association. Available online at http://www.cfha.net/?page=PCBHFAQDefinition = Accessed January 5, 2016.
  14. 14.
    Bodenheimer T, Sinsky C. From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 2014;12(6):573–576.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Fauth J, Tremblay G. The integrated care evaluation project: Full report. Center for Research on Psychological Practice, Antioch University. 2010. Antioch University. Available online at http://www.antiochne.edu/wp-content/uploads/2014/05/ICE_final_report.pdf. Accessed December 2, 2015.
  16. 16.
    Dodge Y. The Concise Encyclopedia of Statistics. New York: Springer-Verlag, 2010.Google Scholar
  17. 17.
    Kirchner JE, Cody M, Thrush CR, et al. Identifying factors critical to implementation of integrated mental health services in rural VA community-based outpatient clinics. The Journal of Behavioral Health Services & Research. 2004;31(1):13–25.CrossRefGoogle Scholar
  18. 18.
    Meredith LS, Mendel P, Pearson M, et al. Implementation and maintenance of quality improvement for treating depression in primary care. Psychiatric Services. 2006;57(1):48–55.CrossRefPubMedGoogle Scholar
  19. 19.
    Scharf DM, Eberhart NK, Schmidt N, et al. Integrating primary care into community behavioral health settings: Programs and early implementation experiences. Psychiatric Services. 2013;64(7):660–665.CrossRefPubMedGoogle Scholar
  20. 20.
    Goldman, ML, Spaeth-Rublee B, Pincus HA. Quality indicators for physical and behavioral health care integration. The Journal of the American Medical Association. 2015;314(8):769–770.CrossRefPubMedGoogle Scholar
  21. 21.
    Jones EB & Ku L. Sharing a playbook: Integrated care in community health centers in the United States. American Journal of Public Health. 2015;105(10):2028–2034.CrossRefPubMedGoogle Scholar
  22. 22.
    Kilbourne AM, Irmiter C, Capobianco J, et al. Improving integrated general medical and mental health services in community-based practices. Administration and Policy in Mental Health and Mental Health Services Research. 2008;35(5):337–345.CrossRefPubMedGoogle Scholar
  23. 23.
    Kolko DJ, Perrin E. The integration of behavioral health interventions in children's health care: Services, science, and suggestions. Journal of Clinical Child & Adolescent Psychology. 2014;43(2):216–228.CrossRefGoogle Scholar

Copyright information

© National Council for Behavioral Health 2017

Authors and Affiliations

  1. 1.Louisiana Public Health InstituteNew OrleansUSA
  2. 2.Louisiana Department of HealthOffice of Public Health, Bureau of Family HealthNew OrleansUSA
  3. 3.Ochsner Health SystemJeffersonUSA
  4. 4.OptumMetairieUSA
  5. 5.Department of Global Health Management and PolicyTulane School of Public Health and Tropical MedicineNew OrleansUSA

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