Integrating primary care into community behavioral health settings: programs and early implementation experiences

Area of Science:

• Health Services Research
• Mental Health Services
• Primary Care Integration

Background:

• Community behavioral health agencies are increasingly integrating primary care services.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) awarded Primary and Behavioral Health Care Integration (PBHCI) grants to facilitate this integration.
• Integrating care aims to improve health outcomes for adults with serious mental illness.

Purpose of the Study:

• To describe the characteristics of community behavioral health agencies receiving PBHCI grants.
• To examine the early implementation experiences of these agencies in integrating primary care.
• To identify barriers and facilitators to integrating primary and behavioral health care.

Main Methods:

• Data collected from 56 PBHCI grantee programs across 26 states (2009-2010).
• Information gathered from grantee proposals, semistructured telephone interviews, and quarterly reports.
• Quantitative and qualitative data analyzed to identify program characteristics and implementation barriers.

Main Results:

• Grantees exhibited variations in organizational characteristics and integration methods despite core grant requirements.
• Initial implementation barriers included staff recruitment/retention, data collection, EHR use, licensing, and physical space.
• By year one, some barriers (e.g., space) resolved, while others (staffing, data) persisted, with new challenges like patient recruitment emerging.

Conclusions:

• Early implementation experiences of PBHCI grantees provide valuable lessons for similar large-scale integration initiatives.
• Findings can inform the development and execution of specialty mental health homes and other integrated care models.
• Successful integration requires addressing persistent challenges in staffing, data management, and patient engagement.