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Articles   |    
Integrating Primary Care Into Community Behavioral Health Settings: Programs and Early Implementation Experiences
Deborah M. Scharf, Ph.D.; Nicole K. Eberhart, Ph.D.; Nicole Schmidt, M.A.; Christine A. Vaughan, Ph.D.; Trina Dutta, M.P.P., M.P.H.; Harold Alan Pincus, M.D.; M. Audrey Burnam, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200269
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Dr. Scharf is affiliated with the Department of Behavioral Health Sciences, RAND Corporation, 4570 Fifth Ave., Suite 600, Pittsburgh, PA 15213 (e-mail: dscharf@rand.org). Dr. Eberhart, Ms. Schmidt, Dr. Vaughan, and Dr. Burnam are with the Department of Behavioral Health Sciences, RAND Corporation, Santa Monica, California. Ms. Dutta is with the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, Maryland. Dr. Pincus is with the Department of Psychiatry, Columbia University, New York City.

Copyright © 2013 by the American Psychiatric Association


Objective  This article describes the characteristics and early implementation experiences of community behavioral health agencies that received Primary and Behavioral Health Care Integration (PBHCI) grants from the Substance Abuse and Mental Health Services Administration to integrate primary care into programs for adults with serious mental illness.

Methods  Data were collected from 56 programs, across 26 states, that received PBHCI grants in 2009 (N=13) or 2010 (N=43). The authors systematically extracted quantitative and qualitative information about program characteristics from grantee proposals and semistructured telephone interviews with core program staff. Quarterly reports submitted by grantees were coded to identify barriers to implementing integrated care.

Results  Grantees shared core features required by the grant but varied widely in terms of characteristics of the organization, such as size and location, and in the way services were integrated, such as through partnerships with a primary care agency. Barriers to program implementation at start-up included difficulty recruiting and retaining qualified staff and issues related to data collection and use of electronic health records, licensing and approvals, and physical space. By the end of the first year, some problems, such as space issues, were largely resolved, but other issues, including problems with staffing and data collection, remained. New challenges, such as patient recruitment, had emerged.

Conclusions  Early implementation experiences of PBHCI grantees may inform other programs that seek to integrate primary care into behavioral health settings as part of new, large-scale government initiatives, such as specialty mental health homes.

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Figure 1 Barriers to program implementation reported at baseline and one-year follow-up by 56 recipients of Primary and Behavioral Health Care Integration (PBHCI) grantsa

a Follow-up data were available for 55 grant recipients.

b EHR, electronic health records

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Table 1Characteristics of consumers expected to receive integrated general medical services at 56 PBHCI programs, in percentagesa
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a The data reflect anticipated clientele over a four-year period among recipients of Primary and Behavioral Health Care Integration (PBHCI) grants.

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b Includes schizophrenia, bipolar disorder, and clinical depression

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c Medicaid and Medicare were not mutually exclusive categories.

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Table 2Full-time employees (FTEs) expected to be supported by Primary and Behavioral Health Care Integration (PBHCI) grantsa
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a Data reflect only grantees that expected to use PBHCI funds for this staff position.

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b Data reflect FTEs per 1,000 unduplicated consumers expected to participate in PBHCI services over the lifetime of the grant.

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c Information on grant-funded FTEs could not be obtained from three of the 56 programs that received PBHCI funds.

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d Primarily nonclinical roles, such as program manager, evaluator, and data entry assistant

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Table 3Expected use of evidence-based practices for behavioral health care by 56 recipients of PBHCI grantsa
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a PBHCI, Primary and Behavioral Health Care Integration

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b U.S. Preventive Services Task Force (USPSTF) Recommendations for Adults



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