Changes in the health care system and a renewed focus on patient-centered medical homes, which integrate behavioral health services into primary care, present professional psychologists with unprecedented workforce and growth opportunities. However, the profession must act immediately to take full advantage of these emerging opportunities. Although many conceptualize integrated primary care as including mental health services in primary care, in practice, the role of the primary care behavioral professional extends far beyond mental health concems. The authors suggest two key domains of action: First, in order to serve optimally as behavioral health professionals and leaders in primary care, psychologists must receive training in clinical health psychology. Second, psychologists need to increase knowledge and skills in the conduct of translational research in "real-world" clinical settings. The discussion centers on delineating the imperatives the profession must address and offers general suggestions for possible approaches, which ideally will form the basis for specific models of professional preparation. What is abundantly clear is that, as the face of health care changes, professional psychology must respond swiftly and appropriately not only to remain viable, but to thrive.

The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.

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