Research suggests that National Collegiate Athletic Association (NCAA) Division I student-athletes have higher levels of stress and other behavioral health issues, including substance use, than nonathletes. For several reasons, student-athletes may be less likely to admit to behavioral health issues and seek mental health care. Integrated care is a model of care that integrates behavioral health into a medical practice. This article explores the newly released NCAA Best Mental Health Practice guidelines and the application of integrated care to a Division I athletic training room setting using the three-worldview framework for successful integration, incorporating clinical outcomes, operational reliability, and financial stability. (PsycINFO Database Record

Background:There is a growing awareness of the importance of mental health care in National Collegiate Athletic Association (NCAA) student-athletes; however, there is a lack of literature on mental health resources in collegiate settings. Identifying current practices can set the stage to improve the delivery of care.Hypothesis:There is great variability in resources and current practices and no “standard of care” exists.Study Design:Observational, quantitative.Level of Evidence:Level 5.Methods:One hundred twenty-seven (36% response rate) head athletic trainers at Division I NCAA member colleges completed a web-based survey. Questions assessed several aspects of mental health clinicians, perception of care coordination, and screening.Results:Seventy-two percent of respondents noted that counseling took place in a counseling center, and 20.5% of respondents indicated that they had a mental health provider who worked in the athletic training room. Mental health clinician credentials included marriage and family therapist, psychologist, clinical social worker, and psychiatrist. The majority of athletic trainers (ATCs) noted that they are satisfied with the feedback from the mental health provider about the student-athletes’ mental health (57.3%) and believe that they would be able to provide better care to student-athletes if mental health services occurred onsite in the training room (46.4%). Fewer than half (43%) indicated that they use screening instruments to assess for mental health disorders.Conclusion:There is wide variability on how mental health services are provided to NCAA Division 1 student-athletes. Some mental health care providers are located offsite, while some provide care in the training room setting. Also, there are inconsistencies in the use of standardized screening tools for mental health evaluation. There is no standard collaborative or integrated care delivery model for student-athletes.Clinical Relevance:Opportunities exist for standardization through integrated care models and increased use of validated screening tools to deliver comprehensive care to student-athletes.

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As the field of collaborative care, or integrated behavioral health, continues to develop, lessons are learned from attempts to establish such programs (Sieber et al., 2012; Unützer, 2014). Part of the success of collaborative care programs is the function of an interdisciplinary team. In this article, faculty from University of San Diego (USD) and University of California, San Diego (UCSD) share changes needed to curriculum and career development to support leadership and teamwork skills essential to program development, implementation, and sustainability for integrated behavioral health. This article uses Unützer's (2014) 4 factors of creating a successful collaborative care program (i.e., shared vision, leadership, staffing, and financial sustainability) to discuss implications for effective collaboration between 2 universities and the training of primary care providers in teamwork and leadership skills for overcoming barriers and pitfalls to expand collaborative care beyond their initial training.

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