An Evidence Roadmap for Implementation of Integrated Behavioral Health under the Affordable Care Act

Abstract

The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to better address mental and behavioral health needs. The integration of behavioral health and primary care is increasingly viewed as an answer to address such needs, and it is advisable that evidence-based models and interventions be implemented whenever possible with fidelity. At the same time, there are few evidence-based models, especially beyond depression and anxiety, and thus further research and evaluation is needed. Resources being allocated to adoption of models of integrated behavioral health care (IBHC) should include quality improvement, evaluation, and translational research efforts using mixed methodology to enhance the evidence base for IBHC in the context of health care reform. This paper covers six key aspects of the evidence for IBHC, consistent with mental and behavioral health elements of the ACA related to infrastructure, payments, and workforce. The evidence for major IBHC models is summarized, as well as evidence for targeted populations and conditions, education and training, information technology, implementation, and cost and sustainability.

A Multidisciplinary, Family-Oriented Approach to Caring for Parents After Miscarriage: The Integrated Behavioral Health Model of Care

“…Additionally, research has not yet tested the IBH model in miscarriage care. As an existing, evidence-based model of care ( 64 , 65 ), IBH represents an important opportunity to address the limitations of current miscarriage care, as well as the barriers to implementation of family-oriented, biopsychosocial care ( 1 , 41 , 44 ).…”

Preparing residents to practice integrated behavioral health care: Multi-site feasibility study of a competency-based curriculum

“…1 Integrated behavioral healthcare may address mental health and substance abuse conditions, health behaviors, life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization. [1][2][3][4][5] Integrated behavioral healthcare in primary care is necessary because of population need and treatment effectiveness and requires training of medical clinicians [2][3][4][5] Although there are numerous ways that practices have IBH services, all models require the development of interprofessional, team-based skills for medical clinicians as well as competency in working within IBH models of care. 6 The emphasis on interprofessional team-based skills and a holistic, patient-centered perspective is evident in the Accreditation Council for Graduate Medical Education revised Family Medicine Milestones 7 and the 2021 National Academies of Science, Engineering, and Medicine report on implementing high-quality primary care.…”

“…1 Integrated behavioral healthcare may address mental health and substance abuse conditions, health behaviors, life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization. 1–5…”

Patient screening for integrated behavioral health in adult primary care: A rapid review of effective procedures.

“…Screening, in combination with clinical decision support and treatment, can improve patient outcomes and reduce health care costs (Talen et al, 2013;Varghese et al, 2018). Despite the importance of addressing BH needs in primary care, screening rates for BH needs are lower than reported prevalence rates of behavioral conditions commonly seen in primary care (Kwan et al, 2015;Sohn et al, 2016;Weitzman & Leventhal, 2006). One potential reason for low BH screening rates in primary care includes the limited evidence base to inform BH screening (Thombs et al, 2012).…”