Clinical Workflows and the Associated Tasks and Behaviors to Support Delivery of Integrated Behavioral Health and Primary Care

Abstract

Background: Integrating primary care and behavioral health is an important focus of health system transformation. Method: Cross-case comparative analysis of 19 practices in the U.S. describing integrated care clinical workflows. Surveys, observation visits, and key informant interviews analyzed using immersion-crystallization. Results: Staff performed tasks and behaviors – guided by protocols or scripts – to support four workflow phases: (1) Identifying; (2) Engaging/transitioning; (3) Providing treatment; and (4) Monitoring/adjusting care. Shared electronic health records (EHR) and accessible staffing/scheduling facilitated workflows. Conclusion: Stakeholders should consider these workflow phases, address structural features, and utilize a developmental approach as they operationalize integrated care delivery.

Facilitators and barriers for implementing the integrated behavioural health care model in the USA: An integrative review

“…A focus on the patient's needs through the use of a tailored care plan is crucial in caring for a complex population with different needs and is noted as an imperative facilitator (Davis et al . 2019; Gleason et al . 2017; Hoffmann et al .…”

“…The overall identified factors in this review are scattered over the various levels of the SEM, as recommended by experts in health promotion and public health (Golden & Earp, 2012). Infrastructure was a vital facilitator (Anastas et al 2019;Beehler & Wray 2012;Davis et al 2019;Dollar et al 2018;Gleason et al 2017;Grazier et al 2014;Hoffmann et al 2019;Mesidor et al 2011;Reiss-Brennan 2014;Wray et al 2016). To increase the likelihood of success of integration, clinic administrators and staff should incorporate flexible appointment scheduling and allow for walk-in appointments.…”

“…To increase the likelihood of success of integration, clinic administrators and staff should incorporate flexible appointment scheduling and allow for walk-in appointments. This can be achieved by allowing an unscheduled behavioural health provider to provide behavioural health care on-demand to reduce wait time and to better meet the needs of people with mental illness by increasing the availability of behavioural health services (Anastas et al 2019;Davis et al 2019;Dollar et al 2018;Hoffmann et al 2019;Mesidor et al 2011). For example, VA clinics that prioritized the same-day access model demonstrated improved treatment of depression (Pomerantz et al 2014).…”

“…It is indisputable that the integrated care goal is to improve the accessibility of highquality care as well as achieve medical and behavioural positive outcomes (Patel et al 2013). Thus, a key facilitator gleaned from the evidence was patient-centered care that tailors care to the patient (Davis et al 2019;Dollar et al 2018;Falconer et al 2018;Gleason et al 2017;Grazier et al 2014;Grazier et al 2016;Hoffmann et al 2019;Jetelina et al 2018;Mesidor et al 2011;Reiss-Brennan 2014;Sanchez et al 2010;Swavely et al 2020;Wray et al 2016).…”

“…A diminished workforce, specifically, staff trained in behavioural health, can result in staff burnout and high turnover (Anastas et al 2019;Davis et al 2019;Mesidor et al 2011;Sanchez et al 2010). To address burnout, several researchers have found benefits to psychological relief through group cohesion and working on personal growth through education (Anastas et al 2019;Hoffmann et al 2019).…”