Integrating Behavioral Health and Primary Care: Consulting, Coordinating and Collaborating Among Professionals

Abstract

Purpose: This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions.Methods: This was a comparative case study in which a multidisciplinary team used an immersioncrystallization approach to analyze data from observations of practice operations, interviews with practice members, and implementation diaries. The observed practices were drawn from 2 studies: Advancing Care Together, a demonstration project of 11 practices located in Colorado; and the Integration Workforce Study, consisting of 8 practices located across the United States.Results: Primary care and behavioral health clinicians used 3 interpersonal strategies to work together in integrated settings: consulting, coordinating, and collaborating (3Cs). Consulting occurred when clinicians sought advice, validated care plans, or corroborated perceptions of a patient's needs with another professional. Coordinating involved 2 professionals working in a parallel or in a backand-forth fashion to achieve a common patient care goal, while delivering care separately. Collaborating involved 2 or more professionals interacting in real time to discuss a patient's presenting symptoms, describe their views on treatment, and jointly develop a care plan. Collaborative behavior emerged when a patient's care or situation was complex or novel. We identified contextual factors shaping use of the 3Cs, including: time to plan patient care, staffing, employing brief therapeutic approaches, proximity of clinical team members, and electronic health record documenting behavior. Compelling research evidence, health care reform initiatives, and clinician and patient needs are driving the integration of primary care and behavioral health services. Emotional, behavioral, and physical comorbidities are common and compound the risk for undesirable patient health outcomes. Conclusion1-11 Regardless of implementation site, integration requires professionals of different backgrounds interacting to provide care, yet little research has focused on understanding the ways clinicians work This article was externally peer reviewed.

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