Defining and measuring core processes and structures in integrated behavioral health in primary care: a cross-model framework

Kari A. Stephens, Constance van Eeghen, Brenda Mollis, Margaret Au, Stephanie A. Brennhofer, Matthew Martin, Jessica Clifton, Elizabeth Witwer, Audrey Hansen, Jeyn Monkman, Gretchen Buchanan, Rodger Kessler

Research output: Contribution to journalArticle

Abstract

A movement towards integrated behavioral health (IBH) in primary care continues to grow, among an accumulating evidence base for its effectiveness for improving care. However, healthcare organizations struggle to navigate where to target their limited resources for improving integration. We evaluated a cross-model framework of IBH core processes and structures. We used a mixed-methods approach for evaluation of the framework, which included (a) an evaluation survey of national experts and stakeholders, (b) crosswalks with common IBH measures, and (c) a real-world usability test. Five core IBH principles, mapping to 25 processes, and nine clinic structures were defined. Survey responses from 29 IBH domain and policy experts and stakeholders resulted in uniformly high ratings of importance and variable levels of feasibility for measurement, particularly with respect to electronic health record (EHR) systems. A real-world usability test resulted in good uptake and use of the framework across a state-wide effort. An IBH Cross-Model Framework of core principles, processes, and structures generated good acceptability and showed good real-world utility in a state-wide effort to improve IBH across disparate levels of integration in diverse primary care settings. Findings identify feasible areas of measurement, particularly with EHR systems. Next steps include testing the relationship between the individual framework components and patient outcomes to help guide clinics towards prioritizing efforts focused on improving integration.

Original languageEnglish (US)
Pages (from-to)527-538
Number of pages12
JournalTranslational behavioral medicine
Volume10
Issue number3
DOIs
StatePublished - Aug 7 2020

Keywords

  • Evidence-based care
  • Integrated behavioral health
  • Primary care
  • Quality care
  • Team-care

ASJC Scopus subject areas

  • Applied Psychology
  • Behavioral Neuroscience

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    Stephens, K. A., van Eeghen, C., Mollis, B., Au, M., Brennhofer, S. A., Martin, M., Clifton, J., Witwer, E., Hansen, A., Monkman, J., Buchanan, G., & Kessler, R. (2020). Defining and measuring core processes and structures in integrated behavioral health in primary care: a cross-model framework. Translational behavioral medicine, 10(3), 527-538. https://doi.org/10.1093/tbm/ibz163