Let’s start with what we know: A mixed methods assessment of practice-based implementation strategies for addressing behavioral health in primary care

Project Dates: 2022-2024

Behavioral health (BH) is a powerful contributor to health; people with BH conditions (e.g., depression, anxiety) die up to 20 years earlier than those without. One mechanism of this premature mortality is insufficient cancer screening rates resulting in greater morbidity and reduced treatment, as BH influences an individual’s access to and ability to engage in care. Primary care providers (PCPs) are typically tasked with cancer screening and are often the first line of treatment for BH conditions, but are not usually equipped to adequately address BH. One evidence-based solution is behavioral health integration (BHI), which is typically defined as augmenting the primary care medical team with a BH professional (e.g., psychologist) who sees patients for brief, focused concerns, can function as a bridge to specialty care, and provides PCPs with support and education around patient BH concerns. BHI has slowly begun to disseminate across the U.S. but practices encounter significant barriers to implementing this critical service. Incorporating these professionals into the care team can also address two of the top ten priorities of Siteman Cancer Center catchment area community members: cancer screening and coordinating care.

Project Goals:

  • Identify and categorize implementation strategies and contextual factors for BHI in primary care clinics.  The primary outcome will be a diagram of each clinic’s implementation process and relevant contextual factors (e.g., practice size, urbanicity, percent of minoritized patients, policies, EHR/data systems, physical space).
  • Evaluate BHI implementation success.   Our team members’ and observers’ perceptions of penetration, sustainability, and fidelity/level of integration will be qualitatively evaluated. The primary outcome will be a clinic profile matrix and within-site and cross-site analyses.
  • Assess the relationship between BHI implementation success and cancer screening rates. Using administrative reports of cancer screening rates at each clinic and results from (1) the percent of shared medical-behavioral patients at the provider and clinic level (penetration), (2) the PRESS (sustainability), and (3) the PIP (level of integration), we will use regression analysis to evaluate their relationship.

Implications for Research and Practice:

This study will identify implementation strategies that may be effective in achieving high-quality BHI, which may contribute to improved cancer screening rates for patients with BH conditions. These strategies can then be examined in a prospective hybrid effectiveness-implementation trial with the goal of facilitating rapid scale-up of BHI to improve health equity

Project Contact: Gretchen Buchanan, PhD,

Project Staff: Byron Powell, Lorella Palazzo,  Sarah Pritchard