Table 2.

Integration Strategy Implemented by ACT practices

Site ID	Integration Strategy	Target Population	Method of Assessment	Assessment Measures Used
4	This practice embedded psychology doctoral trainees in prenatal clinic	Pregnant patients seen at clinic	In waiting room by BHCs	Completion of PHQ9, GAD7, AUDIT, HbA1c
7	This primary care practice automated screening for behavioral health needs using a tablet. A psychologist with a private, colocated practice became an employee who provided traditional mental health services in the practice.	Patients ≥18 y seen at clinic	In waiting room using tablet devices	Completion of PHQ2 followed by PHQ9, if PHQ2 positive
10	This private primary care practice partnered with a CMHC to hire a BHC. The practice also expanded health coaching services.	Patients ≥18 y seen at clinic	In waiting room using paper-based survey, then transition to tablet devices	Completion of PHQ9, GAD7, AUDIT
9	A small primary care practice added a traditional mental health therapist from a private mental health agency to provide colocated care and brief interventions.	Patients ≥18 y seen at clinic	In waiting room using paper-based survey, then transition to tablet devices	Completion of PHQ9, GAD7, AUDIT, and to assess tobacco use.
17	An FQHC with a colocated mental health therapist added a colocated substance use counselor from a collaborating CMHC.	Patients ≥18 y seen at clinic	In waiting or exam room by medical assistants	Completion of PHQ9 and SBIRT
19	This practice screened patients using a tablet device that was programmed to directly transfer entered data to an EHR-linked interface accessible to providers. Further, a PC clinician/MA team, and a BHC were embedded in the practice to provide primary care and BH services.	Patients ≥18 y seen at clinic	In waiting room using handheld tablet devices	Completion of PHQ9, GAD7, AUDIT, BMI, HbA1c
16	This primary care practice expanded their existing integrated care model by working with a research team to develop and implement a screening form for patients to self identify behavioral health needs.	English and Spanish-speaking patients ≥18 y seen at clinic	In waiting room using paper-based survey	Completion of a newly developed “Improve your Health” survey
12	A postdoctoral training program provides colocated mental health services in an FQHC serving seniors. A computerized cognitive and psychological screening program was developed and implemented.	Patients ≥50 y seen for an annual wellness or medically necessary visit	Clinical discretion by primary care providers	Completion of a newly developed cognitive screening tool called CaPS
13	This private primary care practice expanded their partnership with a private mental health agency to provide integrated care. First, an urgent consult schedule was created for BHC services. Over time, services expanded to enable full-time BHC coverage within the practice setting.	Patients ≥18 y seen at clinic for an annual, diabetes, or hypertensive exama	Clinical discretion by primary care providers, then transitioned to systematic in waiting room using paper-based survey	Completion of PHQ2
14	A BHC was embedded in a primary care setting with multiple clinics (e.g., family medicine, pediatrics). BHC provides brief counseling and helps connect patients to specialty MH services within the large, integrated health system or to external resources.	Patients ≥18 y seen at clinic	Clinical discretion by primary care providers	Referral to a behavioral health counselor
18	A primary care team (including PA, MA, care coordinator, and substance use counselor) were embedded in a CMHC.	Clients without primary care physician on record	Clinical discretion by mental health providers	Referral to the primary care team

Abbreviations: BH, behavioral health; BHC, behavioral health clinician; CaPS, Cognitive and Psychological Screen; CMHC, community mental health center; FQHC, federally qualified health center; PC, primary care; AUDIT, Alcohol Use Disorders Identification Test; PHQ, patient health questionnaire; GAD, generalized anxiety disorder; HbA1c, glycosylated hemoglobin; BMI, body mass index; SBIRT, screening, brief intervention, and referral to treatment; PA, physician assistant; MA, medical assistant.

PHQ2 was used to screen for depression; PHQ9 was used to screen or monitor for depression; GAD7 was used to screen or monitor for anxiety disorder; AUDIT was used to screen or monitor for alcohol use; DAST was used to screen or monitor for substance use; BMI was used to screen or monitor for obesity; and HbA1c was measured to monitor for diabetes.

^aTarget population changed midstream.