Characteristics of Health Centers’ Behavioral Health Programs by Stage of Integration*
| Preparation or Action (N=45) | Maintenance (N=32) | OR (95 % CI)† | p-value | |
|---|---|---|---|---|
| BH services at all sites | 23 (51%) | 23 (72%) | 2.44 (0.97–6.13) | 0.06 |
| Appointment types | ||||
| Same day | 30 (67%) | 27 (84%) | 2.70 (1.15–6.32) | 0.02 |
| Scheduled | 41 (91%) | 31 (97%) | 3.02 (0.48–18.99) | 0.24 |
| Wait list | 13 (29%) | 10 (31%) | 1.12 (0.33–3.78) | 0.86 |
| Walk in | 27 (60%) | 17 (53%) | 0.76 (0.34–1.68) | 0.49 |
| Systematic depression screening at all sites | 39 (87%) | 30 (94%) | 2.31 (0.59–9.07) | 0.23 |
| BH registry | 20 (44%) | 18 (62%) | 2.05 (1.15–3.64) | 0.02 |
| Referral arrangement with external BH organization | 24 (53%) | 8 (25%) | 0.32 (0.13–0.78) | 0.01 |
| Track BH referrals | 33 (75%) | 28 (90%) | 3.11 (1.09–8.85) | 0.03 |
| Champion for BH integration | 35 (80%) | 30 (94%) | 3.86 (1.01–14.72) | 0.048 |
| Co-located BH and primary care in same offices | 32 (71%) | 30 (94%) | 6.09 (1.05–35.26) | 0.04 |
| Warm hand-offs | 35 (78%) | 28 (88%) | 2.00 (1.22–3.29) | 0.01 |
| PCPs and BHPs can both access BH treatment plan | 39 (93%) | 28 (89%) | 0.54 (0.17–1.73) | 0.30 |
| BHPs in clinic everyday | 33 (73%) | 28 (88%) | 2.55 (0.94–6.89) | 0.07 |
| BHPs on staff | ||||
| Psychiatrist | 15 (33%) | 14 (44%) | 1.56 (0.49–4.94) | 0.45 |
| Psychologist | 7 (16%) | 12 (38%) | 3.26 (1.74–6.09) | <0.001 |
| Counselor or therapist | 12 (27%) | 16 (50%) | 2.75 (0.94–8.07) | 0.07 |
| Social worker | 33 (73%) | 26 (81%) | 1.58 (0.70–3.54) | 0.27 |
| BH training required for | ||||
| PCPs | 15 (33%) | 15 (47%) | 1.76 (0.66–4.74) | 0.26 |
| Clinical staff | 11 (24%) | 14 (44%) | 2.40 (0.75–7.66) | 0.14 |
| Non-clinical staff | 5 (11%) | 10 (31%) | 3.64 (0.82–16.18) | 0.09 |
| BH training required at least annually | 9 (20%) | 9 (28%) | 1.57 (0.65–3.79) | 0.32 |
| Received ACA behavioral health integration grant | 13 (29%) | 13 (41%) | 1.68 (0.46–6.21) | 0.43 |
BH=behavioral health, PCP=primary care provider, BHP=behavioral health provider, ACA=Affordable Care Act. Values are N (%).
Stage of integration was determined based on the health center leader’s response to the following survey question: “Overall, how would you describe the status of your health center’s efforts to integrate physical and behavioral health care?” Those that selected “We are in the planning stage” were in Preparation. Those that selected “We have implemented some strategies, but have more work to do” were in Action. Those that selected “Our implementation is complete, and we are focused on maintenance and quality improvement” were in Maintenance.
Odds of being in maintenance stage of integration (vs. preparation or action stage), compared to health centers without each behavioral health program characteristic