Barriers to Behavioral Health Integration at Health Centers by Stage of Integration^*

	Preparation or Action (N=45)	Maintenance (N=32)	OR (95 % CI)†	p-value
Reimbursement rates from payers adequately cover the cost of providing BH services, N (%) disagree or strongly disagree	24 (56%)	14 (44%)	0.62 (0.26–1.46)	0.27
Reimbursement rates from payers adequately cover the cost of integrating BH services and medical care, N (%) disagree or strongly disagree	23 (53%)	15 (48%)	0.82 (0.41–1.61)	0.56
Financial barriers prevent patients from being seen by primary care and BH providers on the same day, N (%) agree or strongly agree	20 (44%)	7 (23%)	0.36 (0.12–1.09)	0.07
Certification or licensure requirements prevent trained providers from providing BH services, N (%) agree or strongly agree	9 (20%)	5 (16%)	0.74 (0.25–2.22)	0.59
We have difficulty recruiting or retaining BH counselors, N (%) agree or strongly agree	23 (51%)	12 (38%)	0.57 (0.27–1.24)	0.16
We have difficulty recruiting or retaining psychiatrists, N (%) agree or strongly agree	35 (80%)	20 (69%)	0.57 (0.29–1.11)	0.10

BH=behavioral health

^*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 that did not report each barrier