Poster 21 – Barriers and Facilitators to Integrated Behavioral Health Model Adoption: A Mixed Method Study Among Community Health Care Providers at a FQHC

Summary

While integrated behavioral health services are emerging as a promising model of health care, research regarding implementation outcomes, and specifically adoption of the model, are lacking (Hunter et al., 2018). This study aimed to identify barriers and facilitators to adoption of integration among behavioral health and medical providers at an urban community health clinic using a mixed methods design (i.e., survey, interview, and ecological momentary assessment; EMA). Fourteen health care providers (medical, behavioral, and dental) completed the Barriers and Facilitators Assessment instrument (Harmsen, et al., 2005), with some items reworded to address integrated care. Six providers also completed a brief, semi-structured interview related to barriers and facilitators at the site. Lastly, a small sample of providers agreed to complete bi-weekly “probes” (i.e., EMA) that assessed same-day report of integration (e.g., # of warm hand-offs) as well as factors that facilitated or impeded delivery of the model. Responses on the Barriers and Facilitators Assessment instrument indicated that most providers felt that integrated care fits into their ways of working at their practice, is flexible enough to take their patient’s preferences into account and it is not difficult to implement with older (60+) and younger (under 18) patients. However, half of the sample either agreed or fully agreed that they wished they had known more about integrated care before they were asked to implement it. Further, almost a third (28.6 %) of participants agreed that parts of integrated care are not helpful and that it is difficult to implement integrated care to patients with a different cultural background. Interviews and brief probes will be analyzed via a qualitative thematic analysis (Braune & Clarke, 2006) and reviewed within context of the survey data. It should be noted that these results are reflective of the opinions of medical providers working exclusively within an urban, community FQHC and may not be representative of other settings. This research and use of unique methodology will add to the primary care integrated behavioral health literature by providing more data on model implementation, facilitators, and barriers to adoption from medical, behavioral health, and dental provider perspectives.