Poster 46 – Implementing Integrated Behavioral Healthcare in Varied Clinical Settings and Associations with Health Equity

Summary

Background: Access to behavioral health (BH) services is a major problem in the United States and can be particularly difficult for minorities, those who have lower socioeconomic status, or live in rural areas. Integrated behavioral health (IBH) is a health service delivery model that is a natural solution for addressing BH problems in primary care by incorporating BH professionals into the primary care team. This study examines IBH implementation and health disparities in primary care medical clinics across the state of Minnesota. Aims include (a) determining unique types of IBH implementation in a sample of 102 clinics, (b) testing whether clinic context predicts IBH implementation types; (c) testing whether IBH implementation type predicts clinical outcomes of depression and chronic disease (asthma, cardiovascular disease, or diabetes) management; and (d) testing whether clinics’ identified IBH implementation types moderate the relationship between clinic context, clinical outcomes, and a vector of depression management implementation outcomes (screening, follow-up, remission). Methods: Survey data (N = 102 clinics) were obtained through a community-based participatory research project and were analyzed using latent class analysis (LCA). The resultant latent classes will be utilized in a structural equation model (SEM) depicting the relationships between clinic context variables (rurality, minority populations, and socioeconomic risk of patients), IBH implementation, and both clinical outcomes of depression and chronic health management as well as implementation outcomes of depression management. Findings: The most interpretable and applicable solution was the 4-class solution. Entropy was above .8, indicating a clear fit between cases and their classes. The four classes are: Strong IBH (23.1%), Mixed Principles and Structures (7.9%), Emerging IBH (29.4%), and Low IBH (39.6%). SEM analyses are still being completed. Implications: This study will contribute to future IBH implementation success through generating an understanding of how different clinical contexts relate to IBH implementation, and in turn how IBH implementation may relate to health equity. No research to date has examined how gradations of IBH implementation contribute to its effectiveness. Organizations can use this knowledge to focus their IBH implementation to target health disparities, make IBH more effective, and IBH implementation itself to be more successful.