How Integrated Behavioral Health Works in Primary Care: An Observational Analysis.

The way in which behavioral health providers (BHPs) in integrated primary care settings function and what is needed for their success has not been systematically examined. The present study used direct observation to capture integrated BHPs' clinical activities, workflows, and team interactions. Observations took place in seven integrated primary care clinics in a single health system. The model of integration combined components of the Primary Care Behavioral Health model and the Collaborative Care Model. A trained Research Service Professional (RSP) observed 13 BHPs each during one typical clinical day in an integrated primary care clinic. Data collection methods included surveys, process maps, time tracking, and field notes. We used quantitative and qualitative analysis to describe BHPs' activities. During the days observed, BHPs conducted 77 patient visits and many other activities, including supervising learners. BHPs' clinical time was divided among direct patient care (56%), administrative tasks (29%), and consultation with team members (15%). Process maps revealed similar workflows across BHPs/practices with differences in completing screening, rooming, and scheduling patients. BHPs supervising learners saw on average more patients per day than BHPs on their own (5.1 vs. 7.6). BHPs interacted with all practice team members, and most frequently with medical providers, social workers, care managers, and nurses. BHPs provide clinical care to primary care patients on a wide variety of concerns and spend time on other important team-based tasks. Recommendations for optimizing workflows, reimbursement models, and team-based care from these observations are provided.