An Implementation Blueprint for How to Start Interprofessional Behavioral Health Integration in A Healthcare System: Balancing Patient Needs, Organizational Readiness for Change, Institutional Priorities, and Training Needs.

Background Poor health behaviors are epidemic and lead to chronic disease. Further, there are already hundreds of behavioral health interventions that have shown efficacy for preventing chronic diseases long term. These services are not yet widely available to patients, especially those at high risk for developing chronic diseases: Health disparities exist by race, ethnicity, income, gender, sexual orientation, mental health status, and area. Additionally, mental health issues are also highly prevalent and largely untreated and can be a barrier to preventative care. In recent years, there has been in a movement towards integrating mental health professionals who do behavioral health medicine into primary care and medical clinics to increase access. While this behavioral health integration has been shown to lead to better patient outcomes and decreased costs, and while this practice is growing in popularity, still very few healthcare systems are utilizing this model. While there are implementation science studies for integrating into a single clinic, no dissemination and implementation study to our knowledge has developed a strategy for integration across a large healthcare system. Methods We used four surveys of opinion leaders (N = 12), clinic providers (N = 15), hospital administrators (N = 2), and D&I scientists (N = 27), to asked about barriers and facilitators to integration, as well as: patient need, organizational readiness for change, and student training needs for a sustainable model for integration. Results We learned about key barriers and facilitators to integration within this healthcare system. Importantly, we extrapolated or coded numeric values for each clinic for patient need, organizational readiness for change, and student training needs, creating a priority score for each clinic. When we begin integration, we will start with integrating the most-ready clinic with the most in-need patients and the most perceived student-training need, and move down there. With this process, we created a novel implementation science system for identifying and prioritizing clinics for integration, barriers and facilitators in each clinic, and draw from published work and established models in the field (ORIC, Dynamic Sustainability, RE-AIM). Conclusions This study provides a blueprint for other healthcare systems to create a plan for sustainable integration of psychological services into medical settings for the benefit of healthcare systems, patients, and public health.