Professional Practices in Behavioral Health and Primary Care Integration

The Need

Empirical evidence suggests that the U.S. health care system continues to provide inadequate coverage to consumers and falls short in preventive and chronic disease care, among other indicators.1,2 Rapid changes in the health care system, particularly the implementation of the Affordable Care Act of 2010, have initiated a surge of redesign efforts.3-5 Central to much of this redesign is the need to reduce fragmentation of care through integration, a goal that is particularly relevant to efforts to strengthen the ties between behavioral health and primary care.6

Delivery of effective primary care services has received a great deal of attention in the literature as a way to improve population-based care. Empirical evidence suggests that behavioral health integration—often referred to as collaborative care, integrated primary care, or integrated care—leads to improved care and reduced costs.7-10

Goal of Research

The goal of this research was to assist the field of primary care and behavioral health in identifying core professional practices for successful integration of care. The project team developed a targeted effort focusing on issues related to primary care, behavioral health care, and the integration of the two. The project plan included:

  • An expert panel that guided the development and commission of the project. The panel was composed of experts in primary care and behavioral health.
  • A review of the literature to determine what issues must be addressed to improve delivery of integrated care. The findings of the literature review are presented in a companion report developed under this contract.
  • Identification of key professional practices through observation and semi-structured interviews with people providing integrated care in primary care organizations.

Two New Integrated Care Workforce Resources

A Guidebook of Professional Practices for Behavioral Health and Primary Care Integration: Observations from Exemplary Sites - This Guidebook identifies the key professional practices that are prominent among exemplary integrated primary care organizations, with the aim of helping other sites achieve the goal of integrating care more effectively. Findings are organized into two categories: Organization-Level Professional Practices, and Interpersonal and Individual Professional Practices.

Provider- and Practice-Level Competencies for Integrated Behavioral Health in Primary Care: A Literature Review - This Literature Review highlights a comprehensive set of competencies, practices, providers, and staff required to advance integration efforts and provide comprehensive care to improve patient outcomes. Competencies are organized into Provider and Staff Competencies and Practice-Level Competencies.

Navigate the Guidebook

The Guidebook is a navigable PDF. Readers can access sections of the document by using the PDF bookmarks on the left side of the document or can use the top navigation on each page of the document. The top navigation includes the following sections: Table of Contents, Background, Methodology, Findings, Conclusion and Professional Practices. The Professional Practices tab offers a drop-down menu that navigates to the Organization-Level category and the Interpersonal and Individuals category. Within these categories, the following icons are used:

  Quotes from personnel within the practice being observed


  Comments by the observer   


This interactive PDF provides a user-friendly experience and an efficient process for navigating the report.

[1] Moses H, Matheson DH, Dorsey R, et al. The anatomy of health care in the United States. JAMA. 2013;310(18):1947-1963. PMID: 24219951.

[2] Schoen C, Davis K, How SK,et al. US health system performance: a national scorecard. Health Aff (Millwood). 2006;25(6):w457-w475. PMID:16987933.

[3] Goodson JD. Patient Protection and Affordable Care Act: Promise and Peril for Primary Care. Ann Intern Med. 2010 June1;152(11):742-4. PMID: 20404263.

[4] Dougherty D, Conway PH. The “3T’s” road map to transform US health care. JAMA. 2008;299(19):2319-21. PMID: 18492974.

[5] Kellermann A, Vaiana M, Hussey P, et al. Flattening the trajectory of health care spending: Insights from RAND Health Research. 2012. Rand Corporation.

[6] Levey SM, Miller BF, deGruy FV. Behavioral health integration: an essential element of population-based healthcare redesign. Transl Behav Med. 2012 Sep;2(3):364-71. PMID: 24073136

[7] Kwan B, Nease D, Jr. The state of the evidence for integrated behavioral health in primary care. In: Talen MR, Burke Valeras A, eds. Integrated Behavioral Health in Primary Care. New York: Springer; 2013:65-98.

[8] Bauer AM, Azzone V, Goldman HH, et al. Implementation of collaborative depression management at community-based primary care clinics: an evaluation. Psychiatr Serv. 2011 Sep;62(9):1047-53. PMID: 21885583

[9] Kroenke K, Taylor-Vaisey A, Dietrich AJ, et al. Interventions to improve provider diagnosis and treatment of mental disorders in primary care: a critical review of the literature. Psychosomatics. 2000 Jan-Feb;41(1):39-52. PMID: 10665267

[10] Un├╝tzer J, Katon WJ, Fan M-Y, et al. Long-term cost effects of collaborative care for late-life depression. Am J Manag Care. 2008 Feb;14(2):95-100. PMID: 18269305