Literature Collection

This study examines older adults' perspectives on patient-centered care and engagement in a short-term behavioral health intervention, addressing persistent barriers to mental health access in aging populations. Guided by the NIH Stage Model (Stage 1), the goal was to refine the intervention by integrating participant feedback to enhance recruitment, retention, and overall program acceptability. Data were drawn from focus groups with residents of The Villages® community, alongside program participation and survey records. The 12-week intervention enrolled 183 participants; 115 (62.8%) completed all 10 sessions and both intake and exit surveys. Most completers were female (75.7%) and white (92.2%), with anxiety (60.9%) and depression (54.8%) as the most common treatment reasons. While completion rates were moderate, 37.2% dropped out, and only 33.8% of non-completers responded to follow-up inquiries, underscoring ongoing retention challenges. Findings highlight the potential of embedding behavioral health services within primary care to reduce stigma, improve accessibility, and leverage trust in existing provider relationships. Older adults valued clear communication, early demonstration of benefits, and interventions tailored to their preferences and cultural context. However, early discontinuation-often after perceived improvement-suggests a need for strategies that encourage sustained engagement, such as rapport-building, booster sessions, or follow-up reminders. From a systems perspective, integrating behavioral health into primary care can promote equity, reduce logistical barriers, and support more holistic care delivery. These insights can guide providers, policymakers, and researchers in designing responsive, patient-centered interventions that improve both engagement and outcomes for older adults.

Integrated behavioral health can improve primary care and mental health outcomes. Access to behavioral health and primary care services in Texas is in crisis because of high uninsurance rates, regulatory restrictions, and lack of workforce. To address gaps in access to care, a partnership formed among a large local mental health authority in central Texas, a federally designated rural health clinic, and the Texas A&M University School of Nursing to create an interprofessional team-based health care delivery model led by nurse practitioners in rural and medically underserved areas of central Texas. Academic-practice partners identified 5 clinics for an integrated behavioral health care delivery model. From July 1, 2020, through December 31, 2021, a total of 3183 patient visits were completed. Patients were predominantly female (n = 1719, 54%) and Hispanic (n = 1750, 55%); 1050 (33%) were living at or below the federal poverty level; and 1400 (44%) were uninsured. The purpose of this case study was to describe the first year of implementation of the integrated health care delivery model, barriers to implementation, challenges to sustainability, and successes. We analyzed data from multiple sources, including meeting minutes and agendas, grant reports, direct observations of clinic flow, and interviews with clinic staff, and identified common qualitative themes (eg, challenges to integration, sustainability of integration, outcome successes). Results revealed implementation challenges with the electronic health record, service integration, low staffing levels during a global pandemic, and effective communication. We also examined 2 patient cases to illustrate the success of integrated behavioral health and highlighted lessons learned from the implementation process, including the need for a robust electronic health record and organizational flexibility.