Literature Collection

BACKGROUND: Integrating behavioral health in primary care is a widespread endeavor. Yet rampant variation exists in models and approaches. One significant question is whether frontline providers perceive that behavioral health includes substance use. The current study examined front line providers': 1. definition of behavioral health, and 2. levels of comfort treating patients who use alcohol and other drugs. Frontline providers at two primary care clinics were surveyed using a 28-item instrument designed to assess their comfort and knowledge of behavioral health, including substance use. Two questions from the Integrated Behavioral Health Staff Perceptions Survey pertaining to confidence in clinics' ability to care for patients' behavioral health needs and comfort dealing with patients with behavioral health needs were used for the purposes of this report. Participants also self-reported their clinic role. Responses to these two items were assessed and then compared across roles. Chi square estimates and analysis of variance tests were used to examine relationships between clinic roles and comfort of substance use care delivery. RESULTS: Physicians, nurses/nurse practitioners, medical assistants, and other staff (N = 59) participated. Forty-nine participants included substance use in their definition of behavioral health. Participants reported the least comfort caring for patients who use substances (M = 3.5, SD = 1.0) compared to those with mental health concerns (M = 4.1, SD = 0.7), chronic medical conditions (M = 4.2, SD = 0.7), and general health concerns (M = 4.2, SD = 0.7) (p < 0.001). Physicians (M = 3.0, SD = 0.7) reported significantly lower levels of comfort than medical assistants (M = 4.2, SD = 0.9) (p < 0.001) caring for patients who use substances. CONCLUSIONS: In a small sample of key stakeholders from two primary care clinics who participated in this survey, most considered substance use part of the broad umbrella of behavioral health. Compared to other conditions, primary care providers reported being less comfortable addressing patients' substance use. Level of comfort varied by role, where physicians were least comfortable, and medical assistants most comfortable.

ObjectivesIntegrated neighbourhood teams (INTs) are central to health system reforms in England, aiming to deliver local, coordinated, and personalised care. Understanding the factors that influence their successful functioning is crucial for informing local policy and practice. This rapid evidence synthesis aimed to answer the research question: What factors influence service integration and delivery by INTs operating across health, care, and voluntary sector organisations?MethodsIn February 2025, we searched Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant UK-based primary research and international evidence syntheses published within the last 10 years. The database searches were complemented by searches in Google Scholar and the Google search engine. Eligible studies reported evidence on factors shaping the successful functioning of local and neighbourhood-level integrated teams. Data were rapidly synthesised qualitatively.ResultsDatabase searches identified 5139 articles (4954 after duplicates were removed). Of these, 26 were eligible for inclusion, comprising nine primary studies and 17 evidence syntheses published between 2015 and 2025. The findings were highly consistent. Key factors supporting INT functioning included a clear, shared vision; effective leadership; strong working relationships based on trust and mutual respect; clarity on interprofessional roles and responsibilities; appropriate and sustained resources and funding; opportunities for staff learning and development; co-location, dedicated time for multidisciplinary team meetings; and interoperable information technology systems to support data sharing.ConclusionsThere is strong agreement on key relational and organisational factors that support INT functioning. Our practical framework can be used to support policymakers, commissioners, and professionals when planning and implementing INTs.