Strategic Implementation Planning for Integrated Behavioral Health Services in Pediatric Primary Care

Abstract

Background: Delivering physical and behavioral health services in a single setting is associated with improved quality of care and reduced health care costs. Few health systems implementing integrated care develop conceptual models and targeted measurement strategies a priori with an eye toward adoption, implementation, sustainment, and evaluation. This is a broad challenge in the field, which can make it difficult to disentangle why implementation is or is not successful.

Method: This paper discusses strategic implementation and evaluation planning for a pediatric integrated care program in a large health system. Our team developed a logic model, which defines resources and community characteristics, program components, evaluation activities, short-term activities, and intermediate and anticipated long-term patient-, clinician-, and practice-related outcomes. The model was designed based on research and stakeholder input to support strategic implementation and evaluation of the program. For each aspect of the logic model, a measurement battery was selected. Initial implementation data and intermediate outcomes from a pilot in five practices in a 30-practice pediatric primary care network are presented to illustrate how the logic model and evaluation plan have been used to guide the iterative process of program development.

Results: A total of 4,619 office visits were completed during the two years of the pilot. Primary care clinicians were highly satisfied with the integrated primary care program and provided feedback on ways to further improve the program. Members of the primary care team and behavioral health providers rated the program as being relatively well integrated into the practices after the second year of the pilot.

Conclusions: This logic model and evaluation plan provide a template for future projects integrating behavioral health services in non-specialty mental health settings, including pediatric primary care, and can be used broadly to provide structure to implementation and evaluation activities and promote replication of effective initiatives.

Figure 1.

Logic model for the Healthy Minds, Healthy Kids (HMHK) program. Note: PCC: primary care clinician; HMHK: Healthy Minds, Healthy Kids; MH: mental health; ED: emergency department.