Considerations for Behavioral Health Integration Program Implementation in Pediatric Primary Care Settings: A Qualitative Study

Abstract

BackgroundMore than 16% of children in the United States have a behavioral health (BH) disorder, but less than half receive recommended care. Integrated BH programs in primary care settings can address gaps in BH care. This qualitative study sought to understand pediatric primary care clinicians’ experiences with the novel multicomponent Behavioral Health Integration Program (BHIP) in a large network of independent pediatric practices and to identify potential barriers and facilitators for implementation of such programs. MethodsSemistructured interviews were conducted virtually with a purposive sample of clinicians in BHIP practices from November 2021 to April 2022. The Consolidated Framework for Implementation Research was the study’s theoretical framework. Interviews were audio-recorded and professionally transcribed. Transcripts were analyzed inductively and deductively using Charmaz’s constructivist grounded theory approach. ResultsOf the 31 participants, 74% identified as female and 97% as white. Most participants felt that BH care should be integrated into pediatric primary care and that BHIP helped to do so. Most barriers and facilitators identified centered on inner and outer setting Consolidated Framework for Implementation Research domains, including BH care delivery and finance; practice structures (staffing, training, scope of services, and management); practice culture (leadership, communication, and teamwork); and effects of integration on clinicians. ConclusionsBHIP provided important support for BH integration across varied settings. Potential considerations for effective implementation in other settings included expanded training for BH clinicians, tailoring integration to organizational and practice-level contexts, and increased advocacy to address the structural factors limiting of BH care delivery.