Behavioral Health Integration Research Articles

The Whole PERSON Health Score: A Patient-Focused Tool to Measure Nonmedical Determinants of Health

Summary The development of a plan to deliver health care in America often ignores the nonmedical deficits in patients’ socioeconomic resources, well-being, and quality of life, all of which contribute to patient dissatisfaction, poor clinical outcomes, and higher health care costs and utilization. Social determinants of health have been recognized as significant contributors to health, well-being, and, ultimately, longevity, but have been largely unaddressed in primary care because clinicians lack the tools and training to incorporate them while delivering routine care. Riverside University Health System developed a novel and holistic patient-centered assessment tool named the Whole PERSON Health Score (WPHS) to address these critical needs. This article discusses the framework involved in developing, implementing, and evaluating the WPHS in a multidisciplinary, primary care, safety-net setting. The assessment tool consists of 28 questions (or elements) across six domains of health (one for each letter in the PERSON score [Physical Health, Emotional Health, Resource Utilization, Socioeconomics, Ownership, and Nutrition and Lifestyle]) that were chosen on the basis of a literature review of factors that affect lifespan, mortality, and longevity. The patient receives a letter grade ranging from A (the best) to Z (the worst) in each domain. The A–Z letter assignment is not based on a normalized calculation. Rather, letter assignment is based on anticipated impact on life expectancy. The grades are classified into three colors — red, yellow, and green — on the basis of the severity of the intervention needed. This color-coding system highlights the areas of critical need and prompts the provider to engage with the patient to act. Riverside administered 10,166 WPHS assessments from August 2020 to October 2021, out of which 9,809 were completed, representing 8,829 unique patients. In this article, analysis focuses on the 7,926 unique patients who completed a single assessment, to avoid any confusions pertaining to longitudinal analysis. Overall, the greatest need was in the Nutrition and Lifestyle domain (15.22% of the patients assessed, but 49.79% of all red-zone triggers). That domain was followed by Emotional Health (10.59% of patients, 34.64% of red-zone triggers), and Socioeconomics (9.35% of patients, 30.59% of red-zone triggers). In contrast, the least-triggered need for intervention was the Physical Health domain (1.35% of patients, 4.42% of red-zone triggers). On the basis of a provider survey, the value of the WPHS in providing care differed by discipline. The value was greatest for the Probationer Care Management team, which focuses on the needs of recently released probationers (84.61%), followed by the Behavioral Health integration team (66.67%), the Complex Care Management team (50%), and the Primary Care team (44.82%). The WPHS nudges health care teams to prioritize nontraditional upstream patient needs, including emotional health, ownership, and social determinants of health. Completing the WPHS assessment did lead to a recognition of the nonmedical needs of the patient.

Can Pediatric Primary Care Practices Afford Integrated Behavioral Health? A Comparison of 5 Pediatric Practices.

Licensed behavioral health providers (LBHPs) were integrated into 5 pediatric primary care practices in southeast and east Texas from October 2018 through March 2020. LBHPs Licensed behavioral health providers across the sites were 3 licensed clinical social workers (LCSW), 1 psychologist, and 1 nurse practitioner (NP). Practices provided data for 6 to 15 months. Overall, 2769 units of behavioral health services were provided to 746 children over 2243 hours. Across 4 sites, 44.3% of behavioral health patients were diagnosed with trauma disorders, 22.1% with anxiety, 19.3% with attention-deficit hyperactivity disorder, 15.1% with depression, and 10.9% with disruptive behavior disorders. Overall, the model was financially successful at 2 sites (LCSWs) and unsuccessful at 1 site (NP). The other 2 sites demonstrated potential for financial sustainability with increased behavioral health patient volume. Overall, this model is a financially viable option for pediatric primary care practices with adequate patient volumes to provide integrated behavioral health services.

New framework on comprehensive BH, physical health integration released

Although there have been numerous integrated care models introduced for well over a decade now, some organizations have been unable to find one that fits their capabilities and goals. Additionally, it may be harder to adopt a comprehensive model without a good road map, according to the National Council for Mental Wellbeing (National Council), which recently released a new resource for better physical health and behavioral health integration.

Report from the field: A model of behavioral health integration with pediatric providers.

Children with mental health needs are currently not able to access adequate resources. This report from the field describes the ongoing implementation of an integrated behavioral health model in the state of Texas. The Child Psychiatry Access Network (CPAN) leverages primary care providers (PCPs) in the treatment and management of childhood psychiatric disorders. Data are reported as of November 2021 from consultations placed by PCPs over the preceding 17 months. During that time period, following consultation with the CPAN team, over 90% of PCPs were comfortable delivering the recommended mental health care directly to their patients. This suggests that CPAN is a feasible integrated behavioral health approach to address the shortage of child and adolescent psychiatrists.

Health professionals’ attitudes on integrated care and social work practice

ABSTRACT Research regarding the intersection of social work and integrated care has recently increased. Although research specific to the role and engagement of social workers in integrated care is promising, research regarding attitudes toward social workers on integrated behavioral health (IBH) teams remains scant. This study provides perspective regarding healthcare professionals’ attitudes toward the role of social workers on IBH teams. A survey was constructed and distributed to health professionals (n = 104) from medicine, nursing, pharmacy, and social work. Mixed methods were used to evaluate survey findings. Results suggest attitudes toward social workers on IBH teams are generally favorable.

Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review.

ImportanceSuicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is vital to suicide prevention and is applied throughout this review.MethodsA narrative review was performed.ObservationsMany interventions help improve suicide prevention care. PCP education, screening, safety planning/lethal means reduction, care transitions, psychotherapy, and medication management are all evidence-based strategies. Additionally, the pragmatic topics of financing suicide prevention, supporting providers, enacting suicide postvention, and preparing for future directions in the field at each level of primary care/behavioral health integration are discussed.Conclusions and RelevanceThe findings are clinically relevant for practices interested in implementing evidence-based suicide prevention strategies by attending to the behavioral health/medical interface. Leveraging the patient/provider relationship to allow for optimal suicide prevention care requires clinics to structure provider time to allow for emotionally present care. Defining clear roles for staff and giving attention to provider well being are also critical factors to supporting primary care-based suicide prevention efforts.

Behavioral Health Integration in Community Health Centers and Emergency Department Use.

Medicaid enrollees with behavioral health disorders often experience fragmented care, leading to high rates of preventable use of emergency departments (EDs). As part of its Medicaid Transformation Program, the Washington Health Care Authority partnered with regional accountable communities of health to collect data on behavioral health integration in community health centers. Clinics who participated in the integrated care demonstration received technical and financial support to increase capacity for integration. This column describes results from an analysis that linked clinic surveys to Medicaid claims to explore characteristics of highly integrated clinics and assess whether clinic capacity for behavioral health integration is associated with ED visit frequency.

Assessing Family Medicine Physicians' Perceptions of Integrated Behavioral Health in a Primary Care Residency.

Physicians are increasingly confronted with patients' interrelated psychosocial and physiological issues. To assist physicians in managing the psychosocial needs of patients, integrated behavioral health (IBH) has become increasingly common. This study was completed in a large, Midwestern family medicine residency program where the authors sought to (1) identify physicians' perceptions of IBH implementation and areas of needed IBH improvement, and (2) recognize educational needs to be addressed when providing behavioral health training to resident physicians. The authors utilized a pre/post design to measure physician perception of access and quality of an integrated behavioral health program. For quantitative data, we performed standard descriptive statistics, likelihood ratio χ2 tests, independent sample t test, and linear mixed-model analysis. For qualitative data, we completed phenomenological analysis, derived from a focus group. Physician satisfaction with access and quality of behavioral health services significantly improved after the implementation of the IBH (P<.01). Perception of behavioral health management also improved, including the commitment of the residency program to mental health well-being, benefit from consultations with BHPs, and physician ownership of managing patients' mental health needs. Themes from the focus group indicated a desire for increased communication with BHPs, as well as additional assessment and intervention skills to manage psychiatric disorders. Family physicians value IBH in supporting patients' behavioral health treatment, and resident physicians hone behavioral health management skills through collaborating with BHPs and completing behavioral health training. Residencies should increase focus on teaching essential skills in behavioral health management.

Factors that Sustained the Integration of Behavioral Health into Nurse-Led Primary Care.

Lack of access to primary and behavioral healthcare is prevalent in communities experiencing systematically greater obstacles to healthcare. This study describes the implementation of the Coordinated Care Model in a nurse-led primary care clinic and identifies the essential factors for sustained integration. A mixed-methods explanatory sequential study design was used to collect and analyze quantitative and qualitative data. Participants reported an overall statistically significant mean increase (M = 2.47, SD ± 2.01, p < 0.001) in the level of integration pre-and post-integration. Qualitative results indicated that the optimization and accentuation of team strengths, the Lundeen model of holistic care, and addressing physical and psychological barriers lead to sustained level of integration. Integrated practices are essential in assessing and supporting the holistic needs of individuals, families, and communities. Future studies should examine facilitators or impediments to integrated practice in other healthcare settings, long-term health outcomes of clients in integrated care, and the cost-effectiveness of integration.

Lawmakers introduce bill to expand children's access to MH care

U.S. Senators Chris Murphy (D‐Conn.) and Bill Cassidy, M.D. (R‐La.), members of the U.S. Senate Health, Education, Labor and Pensions Committee, have introduced the Supporting Children's Mental Health Care Access Act, which would reauthorize the Pediatric Mental Health Care Access (PMHCA) program for another five years to better promote the integration of behavioral health and primary care for children, DoingItLocal.com reported April 7. The PMHCA program supports state or regional networks of pediatric mental health care teams to provide teleconsultation, training, technical assistance and care coordination for pediatricians and other pediatric primary care providers to diagnose, treat and refer children with behavioral health conditions. The bill would also expand the types of providers that can be part of the care team and add new sites where the program can operate, such as emergency departments and schools. The PMHCA program was created in bipartisan legislation authored in 2016 by Sens. Murphy and Cassidy in the bipartisan Mental Health Reform Act in 2016, which was signed into law by President Barack Obama.

Preparing residents to practice integrated behavioral health care: Multi-site feasibility study of a competency-based curriculum.

Workforce development is essential for the dissemination of team-based integrated behavioral healthcare. There is limited literature on training family medicine residents to function within an integrated behavioral health (IBH) system. The purpose of this pilot study was to assess the feasibility and value of an IBH competency-based curriculum for family medicine residents across multiple programs. Residency programs were recruited using professional listservs and networks to test a competency-based, multi-modal curriculum for preparing residents to practice IBH in primary care. Faculty instructors who led the workshop were invited to complete semi-structured interviews to examine the feasibility and appropriateness of the curriculum. Interview data were analyzed using thematic analysis to identify, analyze, and report patterns. Residents completed a survey of perceived IBH skill and knowledge before and after training. A paired-sample t-test was used to determine significant differences pre- and post-training. All five instructors completed interviews. Results suggest IBH training is valuable. Instructors gave specific feedback on online modules, implementation flexibility, and adjusting faculty development to differing levels of experience. Nineteen of forty residents (48%) completed anonymous pre-, post-, and retrospective-training surveys. Residents reported an increase in competence after training. The results of this pilot suggest that IBH training implementation is feasible, desirable, timely, and may improve resident ability to work on an IBH team. Training should accommodate variations in program structure and faculty expertise.

Integrating behavioral health & primary care for multiple chronic diseases: Clinical trial of a practice redesign toolkit.

Context: Most patients in need of behavioral health (BH) care are seen in primary care, which often has difficulty responding. Some practices integrate behavioral health care (IBH), with medical and BH providers at the same location, working as a team. However, it is difficult to achieve high levels of integration. Objective: Test the effectiveness of a practice intervention designed to increase BH integration. Study Design: Pragmatic, cluster-randomized controlled trial. Setting: 43 primary care practices with on-site BH services in 13 states. Population: 2,460 adults with multiple chronic medical and behavioral conditions. Intervention: 24-month practice change process including an online curriculum, a practice redesign and implementation workbook, remote quality improvement coaching services, and an online learning community. Outcomes: Primary outcomes were changes in the 8 Patient-Reported Outcomes Measurement Information System (PROMIS-29) domain scores. Secondary outcomes were changes in medication adherence, self-reported healthcare utilization, time lost due to disability, cardiovascular capacity, patient centeredness, provider empathy, and several condition-specific measures. A sample of practice staff completed the Practice Integration Profile at each time point to estimate the degree of BH integration in that site. Practice-level case studies estimated the typical costs of implementing the intervention. Results: The intervention had no significant effect on any of the primary or secondary outcomes. Subgroup analyses showed no convincing patterns of effect in any populations. COVID-19 was apparently not a moderating influence of the effect of the intervention on outcomes. The intervention had a modest effect on the degree of practice integration, reaching statistical significance in the Workflow domain. The median cost of the intervention was $18,204 per practice. In post-hoc analysis, level of BH integration was associated with improved patient outcomes independent of the intervention, both at baseline and longitudinally. Conclusions: The specific intervention tested in this study was inexpensive, but had only a small impact on the degree of BH integration, and none on patient outcomes. However, practices that had more integration at baseline had better patient outcomes, independent of the intervention. Although this particular intervention was ineffective, IBH remains an attractive strategy for improving patient outcomes.

A qualitative study of strategies and challenges in training behavioral health workforce for integrated primary care.

COVID-19 has underscored the need to accelerate behavioral health (BH) integration in primary care, where many patients seek mental health services. Expanding BH integration requires a strong and sustainable BH workforce trained to work in primary care. Psychology internship is a critical period of development when doctorate-level therapists receive supervised clinical experiences with integrated primary care. To explore the strategies and challenges of teaching psychology trainees to practice BH in primary care. Qualitative study. Nine out of 11 psychology internship and postdoctoral fellowship programs across the Washington State that provide integrated primary care training were recruited. Response rate was 82%. Twelve training leads and supervisors completed semi-structured interviews between December 2020 - March 2021. Interviews focused on participant experiences with providing educational training and supervision to psychology trainees practicing integrated primary care. Data were analyzed using grounded theory approach. Four strategies emerged - orient trainees with extensive onboarding to the culture, context, and function of primary care; provide a psychologically safe space for open dialogues that facilitate professional identity development; model the skills needed to collaborate with primary care teams; and create a structured environment for trainees to practice the skills. Training leads and supervisors also reported three challenges - strategies to address trainees' difficulties with acculturating to the culture of primary care; loss of opportunities to shadow and interact with primary care providers due to telemedicine during COVID-19; and limitations of the traditional supervision structure to accommodate the unpredictable and urgent crises experienced by trainees in fast-paced primary care settings. Future recommendations include early exposure to primary care during psychology graduate training, a hybrid model of fixed and flexible supervision schedules, and intentional efforts to define and balance in-person and remote teaching for different types of training needs.

Co-creating the Patient Partner Guide by a Multiple Chronic Conditions Team of Patients, Clinicians, and Researchers: Observational Report

BackgroundEngaging patients as partners can influence research, with rewards and deterrents. The authors are researchers and patient co-investigators who collaborated on a comparative effectiveness, randomized controlled study of a structured quality improvement (QI) process to improve behavioral health and primary care integration for people managing multiple chronic conditions (MCC). Patient co-investigators responded to a gap in available resources to support study clinics in partnering with their own patients in QI and co-created the Patient Partner Guide (PPG).ObjectiveDescribe the development of the PPG, its use by clinics undertaking the QI project, and research team partnerships.DesignObservational report of study intervention component.ParticipantsDiverse patients and family members managing MCC and members of their primary care clinics.InterventionThe PPG component of the study intervention is a five-step workbook providing practical tools and resources to sustain partnerships across clinic QI team members, including patient partners. The process of developing the PPG relied on relationship-building tools that were iteratively assessed, practiced, improved, and incorporated into the PPG under the leadership of patient co-investigators.Main MeasuresObservations related to PPG use and patient partner inclusion in clinic QI; impact on the research team.Key ResultsOf 20 clinics, 6 engaged patients as full partners on QI teams. Clinics found resistance in partnering and challenges in using the PPG but valued the material and their partners’ contributions. Similarly, engagement of patient co-investigators in research brought a shift in perspective to team members. The PPG is available and was adapted for use by research teams.ConclusionsEngagement of patients and other stakeholders in research can be transformative and productive. Building relationships through meaningful work benefits others, and in turn, the research process. This approach can enhance clinical care QI and may result in substantial contributions to the conduct of research.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT02868983

Mental Disorders in Assisted Living Facilities. A Narrative Review of the Prevalence, Existing Models of Care Delivery, and Outcomes

<h3>Introduction</h3> Arising in the late 1970s as an alternative to nursing homes, Assisted Living Facilities (ALFs) are residential communities for older and disabled adults needing assistance with activities of daily living but in a less restrictive, less institutional/medical setting. Offering a variety of communal home-like living arrangements as well as providing a broad range of health-related services, ALFs are highly heterogeneous. As a whole, they seek to preserve resident independence and autonomy, social wellbeing, and flexibility of service offerings to accommodate evolving resident needs. As of 2016, approximately 811,500 individuals resided in ALFs in the US, across 28,900 facilities with 996,100 licensed beds. The number of licensed beds continues to increase, a trend driven in part by consumer preference; a large national survey indicated that 78% of older adults would prefer to reside in Assisted Living versus 12% in a nursing home in the event they needed more care outside their home. While nursing homes are tightly regulated on the federal level, ALFs are regulated by states and vary widely in their approaches to standards, procedures, and staffing. Regardless of setting, community prevalence of mental illness, defined as "mental, behavioral, or emotional disorders," is 14.1% in adults over 50. In addition, about 11% of people aged 65 and older in the United States have dementia. It is becoming increasingly important to monitor the prevalence of mental illness, including dementia, in ALFs, especially as the older adult population and ALF occupancy increase. The aim of this review is to describe the prevalence of mental illness, including dementia, in Assisted Living residents, to detail existing models of mental health care for Assisted Living residents, and to discuss implications for clinical outcomes, health care utilization, and Assisted Living occupancy. For the purposes of this paper, dementia will be included under the rubric of "mental illness" due to its prevalence among Assisted Living residents, and the overlap of care delivery considerations with non-cognitive mental disorders. <h3>Methods</h3> This narrative review followed the best-practice recommendations outlined by Ferrari (2015). PubMed and Google Scholar were searched in June 2021 for the following key words: assisted living facility, psychiatric illness, limitations, hospitalization, discharge, and behavioral health integration, in addition to synonymous words related to three categories of interest including, prevalence of mental illness in ALFs, behavioral health care models in ALFs, and clinical outcomes of ALF residents. Articles were limited to the English language and to the United States or Canada. Emphasis was placed on recent systematic reviews and randomized controlled trials. All articles were initially screened according to title and abstract and were retained if they contained information on prevalence of mental illness in ALFs, behavioral health care models in ALFs, or clinical outcomes of ALF residents. Reference lists were hand-searched for additional research articles. <h3>Results</h3> Many articles reported various rates of mental illness and cognitive disorders in ALFs, however, the prevalence remains high and continues to increase as the older adult population increases. Across articles, prevalence of non-cognitive psychiatric disorders in ALFs ranged from 26% to 33% depending on methodology and study population. Prevalence of cognitive disorders in ALFs range widely depending on the type of facility: some ALFs admit exclusively persons with dementia, whereas other ALF facilities specialize in residents with fewer functional impairments. Studies have demonstrated that both depression and dementia in ALF residents are more prevalent when compared with community-dwelling controls. Behavioral health problems and high health care needs of ALF residents are common reasons for ALF discharge. Integrated models, which bring together specialty behavioral health care providers with health and supportive service providers, have been shown to reduce behavioral health symptoms and contribute to improved health of residents, improve care, and decrease associate care costs including staff turnover. <h3>Conclusions</h3> This narrative review addresses the importance of behavioral health needs in ALF residents. Articles identified limitations in ALF infrastructure and research, specifically relating to data collection and varying definitions of terms, which limits the generalizability of the results. Greater attention to the study, design, and implementation of behavioral health care for ALF residents may reduce the prevalence of distressing symptoms in those with psychiatric and cognitive disorders, and in turn decrease the need for unnecessary Emergency Department visits, hospitalizations, and premature facility discharge. Future research should consider measuring the effectiveness of mental health care in ALFs since there is limited research currently available. <h3>This research was funded by</h3> Unfunded.

BHIPP:0–5: Primary care practice transformation in early childhood behavioral health integration.

BHIPP:0–5: Primary care practice transformation in early childhood behavioral health integration.

Primary Care Behavioral Health Integration and Care Utilization: Implications for Patient Outcome and Healthcare Resource Use.

Behavioral health (BH) integration in primary care (PC) can potentially improve outcomes and reduce cost of care. While different models of integration exist, evidence from real-world examples is needed to demonstrate the effectiveness and value of integration. This study aimed to evaluate the outcomes of six PC practice sites located in Western New York that implemented a primary care behavioral health (PCBH) integration model. To assess the impact of PCBH on all-cause healthcare utilization rates. A retrospective observational study based on historical multi-payer health insurance claims data. Claims data were aggregated on a per-member-per-month basis to compare utilization rates among the patients in the PC practice sites that had implemented PCBH to those in the sites that had not yet done so. The sample included 6768 unique adult health plan members between October 2015 and June 2017 with at least one BH diagnosis code who were attributed to one of the six newly integrated PC practice sites. Under the PCBH integration model, BH specialists were embedded in PC practice sites to treat a wide range of BH conditions. Rates of all-cause ED visits and hospital admissions, along with rates of PC provider and BH provider visits. PCBH implementation was associated with reductions in the rates of outpatient ED visits (14.2%; p < 0.001) and PC provider visits (12.0%; p < 0.001), as well as with an increased rate of BH provider visits (7.5%; p = 0.018). PCBH integration appears to alter the treatment patterns among patients with BH conditions by shifting patient visits away from ED and PC providers toward BH providers who specialize in treatment of such patients.

Integrated Behavioral Health Care in Viet Nam: Examples from the Hanoi Bach Mai Hospital of Patients with Hypertension

Objectives: Behavioral conditions contribute to poor clinical outcomes and are not routinely addressed in medical settings in Viet Nam. Few studies focus on the level of integrated care in clinics, the provider ratings of the prevalence of behavioral conditions, the need for a behavioral health consultant (BHC), and patient health risk assessments (HRAs) in Viet Nam. To fill these research gaps, this study aims to explore the level of behavioral health integration in primary care clinics, the provider perceived prevalence of behavioral problems, the need for an expert behavioral health consultant on the primary care team, and the health risks for patients in Viet Nam. Methodology: This study collected first-hand survey data from two healthcare sites, 41 service providers, and 199 patients in Hanoi, Viet Nam. Regression analyses were conducted to examine the relationship between HRA behavioral conditions and each of the biometric health risk factors. Results: The healthcare site and provider survey results showed low levels of integrated health services, provider perceptions of the moderate prevalence of common behavioral conditions, and the need for a BHC to assist in care. In addition, the patient’s HRA results showed an elevated risk of sleep apnea, fruit and vegetable intake, tobacco, alcohol use for men, and poor health literacy. Conclusion: The level of integrated care services is low in Viet Nam, the need for the providers to have a BHC to assist in treatment is moderate, and the patients reported elevated health risks in several areas. The findings demonstrated a pressing need for the development of integrated behavioral health care services in Viet Nam.

Level of behavioral health integration and suicide risk screening results in pediatric ambulatory subspecialty care

ObjectiveThis study aimed to characterize suicide risk screening results for youth in pediatric ambulatory subspecialty clinics. MethodThe Ask Suicide-Screening Questions was administered to patients ages 9–24 years in 12 subspecialty clinics to assess suicide risk, determined by suicide ideation/behavior. The SAMSHA-HRSA standard framework for integrated health was used to categorize each clinic's level of behavioral health integration. Results6365 patients completed 7440 suicide risk screens; 6.2% of patients screened positive at their initial screen and 4.1% at subsequent annual screens. There was no dose-response pattern between increasing level of integration and decreasing likelihood of a positive suicide screen. Youth identifying as gender expansive were 3.1 times (95% CI [2.0, 4.9]) more likely to screen positive as compared to cisgender youth, adjusted for age, gender, race/ethnicity, screen type, year, and clinic integration level. ConclusionResults surrounding disparities in suicide risk based on gender identity underscore the importance of further investigating how to optimally identify and manage high-risk, often understudied youth at suicide risk.

Assessing Knowledge and Experience of Integrated Behavioral Health among Patients with Limited English Proficiency at a Diverse, Urban Federally Qualified Health Center.

Integrated behavioral health (IBH) embeds behavioral health clinicians in primary care settings to improve access and quality of care. This study investigates whether co-located IBH impacts knowledge and experiences of behavioral healthcare, particularly for individuals with limited English proficiency (LEP). 330 patients were recruited from the waiting rooms of a federally qualified health center to answer multiple-choice and Likert scale questions about behavioral healthcare. English-speaking patients were more confident in their knowledge of IBH (X2(1) = 4.79, p = .03) and external behavioral healthcare (X2(1) = 28.75, p < .001). On average, the 77 patients who accessed IBH believed that IBH appointments had a positive impact (Likert scale mean = 3.90, SD = .10). Despite satisfaction with IBH across demographic groups and similar or higher interest in behavioral health services among patients with LEP, they were found to have less knowledge about IBH than English-speaking patients.