title: Integrating primary care into community behavioral health settings: programs and early implementation experiences.
abstract: OBJECTIVE
  This article describes the characteristics and early implementation experiences of community behavioral health agencies that received Primary and Behavioral Health Care Integration (PBHCI) grants from the Substance Abuse and Mental Health Services Administration to integrate primary care into programs for adults with serious mental illness.
  
  
  METHODS
  Data were collected from 56 programs, across 26 states, that received PBHCI grants in 2009 (N=13) or 2010 (N=43). The authors systematically extracted quantitative and qualitative information about program characteristics from grantee proposals and semistructured telephone interviews with core program staff. Quarterly reports submitted by grantees were coded to identify barriers to implementing integrated care.
  
  
  RESULTS
  Grantees shared core features required by the grant but varied widely in terms of characteristics of the organization, such as size and location, and in the way services were integrated, such as through partnerships with a primary care agency. Barriers to program implementation at start-up included difficulty recruiting and retaining qualified staff and issues related to data collection and use of electronic health records, licensing and approvals, and physical space. By the end of the first year, some problems, such as space issues, were largely resolved, but other issues, including problems with staffing and data collection, remained. New challenges, such as patient recruitment, had emerged.
  
  
  CONCLUSIONS
  Early implementation experiences of PBHCI grantees may inform other programs that seek to integrate primary care into behavioral health settings as part of new, large-scale government initiatives, such as specialty mental health homes.
authors.affiliation: Department of Behavioral Health Sciences, RAND Corporation, 4570 Fifth Ave., Suite 600, Pittsburgh, PA 15213, USA. dscharf@rand.org
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Scharf
authors.forename: Nicole K
authors.initials: NK
authors.lastname: Eberhart
authors.forename: Nicole
authors.initials: N
authors.lastname: Schmidt
authors.forename: Christine A
authors.initials: CA
authors.lastname: Vaughan
authors.forename: Trina
authors.initials: T
authors.lastname: Dutta
authors.forename: Harold Alan
authors.initials: HA
authors.lastname: Pincus
authors.forename: M Audrey
authors.initials: MA
authors.lastname: Burnam
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006284:Health Plan Implementation / Q000458:organization & administration; D006289:Health Planning Support; D006302:Health Services Research; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D010560:Personnel Selection; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D012017:Referral and Consultation; D014481:United States; D014482:United States Substance Abuse and Mental Health Services Administration