An Evidence-Based Leadership Training Intervention to Accelerate Integration of Behavioral Health and Primary Care

Project Summary/Abstract BACKGROUND: Integrated behavioral health (IBH) holds great promise for improving care quality and outcomes for patients with co-occurring mental and physical health conditions by embedding mental health and substance use treatment services into primary care settings. Despite over two decades of effort, however, there still lacks widespread IBH implementation due to insufficient leadership skills to overcome organizational, attitudinal, and financial challenges. This study develops and tests an evidence-based IBH intervention that incorporates leadership concepts to prepare primary care teams to overcome IBH challenges and lead IBH implementation initiatives. SPECIFIC AIMS: Aim 1 is to identify IBH implementation challenges, strategies, and leadership skills needed to successfully implement IBH. Aim 2 is to develop an intervention that uses IBH implementation strategies and leadership training to accelerate IBH into primary care settings. Aim 3 is to conduct a preliminary effectiveness, feasibility, and acceptability pilot by implementing and evaluating the intervention in practice settings. METHODS: I use sequential, complementarity mixed methods and draw upon a conceptual model that blends the implementation science EPIS (Exploration, Preparation, Implementation, and Sustainment) framework with AHRQ’s Integration Framework. Aim 1 uses depth interviews with nationally-renowned IBH stakeholders to develop an inventory of IBH challenges, strategies, and leadership skills. Aim 2 uses a 4-round modified Delphi approach with IBH stakeholders to develop the intervention. Aim 3 uses the New Jersey Primary Care Research Network to recruit 5-10 primary care practices serving health disparity populations. The intervention is delivered to all practice members using practice facilitation, and I will conduct a series of assessment to determine the preliminary effectiveness, feasibility, and acceptability of the intervention in improving leadership skills to address IBH challenges (intermediary outcome) and integrated care processes (primary outcome). IMPACT: This study is novel because it draws upon national IBH experts to develop an intervention that identifies and consolidates IBH strategies and leadership skills that have been effective with IBH implementation in real-world settings. Second, this study produces a systematically-developed intervention that pairs IBH implementation challenges with specific leadership skills for overcoming them, refined and prioritized for action. Third, this is the first study to map the AHRQ Integration Framework to an implementation science framework. Resulting data informs future refining and testing of the intervention in additional clinical settings.