1. Unveiling the Results of a National Survey of Behavioral Health Services Offered Within Primary Care Student Health Centers: Implications for our Practice
Kevin Readdean, MSEd, LMHC
Associate Director, Student Health, Rensselaer
PhD Student, Rutgers University
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2. Learning Objectives Participants will be able to:
identify the variety of organizational models and evidenced-based practices that surround the delivery of primary care behavioral health services in college health
describe the emerging titles and roles of behavioral health staff added to the primary care team
discuss the implications of the findings as they relate to their organizations and the existing literature on primary care behavioral health integration.
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3. Conflicts of Interest
I have no actual or potential conflict of interest in relation to this educational activity or presentation.
However… potential bias…
SUNY at Cobleskill: 13 years in integrated heath/counseling service
Rensselaer: 10 years in integrated health/counseling service
ACHA White paper: Considerations for integration of counseling and health services on college and university campuses
Rutgers University: PhD student, Health Sciences – studying the fundamental, distinctive characteristics of the practice of integrated primary care behavioral health
Married, Cohabitating, or Dating?
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4. IntegrationDNA
The interconnected double-helix of physical and mental health care with the sequence of the four “bases” (ATCG) shaping the design of the organization.
Administration – procedural and financial integration
Technology – EHR integration
Clinical – treatment coordination and integration
Geographic – how space is shared to support collaboration and reflect integration
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5. Primary Care Behavioral Health Survey
Project Objectives
Benchmark current organizational structures of primary care student health centers.
Measure the degree of integration of behavioral health practices within primary care student health centers using the Practice Integration Profile (PIP) survey.
Test the following hypotheses about the relationships between organizational characteristics and levels of integration:
Integrated centers will have higher PIP scores than non-integrated centers.
Integrated centers with longer history of integration will have higher PIP scores than integrated centers with shorter history of integration.
Non-integrated centers with plans to integrate will have higher PIP scores than non- integrated centers without plans to integrate.
Centers with higher numbers of Behavioral Health (BH) FTE staff will have higher PIP scores than centers with lower numbers of BH FTE staff.
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6. Thank You! ACHA, Section Leaders, Rutgers Advisors, Respondents
Pilot survey – Emeriti Directors: n=13
Final survey:
716 ACHA RMI’s invited, 189 responses (26% response rate), good representation of the population of ACHA institutions
54 items: demographics, organizational structures, and the Practice Integration Profile (PIP)
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7. Demographics
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8. Demographics
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9. Demographics
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10. Demographics
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11. Demographics

12. Organizational Models - Integrated
18%
10% 4% 9%
1%  Integrated Contracted Health & Counseling
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13. Organizational Models: Non-Integrated
11%
45% 2%
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14. Survey Data Comparison
Organizational Model
Integration
2007 Survey
2018 Survey
Health director and counseling director report to a single senior administrator
Not Integrated
74%
45%
Health director and counseling director report to different senior administrators
11%
Contracted/Outsourced - Primary Care Only 2%
Center Director with Director of Health and Director of Counseling
Integrated 8%
18%
Single chief health and counseling director reports to a senior administrator 6% 9%
Health director reports to the counseling director who reports to a senior administrator 4%
Counseling director reports to the health director who reports to a senior administrator
10%
Contracted/Outsourced - Primary Care and Counseling Services. - 1%
58%
42%
26%
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15. Survey Data Comparison
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16. More Survey data on Integration
*National Survey of Counseling Center Directors
**ACHA Mental Health Best Practices Taskforce
***Primary Care Behavioral Health Survey
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17. Factors Driving Integration
2007 – Top three factors that drove the integration:
Improve continuity of care
Philosophy of care
Upper administrative directive
2018 – Factors driving the planned integration:
Physical facilities
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18. Small Group Discussion
Regardless of your organizational model:
In what ways are your primary care and behavioral health services integrated?
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19. Practice Integration Profile
Kessler and colleagues
Used with permission
Demonstrated face, content and internal validity
Operationalizes key elements of the Agency for Healthcare Research and Quality (AHRQ) Lexicon for Behavioral Health and Primary Care Integration
Quantifies levels of integration
6 dimensions and overall PIP score
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20. Practice Integration Profile
30 items; 6 dimensions (subscales)
Practice Workflow (protocols, registries, coordination of care)
Clinical Services and Providers (BH clinicians and BH interventions)
Workspace Arrangement (co-location and shared records)
Integration Method (collaboration on treatment plans)
Identification of Need (screening methods)
Patient Engagement and Retention (systematic follow-up for BH)
Scoring: 5-point Likert scale ( )
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21. PIP Scores
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22. Hypothesis 1
Integrated centers will have higher PIP scores than non-integrated centers.
*p < 0.05
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23. Hypothesis 2
Integrated centers with longer history of integration will have higher PIP scores than integrated centers with shorter history of integration.
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24. Hypothesis 3
Non-integrated centers with plans to integrate will have higher PIP scores than non-integrated centers without plans to integrate, but lower PIP scores than integrated centers.
Integrated
Planned Change
No plan to change
PIP scores
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25. Hypothesis 4
Centers with higher numbers of Behavioral Health (BH) FTE staff will have higher PIP scores than centers with lower numbers of BH FTE staff.
Centers with more BH staff score moderately higher on PIP than centers with fewer BH staff (rs = 0.48, p< 0.01)
Non-integrated centers with more BH staff score moderately higher on PIP than centers with fewer BH staff (rs = 0.55, p< 0.01)
Integrated centers with more BH staff do not score significantly higher on PIP than centers with fewer BH staff (rs = 0.31, ns)
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26. Overall Findings
Non-integrated and integrated centers are doing similar collaborative work
Differences lie in co-location, shared records and collaboration on treatment plans
Longevity of integration does not matter
Path is well defined
Presence of Behavioral Health Clinicians matters
Bridge to specialty mental health service?
What are the implications for our practice?
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27. Primary Care Behavioral Health
Behavioral Health Clinicians (PhD, Masters, Substance Abuse Counselor) in non-integrated primary care health center
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28. Primary Care Behavioral Health (PCBH)
Behavioral Health Clinicians embedded in primary care
Accessible (same day)
Team-based (shared space, records, treatment plan)
Generalist (any patient, any condition, brief BH interventions)
Educator (helps improves PC team’s biopsychosocial assessment and intervention skills)
Veterans Administration; Patient Centered Medical Homes; Community Primary Care; College Health Centers
Differs from SBIRT and Chronic Care Model
Team-based, population focused approach
Face validity as promising approach but robust evidence base is lacking
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29. Call to Action - PCBH
Hunter, C.L., Funderburk, J.S., Polaha, J. et al. J Clin Psychol Med Settings (2018) 25: 127.
Patient Outcomes (satisfaction, symptoms, functioning)
Implementation Outcomes (acceptability, adoption, cost, fidelity, reach)
Practice is ahead of the science
What works, for whom, under what conditions, for what cost
Robust, standardized measures
Practice-Based Research Networks
Pragmatic trials
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30. References
American College Health Association (2010). Considerations for integration of counseling and health services on college and university campuses: An ACHA White paper. Journal of American College Health, 58(6):
Blount, A., Integrated Primary Care: Organizing the Evidence. Families, Systems & Health, (2): p
Cohen, D. J., Davis, M. M., Hall, J. D., Gilchrist, E. C., & Miller, B. F. (2015). A Guidebook of Professional Practices for Behavioral Health and Primary Care Integration: Observations From Exemplary Sites. Rockville, MD: Agency for Healthcare Research and Quality.
Funderburk, J. S., Fielder, R. L., DeMartini, K. S., & Flynn, C. A. (2012). Integrating behavioral health services into a university health center: Patient and provider satisfaction. Families, Systems, & Health, 30(2),
Hunter, C. L., Funderburk, J. S., Polaha, J., Bauman, D., Goodie, J. L., & Hunter, C. M. (2017). Primary care behavioral health (PCBH) model research: Current state of the science and a call to action. Journal of clinical psychology in medical settings, 1-30.
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31. References
Macchi, C. R., Kessler, R., Auxier, A., Hitt, J. R., Mullin, D., van Eeghen, C., & Littenberg, B. (2016). The Practice Integration Profile: Rationale, development, method, and research. Families, Systems, & Health, 34(4), 334.
National Survey for Counseling Center Directors Gallagher, R.P. ( ) National Survey for Counseling Center Directors. Arlington, VA: International Association of Counseling Services
Peek, C. J. (2009, June). A collaborative care lexicon for asking practice and research development questions. Paper presented at the Collaborative Care Research Network Research Development Conference, Denver, Colorado. Retrieved from reports/collaborativecare/collab3.html
Pratt, K. M., DeBerard, M. S., Davis, J. W., & Wheeler, A. J. (2012). An evaluation of the development and implementation of a university-based integrated behavioral healthcare program. Professional Psychology: Research and Practice, 43(4),
Spiegelhoff, S. F., & Luke, M. (2015). Integration of College Counseling and Health Services: A Phenomenological Study. The Wisconsin Counseling Journal,
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32. Unveiling the Results of a National Survey of Behavioral Health Services Offered Within Primary Care Student Health Centers: Implications for our Practice
Kevin Readdean, MSEd, LMHC
Associate Director, Student Health, Rensselaer
PhD Student, Rutgers University
@IntegrationDNA