Abstract: Using the Consolidated Framework for Implementation Research to Understand Integrated Care: The Case of the Behavioral Health Integration and Complex Care Initiative (Society for Social Work and Research 26th Annual Conference - Social Work Science for Racial, Social, and Political Justice)

Schedule:

Friday, January 14, 2022

Monument, ML 4 (Marriott Marquis Washington, DC)

* noted as presenting author

Elizabeth Siantz, PhD, MSW, Assistant Professor, University of Utah, Salt Lake City, UT

Benjamin Henwood, PhD, Assistant Professor, University of Southern California, Los Angeles, CA

Borsika Rabin, PhD, Assistant Professor, University of California, San Diego, CA

Kimberly Center, MA, Program Evaluation Manager, University of California, San Diego, CA

Karissa Fenwick, PhD, Research Fellow, Veterans Affairs, CA

Todd Gilmer, PhD, Professor, University of California, San Diego, La Jolla, CA

Background: Integrated behavioral health and primary care can improve the health of persons with complex chronic conditions. While the Affordable Care Act’s Medicaid expansion provided new opportunities to serve this population, shortages of primary care physicians and specialty providers continue to pose serious barriers to accessing care. To address this, the Behavioral Health Integration and Complex Care Initiative (BHICCI) implemented integrated behavioral health, mental health, and primary care teams across a large Medicaid managed-care plan’s partnering Behavioral Health Organizations (BHOs) and Federally Qualified Health Centers (FQHCs). Whether and how BHOs and FQHCs implemented the BHICCI differently is unclear. This mixed method presentation evaluates integration under the BHICCI, with the goal of describing the implementation differences between BHOs and FQHCs.

Methods: This study followed a convergent parallel mixed-method design. To quantitatively measure integration, clinic teams completed the Maine Health Access Site Self-Assessment (SSA) at baseline and 24 months. To qualitatively understand integration, we conducted expert interviews with initiative stakeholders, and one implementation site visit per clinic during which all available BHICCI team members were interviewed, including the executive team, registered nurses, primary care providers, care managers, behavioral health specialists, and social workers. We also conducted follow-up visits at the BHICCI’s conclusion. Qualitative interviews were audio recorded, transcribed, were analyzed using constant comparative methods informed by grounded theory. Results were then organized using the Consolidated Framework for Implementation Research. Quantitative and qualitative results were compared to understand how qualitative findings explained quantitative results.

Results: Data were collected in 7 clinics (n =2 FQHC; n= 5 BHOs). FQHCs reported greatest improvement in the client centered subscale, with a baseline score of 4.6 (SD =0.64) and 7.8 (SD=0.89) at 24 months. BHOs reported greatest improvement in the organizational supports for integration subscale, with a baseline score of 4.8 (SD =1.07) and 7.9 (SD=1.1) at 24 months. We conducted interviews with n=75 stakeholders, including n=70 BHICCI team members (FQHC n=18; BHO n = 52), two health plan executives and three key advisors. Our Consolidated Framework for Implementation Research analysis illustrates contextual factors (such as insurance plan supports and support from practice coaches) and clinic-level challenges, (such as hiring providers and FQHC productivity requirements) that explain these scores.

Conclusions: All clinical settings received support from the health plan, but differences between BHOs and FQHCs affected program implementation. Study results can help identify organizational practices that advance or undermine the delivery of integrated care across multiple clinical settings.