Integrated Behavioral Health Implementation Patterns in Primary Care Using the Cross-Model Framework: A Latent Class Analysis

Gretchen J.R. Buchanan, Timothy Piehler, Jerica M Berge, Audrey Hansen, Kari A. Stephens

Research output: Contribution to journalArticlepeer-review

Abstract

Primary care has increasingly adopted integrated behavioral health (IBH) practices to enhance overall care. The IBH Cross-Model Framework clarifies the core processes and structures of IBH, but little is known about how practices vary in the implementation of these processes and structures. This study aimed to describe clusters of clinics using the IBH Cross-Model Framework for a large sample of primary care clinics, as well as contextual variables associated with differences in implementation. Primary care clinics (N = 102) in Minnesota reported their level of implementation across 18 different components of IBH via the site self-assessment (SSA). The components were mapped to all five principles and four of the nine structures of the IBH Cross-Model Framework. latent class analysis was used to identify unique clusters of IBH components from the SSA across the IBH Cross-Model Framework’s processes and structures. Latent classes were then regressed onto context variables. A four-class model was determined to be the best fit: Low IBH (39.6%), Structural IBH (7.9%), Partial IBH (29.4%), and Strong IBH (23.1%). Partial IBH clinics were more urban than the other three classes, lower in SES risk than Structural IBH clinics, and located in smaller organizations than Strong IBH clinics. There were no differences between classes in race/ethnicity of the clinic area or practice size. Four groups of IBH implementation were identified representing unique profiles of integration. These clusters may represent patterns of community-based implementation of IBH that indicate easier and more challenging aspects of IBH implementation.

Bibliographical note

Funding Information:
This work is supported by ICSI, an ongoing collaboration of healthcare systems in Minnesota focused on improving health across the upper Midwest. Additionally, the first author was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grants TL1R002493 and UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of either the University of Minnesota or the National Institutes of Health’s National Center for Advancing Translational Sciences.

Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Keywords

  • Behavioral health
  • Implementation science
  • Integrated behavioral health
  • Latent class analysis
  • Mental health
  • Primary care

PubMed: MeSH publication types

  • Journal Article

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