#170: Bridging the Gap: Integrated Behavioral Health in Primary Care

March 11, 2026 | By Sam Masur

Audio

Overwhelmed by the youth mental health crisis? Join us this episode to discuss innovative opportunities to improve access to mental and behavioral health services across the lifespan. Addressing youth mental health is a team sport. To tackle this important and challenging topic, we’re joined by two special guests: Dr. Colette Desrochers (an experienced primary care pediatrician and educator) and Dr. Jen Mautone (an expert researcher and clinician in integrated behavioral health). We discuss current barriers to care, models for addressing these barriers, key outcomes, and considerations for implementation. Come join us in bridging the gap! 

IBH Pearls

1. Integrated behavioral health models are not one size fits all. Understanding your patient population, community needs, and practice setting is integral! 
2. Practice asking the hard questions during primary care visits. What are my patient’s most pressing concerns and how can I meet them where they are currently? 
3. Addressing mental and behavioral health is a team sport of primary care providers, behavioral health clinicians, patients, their families, and community supports. 

Integrated Behavioral Health Notes 

Integrated behavioral health (IBH) is the collaboration between primary care and mental health providers to increase access to and delivery of quality behavioral health care (Tomopoulos, 2024). 

Barriers to Care 

There are several barriers to timely mental and behavioral care for patients and families, which include: 

• Provider availability in a geographic region 
• Long wait times 
• Transportation challenges 
• Varying hours of operation 
• School attendance and absence  
• Insurance coverage 

Why Is Integrated Behavioral Health Important? 

Approximately 1 in 5 youth (ages 3-17 years) experience a mental, emotional, or behavioral health condition (CDC, 2024). These conditions include anxiety, depression, ADHD, autism, developmental delay, and behavioral problems. To learn more about the diagnosis and management of these conditions specifically, check out our past episodes (#50/51 Anxiety, #57 Depression, #13 ADHD, #53 Autism). 

Despite the prevalence of these conditions, less than half of children receive timely and relevant access to mental and developmental services (CDC, 2024). 

Integrated behavioral health (IBH) provides an opportunity to address these disparities. From birth through 18 years old, children and teens have at least 30 encounters (i.e. well visits) with their primary care pediatrician. IBH promotes mental and behavioral well being directly in a child’s medical home. Additionally, the models proposed allow for improved access to timely, relevant, and sustainable mental and behavioral health care. 

Models of Integrated Behavioral Health 

Each of these models is based on the level of integration from less integrated to fully integrated. 

Each model or level of integration serves a different purpose for the intended health system (expert opinion). Choosing which model or level to implement depends on your practice and resources! 

Models 

• Coordinated: facilitated referrals between behavioral health and primary care providers in separate spaces. Communication exists by phone or electronic medical record (EMR). (e.g. Massachusetts Child Psychiatry Access Project, Telephonic Psychiatric Consultation Service Program (TiPS))  
• Co-located: a behavioral health clinician is housed within the primary care space and in close proximity for collaboration but may have separate electronic medical records, different administrative structures, etc. 
• Integrated: a behavioral health clinician is present during the primary care visit incorporating warm handoff between providers and patients. Providers exist within the same healthcare system with shared EMRs. 

Primary care mental health model: focuses on prevention and generally has less psychiatry involvement (e.g. Healthy Steps, a national program that provides behavioral health support for children ages birth to three years). 

Collaborative care model: addresses patients with identified mental health diagnoses and can include psychiatrists. 

Levels of Integration 

SAMSHA-HRSA provides the following framework: 

• Level 1: Minimal collaboration between the primary care provider and mental/behavioral health clinician 
• Level 2: Basic collaboration at a distance 
• Level 3: Basic collaboration on site 
• Level 4: Close collaboration on site with some system integration 
• Level 5: Close collaboration approaching an integrated practice 
• Level 6: Full collaboration in a transformed/merged integrated practice 

Types of Providers 

Mental and behavioral health clinicians can include licensed clinical social workers, clinical psychologists, or licensed family and marriage therapists. 

How are Visits Conducted? 

In some models, a patient who flags “at risk” for mental and behavioral health concerns might see their primary care pediatrician first, then have a warm handoff to the in-house behavioral health provider to set up another appointment. In other models, the visit may already be set up from the beginning for the patient to have their primary care visit followed by their behavioral health visit in one sitting. 

Warm handoffs improve successful completion of referral. 

Considerations for Implementation

For the patient and the family, the clinic visit(s) should feel seamless, while administratively, there are several factors to consider, including: 

• Resources within the healthcare system 
• Mental and behavioral health workforce (i.e. how many providers are available in a geographic region) 
• Patient population and insurance payer mix 
• How are collaborative visits billed (e.g. separate for each provider type, fee for service) 
• Patient and family readiness to engage in mental health support 
• Physical space, appointment times within the clinic 
• Employment structure for behavioral health clinicians (i.e. are they being hired by the clinic directly?) 
• Practice readiness for change and integration 

Financial Implications

Overall, integrated behavioral health can reduce total health care spending due to decreased expenditures on emergency department and health care visits in the setting of mental health crises (AHRQ, 2025). 

However, there are several financial considerations and initial upfront costs when implementing a new model. 

Financial Considerations 

• Reimbursement model for behavioral health clinicians (e.g. fee for service, billing only if a psychiatric diagnosis is rendered) 
• Reimbursement model for primary care clinicians (e.g. financial compensation for preventative health measures)
  • In California, the newly enacted ACEs Equity Act (SB 428) mandates insurance coverage for screening of adverse childhood experiences (ACEs) which put patients at higher risk for mental health conditions. 
• Practice payer mix (i.e. types of insurance amongst patients including commercial, Medicare, Medicaid, self-pay) 
• Operational costs for hiring and training new staff, increasing/renovating physical space, introducing new technology (e.g. expanded access to electronic medical record) 

Key Outcomes 

These models are effective for every patient from the newborn stage to adolescence. They specifically can help to modify behaviors at home and foster positive relationships between child-parent dyads. 

Provider Centered Outcomes 

IBH allows pediatricians to be more directly involved in managing these conditions by:  

• Creating a scaffold for addressing common concern
• Building confidence in discussing these concerns
• Improving overall competence of mental and behavioral health in pediatrics 

Ultimately, these outcomes can improve the relationship between pediatricians and their patients. 

Patient Centered Outcomes 

1. Reduction in symptoms 
2. Improvement in children’s sleep 
3. Improvement in medication adherence 
4. Reduction in mental health stigma 
5. Improvement in parent self-efficacy in managing challenging behaviors 
6. Improved engagement in healthcare more broadly (e.g. increased attendance at well visits, increased vaccination rates) 

Specific conditions that can be addressed include:

• Disruptive behavior at home or school 
• ADHD 
• School underachievement 
• Anxiety 
• Depression, including postpartum depression 
• Suicidal ideation and self-harm 

Cultural Considerations 

Implementing a successful IBH model relies on careful consideration of the patient and community’s social needs. Sociocultural stress (e.g. food insecurity, housing insecurity) can influence how ready patients and their families are to engage in care. Additionally, when evaluating the outcomes of an IBH model through research, careful consideration of who is (and who is not) included in research is paramount. 

Understanding your patient population, community needs, and practice setting is integral! 

Links

• Healthy Steps: national program that provides behavioral health support for children ages birth to three years. 
• Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) provide an IBH framework 

Goal

Listeners will be able to understand the common barriers to timely mental health care and the ways in which an integrated behavioral health program can address these barriers. 

Learning Objectives

After listening to this episode listeners will be able to: 

1. Describe the current youth mental health crisis and common access barriers 
2. Define what integrated behavioral health in primary care is and its key benefits 
3. Explain the general framework for integrated behavioral health models and the levels of integration 
4. Discuss best practices in implementing an integrated behavioral health program 

Disclosures

Dr Colette Desrochers and Dr Jennifer Mautone report no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

Citation

Reed J, Desrochers C, Mautone J, Berk J, Chiu C, Masur S. “#170: Bridging the Gap: Integrated Behavioral Health in Primary Care”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com 11th March, 2026.