Evaluation of a California Learning Collaborative Improving Integration of Behavioral Health in Primary Care
Over 20 percent of adults in California have experienced some form of mental illness in the past year. Many of these individuals face barriers to finding, accessing, and paying for the healthcare services and health-related social need services they need to improve their well-being.
Integrating behavioral health within the primary healthcare system is a promising approach to addressing the physical and mental health needs of vulnerable populations. However, this type of change is difficult to implement, particularly for safety net providers.
From October 2021 through May 2023, the California Heath Care Foundation (CHCF) collaborated with the Center for Care Innovation to implement the ABHE-PC Learning Collaborative. The intervention aimed to help Federally Qualified Health Centers and Community Health Center “look-alikes” (CHCs) adopt integrated, trauma-informed behavioral healthcare services. Through a variety of learning activities, the project sought to build patient trust, reduce stigma in behavioral healthcare, and improve screening and referral for behavioral health and health-related social needs.
CHCF engaged AIR to lead an independent mixed-methods evaluation about the impact of the learning collaborative and to identify lessons that could be applied in other CHCs.
AIR's Evaluation Approach and Methods
AIR used a mixed-methods evaluation to assess the implementation and outcomes of the learning collaborative. The AIR evaluation team collected and analyzed a variety of data from:
- A self-assessment tool for CHC teams, developed and overseen by the Center for Care Innovation, to identify where change was needed and assess if they were making improvements;
- Observation of learning sessions and webinars that aimed to help facilitate change;
- A behavioral health service and screening inventory checklist;
- Listening sessions with patients and CHC administrators, providers, and staff;
- A patient survey on quality of care, access, and experience; and
- A universal measure set that collected staffing, care utilization, access, care quality, and mental health and physical health quality metrics, stratified by patient characteristics.
Key Findings
AIR’s evaluation found that the ABHE-PC learning collaborative made significant strides in advancing behavioral health integration in California's primary care settings.
More specific findings include:
- Depression screening and remission improved overall and for some patient populations most impacted by depression;
- While CHCs at the beginning of the intervention showed lower-than-anticipated ability to integrate behavioral health services, teams showed improvement throughout the intervention. Improvement continued into the year following implementation;
- CHCs’ ability to report their data by patient characteristics was difficult for many CHCs at the beginning of the program, but data management and stratification improved over time. Reporting for care quality and delivery also improved over time; and
- In patient surveys, most patients reported positive care experiences, with suggestions for increasing accessibility (e.g., increase availability of in-person appointments) and reducing wait times.
While the intervention’s learning activities and outcomes provide a foundation for continued improvement, additional supports are likely necessary to sustain change. For instance, discussions with CHC teams suggested the need for more funding to support staff participating in learning collaboratives, extended implementation periods, and flexibility in program requirements. Further, strong leadership buy-in, staff engagement, practical data management skills, and patient involvement were necessary to successfully integrate behavioral and primary healthcare.
