Increasing Access to and Utilization of Behavioral Health Care Through Integrated Primary Care.

OBJECTIVES: To evaluate changes in access to and utilization of behavioral health (BH) services after the integration of psychologists into primary care clinics compared with clinics without integrated psychologists. METHODS: We integrated 4 of 12 primary care clinics within our academic health system. We used the median wait time for BH services as a proxy for changes in access and defined BH utilization as the percentage of primary care visits that resulted in contact with a BH clinician within 180 days. We compared changes in access and utilization from the year before integration (September 2015 to September 2016) with the 2 years after integration (October 2016 to October 2018) within integrated clinics and between integrated and nonintegrated clinics. We used difference-in-difference analysis to test the association of study outcomes with the presence of integrated psychologists. RESULTS: Access and utilization were similar across all practices before integration. After integration, BH utilization increased by 143% in integrated clinics compared with 12% in nonintegrated clinics. The utilization of BH services outside of the medical home (ie, specialty BH service) decreased for integrated clinics only. In clinics with integrated psychologists, 93% of initial BH visits happened on the same day as a need was identified. The median wait time for the 7% in integrated clinics who were not seen on the same day was 11.4 days (interquartile range = 5.3-17.7) compared with 48.3 days (interquartile range = 20.4-93.6) for nonintegrated clinics. CONCLUSIONS: A team-based integration model increased BH utilization and access.

ACEs screening in adolescent primary care: Psychological flexibility as a moderator.

PURPOSE: Screening for adverse childhood experiences (ACEs) is increasingly recommended in medical settings; however, there is more to learn about which patients experience negative outcomes following ACEs and how to intervene. This study sought to determine whether psychological flexibility moderated the relationship between ACEs and 2 important health outcomes: depression and elevated body mass index (BMI). Specifically, we hypothesized that as psychological flexibility increased, the relationship between ACEs and these mental and physical health outcomes would weaken. METHOD: Exposure to ACEs, psychological flexibility (AFQ-Y8), depressive symptoms (PHQ9a), and BMI percentiles were assessed using validated, self-report rating scales during adolescent well-child checks in urban primary care practices. A total sample of 402 predominately Black (72.6%), publicly insured (81.8%), and female (63.4%) adolescents with complete data were included in analysis. RESULTS: Psychological flexibility moderated the relationship between self-reported ACEs and depressive symptoms. Patients with high psychological flexibility reported fewer depressive symptoms when they experienced more ACEs, those with average psychological flexibility demonstrated no relationship between ACEs and depressive symptoms, and those with low psychological flexibility reported more depressive symptoms when experiencing higher numbers of ACEs. ACEs were only related to BMIs greater than 99th percentile in this study and moderation was not supported. CONCLUSIONS: Psychological flexibility was helpful in differentiating those who experience increased depressive symptoms following ACE exposure in a primary care setting. Psychological flexibility is a modifiable process and may represent an important population health variable to develop prior to exposure or reduce negative outcomes following ACEs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).