3 - (SYM 76) Implementation of an Adapted Pediatric Integrated Behavioral Health Model in Primary Care Clinics: Identifying Pre-implementation Barriers and Facilitators

Although 16-20% of youth experience a mental health disorder each year, almost half of these youth do not receive needed treatment (Whitney et al., 2019). One approach for improving access to behavioral health services for youth and families is to integrate these services into the pediatric primary care setting, as primary care is an accessible and acceptable setting for many families. However, there continue to be challenges in effectively implementing integrated behavioral health (IBH) models. The current study uses data from a stepped-wedge cluster-randomized clinical trial evaluating the implementation of an adapted pediatric IBH model across 16 pediatric primary care clinics within a large statewide healthcare system. The adapted pediatric IBH model includes behavioral health screening at annual well-child visits; task-shifting services, whereby bachelor’s level interventionists provide a brief CBT intervention for youth with mild to moderate symptoms in the clinic; and behavioral health consultations with specialists for primary care providers. A mixed methods approach was employed to explore individual-, clinic-, and intervention-level barriers and facilitators during the pre-implementation phase of the study. Primary care team members completed a survey, measuring providers’ experience with IBH models and beliefs about behavioral health care provision, implementation climate and leadership, team dynamics, and perceived acceptability, feasibility, and appropriateness of the IBH model. In addition, a subset of team members at each clinic participated in individual qualitative interviews inquiring about pre-implementation facilitators and barriers. Initial survey results indicated a need for mental health services, with primary care providers reporting mental health concerns coming up on average in 48.4% of youth patient visits and on average referring 49.4% of their youth patients with mental health concerns to services. Barriers most frequently endorsed at pre-implementation by team members were current behavioral health supports/resources (46.7%), patient engagement (43.5%), and lack of time (31.5%). Qualitative content analysis of interviews will be conducted to expand on the survey results. Mixed methods results will identify key pre-implementation barriers and facilitators. Implications for implementing IBH models in pediatric primary care and potential strategies for facilitating the implementation process will be discussed.