Integrated behavioral healthcare: examining barriers and facilitators to referring clients virtually in a rural primary care clinic

Abstract

Rural primary care providers are considered the first line for behavioral health and substance use disorder (SUD) treatment in Montana, which is designated as a Mental Health Professional Shortage Area (MHPSA). Virtual integrated behavioral health (IBH) is one approach primary care organizations use to support the efficient use of behavioral health resources. This quality improvement (QI) project aimed to examine barriers and facilitators to a current virtual IBH program at a rural Montana primary care clinic. During the pre-project process mapping and narrative member checks, areas of opportunity for improvement were identified. Areas of potential improvement included access to a warm handoff workflow, a desire for a behavioral health scripted communication tool, and modifications to the mood and SUD screening process. Surveys and narrative data from staff were collected weekly and informed ongoing changes to the IBH process, the scripted communication tool, and the mood and SUD screening process. An IBH "super user" was identified and accepted the role. The project resulted in a staff-approved warm handoff workflow and scripted communication tool and the emergence of an unexpected barrier to the IBH process: differences in the lived experiences of salaried versus hourly staff and their impact on the diffusion of change within the organization. The findings of this QI project demonstrate the importance of organizational buy-in among stakeholders and its importance to the success of collaborative projects. Electronic health record (EHR) documentation of mood and SUD screenings, inclusivity in design methods, and recognition of power differentials are recommended to create and sustain workflow and process modifications.