Facilitators and challenges of implementing an integrated behavioral health model: An exploratory qualitative analysis of a New Jersey demonstration project.

Abstract

Introduction: Despite strong evidence supporting integrated behavioral health (IBH), implementing the Primary Care Behavioral Health (PCBH) model remains challenging, particularly in safety-net settings like Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs). This study examines facilitators and barriers to PCBH adoption during a New Jersey-based demonstration project funded by The Nicholson Foundation (2013-2019).

Method: We conducted semistructured interviews with 18 behavioral health and primary care staff from 10 FQHCs/CHCs between June and September 2022. A thematic analysis using both inductive and deductive approaches guided our interpretation.

Results: Five key facilitators emerged: (a) external system support, (b) leadership champions driving workflow redesign, (c) positive provider attitudes toward change, (d) comprehensive PCBH training for all staff, and (e) visibility of behavioral health consultants. Major challenges included: (a) lack of resources and standardized training materials, (b) difficulty recruiting and retaining behavioral health professionals, and (c) complex billing processes that delay revenue generation.

Discussion: While PCBH implementation is complex, critical enablers can support success in FQHCs/CHCs. As PCBH gains traction in healthcare systems, insights from this study can inform future efforts, particularly in underserved settings aiming to integrate behavioral health into primary care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).