How they are making it work: Behavioral health consultant perspectives on the integration of behavioral health into primary care.

Abstract

Purpose: Integrated behavioral health (IBH) embeds behavioral health services into primary care settings. Despite evidence of its cost and clinical effectiveness, IBH has had limited widespread implementation. As on-the-ground providers, it is important to understand how behavioral health consultants (BHCs) perceive the state of IBH implementation and to identify key strategies they use to overcome IBH implementation challenges.

Method: We conducted qualitative, in-depth interviews with 10 BHCs in different care settings in New Jersey. Interviewees were identified using purposeful, snowball sampling. During data collection, immersion-crystallization review was used to assess thematic saturation, with an editing analysis style conducted in a group setting to identify themes.

Results: IBH requires a hard-fought paradigm shift, and the established (biomedical) paradigm remains. BHCs reported continually learning and adapting to "make it work" within this paradigm using four key strategies: (a) Changing the mindset of one physician at a time, (b) saying "yes" to tasks beyond the role's expectations until trust has been established, (c) proactively identifying patients who may benefit from IBH services, and (d) being physically visible to physicians and staff.

Conclusions: Widespread IBH requires a paradigm shift, one in which biomedical and behavioral health are equitably considered as health care. Future physicians need to be socialized to the IBH philosophy early in their training. IBH training should also be offered as continuing education for practicing physicians. Finally, leaders in the field of IBH need to make the BHC role less ambiguous. (PsycInfo Database Record (c) 2026 APA, all rights reserved).