Integrating Physical Health Care in Behavioral Health Agencies in Rural Pennsylvania

As states and communities undertake efforts to integrate physical and behavioral health services, it is critical to understand how these efforts are organized and implemented. This study examined the early implementation of the Behavioral Health Home Plus (BHHP) program in two county behavioral health agencies in rural Pennsylvania. With support from a behavioral health managed care organization, each agency hired a registered nurse, provided training for its case managers and peer specialists in wellness coaching, and used a web-based tool for tracking consumer outcomes. Findings suggest that agencies successfully trained their staff in wellness coaching, integrated registered nurses into agency functions, developed care planning processes that incorporate physical and behavioral health goals, and increased awareness and knowledge of physical health and wellness among behavioral health staff and consumers. Given the complexity of introducing physical health services into behavioral health care settings, the agencies experienced several early implementation challenges including staff role confusion, difficulty establishing new procedures and communication protocols among staff members, discomfort among case managers and peer specialists in identifying and addressing physical health concerns, difficulty building collaborative relationships with primary care providers, and slower-than-expected uptake of the web-based tools. The agencies were able to overcome many of these challenges with support from the behavioral health managed care organization. The study provides insights into the practical aspects of integrating care and offers recommendations for future efforts.