Community-driven primary and behavioral health care integration: Lessons learned from Heart of the City Health Center

One in every five U.S. adults had a mental illness in 2010. A subset of this population, adults with serious mental illness have been found to die an average of 25 years younger than the general U.S. population. To remedy this and other disparities associated with fragmented systems of care, the integration of primary and behavioral health care has gained increasing momentum. Still, limited research has assessed how such approaches are collectively planned, implemented, sustained, and spread by local safety net providers.

Formative research was therefore conducted to capture developmental processes and initial experiences associated with the launch of an integrated primary and behavioral health care program for adults with serious mental illness and other chronic conditions by three community-based health care organizations. Research methods included 25 key informant interviews and four focus groups conducted with a purposive sample of top management staff, health professionals, and patients across the three organizations. Qualitative data were collected at two time points and inductively analyzed with NVivo 8 software.

Leadership, organization, education, communication, and collaboration emerged as themes critical to the development of an integrated care system among top management and health professionals. Care team cohesion, patient engagement, and alignment of condition self-management goals between care team members and patients emerged as themes salient to the initial experiences of health professionals and patients. These findings informed the program's operational and clinical transformation to an integrated collaborative system of care currently serving 400 adults with chronic conditions at Heart of the City Health Center.