Name
Beyond Warm Handoffs: Expanding Behavioral Health Access Through an Adapted PCBH Model in a Community Practice
Description

This session presents a Year One evaluation of an adapted Primary Care Behavioral Health (PCBH) model implemented in a smaller community-based primary care clinic with one embedded LCSW. Participants will learn how same-day warm handoffs, needs-responsive follow-up care, and structured EMR tracking were operationalized to support sustainability and scalability. We will share data from first year including:

  • volume and utilization
  • payer-mix and demographics
  • patient risk composite scores
  • patient and provider satisfaction
  • workflow, lessons learned

The session highlights how this donor-initiated pilot is being evaluated for replication across UNC Health Medical Group to bridge behavioral health access gaps. Als share and discuss strategies for successful implementation in community-based primary care practices.

Speakers
Erik Butler, MD
Jacqueline Fuentes, MSW, LCSW
Content Level
All Audience
Tags
Patient-centered care or Patient perspectives, Primary Care Behavioral Health Model, Research and evaluation
Session Type
Concurrent
Objective 1
Describe how PCBH principles can be adapted for implementation in a smaller primary care clinic with a single embedded behavioral health clinician.
Objective 2
Identify documentation and workflow strategies, including EMR smart phrases, that support tracking of warm handoffs, non-billable coordination, and sustainability metrics.
Objective 3
Discuss how same-day access and needs-responsive engagement can expand behavioral health access across diverse payer groups and older adult populations.
Content Reference 1

Maeng DD, Martsolf GR, Scanlon DP, Christianson JB. Primary Care Behavioral Health Integration and Healthcare Utilization: A Pragmatic Evaluation. Journal of Behavioral Health Services & Research. 2022

Content Reference 2

Nilsen P, et al. Integrating the Primary Care Behavioral Health Model into Routine Care. BMC Health Services Research. 2026.

Content Reference 3

Gurfinkel D, et al. Patient Perspectives of Integrated Behavioral Health in Primary Care. Journal of Primary Care & Community Health. 2024.

Content Reference 4

Kim J, et al. Integrated Behavioral Health Services and Psychosocial Outcomes in Primary Care. JAMA Network Open. 2025