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Kick start your CFHA Conference experience on the right foot in this session designed for new attendees flying solo or previous attendees who want to expand their networking and get in the inside scoop on what’s new at the Conference. We’ll discuss tips on how to navigate the agenda, maximize your time and meet other attendees.

Integrating behavioral health into primary care ensures that providers deliver timely, patient-centered, comprehensive whole-person care while expanding access to behavioral health services, improving patient outcomes, enhancing care team satisfaction and reducing total cost of care. In this session, we will: • Highlight learnings from a 2025 California payer workgroup collaborating to facilitate behavioral health integration implementation for providers • Map behavioral health integration adoption barriers specific to a carve-out state • Identify opportunities to engage plans around behavioral health integration

Burlington Pediatrics/ Mebane Pediatrics presents the stepwise journey in conceptualizing and operationalizing an integrated medical nutrition program within a primary care pediatric home, based on ideas presented at a past CFHA conference. The interdisciplinary team including an RD, MD, billing specialist, and care team leaders will present the successes and challenges of implementing an evidence-based pediatric nutrition program, with the goal of improving access to family-centered nutritional support and counseling within the pediatric medical home.

As IBH becomes more widely implemented in a variety of medical settings (e.g., primary care, specialty care), it becomes imperative that graduate training programs adequately prepare future clinicians for practice in these settings. This presentation will explore the strategies that promote the incorporation of IBH concepts, knowledge, and skills into six separate clinical mental health counseling graduate programs. Faculty representatives from the six programs will identify specific ways in which their respective programs provide didactic, clinical, and interprofessional training to enrolled students. This presentation will end with an exploration and group discussion of future directions for IBH education in graduate training programs.

In today's rapidly evolving political landscape, children are increasingly affected by changes in policies and societal norms that can influence their development and well-being. This presentation will delve into effective strategies for behavioral health consultants to support children, families, and themselves during these challenging times. By emphasizing resilience-building, emotional support, and inclusive practices, we aim to equip professionals with practical tools and strategies for working with children and families. Additionally, we will foster a supportive environment for practitioners to process their experiences and connect with others who share similar goals.

Working in the collaborative care model (CoCM) requires skills not often taught in graduate training programs such as how to operate in a medical interdisciplinary setting and maintain a registry. CoCM program leaders are tasked with training clinicians on how to perform these skills to meet the needs of the patients while operating efficiently to create a financially sustainable program. This workshop aims to provide CoCM program leaders with guidance on how to effectively train clinicians to practice in CoCM with opportunity for discussion and problem solving.

In an era of burnout, overwhelming demands, and mounting pressures, how we show up clinically has never mattered more. This healing Extended Learning Opportunity invites providers of all disciplines to reconnect with their values and reengage with the honor of serving in primary care. Through the lens of SEEing—Shared vulnerability, Embodied Empathy, Inquiry, Noticing exceptions, and Guiding—we’ll explore a human-centered clinical stance and learn practical strategies to bring meaning, connection, and joy back into our daily work.

This ELO will provide tools applicable to learning and engaging in leadership at three levels. Leadership of self and the practice of personal mastery. Leadership of Team: How to engage and motivate teams. Leadership of System. How to think and act in complex systems.

Health professionals’ mental models of patients’ needs and illness processes are crucial in shaping healthcare and patient outcomes. These mental models consist of internal representations of diseases, symptoms, and patient behaviors, as well as the expectations interaction with other health professionals which clinicians use to diagnose, treat, and communicate with patients. Mental models interact reciprocally with the routines of practice and the structure of roles in a healthcare organization. Trying to initiate the change in routines of practice and in the structure of roles that integrating behavioral health into an organization represents, without taking the mental models of the team members into account, can lead to unexplainable barriers to progress in integration. This presentation will give participants a chance to look at the way the mental models of team members in their settings affect and are affected by the efforts toward integration they have experienced.

Led by instructors from the UNC Family Medicine Residency Program’s Federally Qualified Health Center Track and El Futuro, an inter-disciplinary nonprofit mental health organization, this session will provide real-world insights into building sustainable clinical training programs. Attendees will gain practical strategies to enhance their capacity to train future providers and expand their ability to meet the behavioral health needs of underserved communities.

Recent directions in health care point to the importance of employing culturally responsive, integrated approaches to increase access to high quality, high impact health care for all community members. Despite this growing awareness, current healthcare training curricula are limited in their capacity to adequately prepare professionals to work in interdisciplinary teams to more effectively serve rural and underserved communities.

Developing training curricula that are responsive to specific learning needs of providers in a particular setting, and which also embed cultural responsiveness within the learning methods, may feel daunting for clinical trainers, especially if they lack the expertise needed to create such culturally appropriate curricula. In this workshop the presenters, Rachel Galanter of El Futuro, a community-based mental health organization which has specific expertise in culturally appropriate Latine behavioral health, and Caroline Roberts and Molly Duffy, two family medicine physicians who work within UNC School of Medicine and provide clinical care at Piedmont Health Services, a group of Federally Qualified Health Centers in NC, will share a model of successful interdisciplinary collaborative curriculum development grounded in cultural responsiveness and cultural humility. This interactive workshop supports participants in using this model for developing their own training curriculum for integrated health care provision.

In today’s complex healthcare landscape, fragmented care often means missed chances to truly support healing. Care Without Cracks offers a new way forward — one that centers on the person, not just the problem. Every area of a healthcare system has unique mental health needs, and understanding those differences helps us deliver the right support, in the right way, at the right time.

This approach isn’t just about clinical expertise — it’s about smart, compassionate coordination that brings departments together and closes the gaps. The result? A connected, responsive system where healing happens more naturally — whole, human, and without compromise.

The Groundwater Approach

An interactive presentation on the nature and impact of structural racism and what it looks like across institutions. We examine narratives around racial disproportionality and make use of compelling research data to illustrate the systemic nature of racism and the fallacy of typical explanations like poverty, education, social class, individual behavior, or cultural attributes that often get associated with particular racial groups. The Groundwater metaphor is designed to help practitioners at all levels internalize the reality that we live in a racially structured society, and that is what causes racial inequity. The metaphor is based on three observations:

1. Racial inequity looks the same across systems,
2. Socio-economic difference does not explain the racial inequity; and,
3. Inequities are caused by systems, regardless of people’s culture or behavior.

Embracing these truths helps leaders confront the reality that all our systems, institutions, and outcomes emanate from the racial hierarchy on which the United States was built. In other words, we have a “groundwater” problem, and we need “groundwater” solutions. Starting from there, we begin to unlock transformative change.

This presentation, "Breaking Boundaries: Redefining Access and Expansion in Integrated Care with AI and Personalized Medicine," explores how artificial intelligence (AI) and personalized medicine, when integrated within the biopsychosocial-spiritual (BPSS) framework, can transform healthcare systems. By addressing not only biological factors but also psychological, social, and spiritual needs, AI-driven technologies can create more individualized, holistic care plans. The session will highlight how these innovations improve care coordination, expand access to healthcare, and enhance patient outcomes. Attendees will learn strategies for integrating AI and personalized medicine into existing care models, ensuring healthcare is more accessible, efficient, and tailored to diverse patient needs.

Description coming later. Speaking to the payer side of things and our vision for payers coming together to support providers in integration—with things like higher rates, removal of co-pays/co-insurance, technical and clinical support as well as funding for education and training.

This session explores how interprofessional case discussions serve as a training assessment tool, making sure that behavioral health trainees engage in collaborative practice rather than defaulting to siloed work. The session will share the ways in which the program uses case discussion tracking to measure interprofessional skills, identify and address barriers to interprofessional collaboration, and reinforce habits that promote team-based care.

Increasing the capacity and reach of primary care behavioral health (PCBH) is critical to the success of the program. Programs can use the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate implementation efforts. This presentation will introduce the framework and apply this framework to evaluate the reach of PCBH in a family medicine clinic. The study uses a retrospective cross-sectional design and reports on electronic health record data over a six-month implementation period (July 2024 – December 2024) to assess how many individuals the PCBH program reached and potentially could reach. The presentation will share study findings and support other programs in generalizing the study methods to their practice context.

This presentation will focus on the planning and implementation of integrated care, emphasizing effective and efficient service delivery and a focus on whole-person care as key indicators of success. By connecting Certified Community Behavorial Health Clinic (CCBHC) standards with organizational strategic planning during the initial planning phases, these components can be strengthened. This approach can help create consistency with organization wide standards and execution of whole-person care. Participants will gain valuable insights into the practical steps and benefits of incorporating CCBHC standards into their organizational strategies. Within this process, specific highlights will be on developing referral partners, establishing protocols, and tracking outcomes of participants.

This interactive session brings the Collaborative Care Model (CoCM) psychiatric case review process to life. Through real-world scenarios and live role-play, primary care team members get an exclusive look behind the scenes. Whether you're a Primary Care Provider, Behavioral Health Care Manager, or Psychiatric Consultant, you'll discover strategies to streamline systematic case reviews, strengthen CoCM delivery, and improve patient outcomes.

Post-release from prison and jail, people face enormous barriers to successful reentry and accessing essential health services. We will present an evidence based model of Reentry support that incorporates key elements of collaborative care. The North Carolina Formerly Incarcerated Transition Program (NC FIT), part of the national Transitions Clinic Network, utilizes specially trained Community Health Workers with lived experience of incarceration to assist in comprehensive reentry support and linkages to health care services.

This presentation will focus on ways that behavioral health clinicians and psychiatrists can improve engagement with primary care providers to increase utilization of a Collaborative Care Model program. We will review types of primary care providers and common attitudes towards behavioral health integration including those that facilitate integration and those that pose challenges. The session will also detail strategies to promote engagement through administrative and clinical processes, including practical tips to streamline communication and enhance interprofessional collaboration.

Group interventions are an efficient and effective way to increase patient engagement and access to care but are not often implemented in Integrated Primary Care (IPC) settings. Though most behavioral healthcare professionals (BHPs) receive training in group treatments, there is a common perception that group interventions are incompatible with the brief IPC treatment model. This panel discussion will explore some of these misconceptions regarding groups in integrated care and examine some of the common barriers to and facilitators of implementation. Panelists will leverage their experiences with implementing group-based IPC interventions and workflows, including challenges and lessons learned.

In this presentation, we will discuss the PHLOW Program, an integrated psychiatric care initiative within La Clinica’s broader Integrated Behavioral Health model. We’ll explore how the program improves access to psychiatric services, supports primary care teams in managing behavioral health, and reduces unnecessary referrals. Additionally, we’ll highlight how the program supports the right level of care, promotes cost savings while upskilling primary care providers to handle mild to moderate behavioral health concerns and informs organization wide policies, programming and care philosophies. We will also address the financial sustainability of the program and the successful partnership between our organization and payors.

Adults from racial and ethnic minority groups and older adults are less likely to receive mental health treatment compared to their white counterparts1. The collaborative care model has a robust evidence base to support effectiveness in reducing depression and anxiety symptoms2-5. Current evidence supports that the collaborative care model may provide similar or better outcomes for minority groups compared to their white counterparts3-5. More data is needed to highlight ways that the collaborative care model can reduce disparities and improve access to mental health treatment for underrepresented populations.

We’re surrounded by more health information than ever, yet many people still walk away from healthcare visits feeling confused and unheard. This disconnect, both in clinics and across communities, can harm physical, mental, and emotional health. Integrated care creates new opportunities to close this gap by making medical information easier to understand and more meaningful. In this engaging, case-based session, we’ll explore practical ways to communicate clearly, build trust, and connect the science of medicine with the stories of real people. You’ll leave with tools to make medical talk feel more human—for yourself, your patients, and your team.

Burnout has a negative and pervasive impact on individual workers, employee groups, and organizations (Green et al., 2014; Jackson et al., 1986, Maslach, 1993; O’Connor et al., 2018; Schaufeli, 2005; Thomas et al., 2014). If measures are not pursued to mitigate the degree and significance of burnout on the bio-psycho-social-spiritual well-being of healthcare workers, the profession will be challenged with the negative individual, interpersonal, and organizational effects of burnout and the quality of integrated healthcare will be compromised. Strategies for personal and organizational change will be discussed, and attendees will be able to learn about the three different types of burnout and ways to prevent and mitigate burnout.

Mountain Park Health Center (MPHC), a large FQHC with 11 clinics in the Phoenix metropolitan area, serves approximately 113,000 patients annually (UDS, 2024). MPHC was a pioneer in incorporating integrated behavioral health into primary care over 20 years ago. Many health care settings aspire to provide integrated care but often face implementation and execution challenges. Come learn how we have successfully implemented the PCBH model into our clinics and how we continue to increase collaboration efforts aimed at serving our most vulnerable populations. Some of our programs that you will learn about include our Early Childhood Development (ECD), Medication for Opioid Use Disorder (MOUD), Reach-In, Adverse Childhood Experiences (ACES), brief counseling, clinical pathways, health education classes and many more!

The purpose of this presentation is to provide tips on engaging in collaborative scholarship through lessons learned over the years of the PITCH and PEP programs – HRSA Behavioral Health Workforce Education Training grants focused on the integration of behavioral health trainees in primary care and other integrated care settings. Topics to be discussed in the presentation include planning to collaborate, implementation and models for structure, options for scholarship and authorship, and the dissemination of findings.

This session will focus on the emerging trend of overrepresentation of neurodiverse youth in chronic pain treatment programs. Presenters will share data regarding the prevalence of youth with autism in a multidisciplinary amplified musculoskeletal pain syndrome program and pediatric rheumatology provider perceptions regarding strengths, challenges, and needs for supporting this growing and under-studied population. This work directly pertains to the practice of providers and multidisciplinary teams in both Rheumatology and other pediatric specialties regarding pain assessment, treatment, and care experiences for patients with autism. We hope this session may help to supplement the varied and often lacking training regarding autism in medical education and increase awareness of this patient population, who require a specialized approach and careful consideration to ensure appropriate treatment. Recommendations will be provided for assessment, treatment, and environmental adaptations to best support this population.

This session will explore the integration of autism assessment within primary care in response to the growing need for early identification and support in the community. We will discuss how the assessment workflow has evolved over the past four years, highlighting key improvements and challenges. Additionally, the session will cover strategies for integrating autism assessment within primary care settings. Attendees will gain insights into best practices applicable to our setting, lessons learned, and future directions for enhancing autism care within primary care settings.

This presentation will outline the Gaining Access and Treatment Equity (GATE; Bridges, 2023) Framework for culturally responsive clinical care and discuss how it can be applied in integrated primary care settings. The speakers will give an overview of how the GATE Framework conceptualizes barriers to care that diverse populations face (i.e., perceived need, attitudinal, structural, and clinical barriers) and give examples of practice implications and strategies individuals and health care organizations can employ to better serve diverse populations.

To increase suicide prevention efforts within integrated primary care (IPC), we need to translate what we know from research into real-world clinical practice. However, education alone is not enough, and systemic, provider, and patient barriers make implementation difficult. This presentation will share two innovative ways we supported IPC staff in embracing evidence-based suicide prevention in clinical practice and our lessons learned based on evaluation data from over 1000 providers feedback. First, we will present on a program that provides education and implementation support to increase the number of integrated behavioral health providers in VA medical settings providing brief CBT for insomnia, which was shown efficacious in reducing insomnia and suicidal ideation among Veterans. Second, we will present the components and implementation of a program to support established (non-trainee) integrated primary care staff in delivery of suicide prevention care.

This talk explores organic adaptations of integrated care models to meet the needs of individuals living with HIV/AIDS in Appalachia. We will examine the unique challenges faced by this population, including psychosocial barriers to care. The presentation will also highlight the critical role of integrated care in supporting viral suppression and thus the role of integrated care in advancing efforts to end the HIV/AIDS epidemic. Emphasis will be placed on tailoring workflows to deliver comprehensive care to this underserved population.

This presentation will describe the implementation of an integrated behavioral health training program in rural Eastern NC. This presentation will demonstrate increased access to care, number of behavioral health professionals in various disciplines trained and learner’s self and supervisor ratings of their competence. We will describe skills learned and rotations offered and share data on trainees chosen career settings. Participants will have the opportunity to collaboratively discuss ideas for implementation in their own settings or programs, including utilizing strengths and overcoming barriers to support integrated behavioral health care training programs.

Experience a powerful firsthand account of teen suicide prevention, shared through the eyes of a high school student who became an unexpected lifeline for a friend in crisis. This session illuminates the warning signs, the difficult realities today’s teens face, and the life-saving power of speaking up to prevent death by suicide. By connecting real-life experience with the research, we all can better understand what teens need when they’re struggling. You'll leave reminded that no one is ever alone, and that small acts of kindness and courage can make the difference.

This panel will explore how transdiagnostic care models, like the Common Elements Treatment Approach (CETA), are transforming behavioral health care delivery within Integrated Care through technology and workforce solutions. CETA streamlines assessment, treatment, and measurement-based care, making it ideal for integrated care settings. By functioning as a one-stop behavioral health solution, CETA allows medical providers to efficiently address prevention, short-term psychosocial needs, and moderate symptom treatment while reducing wait times and expanding workforce capacity. Panelists will share real-world applications of CETA’s clinician-supported software and AI-driven pathways, highlighting its impact on improving patient outcomes and enhancing clinical decision-making. Attendees will leave with actionable strategies to break down systemic barriers and scale high-impact behavioral health solutions, especially for underserved populations.

This presentation explores the role of Peer Support Specialists (PSS) as essential members of a multidisciplinary team within the Collaborative Care Model (CoCM). It will highlight the benefits of incorporating PSS, particularly in care settings focused on substance use recovery. A case study will be presented, examining outcomes and key lessons from a pilot clinical program conducted in partnership with large urban community health centers. The case study will help demonstrate the value of an expanded multidisciplinary team in behavioral health integration programs, highlight common operational challenges, and underscore the need for further exploration of PSS integration within CoCM.

This session will explore multiple factors and considerations for determining the sweet spot for Collaborative Care (CoCM) caseload size. We will explore the impact of schedule design on caseload capacity, including visit length and frequency. We will also consider the impact of program parameters, such as patient population, target conditions and acuity/complexity, on the time a Behavioral Health Care Manager (BHCM) needs to effectively engage patients in CoCM. However, CoCM caseloads typically have a mix of patients in different stages of care and with variable care needs. Join us to dig into this challenge of rightsizing caseloads. This session will benefit both operations and clinical roles, including implementation leaders, BHCMs and Psychiatric Consultants.

This all-knowledge-levels presentation offers strategies for lifting up the capacity of Primary Care Behavioral Health (PCBH) strategies to improve primary care services. Two barriers to PCBH expansion are (1) lack of any PCBH services in a clinic, and (2) insufficient training of team members, including primary care providers (PCPs), in skills and knowledge associated with the optimal returns from PCBH integration. Participants will learn to use a worksheet in their community level to encourage conversations between patients and PCPs in clinics that have not yet started services consistent with the PCBH model. Additionally, participants will learn use a core competency tool (CCT) to assess and upskill team members in clinics that have started PCBH implementation but want to deepen the impact. The worksheet and CCT are available for download at http://Speaktoyourdoctor.com (see Speak to Your Doctor Information Sheet and New PCBH Core Competency Tools / Team and Primary Care Provider Core Competency Tool).

Whether or not someone has access to a firearm is one of the strongest predictors of suicide. Providers in Primary Care are expected to ask patients about access to firearms and be able to give basic guidance around safe storage, yet few get formal education on how to do so. This presentation will give a brief introduction to participants on how to talk to patients to patients about firearm safety in a collaborative and non-judgmental way. A similar training was given to Collaborative Care clinicians at a large academic medical center. The group was surveyed before and after the training to see how it changed their comfort and actual practice. There will be discussion on the feasibility of doing this in other settings.

Are you ready to implement the contextual interview (CI) with pediatric patients and their families? If so, this is the presentation for you! This will be an interactive hour filled with practicing the CI, using the CI to develop contextually congruent interventions, and real-time feedback.

60 million Americans lack access to necessary mental health services. Workforce shortages, high costs, and training barriers have exacerbated inequities, disproportionately impacting marginalized communities. This session explores how two non-profit organizations, Helios Behavioral Health and Dignity Health Collective are addressing these barriers through an innovative workforce pipeline. By training and integrating BA-level professionals, community-based workers, and individuals with lived experience into Collaborative Care Model (CoCM) teams, we are creating sustainable career pathways and expanding culturally responsive care. Attendees will gain insights into effective strategies for workforce development, policy advocacy, and reimbursement models that support this transformation.

Being a leader in healthcare is a struggle, one that women often find more difficult than their male counterparts. This workshop describes the journey of three women, in their own words, the struggle and successes, and most importantly the lessons along the way.

REACH Enhanced Primary Care (Recovery and Access to Comprehensive Health) is an academic primary care clinic located in Raleigh, NC serving individuals with serious mental illness and severe substance use disorders. This session will describe the core tenants of enhanced primary care and how the clinic has evolved over time now celebrating 10 years in existence. This clinic is a specialty primary care practice and will demonstrate evidence-based outcomes and various QI initiatives including those for physical health as well as social drivers of care.

This presentation will explore how technology-enabled care is breaking traditional barriers to integrated behavioral health, expanding access while supporting workforce sustainability. By leveraging Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), and the Collaborative Care Model (CoCM), clinics can increase patient engagement, enhance measurement-based care, and scale mental health services efficiently. Using real-world case studies from Wellness Connection, attendees will learn practical strategies for implementing remote monitoring and digital tools to improve behavioral health outcomes while maintaining financial sustainability. This session will provide actionable insights into how technology can redefine access, improve care coordination, and support underserved populations in primary care settings.

Single session therapy (SST) and interventions have been used around the world for many years in the form of walk-in clinics to help offer mental health services when there are long wait times for a standard course of therapy. If you work in integrated care, you know the value of starting the work immediately at the exact moment the patient is asking for help and making a discernable impact that day. A "one at a time" mindset offers a specific combination of skills and interventions to keep the parameters of the discussion narrow and to allow a clinician to move quickly. A single session can make quite a difference in the patient's disposition, particularly when they leave with an action plan and a way to rely on existing support and assistance. This delivery format can fit into just about any model of integrated care in either face to face or virtual settings (and you can bill for it!).

This presentation will describe the paradigm shift and unique model of Tailored Plans and Care Management Agencies (CMAs) leading whole-person care coordination across the healthcare continuum versus primary care practices. In reviewing an example of a member who has benefited from the focus on integrated whole-person care outcomes, we will discuss and amplify the transformational mindset required to effectively shift to the use of data-driven outcome metrics and convey how to harness the power of information to close care gaps and yield quality outcomes.

This session is conducted by an interdisciplinary team of Collaborative Care individuals representing two agencies, three clinics, that embarked on an initiative through Premera (insurance entity) around Health Equity. We will explore the critical role of having baseline data for measuring disparities and tracking progress. Presenters will share their experiences, challenges and success in using the data to drive equitable care improvements. Attendees will gain insights into key outcomes, including both data collection and measurable impacts on patient health.

Group interventions are an efficient and effective way to increase patient engagement and access to care but are not often implemented in Integrated Primary Care (IPC) settings. Though most behavioral healthcare professionals (BHPs) receive training in group treatments, there is a common perception that group interventions are incompatible with the brief IPC treatment model. This practical session will first review some of the common facilitators and barriers to implementing groups in IPC settings and then lead participants through a series of activities to consider how to build evidence-based group services in their setting.

This interactive session explores strategies to improve the implementation of warm handoffs (WHOs) in the Primary Care Behavioral Health (PCBH) model. Using implementation science frameworks—PRISM and Normalization Process Theory—attendees will analyze barriers and facilitators to integrating WHOs as a routine practice. Through case-based problem-solving exercises and group discussions participants will develop practical strategies to enhance workflow efficiency, provider engagement, and leadership support. This session is designed for providers, clinic managers, and organizational leaders looking to strengthen behavioral health integration and improve patient access to care.

The integration of behavioral health in pediatric primary care provides endless benefits for the clinic, PCPs, patients and their families. With medical and mental health professionals working in tandem many childhood challenges can be address. At Providence Health & Services, primary care and pediatric clinics screen for ASD in early childhood visits (e.g., 16-30 months) using the Modified- Checklist for Autism in Toddlers (M-CHAT). Further, behavioral health providers (BHP) and PCPs work together to detect symptoms of ASD and refer for evaluations to our specialized Providence Childhood Development Institute (PCDI). While PCDI is a multidisciplinary clinic specializing in autism evaluations, they do not accept patients over 14, and often those who are 12-13 years old age out while on the waitlist for an evaluation. To bridge this gap pediatric behavioral health providers in the Portland metro area have been offering ASD evaluation services for adolescents who have aged out, or are close to aging out, of PCDI. This presentation will review the need for increased training and competency in ASD evaluations, the necessity for these evaluation services in primary care, how Providence Health & Services pediatric BHPs are working to provide this care, and details about the evaluation process used. Specifically, this presentation will provide information regarding the typical session progression for an ASD evaluation in primary care, the assessment battery used, billing and coding information, and descriptive data detailing length of time from referral to feedback session.

The PEER NC: NP-BHI traineeship, established in 2017, has been dedicated to addressing the healthcare disparities in rural North Carolina.The program’s curriculum equips Primary Care Nurse Practitioners (PC-NPs) and Psychiatric-Mental Health Nurse Practitioners (PMH-NPs) with the expertise to manage behavioral health and substance use disorders within primary care settings. This presentation will elucidate the traineeship’s comprehensive structure and innovative approaches, which foster collaboration among nurse practitioners and their interprofessional team members. These collaborative efforts are instrumental in enhancing healthcare delivery and addressing the unique challenges faced by rural communities.

Rather than reiterating the need to "elevate" women leaders, this interactive session disrupts the dominant narrative by inviting attendees to be curious: Why, in a field dominated by women, are we still having this conversation? Together, we’ll challenge the status quo and explore the implicit biases and conventions that continue to hold women back in behavioral health leadership. Who benefits from maintaining these disparities, and how are we, as professionals in behavioral health and integrated care, unknowingly complicit in upholding them? This session provides an opportunity to critically examine our roles in perpetuating these patterns and offers actionable strategies for disrupting the status quo and creating meaningful change.

This session will describe a private-public partnership between the largest health insurance in the state and an academic medical center to implement Collaborative Care (CoCM) across a state network. Topics will include approaching widespread implementation, incentives provided by the insurance plan for implementation, and optimizing fidelity to the model.

This interactive workshop, featuring a panel of leaders from a North Carolina health plan, will provide participants with strategies and tools to enhance integrated co-management while fostering a healthy culture of vulnerability and learning. The session will highlight how the use of best practices, data solutions, and a cross-discipline co-management model streamlines communication, improves outcomes and creates an environment of balanced health and collaborative care. Attendees will gain a deeper understanding of how bridging gaps and breaking silos within healthcare systems is essential for mastering integrated care management and improving overall outcomes through person-centered approaches, technology, data-driven insights, and co-location of care management.

This session will dive into the significance of intersectionality within integrated care and provide practical concepts for how to infuse cultural responsiveness within systems. An introduction of a comprehensive system-focused framework (CRST) will be introduced and analyzed from the perspective of interdisciplinary treatment philosophy. Throughout this session, presenters will shed light on common misconceptions about systemic barriers and provide context for how to navigate the current healthcare challenges while maintaining hope and mobilizing other departments. The session will be conversational and audience participation will be encouraged, along with a question and answer component for the presenters.

CFHA has captioning and translations this year for the plenary sessions. Use this link to access the Wordly system.

LINK WILL BE AVAILABLE DURING THE CONFERENCE!

Join the annual Poetry and Prose Reading Session at the CFHA Conference. This session validates creative expression among the CFHA membership, encourages emotional reflection on the themes of healing and the life cycle, and creates intimacy and safety among colleagues. Facilitators promote constructive group discussions and reflection about the emotional responses generated by the stories that are shared. All attendees are invited to bring poems, short stories, or essays of a healthcare nature that they have written to the session. Attendees are also welcome to listen and/or participate in discussion only.

HealthPoint has been training Behavioral Health students, interns, and post-docs in the PCBH model of care for 20 years. We want to celebrate this anniversary by inviting alumni of HealthPoint to an event on Thursday evening. If you worked or trained with us at any point since 1971, please join us for food and drinks. RSVP at: https://forms.office.com/r/f2VsaPPp6D

Dr. Allred will provide the location before the event. Contact Robert Allred with any questions here.

Registration and Information Desk is open. Stop by with any questions. Pick up your badge here.

CFHA has captioning and translations this year for the plenary sessions. Use this link to access the Wordly system.

LINK WILL BE AVAILABLE DURING THE CONFERENCE!

As much as we all might wish that mental health problems simply did not exist, millions of people suffer from them, sometimes to an extreme extent. Many others face addiction to alcohol and other drugs, as overdose and suicide deaths abound. Yet the vast majority of doctors receive minimal instruction in treating these conditions during their lengthy medical training. This mismatch ignores the clear overlap between physical and mental distress, and too-often puts mental health clinicians on the outside looking in as the medical system continues to fail many patients. Dr. Damon Tweedy, psychiatrist, medical school professor, and author, blends personal narrative with his academic framework to argue for a more comprehensive and integrated approach to medical care, one where people with mental illness have access to a health care system that places their full well-being front and center.

Implementing a new behavioral health model within a well-established primary care behavioral health system has been both a rewarding and challenging experience. This session will provide insights into our journey of integrating the Collaborative Care Model (CoCM) with a large, complex health system. From forging key partnerships to creating an implementation-ready infrastructure, participants will gain practical strategies and actionable steps to apply in their own CoCM initiatives.

This session will introduce essential mental health crisis and involuntary commitment (IVC) vocabulary and discuss the importance of developing a suicidality protocol in clinical settings. We will use the example of North Carolina’s evolving mental health and IVC systems to illustrate how policy changes impact clinicians managing patients in crisis. Using the UNC Student Health Action Coalition (SHAC) as a case study, we will walk through how our team engaged policy personnel, community members, and providers to create a clinic-specific protocol. Attendees will be guided through developing their own decision trees and discuss real-world applications of protocols and key challenges for clinics implementing crisis response strategies.

Burnout, turnover, and provider shortages continue to define the healthcare landscape, fueling an ironic cycle that only deepens this reality. This workshop is designed to help healthcare workers feel more engaged by reconnecting them with the values that drew them to this field in the first place. In addition to completing value clarification exercises, attendees will gain evidence-based, practical strategies to intentionally engineer both their professional and personal lives for greater fulfillment. Participants will leave feeling energized, grounded, and deeply connected to the profound honor of working in healthcare’s sacred spaces.

This session will provide a structured approach to documenting and evaluating the implementation of CoCM through the use of case studies. By the end of this session, attendees will have the skills and resources to document and share CoCM implementation successes and challenges through well-structured case studies. These case studies will serve as valuable tools for research, evaluation, and quality improvement efforts, ultimately advancing CoCM adoption and effectiveness.

Measurement-Based Care (MBC) is a clinical process that includes repeated measurement to monitor treatment progress and to inform collaborative treatment planning over the course of integrated behavioral health care. Join CFHA’s Measurement-Based Care Workgroup to learn about what MBC is in behavioral health care and integrated primary care, strategies for implementation in daily practice, and tips to help you be at the forefront of this change in service delivery in your organization. The MBC workgroup will present practical strategies and scenarios based on their work creating CFHA’s position statement on Measurement-Based Care and Report on MBC in Integrated Care.

This presentation will focus on specific strategies to address care needs for patients with HIV living in rural areas of the state. The program will begin with a presentation on HIV epidemiology in the United States, then transition into discussion about the Ryan White program and its utilization within our FQHC-based HIV program. Case managers from the program will then be part of a panel to answer audience questions and discuss specific clinical cases and how specific barriers were addressed.

Despite the slow reduction in stigma around mental and behavioral health and the increasing awareness of its systemic impact on individuals and families, the healthcare system continues to favor a pathological and interventive perspective. While reimbursement is available for health education around various biological health markers, the idea of preventative behavioral/mental health care has yet to take hold. There are efforts being made to make a paradigm shift to include prevention in behavioral/mental health, for example the provision of a behavioral/mental health well visit, however states can be unique in their challenges and successes. The session will include a rich discussion from panelists on their state’s effort to achieve a reimbursable payment structure for providing preventative behavioral/mental health services (pediatric to adult).

In this session, we will address the experiences of Marriage and Family Therapists (MFTs) working in pediatric specialty care settings, as integrated behavioral health (IBH) providers. In line with the conference theme of redefining access and integration, the MFT identity and role will be presented in the context of key findings from semi-structured interviews (N=8) using an Interpretive Phenomenological Analysis (IPA). The aim of this study was to explore the unique experiences of trainees and early career professionals, particularly with regard to clinical identity, integrated collaboration, and competency-based skills. The rationale for exploring the team role of MFT trainees, and more specifically the growing presence of medical family therapists (MedFTs) in pediatric specialty care will be highlighted. Gaps in training and preparation for MFTs in these environments will be shared through the emergent themes and sub-themes. Findings will be discussed in the context of enhancing specialty care-focused training, integrated collaboration, and clinical identity formation with implications for future curriculum development and competency-based education for MFTs in IBH settings. Additionally, a proposed Pediatric Specialty Care Skills Assessment tool will be shared with MFT trainees in various settings.

Healthcare systems across the US are adopting Artificial Intelligence (AI) software to improve the delivery of health services. But are the expected outcomes the same for medical and behavioral health providers? Or should Integrated Behavioral Health teams be looking for different ways to measure success? This presentation will explore the quantitative and qualitative impact of a large (~60 clinician) integrated behavioral health department’s adoption of ambient AI technology to support clinical documentation.

In UNC REACH's Enhanced Primary Care Clinic, after a multitude of trainings, integrated peer support specialists provide education in many areas of physical and psycho-social health through one-on-one interventions and evidence-based groups. Warm hand-offs are offered from providers and peers begin building rapport offering services right in the office. Peers schedule follow-ups often meeting in the community in places like parks near their homes, grocery stores, gyms, and food pantries. Also, assisting with follow-ups for specialty appointments. Peers advocate and teach others how to self-advocate to better understand and ensure needs are met.

In the wake of unexpected layoffs, our program faced a choice: adapt, or collapse. This presentation tells the story and lessons learned of an unexpected shift to a telehealth approach for our PCBH clinicians working across seven states. We will discuss relevant metrics, technological developments, clinician competencies, and cultural considerations that make this model successful in improving access to our older adult primary care patients.

This session is designed for primary care providers, behavioral health clinicians, and other non-specialists who are responsible for managing psychiatric conditions in integrated and underserved settings. Attendees will gain practical strategies for psychotropic prescribing, learn how to navigate common treatment barriers, and develop a framework for delivering effective mental health care within real-world constraints. Through interactive Q&A, this workshop will provide actionable insights to help clinicians confidently manage psychiatric conditions when specialty support is limited.

This presentation explores the implementation of the Collaborative Care Model (CoCM) as a strategy to expand behavioral health access, particularly in rural treatment deserts. It highlights key steps in selecting clinics, assessing readiness, and training healthcare teams to foster continuity of care. The discussion will emphasize the role of psychiatric consultants, data-driven outcomes, and lessons learned from early implementation efforts. A panel of experts will share insights on overcoming challenges, building trust within communities, and navigating policy and reimbursement structures. Attendees will gain practical strategies for enhancing collaboration and improving patient outcomes in integrated behavioral health settings.

Curious about how to better support individuals experiencing menopause? This engaging workshop dives into the complexities of this life stage, offering a deeper understanding of the knowns and unknowns. We’ll explore the physical, psychological, and social changes that occur—both typical and surprising—and the unique challenges faced by those navigating menopause. Through dynamic discussions and interdisciplinary evidence-based strategies, we’ll tackle gaps in knowledge, address health disparities, and uncover practical ways to offer meaningful support. Whether you're a healthcare provider, administrator, or someone with lived experience, you’ll leave with the tools to make a real difference in the lives of those experiencing menopause—at work, at home, and beyond.

AAMC will be wanting to present at the conference on the BHI Playbook Laura and I have been working with them on. 

This session tackles the growing need to expand the behavioral health workforce for CoCM implementation, with a focus on Behavioral Health Care Managers (BHCMs). Join us for a conversation on competency-based training, alternative pathways, and rethinking qualifications to address workforce shortages. Through an open discussion, this session aims to inspire innovative strategies to build a resilient, skilled BHCM workforce, to help ensure the long-term success and sustainability of the Collaborative Care Model.

There are few training programs nationally that prepare integrated care clinicians for the workplace and most clinicians need to complete integrated care training after finishing their degree program. We developed a 9-module online training program to provide behavioral health care managers (BHCMs) with the knowledge and skills necessary to be successful. Some trainees completed only the online training while others completed both the online training and supplemental live training. To measure the effect of this training on BHCM functioning we developed a measure of the competencies necessary to be a BHCM and a group of trainees (n=95) completed this measure before and after completing training. In addition, we conducted qualitative interviews with a subset of trainees to understand their experience.

This presentation will provide attendees with actionable skills and resources for integrating ROSC principles into their own work, ultimately enhancing their ability to support recovery in underserved minority populations.

This presentation highlights the growth and expansion journey of an integrated behavioral health team in a rural, under-resourced area. Team members will discuss specific challenges encountered and the strategies implemented to overcome them. Additionally, the presentation will feature key metric and outcome data, including insights from primary care provider (PCP) and patient surveys, to showcase the impact of the team's efforts.

This presentation will present a case example of the implementation of the "Meet the Professor" (MTP) mentoring program within a department of family medicine. The project demonstrated that a MTP event can be useful in Academic Family Medicine, with implementation being minimal for the organization. This is a promising approach to improve mentorship for faculty in academic medicine, specifically in organizations with a large amount of faculty and limited resources for programming.

This session explores innovative approaches to bridging primary care and specialty behavioral health to support children ages 0–5 and their families, ensuring that families are integral to the care process at every stage. Presenters from three different healthcare systems will highlight models that not only increase access and improve care coordination but also prioritize family involvement, ensuring that families are empowered partners in their children's care. Topics will include embedded specialty consultation, stepped care models, and innovative referral pathways. The session will also address current challenges, including advancing health equity in a shifting political landscape and the impact of increasing stress on the U.S. healthcare system. Attendees will gain insights into overcoming systemic barriers, implementing sustainable solutions, and using utilization and demographic data to drive improvements in care.

Street medicine and mobile healthcare teams work to facilitate engagement in healthcare and overcome many of the barriers encountered in traditional clinic settings by bringing healthcare services directly to people experiencing homelessness (PEH). The mobile team at Cabin Creek Health Systems provides medical and behavioral health services to underserved patients with a primary focus on PEH. The team’s approach combines street medicine and mobile unit practices while incorporating various components from integrated care models to provide a trauma-informed and holistic approach to care for PEH. This presentation will describe the model of care and provide descriptive statistics to demonstrate the impact on patients served.

Traditional video reviews in family medicine residency programs are often conducted in person, limiting flexibility and accessibility. This session presents an innovative approach using video conferencing to facilitate video reviews, allowing for remote feedback while maintaining educational effectiveness. We will discuss the implementation process, including technological considerations, resident and faculty engagement, and best practices for optimizing virtual feedback. A case example will illustrate the impact of this approach on resident learning and skill development. Attendees will leave with practical strategies and resources to implement virtual video reviews in their own training programs.

Integrated behavioral health (IBH) is a complex practice redesign for most primary care settings and requires strong leadership for successful implementation. Despite the availability of comprehensive IBH implementation protocols and IBH leadership training programs, IBH has not been widely adopted into health systems across the U.S., suggesting that IBH interventions have not yet engaged the right leaders. In this session, we share the results of our qualitative research study (n=41 IBH experts from across the U.S.), which examines who needs to lead IBH implementations in order to institute system-wide IBH adoption. 

This session will explore the importance of integrating behavioral health collaboration and warm handoffs into residency training programs to better prepare future physicians for practice. Using survey data from an interdisciplinary team in a family medicine residency clinic, the presenters will examine both the benefits and challenges of using warm handoffs as an educational tool from the perspective of both medical learners and educators, with a focus on developing physician competency in behavioral health. Real-world examples and interactive discussions will engage attendees in developing strategies to optimize warm handoff training to enhance physician competencies while avoiding common pitfalls.

This presentation will describe the adoption of a new Behavioral Health Consultant in an academic primary care clinic and as a member of a family medicine residency training team. We will describe what clinical concerns most often led residents to consult with the BHC and the educational need addressed during a resident-BHC encounter. This session will also discuss considerations for other programs and settings implementing a new integrated care model such as PCBH, including the importance of measuring utilization, managing organizational priorities, and communicating the role of a BHC. This presentation demonstrates the room for growth and need for more robust training about BHCs and the PCBH model in family medicine.

Roundtable “Discussion Groups” are highly interactive and provide attendees ample time to share thoughts and ask questions about a topic. The concept is to exchange information around a particular subject and foster lively conversation among table guests. 

HOW IT WORKS

• A list of the Discussion Group topics and facilitators will be listed in the CFHA conference mobile app.
• Discussion Group topics will be posted on a round tables in the Ballroom. Seats will be reserved for the designated Facilitator; up to 9 seats will be available for conference attendees.
• Boxed lunches will be available at 11:45 as morning sessions adjourn. Conference registrants will pick up a lunch and find a seat at one of the 60+ tables holding Discussion Groups.
• The Facilitator will begin discussions at 12:05. Start with a brief introduction about their experience and work in the subject – no more than 5 minutes.
• Discussions end no later than 1:15 PM to allow transition time for afternoon sessions that convene at 1:30 PM.

Collaborative Care Behavioral Health Care Managers (BHCMs) face unique challenges. High caseloads, time constraints, the complexities of patient engagement, and facilitating communication and coordination across the care team can be challenging to manage.

Facilitated by our Clinical Trainers, the AIMS Center now hosts a monthly call just for BHCMs to share resources, dialogue, and network with others working in Collaborative Care or Integrated Care settings. Join us at the next Behavioral Health Care Managers Learning Community to find support and connection!

Pick up a Box Lunch and go to Ballroom C for this session.

The emergence of generative AI and AI tools has changed the landscape across all sectors of our society. The use of AI poses significant challenges and implications for scientific and professional writing processes. Publishers and educational institutions are developing guidelines for their proper use. Despite these efforts, dynamic developments and adoption practices pose key ethical and moral questions. This workshop will engage participants in identifying and addressing these questions so that they may advance the development of responsible writing practices in this new era of innovative technology(ies).

The Systematic Caseload Review (SCR) is a critical component to a successful Collaborative Care (CoCM) program, yet an efficient and effective process takes time to develop and effort to maintain. Once your SCR is up and running, how do you maintain the quality process required for achieving clinical outcomes? This session will provide guidance on measuring success of the SCR process based on our experience of SCR coaching with CoCM programs and past studies. The entire CoCM team will benefit from this session, especially the BHCM and Psychiatric Consultant as they contribute directly to SCR functioning.

This presentation will describe work undertaken by our growing integrated behavioral health team as we work to both remain aligned with our core values while also celebrating the inherent differences associates with practice in varied medical settings. Attendees will have the opportunity to experience our approach to competency review and microlearning, and explore how their teams can incorporate this into their own ongoing learning. We will also discuss how this work has impacted how we train students and how we onboard new providers.

At Children’s Wisconsin (CW) we have committed to using the Patient Reported Outcome Measurement Information System (PROMIS), a set of questionnaires developed and validated by the National Institute of Health using cutting edge measurement science, to support our MBH work. In this session we will describe how we implemented PROMIS MBH measures across 20 pediatric primary care clinics with integrated MBH care, including measure selection, delivery of questionnaires to patients, and coordination with larger health system goals. We will also share how PROMIS scores can be used to deepen understanding of a patient’s functioning and shape/drive patient care decisions. MBH patient outcomes following brief, targeted interventions delivered by behavioral health consultants will also be discussed and used to share future directions.

Behavioral health workforce shortages, increasing demand for services, and persistent access disparities require innovative solutions. Helios Behavioral Health, a Boston-based non-profit, has developed a specialized training curriculum to support BA-level Care Managers working alongside MA-level clinicians in integrated care settings. This hybrid staffing model offers a unique opportunity to address health equity, expand access, and improve patient outcomes by leveraging evidence-based interventions delivered by well-trained BA-level professionals. This session explores how BA-level Care Managers enhance workforce efficiency and behavioral health accessibility, particularly for patients who may not require traditional psychotherapy or medication management. Hear directly from two Helios Care Managers as they share their experiences—what drives their passion for this work, how they navigate imposter syndrome, and the meaningful impact they’re making in patient care. Attendees will gain actionable insights on implementing structured training, supervision models, and brief behavioral health interventions, ultimately supporting the expansion and diversification of the behavioral health workforce.

Engaging with difficult topics through art allows for reflection and meaning-making. It offers a way to communicate thoughts, ideas, traumas, memories, and interactions that are difficult to articulate, and fosters connection and builds community with each other. In this presentation, we will demonstrate how close observation and reflection with artwork provides a means for our clinical teams to address inherent divisions from our political climate, social-cultural context, and personal beliefs. Participants will have the opportunity to explore the pros and cons of openly discussing commonly-taboo topics using an art medium. They will be able to draw on this experiential process to promote these conversations in their home health care communities.

A medical career in integrated care comes with challenges, but resilience transforms setbacks into purpose. In this engaging seminar, integrated care physician experts share personal and professional experiences, highlighting how adversity has shaped their growth. Through the lens of a growth mindset, empowering connections, and resilience, they’ll explore strategies for navigating challenges, finding meaning in setbacks, and fostering personal and professional fulfillment.

This presentation aims to explore the intersection of primary care dermatology and behavioral health consultants. By addressing stigma, alleviating behavioral aggravating factors, and supporting patients through chronic, recurrent conditions exacerbated by mental health conditions, we can enhance patient outcomes and overall well-being. Short interventions such as breathing techniques, distractions, exposure therapy before procedures, and suicidality assessment before starting high-risk medications can result in a much better patient experience and efficacious visits (Clay, 2015). Dermatological services in the primary care setting represent an innovative model of community healthcare delivery, yet research regarding this approach is limited (Cornman, 2024). This presentation will bring together Dermatologist, Primary Care Provider, and Behavioral Health Consultant to discuss innovative approaches and best practices for primary care.

As value-based care (VBC) models continue to expand, integrated behavioral health programs play a critical role in supporting both the clinical and financial success of primary care agencies. This session will explore how the Collaborative Care Model (CoCM) aligns with VBC goals by improving behavioral health outcomes, reducing healthcare costs, and enhancing patient engagement. Attendees will gain practical strategies to track and demonstrate CoCM’s financial impact, including capturing new diagnoses, improving quality ratings, and reducing Medicare expenses. Through real-world case examples and hands-on exercises, participants will learn how to advocate for their CoCM programs as key contributors to their organization’s success. Participants will also apply the fundamentals of collaborative care to patients with more severe mental illnesses. Resources such as performance tracking templates and implementation tools will be provided to support ongoing advocacy and sustainability.

The World Professional Association for Transgender Health (WPATH) standard of care version 8 recommendations allow for a broad group of healthcare professionals to take part in the letter of support evaluation process for patients seeking gender affirming medical and surgical treatments (GAMST’s). In this session, we will review the current standard of care version 8 evaluation process recommendations, provide templates for visits and letter of support completion, and discuss case examples for practice.

The Pediatric Physicians’ Organization at Boston Children’s Hospital (PPOC) is the largest association of independent pediatric primary care providers in Massachusetts. The Behavioral Health Integration Program provides QI guidance and technical assistance for BHI to over 100 practices. This past year, BHIP piloted two initiatives aimed at improving adherence to best practices around suicide screening, and easing access and understanding of BH community resources based on acuity. This program will describe the need and design for these pilots, their implementation, and results/update on wider network wide adoption.  

This presentation explores the intersection of behavioral health care in primary care settings through two integrated care models: the Collaborative Care Model (COCM) and the Primary Care Behavioral Health (PCBH) model. COCM utilizes a structured, interdisciplinary approach to deliver evidence-based behavioral interventions alongside medication recommendation and management. PCBH adopts an integrated care approach, embedding behavioral health consultants within the primary care setting, making it easier for patients to receive holistic treatment. We will discuss key components, patient outcomes, collaboration techniques, and lessons learned in an academic family medicine clinic.

This session will describe findings from a study of adult patients in 50 primary care practices who were prescribed antidepressant medication for more than two years. We will review variations in rates of antidepressant use by age, sex, and race. Small groups of participants will answer key questions regarding these differences and the implications for clinicians and primary care practices. The session will conclude with an exploration of future research questions relevant to long-term antidepressant use in primary care.

Traumatic personal experiences are a major contributing factor to many of the common symptoms of anxiety, depression, sleeplessness, and substance use seen in primary care. This presentation provides guidance on how trauma can be compassionately assessed, discussed, and treated within primary care. Recent developments in empirical evidence support focused, brief interventions to help reduce PTSD and trauma symptoms in the primary care setting, and an overview on these approaches will be highlighted, as well as avenues to appropriate training.

Hear from key representatives of two organizations who worked to bridge access for an integrated child and adolescent psychiatry model to a large pediatric practice. This session reviews how the PHLOW Program, an integrated psychiatric care model within La Clinica, was successfully extended to Southern Oregon Pediatrics, the largest pediatric practice in the region. We discuss big picture ideas, such as finding compatibility with missions, down to the fine details of solving logistical barriers to partnership. We also review the expansion’s mutual value to providers and patients, and opportunities for ongoing support outside of direct consultation and care.

Integrating a population health, risk-stratified program focused on prevention and promotion can positively impact the ability of medical homes to support vulnerable families. This session will share how a practice serving a large number of immigrant and refugee families and other families facing pervasive barriers, has enhanced the care of these families with the implementation of HealthySteps. Participants will get insights and learn best practices for supporting families with children birth through three.

This presentation examines the challenges of implementing value-based care (VBC) in integrated healthcare, including misalignment between payers and providers, inadequate behavioral health metrics, and complex payment structures. A national survey conducted in Fall 2024 (n=50) highlighted key provider concerns, such as contractual clarity (42%), poor state/payer engagement (32%), and misaligned metrics (32%). While financial incentives (50%) and practice flexibility (46%) motivated VBC participation, unclear incentives (22%) and reporting burdens (24%) remained obstacles. The findings underscore the need for stronger provider-payer collaboration, standardized quality metrics, and better education and training. This session will offer practical recommendations to improve VBC adoption, ensuring financial incentives align with patient-centered care.

This session will delve into the findings from a large-scale analysis of over 110,000 patients engaged in Collaborative Care, drawn from the Concert Health dataset. By examining these findings, we will explore best practices, care delivery models, patient engagement strategies, and measurable outcomes across various demographics, regions, and healthcare payers. Attendees will leave with valuable insights on how these findings can inform the future of integrated care and improve patient outcomes across diverse populations.

This presentation introduces the 1-Minute Behavioral Health Preceptor Tool, a practical framework for integrating behavioral health care into family medicine residency training. Designed to enhance resident competency in managing mental health issues, the tool offers a solution for family medicine faculty in regions with limited access to behavioral health clinicians. The presentation will highlight findings from its implementation across four training sites, discussing both the challenges and significant learning impacts observed. Attendees will gain actionable strategies to integrate the tool into their clinics and improve behavioral health training for residents.

Depression and anxiety are among the most underdiagnosed and undertreated mental health conditions encountered by patients in primary care settings and are frequently linked with other chronic conditions. Integrated models of behavioral health care such as Collaborative Care (CoCM) greatly improve access to care, reduce total costs of care, increase primary care provider satisfaction and productivity, improve clinical outcomes, and reduce health disparities and stigma by providing behavioral health treatment in the primary care setting. This presentation will describe an innovative multi-year program implementing embedded behavioral health providers (LCSWs) and consulting psychiatrists at a major academic medical health system. This will provide a brief overview of the program that began in 2018, along with its phases of expansion over the years to ensure that as many primary care patients as possible have access to CoCM services. The discussion will also cover plans for future growth and the lessons learned along the way.

Since 2017, more than 5000 healthcare professionals have been trained in Integrated Primary Care (IPC) through the Veterans Health Administration (VHA) national Competency-based Training (CT). This presentation will focus on recent innovations and enhancements to CT featuring interactive ways to have fun while learning key competencies for high fidelity practice in IPC. We will discuss the use of a variety of interactive methods, including games, used to build key skills while making learning fun. Our target audience includes those interested in interactive methods for training integrated healthcare team members for high fidelity, collaborative practice. Attendees will 1) learn about the process for tailoring and enhancing training materials more broadly, adding fun to learning and 2) experience interactive learning.

This interactive session will provide an overview of local and statewide programs that strive to enhance care access and quality services for agricultural workers in North Carolina. It will highlight collaborative care efforts of North Carolina Farmworkers' Project and UNC Family Medicine. It will allow for shared reflection on how to integrate medical learners into mobile unit care teams to increase capacity, access, and patient experience. It will offer an opportunity for sharing stories of success and challenge in providing high quality care for patients and high quality learning experiences for medical learners.

The E-GATHER is a learning tool designed to engage a new BHC in participatory learning activities that support development of skills and knowledge with high fidelity to the Primary Care Behavioral Health (PCBH) model. This presentation will introduce this learning innovation and demonstrate its use with several supervisees. The E-GATHER can serve as a bridge to use of the PCBH BHC Core Competency Tool during initial months of BHC training and during a brief re-orientation after a BHC practice has veered away from core PCBH skill practices. The presentation will include E-GATHER data and visit completion data from 2 case studies of supervision that used the E-GATHER. Presenters will include one of the tool’s developers, a supervisor, and two supervisees.

Artificial Intelligence (AI) ambient scribing is an emerging tool utilized within healthcare settings to assist medical professionals with the efficient and accurate completion of clinical documentation. In studies examining the physician use of AI ambient scribes, results suggest their use can alleviate physician burnout and improve the timeliness and completeness of documentation. However, there remains a paucity of research examining the impact of AI ambient scribing on the documentation practices, burnout, and productivity of behavioral health providers. The presenters will present preliminary results from a study exploring the impact of AI ambient scribing on behavioral health provider wellbeing and workflows in integrated primary care settings.

Anxiety disorders and subthreshold symptoms are prevalent in primary care patients. Exposure therapy is a gold standard treatment for anxiety, but clinicians rarely use it in integrated primary care (IPC) settings due to challenges in adapting it for feasible delivery in brief sessions. This session will cover how to incorporate elements of exposure techniques for anxiety in your IPC practice with adults, including tips for efficiently explaining the treatment rationale, securing patient buy-in, identifying personalized exposure targets, and setting “baby step” exposure goals within a 30-minute session. We will present qualitative feedback from frontline IPC providers who delivered brief exposure and share examples of exposure goals set by patients in IPC sessions in a recent clinical trial. Finally, we will facilitate a large-group discussion of barriers and facilitators to embracing the spirit of exposure and/or adhering to the “letter of the law” for exposure in IPC clinical practice.

Journey with a panel of primary care leaders through a storytelling discussion about breaking boundaries of primary care leadership and expansion in a variety of primary care settings. Panelists will discuss their efforts to expand health care reach in academic medical centers, federally qualified health clinics, community clinics, family medicine residency clinics, and rural mobile clinics via in person and telehealth clinical services. Panelists will intimately share their lived challenges, specifically in the current, sociopolitical environment, to give voice and space to the scars that develop through breaking boundaries for innovation and expansion. Participants will have the opportunity to begin understanding the universality of professional suffering and its presence within primary care teams. This presentation serves to remind participants that they do not have to wear their scars alone.

Many clinics collect measurement data (e.g., PHQ-9, GAD-7) but fail to integrate it meaningfully into clinical workflows. This session moves beyond compliance-focused MBC to practical strategies that improve patient care and clinical decision-making. Drawing from the Collect, Share, Act Model (Scott et al., 2022), we will explore comprehensive strategies and workflows to get more value from the data you collect!

In this session, we will address the experiences of Marriage and Family Therapists (MFTs) working in integrated, pediatric specialty care settings. In line with the conference theme of redefining access and integration, the role of MFT training and supervision will be presented in the context of key findings from semi-structured interviews. The aim of this Interpretive Phenomenological Analysis (IPA) was to explore the unique experiences of trainees and early career professionals (N=8), regarding competency-based skills, training, and supervision needs. The rationale for exploring the team role of MFT trainees, and more specifically, the growing presence of medical family therapists (MedFTs) in pediatric specialty care will be highlighted. Gaps in training and preparation for MFTs in these environments will be shared through the emergent themes and sub-themes. Findings will be utilized for enhancing specialty care-focused training and supervision, including a proposed Pediatric Specialty Care Skills Assessment tool to be applied with MFT trainees in various settings.

The primary care environment is uniquely poised to target health disparities, increase access, and offer culturally humble behavioral health intervention. Unfortunately, existing research highlights ongoing gaps with respect to integration of culturally and linguistically appropriate care into practice, including in pediatric settings (Chakawa, Crawford, Belzer, & Yeh, 2024; Mainous et al., 2020). In addition, despite calls to increase culturally affirming and responsive care into all healthcare settings, training of pediatric providers requires confrontation of barriers including time, inconsistency with respect to infusion of JEDI and related values into professional education, and provider bias (Barned, Lajoie, & Racine, 2019; Hoffman, Trawalter, Axt, & Oliver, 2016; Okoniewski et al., 2022). 
Clinician awareness of their own intersecting identities and health-related values are critical components of providing effective and patient-centered care, as well as strengthening the patient-provider relationship (Cho, 2019; Rehman, Santhanam, & Sukhera, 2023). This presentation will outline a visual learning tool to designed support clinician understanding of intersectional identity (Kliman, 2010), as well as apply this tool to a cross-cultural treatment planning model (Ask-Share-Compare-Negotiate (ASCN); Kutob, Senf, & Harris, 2009). We will utilize didactic, small group, and case studies to facilitate learning and engagement. Finally, we will discuss strategies for pediatrics providers and trainees to infuse cultural humility into their practice in a way that is adaptable and responsive to the needs of patients and families.

Behavioral health is proven to be an important component of long-term success for weight loss management. From evaluating risk for those entering bariatric surgery to developing pre- and post-surgical care plans, to supporting those utilizing medication for weight management, such as GLP-1 agonists, behavioral health plays a role in positive outcomes. Join us as we share our experiences with integrating behavioral health into bariatric care and medically supervised weight loss.

Hidradenitis Suppurativa (HS) is a severe inflammatory condition characterized by painful lesions, affecting up to 4% of the population and often going undiagnosed for up to a decade, with women of color being disproportionately impacted. This stigmatizing disease increases the risk of mental health disorders and substance abuse, and accessing interdisciplinary care is particularly challenging in rural and marginalized communities. A novel approach integrating dermatology and behavioral health through group medical visits at a rural Federally Qualified Health Center (FQHC) shows promise in enhancing patient experience, improving outcomes, and reducing healthcare costs. This presentation will demonstrate the progression from pilot data presented in 2024 at the CFHA conference to a more structured monthly group model, highlighting the potential for further quality improvement initiatives and better support for HS patients in primary care settings.

Cascadia Health, a large community behavioral health center and FQHC look-alike, developed an innovative workforce development pilot to improve care for individuals with co-occurring mental health and addiction. This pilot is a part of a larger grant-funded program to improve care for people with co-occurring disorders, and enhance the philosophy of harm reduction at our organization. In this dual-certification pilot, mental health staff receive mentorship, on-the-job training, and support for additional content-specific training as they work toward obtaining a Certified Alcohol and Drug Counselor (CADC) certification. By investing in staff training, our goal is to build a more sustainable workforce, equip staff with additional professional skills, and to improve our care for people with complex behavioral health needs. This presentation will outline how departments across our organization have collaborated on this initiative to enhance integrated care for the individuals we serve. We will also highlight strategies used to address barriers to this pilot related to capacity of trainees and mentors, and to support staff in achieving their professional development goals, including approaches that emphasize harm reduction practices.

Supervising mental health providers in PCBH is not well designed for traditional 1 hour per week case conceptualization and self-reflection. And medical precepting models with point of care clinical assessment and plans are too fast paced for PCBH providers in training. A hybrid “super-cepting” model can bring together the best of both worlds. The strategies and structure of both models can be retro-fitted to meet the faster-paced style, but provide the theoretical models, self assessment, and evidence-based skills needed for PCBH providers.

Join us to visit the posters and for the reception.

Families Systems and Health Editorial Meeting - welcome for all who are interested.

Join the Pediatrics Special Interest Group for this networking event. Get to know other attendees who work in Pediatrics

People with Intellectual and Developmental Disabilities (I/DD) face significant health disparities due to fragmented care and systemic barriers. Compass Health Network in collaboration with Easterseals, has pioneered integrated healthcare approaches tailored to individuals with I/DD, addressing their unique medical, behavioral, and social needs. This session will explore innovative care coordination model, the role of population health management, and key policy initiatives that promote equity. Attendees will gain insight into best practices, real-world case studies, and practical strategies for improving health outcomes in this underserved population.

There is a growing crisis of pediatric mental health care needs in the U.S., with the burden falling increasingly on pediatric primary care providers, given the shortage of pediatric mental health providers. To address this need, the pediatric, psychiatry, and psychology teams at Columbia University have undertaken a joint effort to develop training materials for pediatric residents. Developed with user-centered design principles, this mental health care management handbook provides evidence-based and expert diagnostic and treatment algorithms to assist trainees in clinical decision making. This handbook integrates with other program embedded training on the same mental health care topics to reinforce learning.

While primary care has become the “gold standard” training site for Medical Family Therapy (MedFT) practice, there’s an increased need for systemic care in secondary and tertiary care settings. Furthermore, complex conditions in specialty areas of medicine require more roles of the behavioral health regarding family caregiving, social supports, health coaching, and family-based treatment planning. This talk will highlight three MedFT training students who have integrated their services in Addiction Medicine, Internal Medicine, and Pediatric Cardiology. Each presenter will provide an overview of how they have developed collaborations with their respective specialty team, presenting on a unique case that required specific family-centered skills in practice. A physician and registered nurse will provide their perspectives on the utility of MedFTs at these sites and the need for more workforce development of specialty area training.

Elimination disorders (constipation, encopresis, enuresis, “accidents”) are common concerns in pediatric primary care. Treating these disorders often involves behavioral changes in addition to medication options. PCBH providers are well situated to support families and medical providers in implementing these changes. However, they often lack the foundational knowledge of elimination disorders and their treatment, which is necessary for them to provide the needed support. This presentation aims to provide that foundation.

Neurodivergent adults—those who are autistic, ADHD, AuDHD, or have sensory processing differences—frequently experience misdiagnosis, medical trauma, and non-affirming treatment in healthcare settings. Traditional models may prioritize behavioral compliance over autonomy or interpret differences through a deficit lens. Integrated care teams have a unique opportunity to promote affirming, collaborative approaches across primary care, behavioral health, and allied specialties.

Depression is common in primary care, though screening is often infrequent. Approximately, 15 million physician office visits document depressive disorders as a primary diagnosis and 11% indicate depression on the medical record. A 2010-2018 survey indicated 13.1% of primary care encounters involved depression diagnoses with screenings completed 4.1% of the time. Barriers previously identified in research include personnel trainings, perceived clinical relevance, reading and rephrasing questions, patient opinions on purpose of screening, patient cooperation, time constraints, and workflow inefficiencies. The aim of the project was to gain an understanding of medical residents and Advanced Practice Practitioners knowledge and utilization of depression screeners. Qualitative data was gathered via semi-structured focus group with interview led by first author documented using Otter.ai, an online transcription software. Participants included residents (n = 10) and advanced practiced practitioners (APPs; n = 6) in internal medicine. Residents and APPs were interviewed on two separate days. Transcripts from the interviews with the residents and the APPs were entered into ChatGPT to identify key themes and differences between the two transcripts. Key themes identified from both groups include inconsistent use and triggers for using screeners, workflow and systems barriers, concerns about validity and clinical usefulness, concerns for patient experience and comfort, concerns regarding safety and suicide risk screening, and thoughts about opportunities for improvement. Key themes and differences identified in this project can be useful when considering how we can provide education around depression screening and address areas of concern with residents and other healthcare providers.

Profound disparities in pediatric developmental outcomes warrant innovative approaches to support vulnerable youth (Karpman et al., 2023). Integrated efforts with school-based programs enhance access to behavioral health resources. Specifically, school-based mentorship programs offer academic, social, and logistical benefits for participating students (Kuperminc et al., 2020).

We are conducting a mixed-method evaluation a school-based mentorship program (Pioneer Trailblazers) to assess program impact and identify opportunities for enhanced collaboration. We collected targeted data from teachers regarding students' needs as well as feedback from Trailblazers' regarding students' their experiences over the course of the school year. We identified common referral concerns (e.g., academic, social), strategies used by high school mentors to address target goals, and opportunities for program improvement.

As primary care behavioral health (PCBH) has quickly expanded, understanding the workforce needed to deploy the model is limited. The literature review was conducted to summarize the current evidence about behavioral health consultant (BHC) to primary care provider (PCP) ratios within the context of PCBH. The presenter reports on the current state of the literature, gaps in the literature, and proposed next steps to fill these gaps.

Background: Health inequities and disparate treatment outcomes arise from complex, multi-level factors. At the individual level, these inequities are often linked to lower engagement among minoritized patients and a lack of cultural curiosity from providers. The Cultural Formulation Interview (CFI) offers a validated, standardized approach to initiating culturally responsive care. Previous research has identified clinician uncertainty as a key barrier to implementing cultural assessments. To address this challenge and enhance cultural assessment in a fast-paced pediatric integrated primary care (IPC) setting, a Quality Improvement (QI) framework was used to increase the frequency and standardization of cultural assessments as a strategy to reduce individual-level health inequities.

QI Procedure/Team Composition: An iterative Plan-Do-Study-Act (PDSA) process was employed to guide implementation. This approach gathered clinical stakeholder feedback, identified barriers, tested solutions, and supported ongoing modifications.

A five-member QI team was formed, meeting every 2–3 months. The team included three master’s-level behavioral health consultants (BHCs), one doctoral-level supervisor, and one predoctoral intern BHC who served as facilitator. All members worked within pediatric IPC across general and specialty outpatient settings. Cultural assessment efforts focused on patients aged 12–21 and caregivers of patients aged 1–21.

Over the first six months, the team met three times. Meeting agendas were based on protocols outlined by the Institute for Healthcare Improvement. Verbal and written feedback were collected to evaluate cultural assessment frequency, perceived barriers, and facilitators. Meeting transcripts were qualitatively coded to inform procedural changes and refine cultural assessment practices.

QI Results: Initial feedback indicated that clinicians valued cultural assessment for clinical decision-making. Baseline barriers identified were workflow challenges, limited time, and clinician concerns. Proposed solutions included reminders, electronic health record (EHR) shortcuts for standardized questions, and supervision discussions. In the first cycle, all clinicians reported asking cultural assessment questions, collecting clinically useful information, and increasing their frequency of cultural inquiry compared to baseline. Cultural questions were most commonly asked during weight management intakes, but less consistently across other referral reasons.

Despite initial improvements, use of standardized questions remained low (12%), and completion rates remained inconsistent (below 50%) across three QI cycles. Barrier themes persisted, particularly around the feasibility of using standardized questions with every patient's initial follow-up visits. In response to results and team feedback, the team tested workflow modifications, integrated cultural discussions into supervision, developed specific cultural questions for weight management referrals, and created EHR shortcuts.

Discussion: Findings suggest that while clinician-led QI efforts can initially enhance cultural assessment, sustained improvements may require program-level support. Persistent barriers, such as workflow inconsistencies and clinician concerns, remained despite team members recognizing the importance of cultural assessment and implementing proposed solutions. Future strategies could include cultural assessment training, dedicated time for brief IPC intakes, and chart reviews to monitor assessment rates.

This quality improvement project focused on integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) into a university-based student health center to promote early identification of substance use among college students. Through an iterative partnership between academic researchers and clinical leadership, the team transitioned from a research-led model to a sustainable, EHR-integrated universal screening process supported by staff training. This project will be presented as a poster session, offering an opportunity for attendees to engage with the authors during a live Q&A and discuss implementation strategies, challenges, and lessons learned.

Backgroung/Rationale:

Our clinic conducts regular brief screenings of mood, substance use, and domestic violence concerns among patients. These screenings are usually conducted via one page handout incorporating a couple of questions on each area. We realized that we are missing the scheduled administration of these sheets, along with missing the opportunity to follow-up when needed, as well as realizing that the volume of patients needing screened was far too large for number of staff completing the screenings.

Description of the population sampled:

298 Adult patients, both male and female, Native American

Study Design:

Correlational

Procedures and measures used to collect data:

Pink sheet one page screener was administered to every patient coming into the women's clinic and metabolic care clinic of our clinic for one month. These sheets were then collected by select few and entered into a tracking sheet, as well as cross checked through input into a google form to create correlational information regarding amount of positive screens that were missed in clinic, barriers to getting correct information from patient to electronic record as well as any other gaps in the process.

Analytic Approach:

Descriptive and diagnostic analytics

Key Results:

Best outcome is more medical staff involvement: medical providers recording SBIRTs and nursing asking every patient every visit of our patients and alerting MedFTs, a streamlined process of eliminating Registration to determine to whom and when Pink Sheets should be dispersed and elimination of physical paper. Also with the inclusion of medical providers now documenting what they were already addressing an increase of documented SBIRTs allowing us to show that we are reaching our GPRA measures.

In this session, we will explore the intersection of medical and behavioral health, highlighting the importance of integrated healthcare models. We will discuss key research findings, practical examples, and strategies for overcoming challenges in providing holistic, patient-centered care. Additionally, I will share my experience in founding a nonprofit that assists families with the costs of family-centered care. The session aims to equip attendees with tools to better collaborate across disciplines, enhance patient outcomes, and break down the barriers between comprehensive physical and mental health services.

This submission is intended to be a poster presentation on results from a quality improvement project. This project was designed to test if we can replicate past research findings in our clinic by initiating early agenda setting with intentional evidence-based language that elicits patient's concerns. We anticipate seeing an increase in provider-reported efficiency of primary care visits and a decrease in the number of unmet patient needs.

The American Diabetes Association Standards of Care in Diabetes 2025 highlight the impact of psychological wellbeing and health behaviors (i.e., diet, exercise, medication adherence) on patient outcomes, and thus, recommend health behavior change strategies and psychological interventions be routine practice for clinicians caring for patients with diabetes (ElSayad et a., 2025). These updates highlight the integral role of team-based care practices in meeting the diabetes guidelines without further burdening clinicians’ schedules and limiting clinician accessibility. The present quality improvement project collected primary care staff and clinician perceptions of a team-based approach to diabetes care management before and after the implementation of a care pathway for adult patients with Type 1 or Type 2 diabetes in a Family Medicine Residency continuity clinic. The Plan-Do-Study-Act (PDSA) approach was used to build and evaluate the pathway, which was designed based on the recommendations from the 2025 diabetes guidelines (Taylor et al., 2014). The pathway prompted clinicians and staff to consult the Primary Care Behavioral Health (PCBH) Consultation service based on patients’ lab results (A1C > 9.0), changes to psychological wellbeing including onset of psychosocial stressors, and changes to treatment or medication adherence (i.e., reported/evident nonadherence). 28 team members from the clinic completed a pre-survey and 19 team members from the clinic completed a post-survey using 7-item Likert scales examining perceptions of team communication, collaboration, and satisfaction in supporting diabetes care. The survey also examined perceptions of the team’s competency addressing both medical and behavioral/psychological aspects of diabetes management. Descriptive statistics were used to analyze changes in perceptions from pre- to post-survey implementation. The mean of the pre-implementation survey was a 4.63 (SD = 1.46), and the post-implementation survey mean was a 5.1 (SD = 1.19). The sample mean was 4.82 (SD = 1.38). Results indicated an improvement in perceptions of communication, collaboration, and satisfaction with the team’s performance managing diabetes care. Future quality improvement approaches may measure the impact of the clinical pathway on patient outcomes (e.g., lab values, medication adherence, diabetes distress) to further examine the efficacy of the pathway. This pathway provides a “checklist” and structure for primary care teams, which may be replicated in other medical settings to improve the consistency with clinic engagement with the diabetes guidelines, also improving the likelihood of achieving health equity for marginalized patients, standardizing access to evidence-based treatment for all patients.

Literature review indicated limited knowledge of established peer review process across primary care settings for behavioral health providers. Integrated Behavioral Health (IBH) at UCSD Health created a formative peer review system for the behavioral health providers by their peers with the goal of providing feedback on adherence to legal and ethical standards of care, the implementation of short-term therapies, consistency in documentation, and the use of departmental strategies for best practices including measurement-based care and open notes initiative. This presentation will demonstrate each iteration of the review process as well as the rationale for the changes made to improve the peer review process. The presenters will engage attendees in exploring how they may develop and utilize a formative peer review system in their practice settings.

Screening for depression in patients is one of the required screeners for patients at the HealthAlliance Fitchburg Family Practice. However, the clinic was below the minimum threshold. This quality improvement sought to understand barriers to completing the screeners and how to increase screening numbers for patients.

Abstract

Background: Health Alliance Fitchburg Family Practice (HAFFP) was completing 23.9% of depression screenings, below the minimum threshold of 29%. The objectives of the study were to determine factors contributing to the low screening percentage and improve the screening percentages to the minimum requirement of 29%.

Participants: The participants for this study were the clinicians working and the patients receiving care at the clinic.

Study design: The study is a quality improvement project utilizing root cause analysis and quantitative designs.

Procedures and measures: Interventions done include EPIC data analysis, root cause analysis presentation, and monthly EPIC data analysis. Measures used include the PHQ-9 during patient appointments and use of the dot phrase which completes the depression screening within EPIC. The anticipated result is an increase in depression screening/ depression evaluation percentages for the HAFFP clinic. Analyses: Root cause analysis was done to determine the independent variable hypothesis. T tests will be run at the conclusion of the project to determine if significant change occurred over the duration of the project.

Results: Through root cause analysis and meetings with both faculty and residents, the anticipated result is an increase in depression screening/ depression evaluation percentages for the HAFFP clinic.

Conclusions: Clearing care gaps within EPIC is useful for multiple reasons, two of which are appropriate reimbursement for good quality healthcare and appropriate screening of patients. Appropriate screening, particularly for depression, helps patients connect to resources that they may not have been aware of accessible to them.

The integration of behavioral health in primary care is often done by behavioral health-trained providers. This QI project reviews the value to Family Medicine residents in having real-time training with a BH provider. This is done through pre-clinic coaching related to BH interventions, seeing the patients together, and reviewing value and outcomes during precepting. The goal of the project was to increase competence and confidence in the delivery of BH interventions by residents.

Abstract

Primary care physicians (PCPs) are often the first to identify behavioral and mental health concerns during routine visits, yet many feel underprepared to address them. Integrated Behavioral Health (IBH) helps bridge this gap by embedding mental health services into primary care, improving access and outcomes for patients, especially those with chronic conditions or from underserved communities. However, many clinics do not have easy access to mental health providers, often due to workforce shortages, and patients may be reluctant to seek treatment even when it is recommended. Provider satisfaction and burnout are also important considerations. With over 64% of PCPs reporting burnout in 2023, the integration of behavioral health into primary care settings is increasingly seen as a strategy to improve job satisfaction and reduce stress. IBH has been linked to higher job satisfaction and lower burnout, but consistent training remains a challenge. Residency programs play a key role, yet lack standardized behavioral health curricula. Recognizing this, the Wellstar Douglas Family Health Residency program revised its behavioral health curriculum in spring 2024 to include a more longitudinal, hands-on training approach. This includes weekly, supervised sessions where residents practice behavioral health skills with patients, aiming to build a more competent and confident workforce ready to deliver integrated care beyond residency. Our sample population includes current family medicine residents (N=6 PGY-2 and 6 PGY-3), recent graduates (N=6), patients from a GME family medicine clinic (N=42), and full-time faculty members (N=7). Each group completed anonymous surveys—online or on paper—assessing perceptions of the behavioral health clinic curriculum. Responses were collected, collated, and analyzed once the 2024-2025 data collection period ended. Data was collected from September 2024-March 2025 from residents; August 2024 and June 2025 from faculty, and collection is ongoing for patients. Initial data collection shows that almost 95% of patients reported a positive experience with the addition of behavioral health to their routine visits and 100% of patients still felt their primary concern was addressed. Three-quarters of residents found participation in weekly behavioral health clinics to be moderately or very useful. Residents also reported increased confidence in using behavioral health interventions on their own (87.5%) and more willingness to use these tools on their own (62.5%). All faculty felt the training was useful for teaching residents how to incorporate BH interventions into regular office visits.

The ASPIRE Study aims to address the care gap for cancer patients and survivors in underserved communities, where psychosocial distress worsens health outcomes and chronic conditions. It will expand Primary Care Behavioral Health (PCBH) services by integrating same-day behavioral health consultations within primary care. By embedding these services, the study seeks to improve access to care for patients facing mental health challenges. Ultimately, the ASPIRE Study evaluates the impact of this integration on patient outcomes in underserved populations.

his presentation will describe the implementation and evaluation of an 8-year integrated behavioral health workforce development training program within primary care clinics for predoctoral psychology trainees. The training program utilized in person and telehealth services to expand clinical care to primary care sites within mental health professional shortage areas to change the landscape of access to behavioral health services. The panelists will describe the training model; summarize competency attainment and skillset achievement of trainees and illustrate trainee employment data upon completion of the program. The panelists will describe program implementation and evaluation of best practices and lessons learned. This presentation will emphasize an interdisciplinary professional development opportunity for pre-doctoral students to train with numerous healthcare specialties within primary care to highlight the boundaries that can be broken when team-based care and training opportunities are provided.

The Fortify Resilience initiative is a multi-level program designed to cultivate and sustain a culture of wellbeing for Residents and Fellows (R/Fs) at The University of Texas Rio Grande Valley (UTRGV) School of Medicine’s (SOM) Graduate Medical Education (GME) residency and fellowship programs. This initiative addresses burnout and invests in well-being at individual, group, and institutional levels through three core drivers: Access Strategy, Empowerment Initiatives, and System Redesign. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework, the present study utilized data from 48 physician residents to evaluate key intervention outcomes.

This poster presentation outlines the findings of Emily Carmichael's Graduate Assistant (GA) research. Using various certified licensure databases and referring to data available to Emily as a GA, Scholar trends and professional outcomes for HRSA Behavioral Health Workforce Education and Training (BHWET) alumni at Western Carolina University (WCU) were assessed. This poster details the process and results of the program evaluation, offering insight into the efficacy of WCU's BHWET program by examining things like licensure outcomes and student profiles.

Two integrated multidisciplinary sister programs, an OBGYN program for pregnant adolescents and a pediatric teen-tot clinic that provides medical care to parenting adolescents and their babies, are designed to support adolescents during the perinatal period. The presentation will highlight how these integrated programs increase access to perinatal care while supporting the transition to a two-generation medical home for postpartum adolescents and their infants. The programs’ integrated behavioral health (IBH) models of care, program data, and key strategies in working with adolescent parents will be discussed.

This program will explore three pilot studies to provide a model of care for integrating behavioral health within a pediatric practice. Using a PCBH model, a CoCM model and a study evaluating the importance of comprehensive screening, the value components of each care model will be presented to show improved patient access to behavioral healthcare, clinical or symptom improvement, and clinician and patient satisfaction. Identifying key factors through data collection can show program success and help identify trends or areas of need for further intervention.

This presentation will explore the journey of integrating a behavioral health faculty member, specifically a Licensed Clinical Social Worker (LCSW), into an urban, underserved Family Medicine Residency Program, aligning with ACGME requirements for mental health competency, team-based care, and diagnostic skills. It will showcase a multifaceted teaching approach, including direct observations, behavioral health OSCEs, didactics, workshops, and co-precepting, to enhance residents' capabilities in managing mental health conditions, and recognizing contextual factors and behavioral barriers in primary care. The curriculum has evolved based on resident feedback to ensure it meets both educational and patient care needs. Attendees will hear about lessons learned on the integration of an LCSW behavioral health faculty member into a family medicine residency program and how it is expanding resident competency and improving overall clinic operations.

As a part of a quality improvement project designed to increase evidence-based psychosocial intervention (EBPI) use by rural behavioral health providers (BHPs) in the Veterans Health Administration (VHA), a modified, low intensity, graduated training model for Problem-Solving Training for Integrated Care (PST-IC) was developed and opened to a variety of BHPs working in integrated care settings. November of 2024 marked one year since the very first cohort of PST-IC providers who were trained under this new model. In order to understand the scope of sustainment among those trained, a survey was sent to the PST-IC providers. This presentation will review the results of the survey, and provide information regarding facilitators and barriers to sustainment, as well as provide an overview on reported ongoing use by those trained.

This poster presents a qualitative study on the formation and experiences of an interprofessional team at a low-cost medical clinic integrating behavioral health services. It highlights the challenges and successes of collaboration among diverse professionals, emphasizing the impact of teamwork on patient care in a resource-limited setting. Key findings include improved patient outcomes and reduced visit frequency due to effective interprofessional collaboration.

Background/Rationale: This study explores the experiences of forming an interprofessional team at a low-cost medical clinic integrating behavioral health services. The team includes diverse professionals such as physicians, a psychiatric nurse practitioner, clinic administrators, a dentist, community health workers, and students from various disciplines. The aim is to understand how these members navigate roles, collaborate across disciplines, and integrate expertise to improve patient care in a resource-limited setting. Description of the Population Sampled: The study involves staff, volunteers, and students participating in the Integrated Behavioral Health program at Healing Hands Healthcare Clinic. The sample size varies monthly as participation is voluntary and can begin or end at any time. Study Design: This is a year-long qualitative study. On the first Monday of each month, eligible individuals receive an email invitation to complete a brief Qualtrics survey, with a reminder sent the following Monday. The survey includes up to five open-ended questions. Procedures and Measures Used to Collect the Data: Participants identify their profession, indicate any formal interprofessional training, answer 1–2 rotating questions, and reflect on successes or challenges from the prior month. Data collection continues through September 2025. Analytic Approach: The study employs thematic analysis to identify key insights from the qualitative data. Early findings highlight challenges such as staffing shortages, patient no-shows, and complex care needs. However, strong teamwork has emerged as a key strength, enabling more comprehensive, coordinated care. Key Results and Conclusions: Despite staffing and resource challenges, interprofessional collaboration supports coordinated care and positive patient outcomes. Team members draw on each other’s strengths to meet complex needs, highlighting the value of teamwork in sustaining integrated care in this underserved setting. Participants report patient improvements and reduced visit frequency as outcomes of effective collaboration.

Many families referred by pediatricians for mental health care never make it to the first appointment, particularly in underserved communities. This project evaluates the B-HIP program, an integrated behavioral health model embedded in a family medicine clinic, which provided universal mental health screening and same-day services using a tiered care approach. Results showed symptom improvements and strong engagement with in-clinic services. The findings support redesigning care systems, not blaming families, to address pediatric referral dropout and improve access for all.

Abstract

Background: Referral dropout is a critical barrier to pediatric mental health care, with up to 50% of families failing to follow through after referral from primary care. This disproportionately affects underserved families and is often misattributed to parental noncompliance rather than systemic challenges. Population: This program evaluation draws from retrospective data on the B-HIP initiative, an embedded, tiered behavioral health model in an academic family medicine clinic serving predominantly Medicaid-insured and racially diverse children (N = 493 PSC; N = 235 Y-PSC at baseline). Design & Methods: A descriptive evaluation tracked referral engagement patterns, pediatric symptom screening using the Pediatric Symptom Checklist (PSC, Y-PSC), and access to integrated behavioral health services. A tiered care protocol guided treatment assignment based on severity. Analytic Approach: Descriptive statistics summarized symptom severity and service utilization patterns across two time points. Results: Screening data indicated symptom improvement from intake to follow-up, with PSC mean scores decreasing from 10.48 to 9.86 and Y-PSC scores from 13.23 to 9.94. Conclusions: These findings suggest that embedding behavioral health into the pediatric medical home can reduce early dropout and promote engagement. Rather than viewing non-follow-through as a family-level issue, integrated care reframes it as a solvable systems design problem. Recommendations include expanding tiered IBH models in safety-net clinics and funding infrastructure to support ongoing integration.

Inequities in the delivery of child mental health care are prevalent and of continued concern for medical and behavioral health service providers (Montoya-Williams et al., 2020; Robinson et al., 2017; Trent et al., 2019). Children from marginalized groups (e.g., racial minorities, low-income, and LGBTQIA+) are less likely to have access to high quality behavioral health care and can experience increased levels of stigma for attempting to seek mental health care (Hadland et al., 2016; Trent et al., 2019). Multiple levels of integrated primary care currently exist ranging from coordinated (i.e., off-site), co-located to fully integrated. Each type of integrated model has its strengths and shortcomings in addressing the behavioral health needs of the patient population (Burkhart et al., 2020; Hostutler et al., 2023; Yonek et al., 2020). There is increasing interest in whether combining models or levels of integrated care may help increase the reach and breadth of behavioral health services in a primary care setting.

The current analyses describe how a concurrent primary care behavioral health and co-located therapy service within a pediatric primary care setting impacts utilization and equity of services. The 12 pediatric primary care practices included in this study belong to a larger pediatric academic medical center in a mid-size Midwestern city. The sample included 9,284 children ages 0-21 years of age with a median age of eight years. Approximately 47% of the sample identified as Black, 16% Latino, 21% White, 10% biracial/multiracial, and 8% other. The primary care clinics serve patients of diverse socioeconomic backgrounds with 13% covered under commercial insurance, 82% Medicaid, 5% self-pay, and <1% other.

Retrospective observational analyses were conducted using electronic health records. Two separate chi-square analyses were conducted to evaluate the reach of different levels of primary care behavioral health services among the general pediatric primary care population and pediatric primary care patients with an identified mental health condition. Data were also disaggregated by race, preferred language, insurance type, and age to identify potential sources of inequities in accessing behavioral health services.

Results indicated general pediatric primary care patients who received specialty behavioral health care and then transitioned to receiving care from a psychologist in a fully integrated primary care setting were most likely to access behavioral health within six months of their primary care visit, X2(5, N=9,284)= 167.87, p<.05. Similarly, primary care patients with an identified mental health condition who received specialty behavioral health care and then transitioned to receiving care from a psychologist in a fully integrated primary care setting were most likely to access behavioral health services within six months of their primary care visit, X2(5, N=5304)= 162.21, p<.05; however, there were no variables that moderated the relationship between level of primary care integration and likelihood of accessing behavioral health services within six months of a primary care visit.

Two separate one-way ANOVA analyses were also conducted to assess treatment dose across integrated and co-located primary care behavioral health services among the general pediatric primary care population and pediatric primary care patients with an identified mental health condition. Data were also disaggregated by race, preferred language, insurance type, and age. Results indicated patients who received specialty behavioral health and then transitioned to receiving co-located care from a master’s level therapist accessed the highest number of treatment doses while patients who were only seen by psychologists in a fully integrated primary care setting accessed the fewest number of treatment doses, F(5,9278)=144.23, p<.05. Similarly, patients with an identified mental health disorder accessed the most treatment doses when they transitioned from specialty behavioral health to receiving co-located care from a master’s level therapist and accessed the fewest treatment doses when they only saw a psychologist in a fully integrated primary care setting, F(5,5298)=69.15, p<.01. For both one-way ANOVA analyses, there were no variables that moderated the relationship between level of primary care behavioral health and number of treatment doses.

These analyses highlight how previous exposure to mental health treatment may be a greater contributing factor to the likelihood of patients accessing behavioral health care rather than demographic factors such as race, socioeconomic status, preferred language, and age which further underscore the importance of empowering patients and families to attend their first behavioral health appointment. Secondly, each level of integrated behavioral health serves a unique purpose for patients’ mental health needs and thus, triaging patients appropriately continues to be an important practice for primary care behavioral health practitioners. 

We will present a poster on the research discussed further below. Along with the information highlighted in the abstract, we will highlight additional findings, particularly those which may inform efforts to spread integrated care practices. The poster will also contain a QR code linking interested attendants to the full paper.

Introduction: Previous studies have identified Adverse Childhood Experiences (ACEs) as negative or adverse events in childhood that are linked to poor outcomes later in life (Dobson et al., 2021; Downing et al., 2021). ACEs have also been associated with adult health risk behaviors and diseases ( Novais et al., 2021). The farm worker population may be particularly susceptible to ACEs. This study aims to analyze the relationship between maternal ACEs and perinatal depression and anxiety in Latina farm workers. Methods: Data was analyzed from a Toxic Stress Screening Protocol implemented in a Community Health Center. Maternal ACEs, Edinburgh Postnatal Depression Scale (EPDS), and GAD-7 scores were obtained during prenatal visits. Statistical analyses, including correlational analyses were conducted to evaluate the relationship between maternal ACEs and EPDS and GAD-7 scores. Results: This project aimed to enhance understanding of the impact of maternal ACEs on postpartum depression. Findings indicate that higher ACE score was significantly related to both perinatal depression and anxiety. Women who endorsed experiencing domestic violence also had higher depression and anxiety scores. These findings can help clinicians identify potential risk factors that make women more susceptible to depression and anxiety, thereby improving prevention and intervention strategies.

This pilot study examines referral and documentation practices for chronic pain management in a rural Federally Qualified Health Center (FQHC). Although nonpharmacological treatments like behavioral health interventions are effective, they are often underutilized in primary care. A retrospective chart review of 120 adult patients with chronic pain was conducted to analyze referrals, mental health screening rates, and provider documentation. Findings revealed that referrals to behavioral health were rare, and psychosocial factors were seldom documented. However, patients seen by Medical Family Therapists (MedFTs) were significantly more likely to receive mental health screenings. These results highlight missed opportunities for integrated care and suggest the need for improved training and systems to support biopsychosocial approaches to chronic pain.

Abstract

Chronic pain affects over 50 million adults in the United States and contributes to significant physical, emotional, and financial burdens. Although psychological interventions such as cognitive behavioral therapy and acceptance and commitment therapy are supported by evidence as effective treatments, they remain underutilized in primary care settings. This pilot study examined referral patterns and documentation practices related to chronic pain management within a rural Federally Qualified Health Center (FQHC). A retrospective chart review was conducted on 120 adult patients (mean age = 56.2; 70% female) diagnosed with chronic pain between January 2023 and April 2024. The racially and ethnically diverse sample included 43.3% Black, 26.7% White, and 24.2% Hispanic participants, most of whom were low-income. Data extracted from electronic medical records included demographics, pain diagnoses, pain severity (Numeric Pain Rating Scale), prescriptions, referrals to behavioral health, and mental health screenings (PHQ-9 and GAD-7). Provider notes were qualitatively analyzed to assess whether psychosocial factors were considered in treatment planning. Descriptive statistics were used to summarize sample characteristics and referral patterns. Chi-square tests examined associations between mental health screenings, referral activity, and involvement of Medical Family Therapists (MedFTs), while Spearman correlations explored relationships between pain severity, depression, and anxiety scores. Results showed that only 6.7% of patients were referred to behavioral health services, and 93.2% of provider notes did not mention psychosocial factors. Patients seen by MedFTs were significantly more likely to have PHQ-9 and GAD-7 scores documented during visits (χ² = 37.17 and 42.12, respectively; p < .001). A significant positive correlation was found between PHQ-9 scores and pain severity among patients with nonzero depression scores (rs = .68, p = .031). These findings highlight a persistent biomedical focus in chronic pain treatment and suggest missed opportunities for integrated, biopsychosocial care. Enhancing provider training, documentation practices, and referral systems may improve access to nonpharmacological interventions and support more comprehensive chronic pain management in primary care.

Acceptance and Commitment Therapy (ACT) is a third wave behavioral therapy that has been applied to a variety of problems including depression, anxiety, stress, substance use, and chronic pain. ACT aims to improve one’s ability to act in alignment with one’s values and goals in the presence of interfering thoughts, emotions, and physical symptoms, which is relevant and has proven to be effective in populations with chronic illness, including pediatric chronic pain (Pielech et al., 2017). Therefore, it may also be notable for children and adolescent cancer patients and survivors; however, there is limited research on the use of ACT in this population.

In 2025, 2,041,910 new cancer cases are projected to occur, and one in 264 children and adolescents are predicted to be diagnosed with cancer before the age of 20. The cancer mortality rate for the younger population has declined since 1970 due to enhanced knowledge, treatment, and early detection methods. Although this is an important improvement, it has also led to unique challenges and resulting chronic health problems due to prolonged treatment (Siegel et al., 2025). Research has shown cancer and the typical modalities used to treat the disease may have long term physical and psychosocial impacts for children and adolescents (Li et al., 2013). Due to these potential adverse effects, children and adolescent cancer patients and survivors may benefit from ACT.

The goal of this review is to examine the current literature on ACT in child and adolescent cancer patients and to discuss the potential benefit of implementing ACT interventions for this population in integrated health settings. A narrative review, informed by PRISMA guidelines, is currently underway. Peer reviewed articles have initially been reviewed in PsychINFO, PubMed, and CINAHL. Data regarding the use of ACT and its impact on children and adolescent cancer patients and survivors will be reviewed and summarized. Implications for research and practice in integrated health care settings will be discussed.

The study sampled 487 adults aged 18 and older from across the United States, recruited through CloudResearch and surveyed via the Qualtrics platform. The sample was fairly balanced in gender, with 48.0% identifying as female and 51.5% as male. In terms of age distribution, 42.5% were young adults, 39.8% were middle-aged, and 17.7% were older adults. Educational attainment varied, with 14.4% having a high school education or less, 69.9% holding a college degree, and 15.7% possessing a graduate degree. Politically, half of the participants (50.1%) identified as liberal, while 34.7% were conservative and 15.2% moderate. Participants were randomly assigned to one of two vignette conditions: 51.1% to the treatment group (physician with burnout symptoms) and 48.9% to the control group (physician without burnout symptoms). This diverse and representative sample allowed for a robust evaluation of how physician burnout influences perceptions of care quality, safety, and satisfaction.

This study examines how physician burnout affects public perceptions of care quality, safety, and satisfaction, and whether political ideology moderates these effects. Using a vignette-based experiment with 487 U.S. adults, participants were randomly assigned to evaluate a physician exhibiting burnout or non-burnout behaviors. Adjusted ordinal logistic regression revealed extreme effects as individuals perceived non-burnout physicians as having 85 times higher odds of excellent quality ratings (aOR=85.35, 95% CI[47.12,154.63]), 29 times higher odds of safety perceptions (aOR=28.89, 95% CI[16.49,50.62]), and 69 times higher odds of maximum satisfaction (aOR=68.63, 95% CI[36.81,127.96]) (*p*<0.001). Communication quality partially mitigated burnout’s impact (Safety: aOR=1.59; Quality: aOR=1.39; Satisfaction: aOR=1.43, *p*<0.01), while demographics showed no significant effects.

Notably, the interaction between political ideology and burnout moderated satisfaction ratings (*p*<0.05), with conservatives exhibiting weaker dissatisfaction responses (aOR=0.39) than liberals, aligning with Moral Foundations Theory. This suggests that moral values (e.g., authority vs. care priorities) shape tolerance for burnout-related behaviors. The findings highlight burnout’s universal negative influence on people's perceptions, while revealing ideological divides in satisfaction ratings.

Policy implications include structural reforms (e.g., EHR optimization, reduced administrative burden to improve physician well-being, and patient perceptions of care quality. Standardized communication training programs should focus on active listening and empathy. Limitations include cross-sectional design and vignette-based methods. Future research should explore mechanisms linking burnout to perceptions and test interventions targeting provider well-being and patient-provider dynamics.

The strained New York City healthcare landscape and shrinking mental health footprint have contributed to greater volume, complexity and acuity of behavioral health needs identified in primary care settings.  The NewYork-Presbyterian (Columbia) Pediatric Integrated Mental Health in Primary Care Program (IMP) operates in four primary care clinics in Upper Manhattan, a low-income, psychosocially stressedarea.  To meet the demand and maintain access, the IMP needed to maximize its response and treatment time and partner with key community programs to ensure efficient delivery of high-quality care.  

Technology.  To enhance its response to patients and pediatricians, the IMP developed workflows that leverage the Epic electronic health record.  These include a: (1) Safety Inbasket to identify patients whose screeners in the MyChart portal indicate a potential safety concern for suicide or interpersonal violence; (2) Site-Based Escalation Chat Group for pediatricians to message multiple IMP clinicians at once for a real-time and coordinated response to time-sensitive concerns; and (3) weekly team review, triage and assignment of referrals from the Epic referral work queue.     

Clinical Model.  While the IMP has historically provided consultation and treatment for up to six months, it is increasingly employing sessional care intervention, including single-session consultation and Solution-Focused Brief Therapy.  These models have been shown to have positive outcomes while reducing waiting lists and the risks of delayed care.  Clinicians tailor care to each patient – single session, interval, and short-term services.  The aim is for each clinician to have a balanced patient panel that allows access for new referrals and supports program sustainability.    

Care Continuum.  The IMP hired psychiatry case managers (CMs) in 2022, and the role quickly became key to maintaining program access.  The CMs join the referral meetings where the team determines which patients need IMP and/or a higher level of care.  Because specialty mental health clinics often have wait lists, CMs coordinate referrals to align with the end of the patient’s IMP episode of care.  In addition, the IMP established preferred provider relationships with a community mental health clinic and health home.  Regular check-ins, express referral pathways, and clear communication have been essential to the success of these partnerships and timely linkage of patients with care and support.

Poster presentation attendees will gain valuable insights into these scalable, patient-centered solutions that promote efficiency and sustainability in pediatric integrated mental health programming.

This poster presentation will overview an innovative multidisciplinary school-based telehealth program embedded within rural school districts in eastern North Carolina. Specific focus will be on behavioral telehealth implementation and integration under this innovative service design, including review of operations, delivery methods, successes, challenges and systems level implications associated with remote care provision.

Hispanics became the largest racial and ethnic minority in the United States, yet they continue to face significant barriers to healthcare, including limited access, language difficulties, and stigma around mental health treatment. Integrated Behavioral Healthcare (IBH) effectively addresses both mental health issues and chronic conditions, but there is still a lack of culturally responsive care. This presentation will highlight interventions to improve inclusivity for Hispanic/Latinx patients. Providers will learn culturally adapted strategies and tools to deliver more equitable and effective care in integrated healthcare settings.

A discussion on the advantages of having onsite behavioral health and psychiatry services when delivering primary care, with a focus on care for patients with barriers to accessing health and mental health resources. Access to healthcare for patients on Medicaid is often limited by social determinants such as transportation or affordability. Mental healthcare has all the same challenges but with the addition of social stigma as well as an even more limited availability of services. At the internal medicine residents’ continuity clinic at WakeMed, many of the patients are Medicaid beneficiaries and and are more likely to experience challenges when accessing healthcare services. Given the myriad needs of our patient population, case management has long been a part of the care provided. To continue recognizing and addressing the needs of our patients, the clinic sought to expand its collaborative care management (CoCM) team to include embedded behavioral health and psychiatry services. Since the expansion of our services, we are now better able to follow patients not only with their chronic health issues but are also better able to address and follow up on their mental health. Case management is readily available to address SDoH needs, as well as regularly follow up with patients to help facilitate scheduling and getting to appointments. Behavioral health and psychiatry are in-house, allowing for quicker turnaround on referrals and for more comprehensive handoffs. The benefits of this interdisciplinary approach to addressing mental health needs can be seen in the frequency of utilization as well as the wait time between when the referral is made to the first encounter with behavioral health/psychiatry. Moreover, resident physicians have increased their comfort level with managing behavioral health issues and reported overall positive feedback to having in-house psychiatry and behavioral health. This approach highlights the benefit and utility of the integration of mental health resources with primary care, especially when treating patients with limited resources

Once again, we believe this manuscript addresses a critical gap in undergraduate medical student education by evaluating the impact of an Integrated Behavioral Health curriculum on third-year medical students during their family medicine clerkship. The study shows the important role of interprofessional care in medicine and highlights the collaboration between primary care providers and behavioral health consultants and how teaching this model enhances students' understanding of integrated mental health care and care delivery.

This submission is a description of an evaluation of a communication coaching program at the University of Rochester. This is a program that began at University of Rochester in 2011 and has now expanded to include trained communication coaches (often psychologists, though not exclusively) embedded in 11 residency programs at the institution. This project evaluated impact of communication coaching from the perspective of the residency program directors. The communication coaching program overall represents a unique way that psychologists with training in integrated clinical settings and with systems-training can impact patient care by enhancing physician communication.

Background: As of 2023-2024, the University of Rochester Medical Center (URMC) Physician Communication Coaching and Leadership Development program had 11 embedded communication coaches in residency programs educating 371 residents. In 2024, the URMC Physician Communication and Coaching program conducted a needs assessment survey in collaboration with the Graduate Medical Education (GME) office with two aims: 1) Evaluate impact of existing communication coaching interventions in GME programs with embedded coaches, and 2) Identify gaps and opportunities for expanding communication coaching to additional areas within GME.

Method: A needs assessment survey was developed by three senior communication coaches and two senior leaders within the GME office at URMC. The survey included questions regarding competence in communication and professionalism domains and confidence that training programs assess competence in these domains accurately. Participants could also include feedback about how they handle challenges with trainee communication and professionalism practices. The survey rationale was presented to potential participants at GME Committee on 10/21/24, with data collection occurring from 10/21/24 - 12/30/24 and several reminders for survey participation.

Results: 15 residency program directors (PDs) responded (60% response rate from the 25 residency programs overall). PDs who had embedded communication coaches (n = 8) reported significantly greater confidence that their training program assesses communication competence (4.38; 1 = not at all confident, 5 = extremely confident ), compared to PDs (n=7) without an embedded coach (3.14, p = .043). While PDs with embedded coaches were also more confident that trainees achieved competence in patient communication (4.75) compared to PDs without embedded coaches (3.86), this finding did not meet our threshold for statistical significance (p =.051). There were no other significant differences between PDs with or without embedded coaches in their assessment whether trainees develop skills communicating with families/caregivers, communicating on a team, or skills related to professionalism. When PDs were asked about how they approach situations with concerns about trainees’ communication and professionalism, PDs with embedded coaches reported using them as a central part of the process providing continual intervention and feedback. PDs without embedded coaches reported more ad-hoc strategies and increased faculty involvement as communication or professional concerns continue. 

Conclusions: In this sample, residency PDs who have embedded communication coaches reported more confidence that their trainees have achieved competence in communication domains than those without embedded coaches. URMC PDs also work closely with the expert coaches for assistance with challenging situations regarding trainee communication and professionalism concerns. Next steps include continuing to expand and study the communication coaching team and its ability to support trainee and PD needs.

Pregnancy loss is a serious biopsychosocial-spiritual issue that impacts millions of couples and families every year. Approximately 1 in 4 known pregnancies and up to 75% of all conceptions end in loss, with the highest percentage of losses occurring at or prior to 20 weeks gestation. These early pregnancy losses are called miscarriages. Despite the prevalence of this type of loss, relatively little research has been done or cultural recognition given to the impact of miscarriage on individuals, couples, and families. As a result, those who experience miscarriage and other pregnancy losses often feel like their loss is unimportant and their subsequent grief is not permissible. Additionally, because miscarriage and pregnancy loss are typically considered women’s issues, male partners are often excluded from research and discussions about this type of loss. This lack of curiosity about and attention to the male partner’s experience after miscarriage has contributed to a double disenfranchisement of their grief.

This explanatory sequential mixed methods research study used both quantitative and qualitative methods to learn more about how religious/spiritual (R/S) coping and perceived social support impacted the male partner’s grief after miscarriage. In Stage 1 of this study, 44 male participants took a series of assessments, including a demographics questionnaire, the Perinatal Grief Scale (PGS), the Brief Religious Coping Scale (Brief RCOPE), and the Multidimensional Scale of Perceived Social Support (MSPSS). Correlational analyses were used to analyze the data, and significant relationships were identified between negative religious coping and total score on the PGS (r = .482, p = .001), negative religious coping and the active grief subscale (r = .449, p = .003), and negative religious coping and the despair subscale (r = .468, p = .002). This indicates that as negative religious coping increased, overall grief, active grief, and despair also increased. Results from the Stage 1 correlational analyses were used to create the Stage 2 qualitative interview questions. In Stage 2, a subset of the Stage 1 participants (n = 16) was interviewed. These interviews were transcribed and analyzed. One overarching global theme of “Expectation vs. Reality” and three interrelated main themes of “R/S Beliefs,” “Social Support,” and “Socio-Cultural Influence” were identified, each with subthemes. The interrelated nature of the Stage 2 results along with the relationships between variables identified in the Stage 1 data suggested that R/S coping and perceptions of social support do impact the male partner’s grief after miscarriage and that this impact is systemic and relational in essence. Clinical implications for systemic therapists, specifically Medical Family Therapists, are provided, along with suggestions for future miscarriage research.

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CFHA has captioning and translations this year for the plenary sessions. Use this link to access the Wordly system.

LINK WILL BE AVAILABLE DURING THE CONFERENCE!

Our speakers are a psychologist-turned-county commissioner and counselor-turned-policy entrepreneur. In this talk, they will describe their partnership in bringing best practice policy for opioid abatement settlement funding to impact in their home in Southern Appalachia. They will show how their story aligns with models for policy dissemination, discuss how other health professionals can turn into advocates, and provide timely information on the disbursement of opioid abatement funds to the recovery ecosystem.

This presentation will be a description of the creation, implementation, and treatment model of the Comprehensive Addiction Medicine program within the MaineHealth system, specifically in rural locations. Demonstration of how using this integrated model has opened access to SUD treatment for patients in rural communities where access was limited or nonexistent before. Sharing data regarding the number of patients served in various locations, outlining successes and future areas of improvement.

Numerous articles have been written on the Primary Care Behavioral Health (PCBH) model (PCBH Innovation Center, n.d.), including several from the care team’s perspective (Hill, 2015; Serrano & Monden, 2011; Walter et al., 2017; Yin et al., 2021). These articles have largely focused on medical providers' experiences within the PCBH model rather than on lessons learned from their perspective that could inform behaviorally trained clinicians on how to work effectively within integrated teams. This presentation will feature a medical provider and a medical assistant offering their perspectives and suggestions for behaviorally trained providers working in PCBH. Specifically, they will discuss topics such as efficiently scrubbing schedules and rounding in the morning, effectively completing handoffs, and the importance of building relationships with the team, among other key insights.

Overcome limitations in warm handoff processes and expand BHC workflow efficiency using your existing EMR data!  This session will guide participants through the practical steps of developing an EMR-integrated tool to support BHC’s practice, using a real-world project on automating warm handoff identification as a model for innovative solutions. Discover how to build successful interdisciplinary collaborations with data analysts and IT specialists to unlock your EMR's potential for improving access to care.  Attendees will gain actionable insights into rapid iteration development, user-centered design, and receive a development roadmap to adapt this approach for projects within their own organizations, leaving equipped to initiate data-driven quality improvement projects that enhance integrated care delivery and reach.

This presentation will explore and synthesize the findings of three unique mixed-methods studies related to clinical supervision within the integrated primary care (IPC) context. Supervision is an imperative training and professional development experience for supervisees (SEEs) and novice clinicians, highlighting the importance of supervisors (SORs) accurately conceptualizing and contextualizing supervision for the IPC setting. This presentation will provide an overview of findings from studies highlighting SORs’ perceptions of facilitating cognitive complexity in SEEs, SOR competencies in IPC supervision, and SEE needs in IPC supervision. After reviewing the findings from these complementary studies, presenters will transition into an exploration of current practices and future directions for IPC supervision that combines SOR competencies, SEE needs, and strategies for enhancing cognitive complexity among SEEs in IPC settings. This presentation will end with a discussion of supervisory practices that can contribute to the provision of high-quality supervision for SEEs in IPC settings.

Well child checks are an important of pediatric preventative care. Integrating other care team members into the workflow reduces the workload for PCPs and increases the benefits for patients. Often, the integration of behavioral health providers focuses on child and adolescent mental health, while skipping over the many other ways a BHC can provide preventative care to the patient and support the PCP without adding to their workload. These other services when provided by a BHC improve both patient health and provider job satisfaction.

Perinatal psychiatry access programs increase access to behavioral health care for pregnant and postpartum patients and improve quality of care by building the capacity of health care professionals to address perinatal mental health and substance use disorders. This session will introduce NC Maternal Mental Health MATTERS—a perinatal psychiatry access program in North Carolina that has advanced access to perinatal behavioral healthcare across the state. Drawing on six years of performance metrics, real-world case studies, and patient and provider survey data, we will highlight how NC MATTERS streamlines on-demand psychiatric consultation and coordinated care to enhance workforce capacity, improve patient outcomes, and advance health equity. Attendees will gain practical strategies for how a perinatal psychiatry access program (there are 30 statewide or regional access programs) can create sustainable integrated care solutions that can make a difference in maternal and family mental health.

This session focuses on maternal mental health. It focuses on utilizing CoCM to address maternal mental health concerns. It will highlight recommended screenings, interventions, CoCM’s effectiveness for high-risk mothers, and how evolvedMD has incorporate technology to provide 24/7 psychoeducation and therapeutic interventions to patients.

This mixed-methods study investigates implementation challenges and opportunities in integrated care (IC) within medically underserved communities (MUCs), which face significant behavioral health burdens and provider shortages. By analyzing data from surveys and interviews with site leaders and trainees across 16 federally-funded health centers, the research highlights varying levels of IC readiness and differing perspectives on stigma and service delivery. Key findings suggest that while trainees often engage in essential IC activities, they face barriers such as unclear expectations and resource limitations. The study emphasizes the importance of tailored approaches to improve organizational readiness and collaboration, ultimately recommending that health departments and clinical directors utilize these insights to enhance access to quality care in MUCs.

This program will discuss the rationale for having a Medication-Assisted Treatment (MAT) program in primary care. It will explore how the program was first started at a Family Medicine clinic in Wilmington, DE and will describe the workflow amongst a multidisciplinary team. The successes and challenges of implementing MAT will be discussed, as well as the involvement of BHCs and the rest of the multidisciplinary team in the primary care visits and contingency management program. Case examples will illustrate how BHCs and PCPs can effectively work together to improve outcomes for patients.

This session explores the impact of increasing the Primary Care Behavioral Health (PCBH) workforce capacity to address behavioral health disparities in a predominantly Hispanic/Latino community. We will present findings from a quasi-experimental study evaluating the PCBH model's impact in increasing the behavioral health workforce and reducing depressive symptoms in patients over time. Attendees will gain insights into workforce training, patient outcomes, and sustainable models for behavioral health integration in underserved settings.

Pediatric primary care is an important venue in which to identify and mitigate suicide risk. our team has developed and is testing Paloma (Partnering with Parents of Adolescent Latinos on Mental Health Assistance), an intervention for Spanish-speaking parents of youth experiencing suicidal ideation and behavior referred by their pediatrician. The intervention consists of 5 phone calls delivered by a community health worker. It complements usual pediatric care by bolstering parental self-efficacy to engage in behaviors that promote safety, improve parent-child communication and increase parent understanding of suicide risk and prevention. A pragmatic clinical trial of Paloma at 3 pediatric primary care practices in Baltimore, Maryland is ongoing. We propose to present quantitative and qualitative findings from pediatric providers participating in the Paloma pilot trial.

Health-anxious patients often present with persistent concerns about their well-being, despite repeated medical reassurance. This population remains underrecognized in clinical settings, often leading to unnecessary medical utilization and frustration for both patients and health providers. This session will explore the complex and often paradoxical relationship between health-anxious young adults and healthcare systems, which is characterized by simultaneous dependency and mistrust. Informed by an in-depth qualitative analysis, the presenter will explain how family responsibilities and intergenerational transmission of health beliefs significantly shape and exacerbate health anxiety among young adults, particularly within Chinese cultural contexts. The audience will gain insights and strategies for effectively supporting health-anxious patients whose health behaviors are shaped by family beliefs and intergenerational dynamics.

This presentation will outline the steps completed within the OI project. It will highlight background/rationale, study design, procedures, and key results (quantitative and qualitative findings).

We are inviting all clinicians working in specialty medical settings to join us for a discussion of what Integrated Behavioral Health (IBH) looks like in your practice. Our discussion will center around how well PCBH's GATHER framework fits our clinical practices in specialty medicine, identifying commonalities with primary care as well as areas of divergence. We’ll also generate feedback for CFHA on how the organization can support the continued development of IBH services in specialty medical settings.

Equipping family medicine providers with the skills to identify and treat mental and behavioral health concerns in children and adolescents is critical to meet the needs of this population. This presentation will follow up on a co-located child and adolescent psychiatric consultation service in a family medicine clinic, created as a training mechanism for family medicine residents and presented in 2024. We will present findings of a retrospective chart review to describe the patient population that received consultation services, treatment recommendations, and changes in prescribing patterns among family medicine providers. We will discuss how these findings inform training needs of primary care providers and considerations for implementing consultation services in training settings and alongside other integrated care models.

CFHA has captioning and translations this year for the plenary sessions. Use this link to access the Wordly system.

LINK WILL BE AVAILABLE DURING THE CONFERENCE!

Join us as we celebrate the 2025 Award Winners.

Effectively utilizing psychiatric consultation in primary care requires matching the right level of support to the needs of patients, providers, and populations. This session explores how different levels of psychiatric consultation—from brief curbside discussions to comprehensive evaluations—can enhance patient care and optimize mental health outcomes. Through real-world case examples, participants will gain practical insights into selecting the appropriate psychiatric consultative approach to address diverse clinical needs.

This session introduces the Pediatric Collaborative Care Pathways, an evidence-informed framework designed to enhance integrated behavioral health care for children ages 6–11 in primary care settings utilizing the collaborative care model (CoCM). Participants will learn about the current evidence base and research gaps for implementation of the Collaborative Care Model (CoCM) for pediatric patients and how the pediatric collaborative care pathways were developed to address the unique needs of younger children. The session will cover key strategies for screening, differential diagnosis, symptom monitoring, and brief evidence-based interventions. Through case-based discussions and interactive learning, attendees will gain practical tools to apply these pathways in clinical practice.

Healthcare providers – across both mental health and biomedical disciplines – represent some of the highest risk professionals in Western culture(s) for burnout and compassion fatigue. At the same time that they report being wholly-committed to (and loving) what they do, they are oftentimes overwhelmed with the intensity and/or chronicity of their caseloads, workplace and/or interdisciplinary politics, administrative demands, and tendencies to under-report personal struggles or seek help. In this presentation, empirically- and theoretically-conceptualized understandings of this problem, alongside research-proven strategies across multiple systems levels (provider, team, care systems) to prevent and/or mitigate it, will be shared. 

Securing healthcare team "buy-in" is essential for successful Collaborative Care. While Primary Care Provider engagement is known to improve patient outcomes, leveraging the knowledge of your entire healthcare team can help overcome challenges. This session will highlight 50 engagement strategies from a large healthcare system, emphasizing culture, communication, creativity, and data utilization. Participants will explore practical ways to enhance their current or future programs through interactive activities.

This session aligns with Breaking Boundaries: Redefining Access and Expansion in Integrated Care by critically examining what happens when ideal models of integrated behavioral health (IBH) collide with the realities of an organization’s structure, readiness, and limitations. Using a real-world case study from Johnson Health Center, we will explore the challenges of implementing an IBH program within an FQHC setting, focusing on staffing, resources, and organizational readiness. Participants will engage in an interactive, case-based discussion, reflecting on their own experiences and learning strategies to navigate these barriers. Much like a morbidity and mortality (M&M) conference in medicine, we will analyze key decision points, adaptations, and when to pivot or compromise for sustainability.

Transforming access to children's mental health care by empowering the pediatric primary care providers through the NJ pediatric psychiatry collaborative care model. The program plays a crucial role in increasing the comfort and competence of pediatric primary care providers—both pediatricians and family physicians—by equipping them with tools, knowledge, and access to psychiatric consultation. They also help address the national shortage of child and adolescent psychiatrists by shifting certain aspects of mental health care into the hands of PCPs, supported by psychiatric specialists.

California’s groundbreaking Medicaid reform effort includes an $800M "Dyadic Care Benefit," offering primary care-based integrated behavioral health promotion and prevention for ~5.5M beneficiaries ages 0-20. This session describes an academic medical center-based technical assistance center’s support of statewide adoption, highlighting opportunities and needs to streamline dissemination and foster practice transformation.

This session will outline the Relationally-Centered Integrated Behavioral Health Model, a systemically-focused model used in eastern North Carolina for almost 20 years. Using EHR data from several FQHCs, this session will demonstrate how innovative machine learning algorithms were utilized to explore the prominent features impacting psychological and biological patient outcomes with this model of care. This research highlights how clinicians use their relational and integrated care training to collaborate with data analysts and evaluate the impact of their integrated care model.

This proposal outlines the development and implementation of a structured scholarly activity curriculum at a THCGME 8x8x8 FM residency on the West Side of Chicago for busy, second and third-year FM residents, over half of whom are underrepresented in medicine (URiM), and their faculty! Adapting residency program values to scholarly curriculum objectives and outcomes (ie mission-aligned, resident-driven, health equity-emphasis, community-centered) can create sustainable approaches to fostering scholarly skill development and ownership in faculty and resident populations across a diverse range of experiences and interests in scholarship. In this oral presentation, participants will learn some of the stickiness, successes, skills, and sustainability found by our psychologist and physician faculty leaders from this structured approach to scholarly training and mentorship. We will share practical strategies and lessons learned of how to creatively adapt scholarly activity curriculum to best meet program objectives, resident needs, faculty resources, and ACGME requirements. We will highlight how a values-centered and skills-based approach to scholarly activity can foster interprofessional collaboration, address health disparities, promote sustainability, and prepare family medicine residents and faculty to navigate the complexities of primary care in underserved communities as integrated leaders and scholar-practitioners.

Perinatal mood and anxiety disorders (PMADs) are often underdiagnosed in non-birthing partners, despite affecting approximately 1 in 10 fathers (Alvarez-Garcia et al., 2024; Reay et al, 2023). Family-centered care often prioritizes the birthing parent and infant, overlooking the mental health needs of partners, despite including “family” in the title. Expanding the scope of perinatal mental health to include non-birthing parents enhances integrated care teams’ awareness and ability to normalize, assess, and treat PMADs beyond the birthing parent. This presentation will explore why integrated care providers are uniquely positioned to address these mental health concerns. We will discuss evidence-based strategies for assessing and treating PMADs in partners and present case examples demonstrating how interdisciplinary teams can effectively support the entire family unit.

This dynamic session introduces the AAMC Integrated Behavioral Health (IBH) Playbook, an innovative, action-oriented resource co-developed by the Collaborative Family Healthcare Association (CFHA) and the Association of American Medical Colleges (AAMC) through a national academic learning collaborative. Designed to turn over 500 complex IBH metrics into actionable “plays” and “game plans,” the Playbook equips teams with a flexible, purpose-driven framework to improve care delivery and track outcomes. Grounded in the IBH Compass—Care Continuity, Person-Centered Care, Sustainability, and Growth—it complements, rather than replaces, existing quality improvement and business performance strategies. Participants will gain insight into the Playbook’s development process, hear lessons from top academic training programs, and explore practical ways to align metrics with meaningful, scalable improvements across diverse medical environments.

The following presentation will provide a systemic conceptualization of the educational barriers to integrated care workforce development for both behavioral health and healthcare providers. Particular focus will be given to the constraints of current pedogeological training structures in both fields, as well as how these constraints translate into the on-going “workforce” crisis. The use of emerging academic training models and degrees will be discussed as the catalyst necessary to finally allow integrated care to become the standard of care.

Appalachian culture and healthcare intersect in complex ways, shaped by socio-economic and cultural factors unique to the region. This presentation will explore the healthcare disparities faced by Appalachian populations and the influence of local cultural norms on healthcare decision-making. We aim to provide practical insights and strategies on how to approach visits as Behavioral Health Consultants within the context of Appalachian culture to enhance healthcare outcomes and address unique patient needs.

This presentation outlines the story of weaving in behavioral health integration within a Child Advocacy Center in Alaska in response to high volumes of child sexual abuse and neglect within Alaska Native/American Indian children. Alaska CARES, located in Anchorage, Alaska, was the first Child Advocacy Center (CAC) in the state to integrate a full-time Masters Level Clinician (Behavioral Health Consultant (BHC)) to provide responsive, targeted intervention for children, youth and families seen at the CAC for forensic interviews. Children and families have access to responsive behavioral health care during and after being seen for a forensic interview at Alaska CARES and are referred for additional services as needed. The integration of a full-time behavioral health role has been a multiorganizational partnership that wraps around children and families for the best possible long-term health outcomes.

 Suicide rates are rising throughout the lifespan, and primary care providers are increasingly tasked with managing patients experiencing chronic or intermittently heightened suicidal risk. In response, the UNC Suicide Prevention Institute partnered with the UNC Eastowne Internal Medicine Clinic to adapt the Coping with Long-Term Active Suicide Program (CLASP) for use in primary care. This pilot project explores the feasibility and effectiveness of CLASP-PC as a rapid, suicide-focused intervention deliverable by integrated care teams. We will explore the findings, clinical implications for practice, real-world challenges, and recommendations for utilization.

Interactive session to learn about and practice anti-bias training in a multi-disciplinary setting. Will include review of current DEI trainings at residencies across the country and describe our program, including curriculum that we teach. We will use examples of our current curriculum to practice in small groups with a focus on recognizing both structural and interpersonal bias within health care and practicing microaggression interventions through role play. Discussion of challenges to instituting anti-bias training and strategies.

This interactive presentation examines the experiences of neurodivergent women of color leaders in integrated care settings. Using a case example to illustrate the unique systemic barriers existing in integrated care, participants will explore inclusive leadership strategies and equity-centered approaches to mentorship that promote belonging, authenticity, and professional growth. The session will offer practical tools and reflective discussions to help attendees develop actionable steps for fostering inclusive spaces. This session topic aligns with the CFHA’s mission to promote equity and inclusion in healthcare and leadership, ensuring professional spaces are accessible for all.

This interactive learning session explores a collaborative training model that integrates psychology doctoral interns and medical residents into interdisciplinary, team-based care settings. Through structured co-training, participants develop interprofessional competencies in integrated behavioral health (IBH), including real- time collaboration, brief interventions, and systemic implementation and data, metrics and clinical implementation outcomes will be discussed. The session highlights interactive learning methods, including case discussions, small group activities, and expert panels, to showcase how interprofessional training can enhance healthcare outcomes and drive the future of integrated care.