Barriers and Facilitators to Integrating Behavioral Health Services and Pediatric Primary Care

Objective: To describe the barriers and facilitators to integrating behavioral health services and pediatric primary care in federally qualified health centers (FQHCs) during the early stages of implementation. Method: We conducted 34 semistructured interviews with primary care providers (n = 11), behavioral health clinicians (n = 12), community health workers, and other pediatric staff (n = 11) at 3 FQHCs. Themes were identified inductively using methods informed by grounded theory; inductively identified themes were then deductively organized within the Consolidated Framework for Implementation Research. Results: Interviewees perceived that the adoption and sustainability of behavioral health integration (BHI) in the pediatric practices of FQHCs were most dependent on barriers and facilitators in the outer setting (the health system context, including financing, partnerships with community organizations and providers, local supply of specialty behavioral health providers, and characteristics of their patient population) and internal clinic structures (resources to support protected provider/staff time, colocation, professional development, and adequate staffing). In turn, adequate clinic structure was perceived as a foundational component in facilitating the process, relational, and individual changes required for BHI implementation, including improving provider and staff collaboration and communication, reducing staff stigma, improving provider compassion, and supporting provider and staff well-being. Conclusions: The successful adoption and sustainability of BHI in the pediatric primary care practices of urban FQHCs may depend highly on the health system context and internal clinic structures. Implications for implementing pediatric BHI interventions in FQHCs are discussed.