Behavioral Health Services Provision in Primary Care Settings: A Mixed Methods Evaluation

Patricia K. Carreño Lugo

Advisor: Leah M Adams, PhD, Department of Psychology

Committee Members: Krista Highland, Keith Renshaw

Online Location, #https://gmu.zoom.us/meeting/register/ue_06WpSTDC0gdFDGpwKUA
August 11, 2025, 10:30 AM to 12:30 PM

Abstract:

 As BH needs continue to rise in the U.S., much of this care is increasingly delivered within primary care, rather than specialty behavioral health (BH) clinics. However, research indicates that racial and ethnic disparities persist in the provision of BH services and the delivery of guideline-concordant care, particularly within primary care settings. Despite calls for primary care providers (PCPs) to address these growing BH needs, there are mixed findings regarding PCPs' experiences with treating the BH or psychiatric needs of their patients, their perspectives on integrated BH services delivery, and the extent to which PCPs embrace such expanding roles and expectations. Additionally, little empirical attention has been given to PCPs’ pre-visit planning (e.g., their pre-clinical encounter planning behaviors and activities) in the context of BH services provision. To address these gaps in the literature, a two-study mixed-methods paradigm was developed. Study 1 aimed to examine PCPs’ approaches to pre-visit planning through a qualitative experimental design, using a simulated electronic medical record modified by patient race. Analyses revealed no statistically significant differences between provisional working diagnoses rendered, BH-oriented questions, or the breadth or depth of BH-focused questions generated by experimental condition. However, medium to large effect sizes were observed for type of provisional working diagnosis rendered, the number of questions generated, and the proportion of BH-oriented questions produced, indicating potentially meaningful variation in PCP behaviors by patient race. Study 2 used qualitative interviews to understand PCPs’ perspectives regarding: 1) their roles and responsibilities in providing BH services, and 2) their views on selected ‘exemplary’ integrated BH practices. Thematic analysis resulted in key themes, including those focused on PCPs’ routine engagement with measurement-based care and assessment, their perceived benefits of multidisciplinary provider collaborations, and broader BH care approaches. Notably, PCPs’ perceptions of selected integrated BH practices varied depending on whether they worked in settings with (or without) integrated BH services and on availability of structural resources. Taken together, both studies identify areas of continued intervention and support to optimize BH services provision within primary care settings.