The ACT initiative has been on the front lines of behavioral health and primary care integration in the United States. In 2010, the University of Colorado School of Medicine, in conjunction with the Colorado Health Foundation, invited care sites to devise and implement multifaceted, actionable strategies to better integrate behavioral health and primary care interventions within their practices. Ultimately, 11 care sites were selected to participate in the 4-year ACT program, and each site was provided modest funding to help offset the costs of its integrated care endeavors.
Interventions shared across the 11 community mental health and primary care sites included:1
- Developing and utilizing comprehensive, systematic mental health screening tools
- Integrating and facilitating interoperability between medical and behavioral electronic health records
- Introducing and co-locating primary care providers (eg, physicians or mid-level practitioners), mental health care providers (eg, psychologists), and ancillary staff (eg, counselors, social workers, and medical assistants) across both primary care and mental health care clinics
Analyses regarding the effectiveness of ACT interventions have been conducted and results related to best practices in behavioral health screening have been reported. According to Balasubramanian et al, practices that implemented systematic protocols to identify patients needing integrated care had significantly higher reach (ie, extent to which the respective interventions were delivered to the target population) (mean=70% reach, 95% confidence interval [CI] 46.6–93.4%) than did practices that used practitioner discretion to identify patients needing integrated care (mean=7.9% reach, 95% CI 0.6–15.1, P=0.0014).2 These data suggest that utilization of validated, systematic screening tools are necessary to identify patients and populations requiring coordinated behavioral health and primary health services.
Furthermore, Frank deGruy III, MD, chair of the family medicine department at the University of Colorado School of Medicine, has commented on the successes of the ACT program. “All 11 of them succeeded, and they're still doing it,” Dr. deGruy said. “That demonstration project was such a success that we now have a statewide project in Colorado. We just enrolled 100 primary care practices to transform to integrated care, and over the next five years, we're going to increase that number up to 500 primary care practices.”3
To learn more about the ACT program, click below:
- Davis M, Balasubramanian B, Waller E, Miller B, Green L, Cohen D. Integrating behavioral and physical health care in the real world: early lessons from advancing care together. JABFM. 2013;26(5):588–602.
- Balasubramanian B, Fernald D, Dickinson L, et al. REACH of interventions integrating primary care and behavioral health. Journal of the American Board of Family Medicine: JABFM. 2015;28.
- American Academy of Family Physicians. Campaign Highlights Integration of Primary Care, Mental Health. http://www.aafp.org/news/family-medicine-americas-health/20160531hip-mentalhealth.html. Accessed May 3, 2018.