Primary Care Behavioral Health Integration

Behavioral Health Integration at CHA

Cambridge Health Alliance is a national leader in integrating primary care and behavioral health. This work began in 1991 and has grown, expanded, and been refined in the intervening years. In 2011, we adopted a “population-based” approach which includes universal screening for depression, anxiety and substance use disorders, along with registries, co-located/integrated therapists, behavioral care managers and consulting psychiatrists in a team-based system consistent with health home innovations. In December 2016, all twelve of CHA’s primary care practices received Massachusetts Health Policy Commission’s PRIME certification for behavioral health integration, among the first in the state to receive this recognition. In November 2017, CHA led a Harvard Medical School CME-accredited course entitled “Working Together: Integrating Mental Health and Medical Care.” As a premier site for medical education, CHA is training residents and trainees across several disciplines in a model for integration known to be effective in comprehensive patient care.

Why is CHA transforming primary care and behavioral health?

About 1 in 4 adults suffer from a mental disorder in a given year. Behavioral health problems such as depression, anxiety, alcohol or substance use disorders are among the most common and disabling health conditions worldwide, and have a significant impact on health and quality of life. Due to the associated stigma of these conditions, a shortage of mental health specialists and lack of follow-up care, millions of people who have both medical and mental health needs do not receive the care they need.

The good news is that there are effective treatments, and CHA is working to bring them to all our patients by integrating mental health with primary care.

Offering effective treatments within primary care:

  • is more convenient for patients
  • reduces the stigma associated with treatment for mental health conditions
  • builds on existing provider-patient relationships
  • makes a lasting impact on our patients
  • improves primary care provider satisfaction


How does this work?

Since 2011, building on its Patient Centered Medical Home transformation, CHA has been implementing an evidence-based Collaborative Care model for patients 18 and older, which we refer to as Primary Care Behavioral Health Integration (PCBHI). This involves regular screening, assessment, and treatment of common mental health conditions with trained primary care providers and embedded behavioral health professionals. We use systematic tracking and follow-up tools in the electronic medical record to advance care and organize our team approach.

The Primary Care team works collaboratively to ensure that all patients get the care they need in primary care or are supported in getting more intensive care in other settings, such as Outpatient Psychiatry, CHA Outpatient Addiction Services, and the Behavioral Health Home. In this way, CHA patients receive the right care at the right time.

What can our primary care patients expect during their visit?

CHA’s PCBHI program is continuously working to achieve improved coordination to comprehensively address patients’ needs. With our collaborative care model we offer a variety of services at our Primary Care sites for high prevalence mental health concerns, including depression, anxiety, and alcohol and substance use disorders. Services are customized according to patient need, and include:

  • Annual screening and assessment using evidence-based tools
  • Team based collaboration with integrated behavioral health staff
  • Medical interventions including pharmacotherapy, as appropriate
  • Wellness support programming including:
    • psychoeducation
    • coaching
    • introduction to behavioral health websites and smartphone apps
    • and peer support groups
  • Systematic patient tracking and regular outreach
  • Short-term therapy
  • Psychiatric consultation
  • Addiction consultation
  • Group treatment
  • Peer support groups
  • Close coordination with all providers across the continuum of care (special focus on coordinating with individuals’ mental health teams)

Benefits of Collaborative Care

Collaborative Care has now been tested in more than 80 randomized controlled trials in the US and abroad. Several recent meta-analyses indicate that Collaborative Care is an improvement over usual care. It results in better patient outcomes, improved patient and provider satisfaction and reductions in health care costs, achieving the Triple Aim of health care reform.

At CHA, we are beginning to see significant improvements in identification of illness, consistent follow-up for depression, interventions for alcohol and substance use disorders, provider satisfaction, and patient outcomes. CHA will study the impact of PCBHI implementation and publish findings as they emerge. We are currently expanding our services to better include pediatric patients, pain management, and other chronic medical illness care - while optimizing treatment strategies for mental health needs.


Patients: visit your CHA Primary Care Provider to learn more about available services.

Not a CHA patient? Become a CHA patient today!

More information: contact Emily Benedetto, Program Manager for Primary Care Behavioral Health Integration (617) 591-4168