Integration of Behavioral Health Services and Adolescent Depression Screening in Primary Care

Objective: Adolescent depression is a serious behavioral health concern often seen in primary care clinics. The purpose of this study was to examine the relationship between successful implementation of integrated behavioral health (IBH) services in primary care settings and clinics' rates of screening adolescents for depression. Method: We examined clinic-level data, with screening rates obtained from a statewide reporting agency and IBH data obtained through an implementation collaborative. Using the Site Self-Assessment, we first examined global IBH integration using a simple regression, then examined specific components of integration using 2 multiple regressions. Results: While an overall level of behavioral health integration was not significantly related to screening rates, several specific components were. These included positive relationships of adolescent depression screening rates with evidence-based practice and provider/staff integrated care training; and negative relationships of adolescent depression screening rates with funding access and integration, organizational leadership for integrated care, and linking to community resources. Conclusions: Clinical implications include the importance of training providers and staff in behavioral health care and regular use and reinforcement of evidence-based practices to facilitate adolescent depression screening. In addition, clinic personnel may perceive less support for IBH implementation from organizational leadership and less financial integration between behavioral and medical services, when clinics have high screening rates. While more research is needed to examine this unexpected finding, it may be that in clinics with high screening rates a culture of valuing behavioral health care leads to a desire for more organizational support for IBH.