• Deborah J Cohen, Bijal A Balasubramanian, Melinda Davis, Jennifer Hall, Rose Gunn, Kurt C Stange, Larry A Green, William L Miller, Benjamin F Crabtree, Mary Jane England, Khaya Clark, and Benjamin F Miller.
• From the Departments of Family Medicine and of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland (DJC); Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston School of Public Health (BAB); Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX (BAB); Oregon, Rural Practice-Based Research Network (MD); Department of Family Medicine, Oregon Health & Science University, Portland (MD, JH, RG, KC); Department of Epidemiology & Biostatistics, Sociology and the Case Comprehensive Cancer Center, and Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, OH (KCS); Department of Family Medicine, University of Colorado School of Medicine, Aurora (LAG, BFM); Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA (WLM); Department of Family Medicine and Community Health, Rutgers-Robert Wood, Johnson Medical School, Somerset, NJ (BFC); Department of Health Policy and Management, Boston University School of Public, Health, Boston, MA (MJE) cohendj@ohsu.edu.
• J Am Board Fam Med. 2015 Sep 1; 28 Suppl 1 (Suppl 1): S7S20S7-20.

PurposeTo provide empirical evidence on key organizing constructs shaping practical, real-world integration of behavior health and primary care to comprehensively address patients' medical, emotional, and behavioral health needs.MethodsIn a comparative case study using an immersion-crystallization approach, a multidisciplinary team analyzed data from observations of practice operations, interviews, and surveys of practice members, and implementation diaries. Practices were drawn from 2 studies of practices attempting to integrate behavioral health and primary care: Advancing Care Together, a demonstration project of 11 practices located in Colorado, and the Integration Workforce Study, a study of 8 practices across the United States.ResultsWe identified 5 key organizing constructs influencing integration of primary care and behavioral health: 1) Integration REACH (the extent to which the integration program was delivered to the identified target population), 2) establishment of continuum of care pathways addressing the location of care across the range of patient's severity of illness, 3) approach to patient transitions: referrals or warm handoffs, 4) location of the integration workforce, and 5) participants' mental model for integration. These constructs intertwine within an organization's historic and social context to produce locally adapted approaches to integrating care. Contextual factors, particularly practice type, influenced whether specialty mental health and substance use services were colocated within an organization.ConclusionInteraction among 5 organizing constructs and practice context produces diverse expressions of integrated care. These constructs provide a framework for understanding how primary care and behavioral health services can be integrated in routine practice.© Copyright 2015 by the American Board of Family Medicine.

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