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Abstract

The Veterans Health Administration (VHA) has a successful history of integrating behavioral health into primary care through its Primary Care Mental Health Integration (PCMHI) program, utilizing the Colocated Collaborative Care (CCC) model to improve access, early intervention, and team-based care. Recognizing this model’s utility, coupled with the high prevalence of psychological concerns among patients with chronic medical conditions—such as cancer and pain—and their associated elevated suicide risk, VHA launched the Mental and Behavioral Health Integration (MBHI) into Specialty Medicine Demonstration Projects in 2022. These projects expand CCC services into outpatient Oncology and Pain Management clinics, supported by implementation facilitation strategies grounded in evidence-based frameworks provided by the Center for Integrated Healthcare (CIH). Ninety-one positions were funded across selected sites. At 16 months post-award, CIH met individually with teams to explore implementation status. From these meeting notes, implementation determinants were transcribed and analyzed, yielding nine themes. Common barriers included insufficient physical space, recruitment challenges, unclear role understanding, and complex system workflows. Key facilitators involved integrated team activities, prior experience with integrated care, leadership support, and access to national resources. Findings underscore the importance of colocation, proactive team engagement, and education about CCC roles to optimize integration. Lessons learned have informed further expansion of MBHI into Neurology and Sleep Medicine, emphasizing enhanced training, clearer role definitions, and intensified implementation support. These early results highlight the feasibility and value of integrated care in specialty medicine settings to improve Veteran care and mitigate suicide risk.

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