The current model for treating anxiety, depression, and adjustment disorders includes specialty behavioral health care and primary care; the limited scalability of specialty care combined with limited opportunities for patients to receive evidence-based interventions in primary care settings creates a gap in access to adequate care. A growing method of treatment aiming to address this gap is the integration of behavioral health providers into the primary care setting. Primary Care Behavioral Health (PCBH) is one model of treatment in which behavioral health consultants (BHC) work directly with primary care providers. This model addresses barriers to care by targeting population health, reducing cost, improving patient experience, and maintaining care team well-being. There is growing evidence that supports the benefits of the PCBH model; however, there are challenges to implementing this model, including a lack of available data demonstrating the effectiveness in treating certain behavioral health conditions.

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BMH-20GMH
Appointment NumberN = 1,353
Non-Cognitive Predictors of Student Success:
A Predictive Validity Comparison Between Domestic and International Students
Behavioral Health Consultants using
the Primary Care Behavioral Health
model produced clinically meaningful
change in four appointments or less.
Non-Cognitive Predictors of Student Success:
A Predictive Validity Comparison Between Domestic and International Students
INTRO
• Anxiety, depression, & adjustment disorders
are prevalent in civilian & military populations
• Specialty behavioral health and primary care,
do not adequately address these problems
• PCBH model integrates behavioral health
providers into the primary care setting.
• Additional evidence is needed regarding the
effectiveness of the PCBH model
METHODS
• 5,402 Military Health Care Beneficiaries
• Female (65%), military dependents (53%)
• 2 - 4 (88%), 16 - 30 min (74%) appointments
• Data collected and deidentified as part of
routine extraction
• Appointment characteristics and diagnoses
were derived from CPT and EMR data
• BHM-20 Global Mental Health Scale used as
primary outcome measure
DATA ANALYSIS
• Rate of clinically meaningful change
calculated using reliable change index
• Predictive value of baseline severity
determined using linear regression
• Predictive values of appointment
characteristics analyzed with GLMM
RESULTS
• Clinically reliable improvement: 17% to 19%
• Severe functioning at baseline: 33%
• More severe functioning at baseline predicted
more improvement at final appointment
• Appointment characteristics revealed better
outcomes with shorter interval between
appointments and fewer total appointments
DISCUSSION
• Results support PCBH model, including:
• 4 appointments or less, lasting 30 mins or
less, resulted in clinically meaningful change
• PCBH model yielded the greatest functional
improvement in the first 4 appointments
• Future studies should assess the PCBH model
in other capacities and populations
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The Impact of Brief Intervention
on Functioning in IPC
The Effectiveness of The PCBH
Model
Kevin Wilfong, Jeffrey Goodie,
Justin Curry, Christopher Hunter,
Phillip Kroke
N = 5,402 N = 5,402 N = 2,719 N = 653 N = 332 N = 188 N = 103 N = 63
Mean BHM-20 GMH Score by Appointment Number and Baseline Severity
Severe
Normal
Mild
Moderate
Excluded (n = 25,968)
Only 1 Appointment
Greater than 1 Appointment
(n = 23,543)
Greater than 1 Appointment and BHM-20 Scores
(n = 11,024)
Assessed for eligibility
(n = 49,511)
Analyzed (n = 5,402)
Total Excluded from Analysis
(n = 44,109)
Excluded (n = 12,519)
Missing BHM-20 Score
Excluded (n = 5,622)
No Diagnosis of Anx, Dep, or Adj
Disorder
CONSORT DIAGRAM
Change Category Categories
Variable
Reliable
Improvement
Improvement
Reliable
Deterioration
Deterioration No Change Total
Total 927 (17.16%) 2,839 (52.55%) 132 (2.44%) 1,308 (24.21%) 196 (3.63%) 5,402 (100%)
Diagnostic Category
Depression 377 (21.36%) 901 (51.05%) 44 (2.49%) 385 (21.81%) 58 (3.29%) 1,765 (100%)
Anxiety 287 (13.67%) 1,157 (55.10%) 51 (2.43%) 520 (24.76%) 85 (4.05%) 2,100 (100%)
Adjustment 49 (13.39%) 189 (51.64%) 12 (3.28%) 99 (27.05%) 17 (4.64%) 366 (100%)
Mixed 214 (18.27%) 592 (50.56%) 25 (2.13%) 304 (25.96%) 36 (3.07%) 1,171 (100%)
Baseline Severity
Normal 26 (2.00%) 685 (52.69%) 68 (5.23%) 453 (34.85%) 68 (5.23%) 1300 (100%)
Mild 216 (12.75%) 939 (55.43%) 30 (1.77%) 445 (26.27%) 64 (3.78%) 1694 (100%)
Moderate 205 (21.49%) 510 (53.46%) 17 (1.78%) 199 (20.86%) 23 (2.41%) 954 (100%)
Severe 480 (33.01%) 705 (48.49%) 17 (1.17%) 211 (14.51%) 41 (2.82%) 1454 (100%)
Gender
Male 269 (14.14%) 988 (51.92%) 62 (3.26%) 498 (26.17%) 86 (4.52%) 1,903 (100%)
Female 658 (18.81%) 1,851 (52.90%) 70 (2.00%) 810 (23.15%) 110 (3.14%) 3,499 (100%)
Table 2. Reliable Change Index (N = 5,402)
Note: Individuals with change a magnitude of change greater than 0.76 are identified as showing reliable
improvement or reliable deterioration, respectively. Individuals showing any improvement or deterioration
are noted separately. No change indicated a difference score of 0 in the BHM-20 Global Mental Health score.
Model 1 Model 2 Model 3 Model 4 Model 5
Variable b SE b b SE b b SE b b SE b b SE b Beta sr2
Constant 1.206 0.030 1.159 0.034 1.169 0.038 1.159 0.041 1.110 0.042 -- --
BHM-20 Initial -0.351** 0.012 -0.351** 0.012 -0.350** 0.012 -0.351** 0.012 -0.350** 0.012 -0.379 0.140
Days Since Initial 0.003** 0.000 0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001 -0.018 0.000
Appointment Interval -0.005** 0.001 -0.003** 0.001 -0.003** 0.001 -0.003** 0.001 -0.003** 0.001 -0.085 0.002
Total Appointments -- -- 0.021* 0.007 0.021* 0.007 0.021* 0.007 0.022* 0.007 0.047 0.001
Appointment Duration -- -- -- -- 0.000 0.001 0.000 0.001 0.000 0.001 -0.009 0.000
Age -- -- -- -- -- -- 0.000 0.001 0.000 0.001 0.009 0.000
Gender -- -- -- -- -- -- -- -- 0.082** 0.015 0.009 0.005
R2 0.162 0.163 0.163 0.163 0.168
F for change in R2 59.953** 8.171* 0.280 0.442 30.724**
Note: *p < 0.01. **p< 0.001.
Table 3. Summary of Hierarchical Regression Analysis for Variables Predicting BHM-20 GMH
Difference Score (N = 5,402)
Effects B 95% CI
[LL,UL]
SE p Semi-
partial R2
Fixed Effects
Intercepts 0.637 [0.5691,0.683] 0.024 <0.001 --
Within-Subjects
Deviation Appointment Duration (min) -0.003 [-0.004,-0.002] 0.000 <0.001 0.003
Deviation Appointment Interval 0.001 [0.000,0.001] 0.000 <0.001 0.002
Appointment Number 0.081 [0.075,0.086] 0.003 <0.001 0.143
Between-Subjects
Mean Appointment Duration (min) 0.000 [-0.001,0.000] 0.000 0.366 --
Mean Appointment Interval -0.001 [-0.001,0.000] 0.000 <0.001 0.002
Total Appointment Number -0.034 [-0.039,-0.029] 0.003 <0.001 0.031
Covariates
Gender 0.050 [0.033,0.067] 0.009 <0.001 0.0056
Age 0.000 [0.000,0.001] 0.000 0.096 --
Baseline BHM-20 GMH Score 0.779 [0.766,0.793] 0.007 <0.001 0.694
Variance ρ SE p
Random Effects
Intercept 0.026 -- 0.002 <0.001
Repeated Effects
Appointments 0.151 -- 0.003 <0.001
-- 0.898 0.005 <0.001
Note: Semi-partial R2 is a measure of effect size for each variable (Edwards et al.,
2008). Effect sizes are classified as small (≥ 0.02), medium (≥ 0.13), and large (≥ 0.26).
Table 5. Summary of Linear Mixed Model for Appointment Characteristics BHM-20 GMH Score
(N = 5,402)
Appointment Number