• Ann M Nguyen, Rebecca A Klege, Theresa Menders, Charu Verma, Stephanie Marcello, and Benjamin F Crabtree.
• From the Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); Henry J. Austin Health Center, Trenton, NJ (RAK); University of Illinois Chicago, School of Public Health, Chicago, IL (TM); Institute for Health, Healthcare Policy and Aging Research, Rutgers University, New Brunswick, NJ (CV); Rutgers University Behavioral Health Care, New Brunswick, NJ (SM); Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (BFC). anguyen@ifh.rutgers.edu.
• J Am Board Fam Med. 2025 Jan 30.

BackgroundIntegrated behavioral health (IBH) is a promising approach which embeds behavioral health services into primary care. Yet, IBH has had limited implementation. Our objective was to identify strategies to successfully implement the "Cherokee" IBH model by examining a 2013 to 2019 IBH demonstration project in New Jersey that included Federally Qualified Health Centers (FQHCs) and Community Health Centers (CHCs).MethodsWe conducted qualitative semistructured interviews of 18 primary care and behavioral health clinicians from 10 FQHCs/CHCs in 2022. Interview guide questions drew on the Proctor Implementation Outcomes Framework to capture strategies to optimize acceptability, appropriateness, feasibility, fidelity, penetration, and sustainability of IBH implementations. A template approach was used to code data and identify themes.ResultsAll participating FQHCs/CHCs were still offering IBH services 3 years after the demonstration project, suggesting that strategies were successful in implementing and sustaining IBH. Strategies these FQHCs/CHCs employed included: (1) select champions with experience leading organizational change; (2) provide training that emphasizes how brief behavioral health interventions differ from traditional therapy; (3) develop on-going IBH training procedures for new staff; (4) create physical spaces for behavioral health consultants; (5) establish scheduling systems; and (6) identify local IBH billing codes, policies, and procedures.DiscussionChange management approaches can help in the implementation of IBH; however, additional strategies unique to IBH may be needed to address the attitudinal, organizational, and financial challenges inherent to IBH.ConclusionFuture implementations should apply multi-faceted approaches that address persistent and seemingly intractable barriers that have inhibited IBH integration.© Copyright by the American Board of Family Medicine.

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