Explication of a Behavioral Health-Primary Care Integration Learning Collaborative and Its Quality Improvement Implications

  • Martha Okafor
  • Victor Ede
  • Rosemary Kinuthia
  • David Satcher
Brief Report


In an effort to tackle fragmented care in the US healthcare delivery system, we explored the use of learning collaborative (LC) to advance integration of behavioral health and primary care as one of the potential solutions to a holistic approach to the delivery of quality healthcare to individuals with physical and mental illness. How a diverse group of primary care and behavioral health providers formed a Community of Practice (CoP) with a common purpose and shared vision to advance integrated care using a LC approach is described. An account of their learning experience, key components of their quality improvement, practice changes, clinical processes, and improved outcomes are explained. This paper aims at describing the history, creative design, processes, roles of the CoP and impact of the LC on the advancement of integrated care practice and quality improvements for further exploration and replications.


Learning collaborative Community of practice Integration of behavioral health and primary care Quality improvement 



Integrated Care Practice Change and Quality Improvement (ICPCQI) initiative was funded by Grants from Kaiser Permanente and Georgia State Department of Behavioral Health and Developmental Disabilities (DBHDD). We thank the patients, staff, and providers at Asa G. Yancey Health Center, Mercy Care Services, Neighborhood Union Health Center, North Fulton Service Center, Cobb County Community Service Board (CSB) and McIntosh Trail CSB for their participation in the Learning Community and ICPCQI.

Compliance with Ethical Standards

Conflict of interest

There are no commercial associations that might pose a conflict of interest in connection with this manuscript. All authors certified responsibility for the study.


  1. Antonini, V. P., Oeser, B. T., & Urada, D. (2012). The California integration learning collaborative: A forum to address challenges of SUD-primary care service integration. Journal of Psychoactive Drugs, 44(4), 285–291.CrossRefPubMedGoogle Scholar
  2. Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., & Coventry, P. (2012). Collaborative care for depression and anxiety problems. Cochrane database of systematic reviews (Online: Update Software), 10, CD006525. Scholar
  3. Aronson, E., Blaney, N., Stephan, C., Sikes, J., & Snapp, M. (1978). The jigsaw classroom. Beverley Hills, CA: Sage.Google Scholar
  4. Ayers, L. R., Beyea, S. C., Godfrey, M. M., Harper, D. C., Nelson, E. C., & Batalden, P. B. (2005). Quality improvement learning collaboratives. Quality Management in Health Care, 14(4), 234–247.CrossRefPubMedGoogle Scholar
  5. Burns, J. M. (1978). Leadership. New York: Harper & Row.Google Scholar
  6. Das, J., Das, R. K., & Das, V. (2012). The mental health gender-gap in urban India: Patterns and narratives. Social Science & Medicine, 75(9), 1660–1672.CrossRefGoogle Scholar
  7. Dillenbourg, P. (1999). Collaborative learning: Cognitive and computational approaches. Advances in learning and instruction series. New York, NY: Elsevier Science, Inc.Google Scholar
  8. Duffy, F. F., Chung, H., Trivedi, M., Rae, D. S., Regier, D. A., & Katzelnick, D. J. (2008). Systematic use of patient-rated depression severity monitoring: Is it helpful and feasible in clinical psychiatry? Psychiatric Services, 59(10), 1148–1154.CrossRefPubMedGoogle Scholar
  9. Ebert, L., Amaya-Jackson, L., Markiewicz, J. M., Kisiel, C., & Fairbank, J. A. (2011). Use of the breakthrough series collaborative to support broad and sustained use of evidence-based trauma treatment for children in community practice settings. Administration and Policy in Mental Health and Mental Health Services Research, 39(3), 187–199.CrossRefGoogle Scholar
  10. Ede, V., Okafor, M., Kinuthia, R., Belay, Z., Teclemichael, T., Alema-Mensah, E., et al. (2015). An examination of perceptions in integrated care practice. Community Mental Health.Google Scholar
  11. Epstein, J. N., Langberg, J. M., Lichtenstein, P. K., Altaye, M., Brinkman, W. B., House, K., & Stark, L. J. (2010). Attention-deficit/hyperactivity disorder outcomes for children treated in community-based pediatric settings. Archives of Pediatrics & Adolescent Medicine, 164(2), 160–165.CrossRefGoogle Scholar
  12. Freeman, J. S. (2015). Providing whole-person care: Integrating behavioral health into primary care. North Carolina Medical Journal, 76(1), 24–28.CrossRefPubMedGoogle Scholar
  13. Haine-Schlagel, R., Brookman-Frazee, L., Janis, B., & Gordon, J. (2013). Evaluating a learning collaborative to implement evidence-informed engagement strategies in community-based services for young children. Child & Youth Care Forum, 42(5), 457–473.CrossRefGoogle Scholar
  14. Horbar, J. D., Plsek, P. E., & Leahy, K. (2003). NIC/Q 2000: Establishing habits for improvement in neonatal intensive care units. Pediatrics, 111(4 Pt 2), e397–e410.PubMedGoogle Scholar
  15. Huang, H., Meller, W., Kishi, Y., & Kathol, R. G. (2014). What is integrated care? International Review of Psychiatry, 26(6), 620–628.CrossRefPubMedGoogle Scholar
  16. Huang, Y., Wei, X., Wu, T., Chen, R., & Guo, A. (2013). Collaborative care for patients with depression and diabetes mellitus: A systematic review and meta-analysis. BMC Psychiatry, 13(1), 260.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Ivbijaro, G. O., Enum, Y., Khan, A. A., Lam, S. S., & Gabzdyl, A. (2014). Collaborative care: Models for treatment of patients with complex medical-psychiatric conditions. Current Psychiatry Reports, 16(11), 506.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Katon, W., Russo, J., Lin, E. H., Schmittdiel, J., Ciechanowski, P., Ludman, E., et al. (2012). Cost-effectiveness of a multicondition collaborative care intervention: A randomized controlled trial. Archives of General Psychiatry, 69(5), 506–514.CrossRefPubMedGoogle Scholar
  19. Katzelnick, D. J., Von Korff, M., Chung, H., Provost, L. P., & Wagner, E. H. (2005). Applying depression-specific change concepts in a collaborative breakthrough series. The Joint Commision Journal on Quality and Patient Safety, 31(7), 386–397.CrossRefGoogle Scholar
  20. Kilo, C. M. (1998). A framework for collaborative improvement. Quality Management in Health Care, 6(4), 1–14.CrossRefPubMedGoogle Scholar
  21. Klein, S., & Hostetter, M. (2014). In focus: Integrating behavioral health and primary care. The Commonwealth Fund, Retrieved from
  22. Kohn, R. (2014). Trends, gaps, and disparities in mental health. In S. O. Okpaku (Ed.) Essentials of global mental health (pp. 27–38). Cambridge: Cambridge University Press.Google Scholar
  23. Lipshutz, A. K., Fee, C., Schell, H., Campbell, L., Taylor, J., Sharpe, B. A., et al. (2008). Strategies for success: A PDSA analysis of three QI initiatives in critical care. The Joint Commision Journal on Quality and Patient Safety, 34(8), 435–444.CrossRefGoogle Scholar
  24. Minkman, M., Schouten, L., Huijsman, R., & Splunteren, P. V. (2005). Integrated care for patients with a stroke in the Netherlands: Results and experiences from a National breakthrough collaborative improvement project. International Journal of Integrated Care.
  25. Morehouse School of Medicine. The Satcher Health Leadership Institute. (2015). Division of Behavioral Health, Behavioral Health Integration Demonstration Project Report. Retrieved Aug 11, 2015 from utus.php.
  26. Morrissey, J. P., Domino, M., Wicher, C., Kilany, M., Gaynes, B. (2009). Integrating primary care and mental health services: Final evaluation report on the ICARE integration pilot sites. Chapel Hill: University of North Carolina at Chapel Hill.Google Scholar
  27. Nadeem, E., Olin, S. S., Hill, L. C., Hoagwood, K. E., & Horwitz, S. M. (2014). A literature review of learning collaboratives in mental health care: Used but untested. Psychiatric Services, 65(9), 1088–1099.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Nembhard, I. M. (2012). All teach, all learn, all improve?: The role of interorganizational learning in quality improvement collaboratives. Health Care Management Review, 37(2), 154–164.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Okafor, M., Ede, V., Kinuthia, R., Strotz, D., Marchman, C., Weeks, S., et al. (2014). Impact of relaxation and group psycho-education on health outcomes using integrated care models and quality improvement. Open Journal of Preventative Medicine, 4(12), 887–896.CrossRefGoogle Scholar
  30. OVretveit, J., Bate, P., Cleary, P., Cretin, S., Gustafson, D., McInnes, K., et al. (2002). Quality collaboratives: Lessons from research. Quality and Safety in Health Care, 11(4), 345–351.CrossRefPubMedGoogle Scholar
  31. Paula, C. S., Bordin, I. A., Mari, J. J., Velasque, L., Rohde, L. A., & Coutinho, E. S. (2014). The mental health care gap among children and adolescents: Data from an epidemiological survey from four brazilian regions. PLoS ONE, 9(2), e88241CrossRefPubMedPubMedCentralGoogle Scholar
  32. Schouten, L. M., Hulscher, M. E., Everdingen, J. J., Huijsman, R., & Grol, R. P. (2008). Evidence for the impact of quality improvement collaboratives: Systematic review. BMJ, 336(7659), 1491–1494.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Stephan, S. H., Connors, E. H., Arora, P., & Brey, L. (2013). A learning collaborative approach to training school-based health providers in evidence-based mental health treatment. Children and Youth Services Review, 35(12), 1970–1978.CrossRefGoogle Scholar
  34. Unützer, J., Katon, Callahan, Williams, Jr., Hunkeler, & Harpole, … For the IMPACT Investigators. (2002). Collaborative care management of late-life depression in the primary care setting. JAMA: The Journal of the American Medical Association, 288(22), 2836.CrossRefPubMedGoogle Scholar
  35. Urada, D., Schaper, E., Alvarez, L., Reilly, C., Dawar, M., Field, R., … Rawson, R. A. (2012). Perceptions of mental health and substance use disorder services integration among the workforce in primary care settings. Journal of Psychoactive Drugs, 44(4), 292–298.CrossRefPubMedGoogle Scholar
  36. Van der Voort, T. Y., Meijel, B. V., Hoogendoorn, A. W., Goossens, P. J., Beekman, A. T., & Kupka, R. W. (2015). Collaborative care for patients with bipolar disorder: Effects on functioning and quality of life. Journal of Affective Disorders, 179, 14–22.CrossRefPubMedGoogle Scholar
  37. Versteeg, M. H., Laurant, M. G., Franx, G. C., Jacobs, A. J., & Wensing, M. J. (2012). Factors associated with the impact of quality improvement collaboratives in mental healthcare: An exploratory study. Implementation Science, 7(1), 1.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Wilson, C., Yasamy, M. T., Morris, J., Novin, A., Saeed, K., & Nkomo, S. D. (2014). Mental health services: The African gap. Journal of Public Mental Health, 13(3), 132–141.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Yale University School of NursingNew HeavenUSA
  2. 2.Frank H. Netter School of MedicineQuinnipiac UniversityNorth HavenUSA
  3. 3.Division of Behavioral Health, The Satcher Health Leadership InstituteMorehouse School of MedicineAtlantaUSA
  4. 4.Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaGeorgia
  5. 5.The Satcher Health Leadership InstituteMorehouse School of MedicineAtlantaUSA

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