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Psychologists in integrated primary care

Developed by the Integrated Primary Care Advisory Group

Rethinking behavioral health integration in primary care

As health systems continue to evolve toward more coordinated, patient-centered care, the integration of behavioral health into primary care settings has emerged as a practical and evidence-based approach. The Primary Care Behavioral Health (PCBH) model places licensed psychologists—functioning as Behavioral Health Consultants (BHCs)—within primary care teams to support prevention, early intervention, and treatment across the lifespan.

This model is designed to tailor care to each patient’s needs, reduce barriers to care, and improve outcomes through timely, team-based support.

What psychologists bring to primary care teams 

Improving access to behavioral health services

  • Embedding psychologists into primary care helps reduce long wait times and increases engagement, especially in rural and underserved communities.1–3
  • Children and families benefit from earlier screening, more timely behavioral health visits, and access to evidence-based care.4
  • Integrated care models have shown flexibility5 during crises like Covid-19,6 helping maintain continuity of behavioral health services.7

Supporting cost-effective care delivery

  • Studies show that integrating psychologists can reduce annual per-patient costs8 and lower emergency department9–10 and inpatient utilization.11
  • In pediatric settings, PCBH has demonstrated a positive return on investment through reduced medical costs.12
  • Primary care clinicians report improved efficiency, with more patients seen per day and increased revenue when psychologists are part of the care team.13

Strengthening the health system

  • Collaboration with psychologists can alleviate health care clinician burnout14 and improve care coordination.15
  • Integrated behavioral health programs have led to measurable improvements in early identification, symptom reduction,16 and patient satisfaction.3,17
  • Integrated behavioral health services are particularly impactful in diverse populations18–20 and specialized programs, such as women’s health,21 perinatal care,22 and chronic disease management.23–25

Enhancing health outcomes

  • PCBH contributes to improved physical and behavioral health outcomes,26 including better diabetes management,27 reduced insomnia,28–29 and increased tobacco cessation.30
  • Patients report reduced distress,31 improved functioning,32–34 and sustained benefits across a range of behavioral health conditions,31 including posttraumatic stress disorder.35
  • Integration supports adherence to medical treatment,17,27 and supports sustained participation in care.1,17

Moving forward

Health systems exploring ways to improve access, reduce costs, and enhance outcomes can benefit from integrating psychologists into primary care teams. The evidence base continues to grow, pointing to meaningful advantages for patients, clinicians, and the broader health system. Rather than a one-size-fits-all solution, PCBH offers a flexible framework that can be adapted to meet the unique needs of each clinical setting. As organizations consider next steps in behavioral health integration, psychologists are well-positioned to contribute to a more responsive and effective model of care.

References

1. Possemato, K., Johnson, E. M., Beehler, G. P., Shepardson, R. L., King, P., Vair, C. L., Funderburk, J. S., Maisto, S. A., & Wray, L. O. (2018). Patient outcomes associated with primary care behavioral health services: A systematic review. General Hospital Psychiatry, 53, 1–11. https://doi.org/10.1016/j.genhosppsych.2018.04.002opens in new window

2. Scafe, M. J., Mapes, A. R., Guzman, L. E., & Bridges, A. J. (2021). Rural versus urban primary care patients’ behavioral health needs and service utilization. Journal of Rural Mental Health, 45(4), 268–280. https://doi.org/10.1037/rmh0000178

3. Ogbeide, S. A., Landoll, R. R., Nielsen, M. K., & Kanzler, K. E. (2018). To go or not go: Patient preference in seeking specialty mental health versus behavioral consultation within the primary care behavioral health consultation model. Families, Systems & Health, 36(4), 513–517. https://doi.org/10.1037/fsh0000374opens in new window

4. Walter, H. J., Vernacchio, L., Correa, E. T., Bromberg, J., Goodman, E., Barton, J., Young, G. J., DeMaso, D. R., & Focht, G. (2021). Five-phase replication of behavioral health integration in pediatric primary care. Pediatrics, 148(2), e2020001073. https://doi.org/10.1542/peds.2020-001073

5. Stephens, K. A., van Eeghen, C., Zheng, Z., Anastas, T., Ma, K. P. K., Prado, M. G., Clifton, J., Rose, G., Mullin, D., Chan, K. C. G., & Kessler, R. (2025). Intervention stage completion and behavioral health outcomes: An integrated behavioral health and primary care randomized pragmatic trial. Annals of Family Medicine, 23(1), 35–43. https://doi.org/10.1370/afm.230576opens in new window

6. Kanzler, K. E., & Ogbeide, S. (2020). Addressing trauma and stress in the COVID-19 pandemic: Challenges and the promise of integrated primary care. Psychological Trauma, 12(S1), S177–S179. https://doi.org/10.1037/tra0000761opens in new window

7. Bogucki, O. E., Mattson, A. B., Leasure, W. B., Berg, S. L., Mulholland, H. L., & Sawchuk, C. N. (2021). Adaptations of an integrated behavioral health program during COVID-19. Cognitive and Behavioral Practice, 28(4), 481–491. https://doi.org/10.1016/j.cbpra.2021.01.006opens in new window

8. Ross, K. M., Klein, B., Ferro, K., McQueeney, D. A., Gernon, R., & Miller, B. F. (2019). The cost effectiveness of embedding a behavioral health clinician into an existing primary care practice to facilitate the integration of care: A prospective, case-control program evaluation. Journal of Clinical Psychology in Medical Settings, 26(1), 59–67. https://doi.org/10.1007/s10880-018-9564-9

9. Reppeto, H., Tuning, C., Olsen, D. H., Mullane, A., & Smith, C. (2021). Triple aim: Benefits of behavioral health providers in primary care. Journal of Health Psychology, 26(2), 205–213. https://doi.org/10.1177/1359105318802949opens in new window

10. Maeng, D. D., Poleshuck, E., Rosenberg, T., Kulak, A., Mahoney, T., Nasra, G., Lee, H. B., & Li, Y. (2022). Primary care behavioral health integration and care utilization: Implications for patient outcome and healthcare resource use. Journal of General Internal Medicine, 37(11), 2691–2697. https://doi.org/10.1007/s11606-021-07372-6opens in new window

11. Lanoye, A., Stewart, K. E., Rybarczyk, B. D., Auerbach, S. M., Sadock, E., Aggarwal, A., Waller, R., Wolver, S., & Austin, K. (2017). The impact of integrated psychological services in a safety net primary care clinic on medical utilization: Impact of integrated services on utilization. Journal of Clinical Psychology, 73(6), 681–692. https://doi.org/10.1002/jclp.22367opens in new window

12. Dopp, A. R., Smith, A. B., Dueweke, A. R., & Bridges, A. J. (2018). Cost-savings analysis of primary care behavioral health in a pediatric setting: Implications for provider agencies and training programs. Clinical Practice in Pediatric Psychology, 6(2), 129–139. https://doi.org/10.1037/cpp0000231

13. Gouge, N., Polaha, J., Rogers, R., & Harden, A. (2016). Integrating behavioral health into pediatric primary care: Implications for provider time and cost. Southern Medical Journal, 109(12), 774–778. https://doi.org/10.14423/SMJ.0000000000000564

14. Zubatsky, M., Pettinelli, D., Salas, J., & Davis, D. (2018). Associations between integrated care practice and burnout factors of primary care physicians. Family Medicine, 50(10), 770–774. https://doi.org/10.22454/FamMed.2018.655711opens in new window

15. Riley, A. R., Paternostro, J. K., Walker, B. L., & Wagner, D. V. (2019). The impact of behavioral health consultations on medical encounter duration in pediatric primary care: A retrospective match-controlled study. Families, Systems & Health, (2), 162–166. https://doi.org/10.1037/fsh0000406

16. Schweitzer, J., Bird, A., Bowers, H., Carr-Lee, N., Gibney, J., Schellinger, K., Holt, J. R., Adams, D. P., Hensler, D. J., & Hollenbach, K. (2023). Developing an innovative pediatric integrated mental health care program: interdisciplinary team successes and challenges. Frontiers in Psychiatry, 14, 1252037. https://doi.org/10.3389/fpsyt.2023.1252037opens in new window

17. Robinson, P., Von Korff, M., Bush, T., Lin, E. H. B., & Ludman, E. J. (2020). The impact of primary care behavioral health services on patient behaviors: A randomized controlled trial. Families, Systems & Health, 38(1), 6–15. https://doi.org/10.1037/fsh0000474

18. Flynn, A., Gonzalez, V., Mata, M., Salinas, L. A., & Atkins, A. (2020). Integrated care improves mental health in a medically underserved U.S.-Mexico border population. Families, Systems & Health, 38(2), 105–115. https://doi.org/10.1037/fsh0000490opens in new window

19. Berge, J. M., Trump, L., Trudeau, S., Utržan, D. S., Mandrich, M., Slattengren, A., Nissly, T., Miller, L., Baird, M., Coleman, E., & Wootten, M. (2017). Integrated care clinic: Creating enhanced clinical pathways for integrated behavioral health care in a family medicine residency clinic serving a low-income, minority population. Families, Systems, & Health, 35(3), 283–294. https://doi.org/10.1037/fsh0000285opens in new window

20. Carroll, I. C., Senior, C. J., Davenport, M. A., Foster, C. S., Diaz-LePage, A. K., Hughes-Reid, C. L., & Hatchimonji, D. R. (2024). Racial match: Black youth and pediatric integrated primary care. Clinical Practice in Pediatric Psychology. Advance online publication. https://dx.doi.org/10.1037/cpp0000526opens in new window

21.Dang, D., & Salcedo, J. (2023). Patient acceptance of primary care behavioral health in a resident obstetrics and gynecology clinic. Southern Medical Journal, 116(9), 733–738. https://doi.org/10.14423/SMJ.0000000000001596opens in new window

22.Lomonaco-Haycraft, K. C., Hyer, J., Tibbits, B., Grote, J., Stainback-Tracy, K., Ulrickson, C., Lieberman, A., van Bekkum, L., & Hoffman, M. C. (2019). Integrated perinatal mental health care: A national model of perinatal primary care in vulnerable populations. Primary Health Care Research & Development, 20, e77. https://doi.org/10.1017/S1463423618000348opens in new window

23. Wan, J., Chua, E. Y. C., Soon, W. S. W., Xie, Y., & Tang, W. E. (2021). The impact of a mental health service on chronic disease management in primary care. Singapore Medical Journal, 62(5), 235–239. https://doi.org/10.11622/smedj.2021063opens in new window

24. Miller-Matero, L. R., Hecht, L. M., Miller, M. K., Autio, K., Pester, B. D., Tobin, E. T., Patel, S., Braciszewski, J. M., Maye, M., & Ahmedani, B. K. (2021). A brief psychological intervention for chronic pain in primary care: A pilot randomized controlled trial. Pain Medicine, 22(7), 1603–1611. https://doi.org/10.1093/pm/pnaa444opens in new window

25. Wilfong, K. M., Hunter, C. L., Kroke, P. C., Curry, J. C., & Goodie, J. L. (2025). Penetration rates of behavioral health consultants targeting cardiovascular disease and associated modifiable risk factors among military health care beneficiaries. Families, Systems & Health, 43(1), 27–37. https://doi.org/10.1037/fsh0000917opens in new window

26. Nyman, S. J., Vogel, M. E., Heller, G. M., Hella, J. R., Illes, R. A., & Kirkpatrick, H. A. (2023). Development and evaluation of a health behavior change clinic in primary care: An interdisciplinary partnership. Journal of Clinical Psychology in Medical Settings, 30(4), 909–923. https://doi.org/10.1007/s10880-023-09945-5opens in new window

27. Cummings, D. M., Lutes, L. D., Littlewood, K., Solar, C., Carraway, M., Kirian, K., Patil, S., Adams, A., Ciszewski, S., Edwards, S., Gatlin, P., & Hambidge, B. (2019). Randomized trial of a tailored cognitive behavioral intervention in Type 2 diabetes with comorbid depressive and/or regimen-related distress symptoms: 12-month outcomes from COMRADE. Diabetes Care, 42(5), 841–848. https://doi.org/10.2337/dc18-1841

28. Pigeon, W. R., Funderburk, J., Bishop, T. M., & Crean, H. F. (2017). Brief cognitive behavioral therapy for insomnia delivered to depressed veterans receiving primary care services: A pilot study. Journal of Affective Disorders, 217, 105–111. https://doi.org/10.1016/j.jad.2017.04.003opens in new window

29. Pigeon, W. R., Funderburk, J. S., Cross, W., Bishop, T. M., & Crean, H. F. (2019). Brief CBT for insomnia delivered in primary care to patients endorsing suicidal ideation: A proof-of-concept randomized clinical trial. Translational Behavioral Medicine, 9(6), 1169–1177. https://doi.org/10.1093/tbm/ibz108opens in new window

30. Wray, J. M., Funderburk, J. S., Acker, J. D., Wray, L. O., & Maisto, S. A. (2018). A meta-analysis of brief tobacco interventions for use in integrated primary care. Nicotine & Tobacco Research, 20(12), 1418–1426. https://doi.org/10.1093/ntr/ntx212opens in new window

31.Cigrang, J. A., Dobmeyer, A. C., Becknell, M. E., Roa-Navarrete, R. A., & Yerian, S. R. (2007). Evaluation of a collaborative mental health program in primary care: Effects on patient distress and health care utilization. Primary Care and Community Psychiatry, 11(3), 121–127. https://doi.org/10.1185/135525706X121192opens in new window

32. Komaromy, M., Madden, E. F., Hager, B., Qeadan, F., Ceballos, V., Duhigg, D., Carlson, T., & Arora, S. (2019). Improvement in behavioral health symptoms and functioning among rural patients cared for by primary care teams using the extension for community health care outcomes model. Journal of Rural Mental Health, 43(2–3), 73–80. https://doi.org/10.1037/rmh0000115opens in new window

33. Cully, J. A., Stanley, M. A., Petersen, N. J., Hundt, N. E., Kauth, M. R., Naik, A. D., Sorocco, K., Sansgiry, S., Zeno, D., & Kunik, M. E. (2017). Delivery of brief cognitive behavioral therapy for medically ill patients in primary care: A pragmatic randomized clinical trial. Journal of General Internal Medicine, 32(9), 1014–1024. https://doi.org/10.1007/s11606-017-4101-3opens in new window

34. Wilfong, K. M., Goodie, J. L., Curry, J. C., Hunter, C. L., & Kroke, P. C. (2022). The impact of brief interventions on functioning among those demonstrating anxiety, depressive, and adjustment disorder symptoms in primary care: The effectiveness of the primary care behavioral health (PCBH) model. Journal of Clinical Psychology in Medical Settings, 29(2), 318–331. https://doi.org/10.1007/s10880-021-09826-9opens in new window

35. Rauch, S. A. M., Kim, H. M., Acierno, R., Ragin, C., Wangelin, B., Blitch, K., Muzzy, W., Hart, S., & Zivin, K. (2023). Improving function through primary care treatment of posttraumatic stress disorder study outcomes: A randomized controlled trial of prolonged exposure for primary care in veterans. Families, Systems, & Health, 41(4), 502–513. https://doi.org/10.1037/fsh0000823opens in new window

Date created: February 2026

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