Behavioral Consultation and Primary Care
A Guide To Integrating Services
3rd Edition
This third edition of Behavioral Consultation and Primary Care builds on the success of the previous editions, with updates and an expanded offering of tools and practice strategies. It is designed to have something for everyone – including new and experienced behavioral health professionals, primary care providers, nurses, and other members of the healthcare team. This updated edition is also a great text for the growing number of graduate courses introducing integrated primary care to students. The book provides, in great detail, both the rationale for this model of care and practical strategies for implementing it, including myriad practice tools that integrated care teams can start utilizing immediately. If your goal for integration is to improve primary care for everyone, this book shows how to achieve that goal.
Robinson and Reiter have crafted a masterpiece with this third edition of Behavioral Consultation and Primary Care. Their great care in building the PCBH model explains its positive impact on patients and healthcare systems around the world and its remarkable growth over the past 17 years. This edition, enriched with new research, practical tools, evolved thinking, and the authors’ stunning ability to keep things simple, is a tour de force of how to make evidence-based work clinically relevant. I am thrilled to see this comprehensive guide continue to advance the field. It’s THE essential resource for clinicians, leaders, and anyone who is passionate about transforming primary care through behavioral health integration.
Steven C. Hayes, PhD, Foundation Professor of Psychology Emeritus, University of Nevada, Reno
Expect this book to be dog-eared and covered with notes. This is not a pristine book to sit on your shelf. This is your go-to guide for integrating behavioral health services into primary care. From the basics to the complex nuances of implementation and scaling integration — this is your resource. Whether you are just starting to integrate behavioral health into your practice, or have a seasoned integrated system, this book is for you.
Parinda Khatri, PhD, Chief Health Officer, Cherokee Health Systems
“Robinson & Reiter’s latest edition illuminates the leading edge of integrated behavioral health. These authors are pracademics who have one foot in the work of doing it and one in the context that empowers and spreads the innovation. Practical, evidence-informed, and visionary, this book will be a key source for my organization across the range of implementers and researchers.” (Jodi Polaha, PhD, Professor and Director, East Tennessee State University Institute for Integrated Behavioral Health)
“The previous edition of Behavioural Consultation and Primary Care has been our “bible” over the past 5 years, for those of us implementing and delivering the Primary Behavioural Healthcare programme here in New Zealand. This third edition contains substantial new material, including very useful tools, chapters on advanced BHC roles and leadership, and new patient handouts. No doubt it will become our new bible as we take this wonderful programme forward into the next 5 years and beyond.” (Dr David Codyre, Clinical Director Mental Health and Wellness Support / Consultant Psychiatrist, Tāmaki Health and Clinical Director, Tū Whakaruruhau (Auckland Wellbeing Collaborative))
“This book has become an indispensable resource for any primary care practice starting an integrated behavioral health program. Our multiculturally diverse FQHC wishes it had been available when we started our PCBH program many years ago. This 3rd edition provides valuable new resources to support thriving programs in meeting the complexities of ever-evolving healthcare systems.” (Judy Featherstone, MD, Chief Health Officer (retired), HealthPoint)
“This seminal update captures the maturity of the PCBH movement and sets it up for its next evolution. From practical insights to build, sustain, and scale PCBH, this must-have guide describes how all members of primary care can work to advance equitable healthcare. Most importantly, it provides a map for career advancement, workforce development and step-by-step wisdom to train, retain, and grow in PCBH as a professional and as a health system.” (Deepu George, PhD, LMFT, Associate Professor, Primary Care & Community Medicine, ISU,
Director, Integrated Behavioral Health, University of Texas Rio Grand Valley School of Medicine)
“The 3rd edition of Behavioural Consultation and Primary Care is a completely new book with seven completely new chapters. Robinson and Reiter are the experts on integration, and both have extensive experience and a passion for primary care. There is something here for everyone – clinicians, patients, managers, leaders, funders and politicians. This book can help you change healthcare in your region, as Patti Robinson has done in New Zealand, where most primary care clinics now offer the services of Behavioural Health Consultants / Health Improvement Practitioners.” (Bruce Arroll MBChB, PHD, FRNZCGP (Distinguished); FRNZCUC (Honorary)
Elaine Gurr Chair in General Practice, Director of the Goodfellow Unit for Department of General Practice and Primary Health Care University of Auckland)
“This is THE comprehensive guide to primary care behavioral health practice, implementation, and evaluation. Patti and Jeff’s first handbook facilitated transformation of primary care services around the world. This new edition, bursting with encouragement and practical resources, will inspire further evolution of primary care teams that effectively optimize health and vitality across populations.” (Kathryn E. Kanzler, PsyD, ABPP, Associate Professor, Department of Medicine, Section of Health Services Research, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; Clinical Investigator, Center for Innovations, DeBakey Veterans Administration Medical Center)
“The new material in this edition will serve as a compass, guiding our ongoing transformation of Primary Care in Te Waipounamu (South Island of New Zealand) through the integration of the PCBH model. The introduction of new core competency tools promises to be an exciting addition, enhancing the capability of our workforce.” (Sarah Redfearn, Master Trainer Candidate, WellSouth Primary Health Organization, Dunedin, Te Waiponamu Region, New Zealand)
“A must-have for any professional working with behavioural or mental health in primary care! Updated, revised, and expanded, the third edition of Behavioral Consultation and Primary Care is even more powerful and practical than before. This in-depth yet easy-to-use guide is packed full of tools, techniques, ideas and strategies that will enable you to improve health in your community, in ways both great and small.” (Dr Russ Harris, Author of “The Happiness Trap and ACT Made Simple)
“Reiter and Robinson’s 3rd edition of Behavioral Consultation and Primary Care is an indispensable guide for integrating behavioral health services in rural and underserved communities. Their expertise shines through, making it a must-read for advancing holistic patient care. Highly recommended!” (Jennifer Yturriondobeitia, MSW, DBH, CEO/President Cornerstone Whole Healthcare Organization, Inc (C-WHO))
“The first edition of this text was a seminal guide to integration that I leveraged as an early career professional. Now 17 years later, the updates highlight the evolution of PCBH, new and evolving leadership roles and truly highlight the power of integration. This book is energizing regarding the power of PCBH and the wide ripple effects it has on healthcare delivery for patients and the care team.” (Elizabeth Zeidler Schreiter, PsyD, Chief Behavioral Health Officer, Access Community Health Centers)
“Primary Care Behavioral Health (PCBH) is an essential component of high-quality primary care. Robinson and Reiter have done it again! Their book in its 3rd edition is your comprehensive, how-to guide to PCBH training, implementation, and sustainment. This is how you do it!” (Julie Oyemaja, PsyD, Relational Leader, Interprofessional Primary Care Institute)
“This book excels in delivering comprehensive insights into primary care, PCBH leadership, and essential BHC competencies, making it an invaluable resource for healthcare professionals. They truly knocked it out of the park (again) with their thorough and practical approach. Loved the resources and application tools for all seasoned providers and newcomers involved in primary care behavioral health. Highly recommend!” (Lesley Manson, PsyD, Co-Author of “Integrating Behavioral Health into the Medical Home” and Clinical Associate Professor, Arizona State University)
“Robinson and Dr. Reiter have done it again – this is the definitive source for anyone looking to learn about, implement, and/or improve their primary care behavioral health practice. A rare mix of science and practice, this book is written in an accessible language, provides practical examples and a plethora of resources to clinicians, and captures the developing and rich scientific background supporting the PCBH model of care.” (Ana Bridges, PhD, Professor & Director of Clinical Training, University of Arkansas)
“Primary Care Behavioral Health has had a critical impact for my primary care providers and the patients they serve; improved access and outcomes are just the beginning. This updated guide from PCBH’s founding experts makes sustained excellence in this work accessible to teams everywhere. Success in integrating behavioral health and primary care requires more than an intention to begin; leaders must also have the vision to grow and manage the model to key success metrics over time. Patti and Jeff’s guide provides critical tools and a roadmap which makes excellence in this work accessible to all.” (Mia Wise, MD, Chief Medical Officer, Kinwell Medical Group)
“The first edition of this book was instrumental in helping me learn about the PCBH model, which has been a wonderful change in the primary care world. Now that the PCBH model is in widespread use, I’m looking forward to reading all the updated material in this newest edition – particularly the chapters on core competencies for primary care providers and the new chapter on leadership. This is a wonderful addition to any primary care provider’s library.” (Kim McDermott, MD, Pediatrician, HealthPoint)
“Drs. Robinson and Reiter have really outdone themselves with this COMPREHENSIVE guide! They truly thought of EVERYTHING with this 3rd edition – from Core Competencies for ALL team members, to an essential repository of tools, hand-outs, fliers, and scripting for all things—implementation to expansion to evolution. I’m better prepared to train the new workforce thanks to Patti and Jeff!” (Bridget Beachy, PsyD, Director of Primary Behavioral Health Care, Community Health of Central Washington)
“I continue to be amazed by the evolutions each edition brings and this one is no exception, as intentional focus on developing PCBH leaders, education for all team members that make PCBH go, and the incorporation of context and fACT is unmatched!!!! Knowing how impactful the first two editions were for my development and understanding of PCBH, my mind cannot wait to see how this updated edition ripples out to the field and future BHCs working in primary care!” (David Bauman, PsyD; Primary Care Behavioral Health Education Director, Community Health of Central Washington)
“Behavioral Consultation in Primary Care by Patricia Robinson and Jeffrey Reiter is essential for trainers, BHCs, and leaders implementing PCBH programs. The 3rd edition provides critical techniques for supporting BHC competency development, practical assessment and intervention strategies, and ensures efficient, patient-centered care. A must-read for the entire team!” (Colleen Clemency Cordes, PhD (she/her/hers), Provost Fellow, Office for Academic Personnel, Associate Dean of Career Track Faculty Success, Clinical Professor, Arizona State University)
“When I reflect on my 20+ year journey in primary care behavioral health, Patti and Jeff were ever-present and always one step ahead. I am so grateful to receive a new edition of their guide to integrating services; a guiding light for us who traveled that “other road”.” (Jeffrey A. Cigrang, PhD, ABPP (Ret, USAF), Dayton Veterans Administration Medical Center, Hematology and Oncology Service)
“In this third edition, Robinson and Reiter created an indispensable blueprint for anyone committed to advancing behavioural and population health in primary care. With real world application, they provide a compelling rationale and practical guidance on foundational concepts for integrated care implementation and sustainability.” (Márcia Sasano (MSc), Psychologist and Primary Care Behavioural Health Master Trainer; President, Thought Collective; Founder, Aotearoa Integrated Care Association (NZ))
“After 20+ years of building integrated care programs and training hundreds of students and professionals, this is still my go-to leading text for the Primary Care Behavioral Health service delivery model. The revision is worth reading even for those inspired by earlier editions, as Patti and Jeff have new ideas and new materials that are sure to open new doors in your integration journey.” (Neftali Serrano, PsyD, Editor of “The Implementer’s Guide to Primary Care Behavioral Health”)
“Behavioral Consultation and Primary Care was our trusted blueprint to build a successful PCBH program in our primary care practices. Because of all the new content, the 3rd edition will be an invaluable resource for new programs as well as for ongoing program development for existing programs.” (Lisa Braverman, PhD, Margaret Cornell, PsyD, and Julie Geiler, MA)
“This book is a crucial resource for behavioral health practitioners working in primary care. This third edition offers highly valuable and cutting-edge updates. The examples and tools used throughout the book provide important tips and direction for both new and more advanced behavioral consultants in primary care.” (Christine M. Hunter, PhD, ABPP, Co-Director, C&C Hunter Consulting)
“This third edition is an indispensable resource for anyone involved in the Primary Care Behavioral Health (PCBH) model. Beginners and experts alike will benefit from the wisdom of these pioneers in the field. The book is full of pearls for the practice, implementation, and evaluation of the PCBH model.” (Jeffrey L. Goodie, PhD, ABPP, Co-author of “Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention, Third Edition”)
“There is something for everyone in this newly rewritten edition of Patti and Jeff’s classic work. For those who are starting from scratch in a site with excellent readiness, the whole development process is here. For those who find themselves in a site that requires a more piecemeal approach, there are specific suggestions, forms, and tools, to help build support, reduce uncertainty, and provide myriad ways to move toward more efficient and effective integration.” (Alexander Blount, EdD, Professor Emeritus of Family Medicine and Community Health, University of Massachusetts, Past Chair, AHRQ National Integration Academy Council, President, Integrated Primary Care, Inc.)
“I highly recommend this book. A must have for clinicians and leadership to maximize effective implementation and sustainment of top-notch primary care behavioral health services. In their 3rd edition, Robinson and Reiter introduced 7 new chapters and strategically updated others to sync with the evolving nature of primary care.” (Christopher L. Hunter, PhD, ABPP, Co-Director, C & C Hunter Consulting, Lead Author: “Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention, 3rd Edition 2024”)
“This updated edition provides the guidance, direction, and hope so desperately needed in primary care. In articulating the potential of primary care, it is apparent that Behavioral Consultation and Primary Care is not just a clear path to achieve behavioral health integration but also Starfield’s tenets of comprehensive, continuous, coordinated, and accessible primary care.” (Andrew Valeras, DO, Dartmouth Health, past President of Collaborative Family Healthcare Association)
“The importance of centering primary care and the value of integrating behavioral health have been well accepted on a global scale. However, effective and efficient implementation of Primary Care Behavioral Health is still a mystery to many, especially those who are new to the practice of integrated care. In this latest and substantially updated edition of Behavioral Consultation and Primary Care: A Guide to Integrating Services, Robinson and Reiter trace the history of PCBH and the dynamic changes in the healthcare environment as context for a pragmatic, real world-based guide to every aspect of model implementation and optimization.” (Natalie Levkovich, Chief Executive Officer, Health Federation of Philadelphia)
“Since this book’s first edition, behavioral health consultation has expanded across the U.S., Canada and beyond. Robinson and Reiter have tracked primary care’s evolution and again masterfully equipped us to meet shifting demands and novel challenges, while maintaining consistency with best practices. Highly valuable for novices and experts!” (Kent A. Corso, PsyD, BCBA-D, Founder, PROSPER)
Table 3.1 PCBH Phases 1-3 Training Goals and Activities
Table 3.2 Foundation Training Topics for all PC and PCBH Staff
Table 3.3 Foundation Training Topics for PCBH Staff
Table 3.4 Phase 3 Webinar Topics Table 3.5 PCBH Goals and Objectives
Table 3.5 PCBH Goals and Objectives
Table 4.1 Additional BHC Job Requirements
Table 4.2 Additional BHC 2 Job Requirements
Table 4.3 Additional Behavioral Health Assistant Skills and Duties
Table 4.4 Areas of Training of Interest for Many Community Support Workers
Table 4.5 List of Possible Tasks for a Behavioral Health Assistant
Table 5.1 Behavioral Health Consultant Core Competency Tool Abbreviated
Table 6.1 Team and Primary Care Provider Core Competency Tool Abbreviated
Table 7.1 Possible Referral Problems or Concerns
Table 7.2 The CCOC Approach to Recalling Core Elements in the BHC Visit Introduction
Table 7.3 Definitions of Key PCBH Fidelity Metrics
Table 7.4 Potential Elements of a BHC template
Table 7.5 Templated Questions for BHC Follow-up Visits
Table 9.2 Interventions Commonly Used in FACT
Table 9.3 FACT Quick Reference Guide
Table 9.4 Cognitive Behavioral Therapy Quick Reference Guide
Table 9.5 Examples of Top Ten Patient Education Handouts
Table 10.1 Example of a Primary Care Behavioral Health Pathway Summary
Table 10.2 Coping Strategy Use Scale
Table 11.1 Leadership Skills for the Behavioral Health Consultant 2
Table 11.2 Generalist Reflections from a New BHC
Table 11.3 Educator Reflections from a New BHC
Table 11.4 Visit Content Reflections from a New BHC
Table 12.1 BHC Sam’s Schedule for Monday
Table 13.1 Codes Commonly Used for PCBH Visits
Table 14.1 Integration Models and their Goals, Population Targets, Benefits, Limitations
Fig. 7.1 GATHER The Essentials of PCBH
Fig. 7.2 Tips for Talking with Patients about BHC Services
Fig. 7.3 Poster Announcement of Start of BHC Services
Fig. 7.4 BHC Visits WHO WHAT WHEN HOW
Fig. 7.5 Half-Page Patient Facing Poster or Handout
Fig. 7.6 BHC Visit Introduction to Patients
Fig. 7.7 PCBH Chart Review Tool
Fig. 7.8 GATHER Reflection and Planning Tool
Fig. 8.1 BHC Start-Up Checklist
Fig. 8.2 Medical Director On-Boarding Meeting Topics
Fig. 8.3 PCBH Director On-Boarding Meeting Topics
Fig. 8.4 Clinic Manager On-Boarding Meeting Topics
Fig. 8.5 BHC Note Sheet for Shadowing PCPs
Fig. 8.6 BHC Note Sheet for Shadowing Team Members
Fig. 8.7 Daily Practice Management Sheet
Fig. 8.8 BHC Request of the Week
Fig. 8.9 New Ways to Use the BHC
Fig. 8.10 Pathway and Class Services Survey
Fig. 8.11 Barriers to Using the BHC Survey
Fig. 8.12 PCBH Integration Tool
Fig. 11.1 BHC Satisfaction Survey