Findings converge with previous research, showing that approximately one quarter of all primary care visits involve a discussion of behavioral, developmental, or emotional concerns. Moreover, this study is the first to document the specific impact of such concerns on pediatricians' time, often sited as a key reason why they struggle to effectively identify and treat behavioral concerns presenting in primary care. These data provide a starting point for controlled studies, including comparisons of rural versus urban samples and the impact of various collaborative models of care.

The Primary Care Behavioral Health (PCBH) model of service delivery is being used increasingly as an effective way to integrate behavioral health services into primary care. Despite its growing popularity, scientifically robust research on the model is lacking. In this article, we provide a qualitative review of published PCBH model research on patient and implementation outcomes. We review common barriers and potential solutions for improving the quantity and quality of PCBH model research, the vital data that need to be collected over the next 10 years, and how to collect those data.

These data replicate previous findings showing high rates of parent-rated psychosocial problems in pediatric primary care. Given the prevalence of these problems in primary care and parents' frequent help seeking in this setting, more research is needed on innovative approaches to integrated care in rural settings.

The time savings demonstrated on days when the consultant was available point to the efficiency and potential financial viability of this model. These results have important implications for the feasibility of hiring behavioral health professionals in a fee-for-service system. They have equally useful implications for the utility of moving to a bundled system of care in which collaborative practice is valued.

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The results provide directions for future research as well as the translation of pill swallowing interventions to primary care.

Many barriers have been proposed to explain why rural residents do not receive adequate behavioral health services even though the need for such services is great. One solution proposed to address the need in rural settings is to offer these services within primary care. This study was designed to examine child attendance rates at integrated behavioral health clinics (BHCs) in rural primary care offices. Referral forms for all children recommended to attend three BHCs were reviewed by research assistants. Attendance at appointment, length of time on waiting list, severity of the prob-lem, referral reasons, and parent stress were coded. Across the three BHCs, nearly 88% of children referred were scheduled for an initial appointment, and 81% of children referred for behavioral health services attended the initial appointment. Follow through for children referred by their primary care physician to a colocated behavioral health specialist in rural settings was much higher than found in other studies. These data suggest that in rural settings integrated care may increase access to and continuity of care for a population that is often neglected.

In this article, we demonstrate how an implementation science (IS) framework is coupled with the measurement of implementation outcomes to effectively integrate evidence-based family interventions in primary care. The primary care environment presents a number of challenges for successfully integrating such interventions. However, IS methods can improve the prospect of successfully implementing a new intervention while simultaneously and rigorously evaluating the impact on salient outcomes. We use our experiences across two pilot trials where the Family Check-Up, an evidence-based family intervention, was integrated into primary care. In these pilot trials, the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and the Proctor et al. taxonomy of implementation outcomes were used to guide the implementation and evaluate its success. Grounding our presentation in our pilot work offers an illustration of applying the EPIS framework and outcomes measurement to real-world problems and contexts. When embarking on new efforts to integrate behavioral interventions into healthcare settings, the application of IS frameworks and measurement strategies can create generalizable knowledge that substantively contributes to a sparse literature. Today, those “in the trenches” who are translating evidence-based interventions to their setting can contribute to the corpus of research in integrated care by using IS methods to plan a new program and evaluate its feasibility, adoption, and reach.