Tai M. Paquin, LMSW, LADAC

BH2I grantees have already discussed sustainability and received resources on this topic. A recently posed question was: “If the funding disappeared tomorrow, would integrated care continue? Would your agency be resilient enough to sustain it?” Now is a suitable time to look at how integrated behavioral health works in real life. Ask what would happen if a key resource changed.

Organizational resilience does not mean you must keep every BH2I job or activity the same. It means your agency can handle change. This includes changes in funding, staffing, leadership, or patient need. Even so, you can keep primary care and behavioral health connected. Pressure points differ across rural and urban Tribal clinics. You may face a small workforce, long distances between services, high patient volume, many referral systems, or trouble coordinating programs. Resilience means you adapt to your setting. At the same time, you keep the most essential functions running (Fridell et al., 2020).

Define What Must Continue

Before discussing funding sources, identify the integrated-care functions your patients and community cannot afford to lose. These may include recognizing behavioral health needs in primary care, responding to risk, connecting patients to services, coordinating care, and maintaining trusted community referral pathways.

If resources decrease, the delivery method may need to change. Based on local realities, your clinic might

  • modify warm handoffs,
  • use telehealth or regional partners,
  • focus on limited capacity on higher-risk needs, or
  • transfer coordination duties to another role.

Adaptation can support sustainment when it protects the intervention’s purpose and fits the changing local context (Chambers et al., 2013).

Ask your team: If we could protect only three functions of integrated care, which three would matter most to our patients and community?

Locate the Point Where the System Would Break

Now test those functions against one realistic disruption: a funded position ends, a key champion leaves, leadership changes, or demand exceeds available behavioral health capacity. You can follow the effect through your actual setting. For instance, if a care coordinator left, who would monitor referrals? If no local behavioral health provider were available, would staff know the telehealth or regional pathway? If several outside providers were involved, who would coordinate follow-up? If an outreach position ended, who would maintain trusted relationships and communicate how to access services?

Pay particular attention to functions that depend on:

  • one person’s knowledge or personal relationships.
  • an informal agreement between departments.
  • grant-funded time that is not reflected in a permanent role; or
  • a workflow that works only when the clinic is fully staffed.

These are your agency’s pressure points. Fixing one may help more than adding a new goal to your sustainability plan. Practical responses include naming a backup person, writing down who can make decisions, and cross-training staff. You can also simplify a workflow, so it works with the resources you have. Research on integrated behavioral health backs this up. It points to strong leadership, staff training, better scheduling, and billing systems, not just funding, as key to lasting change (Nguyen et al., 2025).

Decide How You Will Adapt

For the disruption you selected, decide what your agency would protect, modify, transfer, or discontinue. Be specific about who can make the decision and who will carry it out. Without that clarity, small reductions can accumulate until behavioral health is no longer meaningfully integrated with primary care.

Complete the statement below. Bring it to an upcoming TA session or office-hours visit. Use the discussion to talk about a weak spot in your rural or urban setting. This could be sharing a task with someone else, changing a primary care workflow, coordinating referrals outside your clinic, or keeping up an important community connection.

Complete this resilience statement:

If __________ changed tomorrow, our ability to provide __________ would be at risk. We would protect the function by __________. The person authorized and responsible to act is __________.

As CY5 continues, the goal is not to preserve every BH2I activity exactly as it exists. Your organization should be able to adapt, whether you serve a rural or urban Tribal community. You should not lose the integrated-care functions your patients depend on. Use the remaining months to find one area of weakness. This could be in staffing, funding, leadership, or community connections. Then take one clear step to make it stronger. Your TA lead and evaluation team can help. They will help you turn that risk into a real action for your sustainability plan.

References

Chambers, D. A., Glasgow, R. E., & Stange, K. C. (2013). The dynamic sustainability framework: Addressing the paradox of sustainment amid ongoing change. Implementation Science, 8, Article 117. https://doi.org/10.1186/1748-5908-8-117

Fridell, M., Edwin, S., von Schreeb, J., & Saulnier, D. D. (2020). Health system resilience: What are we talking about? A scoping review mapping characteristics and keywords. International Journal of Health Policy and Management, 9(1), 6–16. https://doi.org/10.15171/ijhpm.2019.71

Nguyen, A. M., Klege, R. A., Menders, T., Verma, C., Marcello, S., & Crabtree, B. F. (2025). Strategies for implementing integrated behavioral health into health centers. Journal of the American Board of Family Medicine, 37(5), 833–846. https://doi.org/10.3122/jabfm.2023.230417R1