Making Behavioral Health Integration the Standard of Care in California
September 24th, 2026
Key takeaways from CQC’s inaugural Healthcare Leadership Summit, The State of Integration
What does it take to re-imagine the standard of care for an entire state?
At the California Quality Collaborative’s (CQC) inaugural Healthcare Leadership Summit, focused on The State of Integration, more than 100 healthcare leaders from across California came together to consider that question. Providers, health plans, purchasers and policy leaders gathered in San Diego to reflect on lessons from CQC’s Behavioral Health Integration Initiative and, more importantly, identify what it will take to make integrated behavioral health care the norm across California.
The Healthcare Leadership Summit is CQC’s annual, high-impact convening designed to bring leaders from health plans, provider organizations and state government together around a pressing challenge facing California’s healthcare system.
Across the day’s conversations, several themes emerged that can help guide California’s next phase of behavioral health integration.
Fortifying Care Teams
Three of every four primary care visits already include a behavioral health component. At the same time, new quality measures such as depression screening and follow-up are increasing expectations for primary care teams to screen for depression and anxiety, manage mild-to-moderate conditions, coordinate referrals, address social needs, support families and caregivers, and respond when specialty care is not available.
If we don’t provide primary care teams with the infrastructure and workforce needed to integrate behavioral health into primary care, we will not achieve the population health, quality, cost, equity, provider burnout and access goals California is working toward.
Integration is Advanced Primary Care
The day began with a point of broad consensus: behavioral health integration is no longer an innovation. It is an expectation for advanced primary care.
As one provider shared, “We are in a place in California where we know behavioral health integration works. We don’t need proof of concept. And, we’re now scaling it.”
That shift matters. The question is increasingly not whether behavioral health belongs in primary care, but how California can build the financing, workforce, data and operational infrastructure needed to make integration sustainable at scale.
What it Takes to Scale
The work is not over. There are still workforce challenges to solve creatively, financing workflows to simplify and measurement approaches to adapt.
Through CQC’s partnerships across California and nationally, we have developed a rich collection of resources that can help providers, health plans and other stakeholders take the next steps toward spreading integrated care.
But resources alone will not create system change. Progress also requires alignment, shared problem-solving and opportunities for leaders across sectors to learn from one another and act around common priorities. There are many ways to ignite this, including collective action and convening.
From Summit to Action
CQC’s first Healthcare Leadership Summit provided a spark for that collective action, bringing invested stakeholders together to share what is working, tackle persisent challenges and identify opportunities to move forward around a common vision.
The engagement throughout the day made clear that California has the leaders, bright spots and collective energy to continue to work. As one panelist out it, “behavioral health should not be a luxury; it should be available to everyone.”
The Summit was not intended to end the conversation. It was an opportunity to sharpen the questions, cross-pollinate learnings of what is already working and strengthen the connections needed to move from individual bright spots toward a more integrated system of care.
To continue exploring the themes and outcomes highlighted at the Summit, view CQC’s 2025 Behavioral Health Integration Initiative Annual Report.
The Healthcare Leadership Summit will return in 2027 with a new issue at the center of the conversation. Join CQC’s mailing list to be the first to hear about next year’s summit, other opportunities to engage and ways to keep this work moving forward.
Building Behavioral Health Capacity in Every Care Team
May 14th, 2026
In response to workforce shortages in licensed mental health professionals, the California Quality Collaborative (CQC), through its Behavioral Health Integration Initiative, sponsored eight individuals from collaborative participants to complete the Lay Counselor Academy (LCA) in 2025. The 14-week training equips care team members such as community health workers and medical assistants with the skills and knowledge to deliver empathic, evidence-based behavioral health support and expand access to culturally responsive services.
The LCA is designed to build frontline behavioral health capacity in nonlicensed professionals, including community health workers, case managers and other frontline staff. Through the course, participants developed practical, evidence-based mental health counseling skills that strengthened confidence, clarified roles and improved patient engagement.
After the LCA, CQC conducted interviews with participants and their supervisors, as well as reviewed course survey responses. Interviews with participants and supervisors showed that the LCA supported not only skill development, but meaningful shifts in mindset, scope and care delivery. Participants moved beyond task-based support toward more intentional, relationship-centered behavioral health work, while supervisors reported clearer role definition and stronger team integration.
Skills and Confidence in Patient Support
Across the organizations that participated in the LCA, which included Chinese Hospital, Community Memorial Health System, Mallu Reddy MD Inc and Sharp Rees Stealy, the LCA trainees demonstrated stronger communication, active listening and greater confidence guiding patients through behavioral health screenings with empathy and flexibility.
One physician noted their front office team member “has developed great communication skills and rapport with patients,” highlighting a shift from administrative responsibilities to direct patient care alongside clinical staff. At Chinese Hospital, one supervisor emphasized the value of skill development and capacity‑building, describing deeper, more confident patient interactions.
Participants reported increased comfort using open‑ended questions and relational techniques: one trainee entered the program unsure and fearful of saying the wrong thing but left with practical skills and a stronger sense of professional confidence. Participants demonstrated a 30.82‑point increase (on a 0–100 scale) in confidence supporting individuals with mental and emotional health challenges, translating into more grounded engagement and broader readiness across behavioral health needs.
Role Clarity, Reduced Drift
Teams consistently reported that the LCA participation clarified the lay counselor role within care teams equipping staff to engage more intentionally in behavioral health conversations while reinforcing clear role boundaries. Improved clarity supported cross‑team collaboration and shared accountability for behavioral health support, reducing uncertainty about scope while strengthening integration within clinical workflows.
The LCA not only strengthened existing roles, but also enabled staff to assume new clinical and project leadership responsibilities. One trainee is launching an initiative supporting patients with schizophrenia, while another is leading a brain health screening project that includes memory assessments and referral protocols. In collaboration with leadership, trainees are identifying patients in need and helping design workflows that connect patients with social work or appropriate levels of care. These developments underscore the return on investment of structured behavioral health training and sustained mentorship.
From Fixing Problems to Guiding People
Participants described a meaningful mindset shift moving away from “fix” problems and toward guiding patients through reflection and emotional regulation. Grounding techniques, mindful breathing and presence became central tools, particularly during intake and crisis situations.
One participant shared:
“I’ve learned the value of just being present—not rushing to solve, but helping others become better versions of themselves.”
Across all participating sites, cultural humility emerged as a foundational principle. Trainees adopted a “know‑nothing” mindset, approaching each interaction with openness and curiosity. One participant reflected on uncovering biases around food assistance rooted in childhood experiences, noting that the course reinforced how assumptions shape care and how self‑awareness is essential to effective behavioral health support.
Why This Matters for California
California faces a persistent behavioral health workforce shortage, rising demand for services, and deep inequities in access, particularly in community‑based and safety‑net settings. The LCA demonstrates a scalable approach to expanding behavioral health capacity by equipping trusted, nonlicensed frontline staff with practical, evidence‑based skills.
By strengthening confidence, clarifying roles and supporting integration within care teams, the LCA helps organizations respond to behavioral health needs without relying solely on licensed clinicians. This model aligns with California’s goals to improve access, advance equity and build a more sustainable behavioral health workforce, especially in underserved communities where trusted relationships are critical to engagement and outcomes.
Defining Behavioral Health Integration in Advanced Primary Care
January 27th, 2026
A new CQC issue brief synthesizes insights from national and California stakeholders to clarify what behavioral health integration looks like in practice to better support statewide investment and widespread adoption.
Advanced primary care is California’s standard of care, placing patients at the center of every interaction and delivering high-quality care through patient-centered, results-oriented measures. Behavioral health integration is an essential attribute of high-performing primary care practices, where care teams address patients’ physical, behavioral and social needs in a coordinated way.
While there is broad agreement across stakeholders on the importance of behavioral health integration, a key barrier to widespread adoption in California has been a lack of consensus on how it should be defined in practice.
Behavioral Health Integration is Advanced Primary Care
The California Quality Collaborative (CQC) works alongside providers, payers, purchasers and the state to advance behavioral health integration through its Behavioral Health Integration (BHI) Initiative, which includes learning collaboratives, multi-payer collective solutions and technical assistance. This work supports primary care practices as they integrate behavioral health services in ways that are practical, sustainable and responsive to patient needs.
Through this work CQC has observed that a lack of statewide consensus on how BHI is defined and interpreted has made it challenging to incentivize and sustain the clinical work. To address this gap, CQC released an issue brief, Aligning for Impact: A Shared Definition and Multi-Stakeholder Insights on Behavioral Health Integration in California. The paper synthesizes insights from more than 20 key informants across California to clarify what BHI means in practice, and lessons around multi-stakeholder engagement supporting BHI from Colorado, Pennsylvania, Texas and Virginia.
Key Themes from Stakeholder Perspectives
Across interviews with health plans, provider organizations, state agencies and policy leaders, several themes emerged:
- Behavioral health integration is part of advanced primary care.
Stakeholders consistently emphasized that behavioral health services, such as screening, diagnosis and treatment for conditions like depression, anxiety and substance use, are fundamental components of comprehensive primary care.
- Shared definitions matter.
Without common language and expectations, efforts to advance integration risk fragmentation. By embedding the definition in payment models, regulatory frameworks and implementation programs, California can accelerate consistent, scalable and sustainable integration of behavioral health into primary care to advance whole-person care statewide.
- Multi-stakeholder alignment is essential.
No single group can advance behavioral health integration alone. Progress depends on coordination across multiple health care stakeholders and prioritization of their shared goals.
Explore the full issue brief.
The State of Integration: BHI Health Care Leadership Summit
CQC will host the BHI Health Care Leadership Summit September 16-17 in San Diego, convening health care leaders from across the delivery system to advance integration of behavioral health into primary care and move from shared understanding to concrete, statewide action. Be part of the Leadership Summit.