IN DEPTH ARTICLE: COMMENTARY Behavioral Health and Primary Care Integration in Ohio’ s Psychiatry Residency Training Eric Reed 1 & Dushka Crane 2 & Dale Svendsen 2 & Lon Herman 3 & Brian Evans 4 & Julie Niedermier 2 & William Resch 5 & Robert Ronis 6 & Joseph Varley 3 & Randy Welton 7 Received: 12 May 2016 /Accepted: 13 September 2016 # Academic Psychiatry 2016 Integration of behavioral health and primary care is described as a gold standard for improving quality of care [1, 2]. Widespread consensus (e.g., World Psychiatric Association, June 2015), backed by a growing body of research, suggests that integration is an effective strategy for achieving the Institute for Healthcare Improvement’ s triple aim of (1) im- proving symptomatology, functioning, and quality of life out- comes; (2) reducing the high cost of care; and (3) improving patient satisfaction with care [3–5]. Within psychiatry, integra- tion of care has been identified as a core strategy to address the shortage of psychiatric care [6] and establish a new role for psychiatry in health care reform [2]. Integrated care offers opportunities for mental health practitioners to expand their role as leaders of interdisciplinary treatment models associated with patient-centered medical homes and health home models. Collaborative care offers an opportunity to reach a larger pop- ulation of patients and play a vital role in improving outcomes in new value-based systems of care. Psychiatry has also been called upon to take a more active role in managing routine medical problems and health risks posed by psychiatric med- ications, thus avoiding the cost of duplicate appointments, increasing access to care, and decreasing delays in receiving care [2, 7, 8] (Table 1). Through the Affordable Care Act (ACA), new programs and policy initiatives have paved the way for integration. The Substance Abuse and Mental Health Services Administration (SAMHSA) has provided over 100 grants for behavioral health care integration, along with support and technical assistance. The Behavioral Health Homes State Plan Amendment and expansion of community health centers have provided new funding streams for the sustainability of the model. More re- cently, the transition to pay-for-performance models of reim- bursement through system innovation grants and managed care has added incentive to integrate care as a means of improving patient outcomes and reducing costs. As these initiatives come to fruition, concern is growing about the workforce for integrated care. Not only does Medicaid expansion increase demand for primary and behav- ioral health care, but integrated care also requires a set of skills and competencies unlike those of traditional “silo” care delivery models [9]. In an effort sponsored by SAMHSA, Hoge and colleagues [10] identified nine categories of core competencies to guide educators in developing curricula and training pro- grams and help health care providers establish new job descrip- tions, education, training, and performance review: (1) interper- sonal communication; (2) collaboration and teamwork; (3) screening and assessment; (4) care planning and coordination; (5) intervention strategies; (6) cultural competence and adapta- tion; (7) system-oriented practice; (8) practice-based learning and quality improvement; (9) and informatics. These compe- tencies apply to all disciplines; additional work has focused on competencies specific to psychiatry [2, 11, 12]. A recent report issued by the American Psychiatric Association (APA) Council on Education and Lifelong Learning recommends teaching in- tegration through integrated clinical experiences in graduate medical education (GME) and continuing medical education * Eric Reed ereed@psych.uic.edu 1 University of Illinois at Chicago, Chicago, IL, USA 2 The Ohio State University, Columbus, OH, USA 3 Northeast Ohio Medical University, Akron, OH, USA 4 University of Cincinnati, Cincinnati, OH, USA 5 Ohio University, Athens, OH, USA 6 Case Western Reserve University, Cleveland, OH, USA 7 Wright State University, Dayton, OH, USA Acad Psychiatry DOI 10.1007/s40596-016-0623-y