Degree Name

PhD (Doctor of Philosophy)



Date of Award


Committee Chair or Co-Chairs

Jodi Polaha

Committee Members

Thomas Bishop, Chris Dula, Matthew McBee


Decades of research have shown that there are significant advantages to maintaining close communicative and collaborative relationships between primary care and behavioral health providers. Fiscal, structural, and systemic barriers, however, often restrict the degree to which such interprofessional collaboration can occur. In the present study the authors examined relationships between primary care clinics in the Appalachian region’s characteristics (i.e., clinic type, rurality, and clinic size), barriers (i.e., fiscal, structural, and systemic) reported to using increased collaboration, and the level of collaboration used at a particular clinic.

For the present study 136 surveys were completed by providers working in primary care practices across the Appalachian region of Tennessee. The results showed that only about one fifth of the primary care clinics in Appalachian Tennessee reported engaging in moderate to high levels of primary care behavioral health (PCBH) collaboration (e.g., colocated or integrated models of care). Among community health clinics, however, nearly half reported moderate or high levels of collaboration.

The findings of this study underscore the importance policy change (e.g., changes in reimbursement patterns, increases in incentives, introduction of PCBH models in training programs) in facilitating the uptake of high levels of PCBH collaboration in Appalachian Tennessee (especially in regards to nonpublicly funded clinics). Further, the methodology used in this study could provide policymakers and researchers in other regions of the U.S. with a means for obtaining baseline data regarding local trends in PCBH collaboration and could serve as first step in developing a standardized methodology for comparing the overall uptake of PCBH collaboration models across regions.

Document Type

Dissertation - unrestricted


Copyright by the authors.