Graduation Date

Fall 12-16-2016

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Promotion and Disease Prevention Research

First Advisor

Shinobu-Watanabe Galloway

Second Advisor

Ghada Soliman

Third Advisor

Melissa Tibbits


Mental, emotional, and behavioral issues in children are a significant concern for the children, their families, and society. Despite the existence of evidence-based treatments, the success of behavioral healthcare to meet the needs of these families will require high quality communication and relationships across a wide range of stakeholders. Integration of care represents a patient-centered strategy to unify these stakeholders into a single cohesive care team. The purpose of this dissertation is to define the behavioral healthcare team in integrated primary care for children in terms of the functional roles involved and to evaluate the quality of relationships and communications between them. Using a pragmatic mixed method approach involving interviews (n=16) and a survey (n=154) of primary care and behavioral health providers at 48 co-located clinics across the state of Nebraska supplemented by a pilot test survey of (n=16) parents, this project found that there were 8 key roles involved including: families, primary care providers, behavioral health specialists, care coordinators, psychiatric providers, primary care nurses, school personnel, and government agencies. Further, it was found that although co-location did not always equate to full integration, it was associated with significantly better relationships and communication between providers which were in turn positively correlated with their perceived ability to meet the needs of their patients with behavioral health concerns. These findings provide additional justification for the co-location of behavioral health providers into primary care clinics and offer a number of actionable suggestions to overcome interpersonal and system barriers to teamwork within co-located clinics.