How to Integrate Behavioral Health into Behavior Change Programs

June 28, 2023

Dylan Staniszewski

The movement to ‘go digital’ in healthcare has accelerated greatly in recent years, especially given that the pandemic created more barriers to attending to our health through in-person visits. One byproduct of this movement is that we are seeing a lot more digital health programs in the market that are aimed at engaging their members in obtaining sustained behavior change to achieve their health goals. Behavior change refers to adjusting or modifying a behavior or behaviors to affect how you function, often for the goal of self-improvement or self-care.

Behavior change programs focus on supporting behaviors that help prevent and manage chronic disease, like medication adherence, physical activity, diet, improving sleep, managing stress and more. Efforts to make change can impact our mood and stress levels, and as part of achieving physiological health, we need to attune to our emotional and mental well-being.

As a psychologist, I am especially interested in getting people access to tools that help them maintain the change they work hard to achieve, and I believe digital health programs should strive to meet behavioral health needs in conjunction with behavior change efforts to support whole-person health for their members.

The American Medical Association defines behavioral health care as the prevention, diagnosis, and treatment of “mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms.” These could include conditions like anxiety, depression, stress, weight loss, diabetes management, substance use, high blood pressure, and more. Given the impact of these behavioral health concerns on chronic disease management and the evidence on the benefits of behavioral health integration (see here and here), a growing number of digital behavior change health programs are looking to integrate behavioral health care into their offerings.

However, this is much easier said than done. The key is unlocking strategies to implement effective behavioral health interventions by addressing a person’s behavior change goals holistically, all while ensuring equitable access to high-quality care. To do this in the digital health space, we can directly apply many of the learnings and research conducted in the in-person healthcare world. Here are three core strategies for optimizing health outcomes through behavioral health care.

Top Strategies for Integrating Behavioral Health Care

Assessment

In order to address the behavioral health needs of members, behavior change programs first need a way to assess what those unique needs are. Building in comprehensive screening tools and measurement metrics (like the four-item Patient Health Questionnaire or other standardized screeners) that gauge the following, can identify where to leverage and tailor behavioral change efforts:

Mental and emotional well-being
Motivation and energy for change
Social drivers of health

Incorporating initial assessments can also lead to early identification of users who have higher acuity needs. Furthermore, administering assessments subsequently at regular cadences also allows care teams and members to track improvements and progress over time, and signal when and how much to integrate behavioral health goals into their care journey.

As a provider, I have personally seen the benefit of incorporating measurement in care, as it provides a quantifiable way to reflect progress — or lack thereof — in a person’s journey, and thus can serve as a tool for subjective feedback on what is working and what needs to change. In fact, I would utilize symptom measures periodically in therapy as a “personal scientist” approach.

For instance, I recall showing patients who went through trauma processing where they rated their symptoms in the beginning of treatment versus now, and that visual representation of the heavy work they engaged in had a profound impact on validating the amount of time and energy they put into themselves.

Education & Intervention

As a provider, it can feel obvious that someone would need to work on their well-being holistically, but when someone is connecting to care to get support for changing their diet or physical activity, they may not immediately recognize how that relates to their mood. Thus, behavior change programs and care teams need to provide members with relevant, research-based content so that members can understand the underlying value of addressing their behavioral health to reach and maintain their overall health goals (source).

However, providing users articles of information will not necessarily prompt change. For instance, sharing the fact that sleep hygiene can benefit overall health is interesting, but creating a tool to help users track their sleep and identify habits they can build into their routine is much more effective. Thus, programs need to make content accessible and engaging, with practical and/or interactive content on building skills and teaching strategies to maintain healthier lifestyle changes. These skills include, but are not limited to:

Developing healthy sleep habits
Engaging with mindfulness tools
Building distress tolerance
Regulating emotions
Increasing awareness of mood states and impact on behaviors
Reflecting on unhelpful thinking patterns, and more.

By integrating behavioral health practices that foster self-reflection on the connection between thoughts, emotions, and behaviors, programs and their care teams can support their users’ competence and autonomy in better managing their health-related actions (source).

Support

In line with measuring behavioral health needs and increasing education and skill-building, members are also impacted by their level of social connectedness and support to implement health changes.

Social support can mean both close relationships that a member identifies as supportive, as well as larger structural social environments (e.g., school, workplace, etc.) that may impact a member’s ability to sustain healthy behaviors. If users are feeling isolated in their health journey, they are less likely to obtain and sustain health outcomes. Thus, recruiting preferred social supports into users’ journeys can promote a sense of connection and motivation to bolster health-related actions (source). Programs can also connect peer groups of users that are experiencing the same struggles and are focusing on similar goals (e.g., a self-care community) to encourage each other in their individual journeys.

It is also important to navigate any limits or challenges users may face in maintaining healthy changes within their broader social system. This last point is especially important in digital platforms because, as we know —

making change is hard and having people in your corner rooting for you makes a difference.

In in-person therapeutic sessions, I was able to support individuals one-on-one and witness the change happening in the room. In the digital world, we need to unlock the ways in which human-led support can facilitate a connection that helps a member flourish in their journey, and increases their appetite to engage in healthy changes. Personally, the last thing I would want to do when practicing skills to make a lifestyle change is interact solely with a chatbot!

Incorporating health coaches to provide personalized support, like the practical elements of brainstorming ways to work through difficulties or obstacles, collaborate on finding coping strategies for stress management, or provide valuable emotional support — including validation and encouragement — can further strengthen user commitment and success in achieving health goals.

Additionally, we know that mental and emotional well-being are important pieces of whole-person health, and not everyone signing up for behavior change programs has access to external professionals to meet behavioral health needs. In order to support individuals comprehensively, it is crucial to build in clinical training on how to apply a behavioral health lens when working with members, as well as workflow considerations to ensure programs can enable coaching to be personalized in this way (source).

This is especially true for less acute cases where members could use the support of behavioral health coaching and develop healthy habits that will impact their mood and mindset.

Further, not every member will be as immediately impassioned to focus on this aspect of their health journey, and coaching through a behavioral health lens can be a great way to fold in more ambivalent individuals.

On the other hand, some members might have higher-level behavioral health needs. Leveraging licensed specialists that can consult with care teams and oversee more complex symptoms some members may face when coping with chronic condition management helps ensure that people who can use behavior change programs effectively can maximally do so. It is also important for care teams to recognize when individuals have acute needs that require a higher level of care beyond what can safely be provided within their platform. Care teams can support helping these individuals navigate to external mental healthcare professionals, like therapists, psychologists, and psychiatrists. If users are already connected to external providers, facilitating collaboration of care that bolsters information tracking and exchange as well as efficient communication within the care team is vital for members to be treated holistically in their health.

Conclusion

Responding to behavioral health needs is an essential part of addressing disease management and prevention comprehensively. Psychological stress often accompanies and exacerbates chronic illness and disease and thus needs to be assessed and addressed within care approaches to thoroughly manage members’ health goals.

An integrated approach allows programs to navigate whole-person health in that it does not just focus on behavior, but also connects users’ physical health with their mental and emotional well-being, and acknowledges the impact of their social environment on their health maintenance goals. Behavior change programs will benefit from continuing to ideate on ways to comprehensively and effectively incorporate behavioral health care to meet the holistic needs of their users to support them in reaching better health outcomes.