# Where Is the Client in Client-Centered Care? Centering the Experiences of Integrated Care Among Black Women in Public Health Settings

## TL;DR

The study highlights how integrated behavioral healthcare in public health clinics helps Black women with low income access mental health care, but ongoing support and follow-up are often missing, leaving needs unmet.

## Contribution

The study reveals that qualitative insights uncover unmet mental health needs and the importance of person-centered care in integrated behavioral healthcare for Black women.

## Key findings

- Quantitative metrics failed to capture nuanced experiences and unmet mental health needs of Black women in integrated care.
- Clients emphasized the importance of person-centered care and closed-loop referrals to ensure effective mental health support.
- Many clients 'fell through the cracks' after referrals, leading to persistent unmet needs and perceptions of institutional betrayal.

## Abstract

What are the main findings?
Quantitative satisfaction and cultural responsiveness metrics failed to capture nuanced integrated behavioral healthcare (IC) experiences and persistent unmet needs, which were revealed through qualitative inquiry.IC in public health clinics enabled critical access to mental healthcare for Black women with low-income and economically marginalized status (LIEM), but mental health needs remained unmet without follow-up and more hands-on support.

Quantitative satisfaction and cultural responsiveness metrics failed to capture nuanced integrated behavioral healthcare (IC) experiences and persistent unmet needs, which were revealed through qualitative inquiry.

IC in public health clinics enabled critical access to mental healthcare for Black women with low-income and economically marginalized status (LIEM), but mental health needs remained unmet without follow-up and more hands-on support.

What are the implications of the main findings?
Clients described person-centered (rather than client-centered) care as crucial for positive IC experiences, which requires providers and healthcare systems to holistically understand clients and to follow up with appropriate action.While IC facilitates essential mental healthcare access for Black women with LIEM status, its equity-promoting potential is undermined without closed-loop referrals, which may inadvertently compound institutional harm.

Clients described person-centered (rather than client-centered) care as crucial for positive IC experiences, which requires providers and healthcare systems to holistically understand clients and to follow up with appropriate action.

While IC facilitates essential mental healthcare access for Black women with LIEM status, its equity-promoting potential is undermined without closed-loop referrals, which may inadvertently compound institutional harm.

Background/Objectives: Integrated behavioral healthcare (IC) in public health settings may be optimal for advancing mental health equity among low-income and economically marginalized (LIEM) Black women. This study explores the provision of mental health services in public health clinics and assesses client experiences and recommendations for healthcare system improvement. Methods: Black women receiving mental health services in public health clinics completed surveys (n = 81) and in-depth interviews (n = 8, follow-up: n = 7). Analysis included descriptive statistics, interpretive phenomenological analysis, and member checking (n = 4). Results: Survey respondents reported high perceptions of providers’ cultural responsiveness (M = 13.35/14) and high satisfaction with IC services (M = 4.48/5.0). However, qualitative interviews revealed that these scores may be relative to low baseline expectations for care. Across interviewees, personalized care emerged as critical for high-quality IC service delivery, and pregnant interviewees reflected on the importance of IC during pregnancy, which can compound prior mental health concerns. Notably, positive IC reflections waned over time, and 75% of interviewees “fell through the cracks” between receiving referral for and accessing community resources, resulting in persistent unmet mental health needs. This experience, paired with a lack of systemic follow-up from the public health department, was perceived as a form of institutional betrayal. Conclusions: While IC in public health settings holds promise for health equity, results underscore the need for person-centered care that prioritizes authentic screening, warm handoffs, and closed-loop referrals—particularly for LIEM Black women, who frequently have prior experiences with fragmented healthcare systems. To ensure IC meets client needs without causing unintentional harm, healthcare systems should co-design solutions with clients.