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

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.