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The Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ)

The PPAQ is a 48-item self-report measure designed to assess fidelity to the model of integrated primary care known as Primary Care Behavioral Health (PCBH), or Co-located, Collaborative Care (CCC).



Purpose and Function

The PPAQ uses a 5-point, Likert-type response scale ranging from “never” to “always.” The PPAQ includes essential items, which measure behaviors that are highly consistent with the PCBH/CCC model, and prohibited items, which measure behaviors that are inconsistent with the PCBH/CCC model. When used as a self-assessment, PC-MHI providers can evaluate their usual clinical practices across four domains of practice: Clinical Scope and Interventions; Practice and Session Management; Referral Management and Care Continuity; Consultation, Collaboration, and Interprofessional Communication.

The PPAQ has also been converted into a user-friendly self-assessment toolkit. The Excel-based PPAQ toolkit automatically scores the PPAQ items and includes interpretation guides as well as suggestions for how to apply the results of the self-assessment to improve integrated care practice. There are three versions of the toolkit available: one for VA-based integrated care providers; one for integrated care providers practicing in non-VA settings; and the latest version applicable to both VA and non-VA providers which will compare PPAQ scores at two time points (e.g., baseline and follow-up).

All PPAQ products are free to use for personal reference, training, or quality improvement activities. Please contact us at ( to discuss options if you would like to use the PPAQ in research.

Additional Information

For additional information about the PPAQ, contact:

Dr. Gregory P. Beehler
Associate Director for Research & Clinical Research Psychologist
VA Center for Integrated Healthcare
Phone: 716-862-7934


The PPAQ has been developed and validated through a series of studies described in the following publications:

Beehler, G. P., Funderburk, J. S., Possemato, K., & Vair, C. (2013). Developing a measure of provider adherence to improve the implementation of behavioral health services in primary care: A Delphi study. Implementation Science, 8, 19. (Link to PubMed Abstract)

Beehler, G. P., Funderburk, J. S., Possemato, K., & Dollar, K. (2013). Psychometric assessment of the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ). Translational Behavioral Medicine, 3, 379-391. (Link to PubMed Abstract)

Beehler, G. P., Funderburk, J. S., King, P., Wade, M., & Possemato, K. (2015). Using the Primary Care Behavioral Health Provider Adherence Questionnaire (PPAQ) to identify practice patterns. Translational Behavioral Medicine, 5, 384-392. (Link to PubMed Abstract)

Beehler, G. P., & Lilienthal, K. R. (2017). Provider perceptions of an integrated primary care quality improvement strategy: The PPAQ Toolkit. Psychological Services, 14, 50-56. (Link to PubMed Abstract)

More about PPAQ

Learn more about the research-clinical partnerships that led to the development of the PPAQ in a presentation to the Collaborative Family Healthcare Association: