Community health centers serve as the primary medical home for over 27 million vulnerable Americans.

Behavioral health conditions are now the most common problems these centers treat, even more than diabetes or hypertension. At the same time, many FQHCs face chronic challenges in engaging these patients. Barriers like transportation issues, work schedules, stigma, and social needs cause patients to miss appointments or drop out of care. Severe workforce shortages compound the problem: roughly 77% of FQHCs report shortages of mental health providers, and most struggle to schedule timely behavioral health follow-ups. In short, while demand for behavioral health services is surging, keeping patients actively engaged in treatment remains difficult.

This brief aims to equip FQHC leaders with research-backed strategies to increase patient engagement in behavioral health.

We summarize key findings on evidence-based approaches, from culturally competent care to digital tools, that help retain and empower patients. Our goal is to provide actionable insights so FQHCs can strengthen patient-provider relationships and improve outcomes in mental health and substance use care. By understanding what works, leaders can proactively mitigate dropout and care gaps among their behavioral health populations.

Patient-Centered, Holistic Care

Engagement improves when care addresses patients’ broad needs. FQHCs that offer value-added services (for example, wellness programs, nutrition counseling, social support, or mental health coaching) signal a commitment to patients’ overall well-being. Studies show this holistic approach makes patients feel “genuinely cared for,” increasing loyalty and follow-up. Similarly, engaging community health workers (CHWs) and peer supporters builds trust. CHWs bridge cultural or language gaps and connect patients to needed resources, which fosters confidence and keeps patients in care.

Inclusive Communication and Feedback

Encouraging open dialogue and shared decision-making empowers patients. FQHCs that actively solicit and act on patient feedback show they value patients’ voices. For example, one report notes that prioritizing patient input “fosters trust and engagement” and can boost retention. Training staff in cultural competency and using interpreters or translation tools also make diverse patients feel understood and respected, further improving participation in care.

Technology-Enabled Engagement

Digital tools extend reach and simplify access. The widespread adoption of patient portals, secure texting and telehealth has been embraced by FQHCs: in 2024 about 88% offered telehealth for substance use treatment and 70% for mental health counseling. Telehealth visits and remote check-ins can keep patients connected between office visits, a proven strategy especially in rural areas. Automated reminders (via text, email or phone) tied to EHR registries also help prevent “silent attrition” by flagging patients due for appointments or screenings.

Proactive Outreach and Data Use

Treating engagement as a metric drives improvement. FQHCs using data systems can identify patients who have fallen out of care and reach out directly. For example, clinics that generate lists of patients overdue for follow-ups and then deploy outreach (phone, mail, or in-person) see higher recapture. One advice report recommends building patient “recall” workflows in the EHR and training staff to schedule the next visit at check-out. More advanced tools are emerging: FQHCs are experimenting with AI-driven chatbots and predictive analytics to engage high-risk patients. Early evidence shows that AI-enabled chatbots, used in English or Spanish, successfully prompted patients about preventive and behavioral health needs and overcame access barriers like transportation or literacy. Machine learning systems can also flag patients likely to benefit from outreach and then automatically send tailored health messages or appointment reminders.

Patient Engagement in Governance

Giving patients a seat at the table can improve services. Many FQHCs now involve patients in advisory councils or even board membership. Research finds that when patients help shape clinic policies or quality improvement projects, clinics gain insights that align services with patient needs. In practice, this means creating patient advisory committees where members who are chosen to represent the clinic’s population provide feedback on clinic operations and outreach strategies. Involving patients at both high-level (governance boards) and hands-on (PACs) levels has been shown to improve clinical programs and patient experience.

Patient engagement in behavioral health is a critical challenge for FQHCs, but one that can be addressed with a mix of strategies.

Bringing the patient's voice into decision-making, offering holistic and culturally sensitive support, leveraging telehealth and automated outreach, and deploying new AI tools all help strengthen the patient-provider partnership. Research consistently shows that engaged patients adhere better to treatment plans, drop out less often, and achieve better outcomes. For FQHCs, improving engagement in behavioral health not only boosts health outcomes but also enhances productivity and community trust. In summary, focusing on patient-centered communication and support, combined with thoughtful use of technology and data, can significantly mitigate the effects of missed appointments and disengagement in FQHC behavioral health programs.

In the full research article we explore these themes in depth, including:

• The landscape of behavioral health demand and FQHC challenges
• Patient-centered care practices (peer support, cultural competence, patient councils)
• Technology solutions (telehealth, patient portals, AI chatbots)
• Proactive outreach and data-driven recall workflows
• Implementation considerations (staff training, workflow changes)
• A brief look at emerging AI opportunities. The article provides evidence-based examples for each strategy and concludes with actionable recommendations.

At Peregrine Health, we believe behavioral health engagement is one of the defining equity challenges in community care today. If a patient walks out after their first therapy session and never comes back, we’ve missed an opportunity to change a life. And when that happens at scale, it erodes trust in the entire system.

We work side-by-side with FQHCs trying to navigate this reality. We’ve seen how hard it is to keep patients in care, especially when they're facing transportation barriers, stigma, or long waitlists. And we’ve also seen what works: community health workers who bridge the gap, patient portals that remove friction, and clinics that take the time to listen and adapt based on patient feedback.

This report reflects the heart of our mission: to ensure that vulnerable populations receive consistent, high-quality care. By focusing on evidence-based engagement strategies, we’re not just sharing best practices, we’re investing in the long-term sustainability of FQHC behavioral health services. Because every patient who stays connected is a step closer to a healthier, more equitable community.