Integration – Coordinated Care Service Delivery Models – Where Are They? How Can We Find Where They Are?
Kathye Gorosh
ATOD Health Reform Work Group Coordinator; Section Councilor; CEO, New Age Services
This new era of health care reform is bringing long overdue recognition to the need for integrated health care service delivery. While "integration" is a keyword in many circles – it has multiple meanings, not unlike "co-occurring disorders" which references different disorders depending on the context (i.e., substance use and mental health; HIV and mental health; HIV and substance use).
What is emerging as a common understanding of the term is the connection between behavioral and physical health. Evidence of Integration “projects” is beginning to emerge across the country as a variety of these care models have been funded similar to demonstration grants. Both primary care settings and behavioral health settings (with substance use often in standalone settings distinct from mental health) need to benefit from new funding opportunities that will assess population-based care as well as cost and utilization factors. Generally speaking, this combination of care is described as integration or collaboration
In 2009, SAMHSA put out an RFA which funded 56 grantees as part of their PBHCI (Primary and Behavioral Health Care Integration) program “for improving the physical health status of people with serious mental illnesses and substance abuse and co-occurring disorders. It facilitates the integration of primary care services with the care delivered in publicly funded community mental health and other community-based behavioral health settings.” For what seems to be a partial listing of grantees, go to: http://www.samhsa.gov/Grants/2010/awards/sm-09-011.aspx.
The ATOD Section of APHA is seeking integrated service delivery models to share with our members. Your agency may be such a model either out of necessity based on your geographic location (most likely outside of concentrated urban areas) or as a “work in progress” to meet the evolving needs dictated by the Affordable Care Act. Or, you may have received funding to work specifically on integration.
As you may know, it continues to be an uphill struggle for “addiction” to be meaningfully included as part of behavioral health funding and planning – which commonly includes mental health specific services and excludes drug prevention and treatment. Therefore, there is a continued need for your advocacy – particularly at the state and federal levels to specify addiction for funding and services.
Check out SAMHSA’s site on health reform – it is filled with information: tools, models, outcomes, research and other documents – with an overall focus on Integration and Health Homes: http://www.samhsa.gov/healthReform/healthHomes/index.aspx.
Please let the ATOD Section know of the name/location/contact person so we can compile a list to share with our members on our APHA ATOD website. At this year’s Annual APHA meeting in D.C., we would like to arrange for a “tour” of local models. Last year a group of us visited Arapahoe House in Denver - see newsletter article on “Exploring Local Services.” Suggestions for D.C. are welcome!