Behavioral Health at Community Health Centers: A Chicago Snapshot 

Ann G. Mahony, MPH, and Kathye Gorosh, MBA

Following APHA’s midyear meeting on health reform, members of the ATOD Section’s health reform team, Kathye Gorosh and Ann Mahony, led site visits at three Chicago-based Community Health Centers.  The goal was to engage CHC staff in describing the challenges, barriers and successes in working toward behavioral health integration in the primary care health setting. Identifying and engaging sites was achieved via coordination with David Bingaman, the Health Resources and Services Administration deputy Region V administrator (IL, IN, MI, MN, OH, WI) and via outreach Kathye had conducted with her Illinois public health network. Two of the three sites, Erie Family Health Center and PCC Wellness Community Center, are federally-qualified health centers with multiple delivery sites in and surrounding Chicago. The third site, Trilogy Behavioral Healthcare, assists people in their recovery for persons with serious mental illness. All three sites engaged openly in discussions about the clinical and operational challenges faced with the integration of an additional complex clinical chronic disease model for substance use disorders to its existing expansive primary care and mental health service delivery agenda.

The challenges are clear, especially with regard to substance use disorders with limited time, dollars and staffing resources. Some of the barriers talked about were bureaucratic, nonetheless daunting, including further opening the door to gain knowledge of reimbursement and clinical delivery of substance use screening.  Across sites, lead clinical staff acknowledged the need for additional training to gain comfort and achieve expertise to screen for substance use problems along the continuum of severity and to make treatment referrals, when clinically indicated, to substance use treatment service organizations. Overall, sites acknowledged greater knowledge and expertise of mental health disorders and the provision of mental health services. Clearly all sites visited provided the ATOD health reform team with a clear vision of their commitment to challenging the status quo to achieve the delivery of an integrated primary care service model inclusive of substance use and mental health services.