Compiled by the AETC Mental Health Committee in 2014-2015.
Common barriers to integrating care include care silos, disjointed patient records, uncovered care costs, and limited local services. The tools below can help programs address these challenges.
Barrier: Care Silos
Patients are best served in systems where the multidisciplinary care teams have the opportunity to collaborate for holistic care, including integration of mental health, substance use, HIV, and medical care (e.g. regular case management with the entire interprofessional team). How integrated systems are achieved varies widely, but the following programs provide a rich collection of resources and technical assistance for clinics wishing to begin, continue, or improve their integration processes.
Useful Tools and Resources
- Integrated Care Models, SAMHSA/HRSA Center for Integrated Health Solutions (CIHS). The CIHS supports care integration with resources, training, and individualized support.
- Integrating Behavioral Health into Primary Care, SAMHSA/HRSA Center for Integrated Health Solutions
- Academy for Integrating Behavioral Health and Primary Care, Agency for Healthcare Research and Quality (AHRQ)
Barrier: Disjointed Patient Records
Integrated care is made possible when all of a patient's providers have easy access to their full set of interdisciplinary records (e.g. evaluation, treatment, follow-up notes, medication reconciliation, problem list). Many clinics have yet to integrate their internal systems, let alone provide for care coordination with external providers.
Useful Tools and Resources
- Integrated Care: Confidentiality. SAMHSA/HRSA Center for Integrated Health Solutions. Tools and resources related to addressing confidentiality within and across institutions, often a necessary first step to establishing access to care records.
- FAQ: How can health centers integrate oral health into the primary care setting? HRSA Health IT for Children Toolbox. This article discusses IT-related approaches to integrating specialty and primary care. In this case, it is dental care and primary pediatric care, but the approaches would work in many settings, including primary and mental health or substance abuse care.
Barrier: Care Costs
Historically, most health care plans provided limited reimbursement for ongoing cognitive psychotherapy. Many plans cover a limited number of short-term therapy sessions, regardless of need for extended individual or group therapy. The Affordable Care Act has triggered major changes in mental health and substance abuse coverage, but individuals and their providers may not be aware of how these changes impact their care options.
Useful Tools and Resources
- What plans cover: Mental health and substance abuse coverage, Healthcare.gov
- Health Insurance and Mental Health Services: How does the Affordable Care Act help people with mental health issues? MentalHealth.gov
- Health Financing, SAMHSA issue brief
Barrier: Limited Local Services
How can primary care providers offer integrated care when their communities lack mental health, substance abuse, and supportive service providers?
Useful Tools and Resources
- AIDS Education and Training Centers. HRSA-funded technical assistance and training providers. Regional and local offices offer online training, telehealth support, and individualized consultation.
- AIDS.gov Service Locator Tool. This tool integrates service directories of CDC, SAMHSA, HOPWA, HRSA, Ryan White Program, and Office of Population Affairs.
- Rural Assistance Center. HRSA-funded center to support health care in rural settings.
