Behavioral Health and Primary Care Integration

Primary care settings facilitate access to behavioral care for many individuals presenting with behavioral health needs. Health centers looking to integrate behavioral health into the primary care setting may benefit from the following resources that highlight key considerations around integration.

• HRSA Webinar: Primary Care and Behavioral Health Integration: Building Workforce Capacities 
  HRSA-funded health centers share promising practices on building behavioral health workforce capacities, including how they developed training programs and practices that provide high-quality, integrated behavioral health care.
• HRSA Webinar: Promising Practices in Behavioral Health Workforce Planning 
  Experts from the University of Michigan, University at Albany-SUNY and the Association of Clinicians for the Underserved (a HRSA-funded National Training and Technical Assistance Partners (NTTAP)) share promising practices and resources focused on behavioral health workforce planning, recruitment, and retention. They also present evidence-based research to improve and design strategic investment in behavioral health workforce planning.
• Integrated Care Models for Primary Care
  The Agency for Healthcare Research and Quality (AHRQ) describes an integration framework for behavioral health and primary care.
• Integrated Care
  The National Institute of Mental Health provides an overview of integrated primary and mental health care and describes varying levels of integration.
• SAMHSA-HRSA Center for Integrated Health Solutions Standard Framework for Levels of Integrated Healthcare (PDF - 429 KB)
  This tool from the former SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) describes the six levels of primary and behavioral health care integration.
• Policy and Financing
  AHRQ addresses policy and financing around integrated behavioral health care and the cost-effectiveness of the model.
• The Value of Integrated Behavioral Health (PPT - 1 MB)
  This tool from the former CIHS addresses the business case for integrated behavioral health care and provides additional resources for organizations providing these services.
• The Academy: Integrating Behavioral Health and Primary Care
  The Agency for Healthcare Research and Quality (AHRQ) Academy Web Portal offers definitions, measures, strategies, lessons learned, and other practical wisdom for quick application to the field of behavioral health integration.
• Lexicon for Behavioral Health and Primary Care Integration (PDF - 2.05 MB)
  The AHRQ Lexicon is a set of concepts and definitions developed by experts to provide a functional definition of behavioral health integration as implemented in actual practice settings.
• Centers for Medicare & Medicaid Services (CMS)'s Behavioral Health Integration Services Fact Sheet (PDF - 1.02 MB)
  CMS’s Medicare Learning Network (MLN) fact sheet provides information about Medicare coverage of behavioral health integration services.
• Linking Older Adults with Medication, Alcohol, and Mental Health Resources 
  This SAMHSA toolkit helps service providers for the aging learn more about mental illness and substance use disorders in older adults, including focus on alcohol and medication use.
• In Brief: Rural Behavioral Health: Telehealth Challenges and Opportunities 
  This SAMHSA guide explores barriers to accessing substance use disorder and mental health treatment services in rural communities, and the benefits of telehealth for these communities.
• National Institute of Mental Health (NIMH) 
  NIMH offers information on mental disorders, a range of related topics, and the latest mental health research.
• The Case for Behavioral Health Screening in HIV Care Settings 
  This report from the former CIHS highlights the need for HIV treatment providers to address behavioral health concerns with HIV patients.
• Supporting Vulnerable Patients: Resources for Safe Care of Special Populations 
  The ECRI Institute webinar describes resources available to assist providers and staff in providing accessible, high-quality health care for patients who are homeless or disabled. (ECRI login required)
• Suicide Risk Assessment and Management for LGBT People 
  The National LGBT Health Education Center is a HRSA-funded National Training and Technical Assistance Partners (NTTAP). The National LGBT Health Education Center hosted a webinar focused on some of the bio-psycho-social underlying issues, risk factors, interventions and resiliency in the LGBT community.
• Addressing Opioid Use Disorders among LGBT People through Trauma-informed Care and Behavioral Health Integration 
  The National LGBT Health Education Center hosted a webinar focused on identifying risk factors and implementing best practices for addressing opioid use disorder in LGBT populations.
• Providing Mental Health Care for Youth with Non-Binary Gender Identities 
  The School-Based Health Alliance (SBHA) is a HRSA-funded NTTAP. SBHA hosted this webinar focused on the best mental health clinical practices and how to create an inclusive and affirming health care environment for youth with non-binary gender identities.
• Trauma and Youth 
  SBHA hosted this webinar focused on how to provide trauma-informed care to various youth populations and offered recommendations for developing responsive, organization-wide practices, and policies.

UDS Resources

Each year, health center grantees and look-alikes report on their performance using the measures defined in the UDS. Resources to assist health centers in collecting and submitting their data include UDS manuals, webinars, trainings, validations, crosswalks, and other technical assistance resources.

UDS Table 6B - Quality of Care Measures: Depression Screening and Follow-up

This clinical quality measure requires health centers to report the number of patients age 12 and older screened for depression and, if diagnosed, receiving a follow-up plan.

UDS Table 6A - Selected Diagnoses and Services Rendered: Screening, Brief Intervention, and Referral to Treatment (SBIRT)

Health centers annually report this performance measure, as well as other substance use counseling and treatment services.

• National Institute on Drug Abuse Screening and Assessment Tools Chart
  NIDAMED provides guidance on evidence-based behavioral health screening tools.
• What is Screening, Brief Intervention, and Referral to Treatment (SBIRT) 
  SAMHSA explains the SBIRT process and provides resources for training and implementing screening tools.
• Motivational Interviewing: The Brief Intervention of SBIRT 
  SBHA hosted a webinar focused on the four-step SBIRT model and brief negotiated interview tools for the child and adolescent population.
• SBIRT with LGBT Patients: Identifying and Addressing Unhealthy Substance Use in Primary Care Settings 
  The National LGBT Health Education Center, a HRSA-funded NTTAP, hosted a webinar focused on how to implement SBIRT in a primary care setting and explaining the disparities in substance use in LGBT populations.
• CMS' SBIRT Services Booklet (PDF - 2.73 MB)
  This MLN booklet provides information about Medicare and Medicaid coverage of SBIRT services including eligible providers documenting SBIRT services, billing for SBIRT services, dual eligibles, and additional resources.
• NIDA Drug Screening Tool-NIDA-Modified ASSIST 
  This tool guides providers through a series of questions to identify risky substance use in their adult patients.

• HRSA Webinar: NIDAMED: Provider Resources on Substance Use 
  Watch an overview of the National Institute on Drug Abuse’s (NIDA) online repository of science-based resources for health professionals on substance use disorder called NIDAMED. Experts discuss NIDAMED’s resources, including continuing medical education courses, patient resources, and clinical trial information. The discussion also focuses on available substance use disorder screening guidance and tools.
• HRSA’s Opioid Crisis Website
  This website provides HRSA-supported resources, technical assistance, and training to integrate behavioral health services into practice settings and communities in response to the opioid crisis.
• Primary Health Care Digest Special Edition on Opioids 
  HRSA’s special edition newsletter provides resources and best practices to help health centers meet the challenges of providing substance use disorder services, including addressing opioid use disorder.
• Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (NSDUH)
  SAMHSA’s NSDUH annual report presents the 2018 national estimates of use of alcohol, tobacco products, illicit drugs, substance use disorders, and substance use treatment among people 12 years of age and older.
• Professional Education Materials on Alcohol
  The National Institute on Alcohol Abuse and Alcoholism provides resources for clinicians and other health care professionals on underage and college drinking, alcohol screening and brief intervention, medications for the treatment of alcohol use disorder, and more.
• Alcohol Use Disorder Brochures and Fact Sheets
  The National Institute on Alcohol Abuse and Alcoholism offers easy-to-read information for patients on a wide range of alcohol-related topics.
• CDC’s Alcohol Portal
  CDC’s Alcohol Portal compiles information on the health effects of drinking alcohol. It includes patient fact sheets, as well as information for providers on alcohol screening and brief intervention and evidence-based strategies to prevent excessive alcohol use.
• Alcohol Screening and Brief Intervention for People Who Consume Alcohol and Use Opioids
  This CDC webpage provides information on how health care providers can use alcohol screening and brief intervention (ASBI) before prescribing opioids to reduce opioid overdose deaths involving alcohol.

• Substance Use Warmline 
  This Warmline provides free clinician-to-clinician consultation over the phone, assisting primary care clinicians in addressing the difficult issues of substance use disorder, chronic pain, and behavioral health.
• Integrated Health Solutions 
  The website for SAMHSA’s new Center of Excellence for Integrated Health Solution provides information on promising practices in integrated behavioral health care, financing, and workforce training and tools.
• SAMHSA's Knowledge Network
  SAMHSA’s library hosts a wealth of resources on behavioral health training, technical assistance, collaboration, and workforce development for the health care community.
• Addiction Technology Transfer Center (ATTC) Network 
  SAMHSA’s Addiction Technology Transfer Center (ATTC) Network trains providers using the latest evidence-based practices, current research, and creates alliances among agencies and organizations that provide substance use disorder treatment and recovery services.