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.

• Integrated Care Models for HRSA-Supported Safety Net Providers
  The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) offers examples of behavioral health models that providers can implement in primary care settings.
• Standard Framework for Levels of Integrated Healthcare
  This CIHS tool helps primary and behavioral health care provider organizations understand where they are on the integration continuum so that they can improve outcomes.
• Business Case for the Integration of Behavioral Health and Primary Care (PDF - 287 KB)
  This CIHS tool addresses the business case for integrated behavioral health care and guides evaluation of this business case at an individual health center.
• 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 CIHS report 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 Cooperative Agreement (NCA). 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 NCA. 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.
• The Abyss: Addiction, Homelessness, and Trauma
  The National Health Care for the Homeless Council, a HRSA-funded NCA, hosted a webinar examining the research and science behind the connections between substance use disorder and trauma.

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.

• Screening Tools for Depression
  CIHS provides guidance on evidence-based depression screening tools and workflow implementation.
• 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 NCA, 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’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.
• The Surgeon General’s Report on Alcohol, Drugs, and Health
  This report discusses opportunities for integrating substance use disorder treatment into physical health care to address a patients’ total health and wellbeing, as well as recommendations to prevent substance use disorder.
• National Institute on Drug Abuse for Medical & Health Professionals (NIDAMED)
  This website provides medical and health care professionals access to online practical tools/resources, health education credits, patient resources, and clinical trial information.
• National Institute on Drug Abuse (NIDA) Commonly Abused Drugs Charts
  These charts provide information about a variety of commonly misused drugs, possible health effects, and available treatment options.
• NIDA Publications
  This website provides access to downloadable full-text publications on addiction science, medical consequences, trends and statistics, and the link between drug use and HIV/AIDS.
• Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (NSDUH)
  SAMHSA’s NSDUH annual report presents the 2016 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.

• 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.
• Opioid Addiction Treatment ECHO
  This ECHO provides health center staff with free training and support in treating opioid use disorder via videoconferencing technology.
• SAMHSA-HRSA Center for Integrated Health Solutions (CIHS)
  CIHS is a national training and technical assistance center focused on the integration of primary and behavioral health care and related workforce development.
• 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.