CCBHCs and the Integrated Behavioral Health Model (IBHM) in Primary Care

Author: Rose D.

Hello, everyone! I know it's been some time, so allow me to update you. As you know, I left bedside care just before the COVID-19 pandemic began almost three years ago. Simultaneously, I completed my undergrad and graduate studies while working full-time. Since then, I have found myself in behavioral and mental health fields in a more meaningful and focused way.

Behavioral and mental health illnesses and disorders are not unfamiliar to me. Throughout my career in healthcare, health services in education, social services, and volunteer work. I cared for and served individuals with behavioral and mental health illnesses and co-occurring disorders. Many individuals with developmental, intellectual, emotional, behavioral, or neurological disabilities in a variety of settings, from Acute care, Rehabilitative and Physical Medicine, Community Integrated Living Arrangement (CILA), Intermittent CILA, Home-based services, etc.

In hindsight, my return to the field has been an interesting journey and quite seamless. For almost two years now, while finishing my Master of Public Health (MPH) degree, I have been a Behavioral Health Case Manager at a Federally Qualified Health Center (FQHC) with the distinction of also being a Certified Community Behavioral Health Clinic (CCBHC). I am currently in the pre-certification process to become a Certified Drug and Alcohol Counselor (CADC). I have enjoyed serving and supporting this sub-population. Simultaneously, my master's thesis and much of my academic interests for the last couple of years, as part of a concentration in Program Planning and Evaluation and Health Communication, were focused on federal policy, funding sources, and programming related to the delivery of behavioral and mental health services. In so many words, I am exactly where I need and want to be.

Allow me to discuss CCBHCs and their impact further. CCBHCs began as a demonstration to assess community-based mental health services. The expansion of Medicaid due to the Patient Protection and Affordable Care Act (ACA) and the initiation of Section 223 of the Protecting Access to Medicare Act (PAMA) in 2014 prompted a two-year demonstration to deliver State-directed funding and reimburse Community Mental Health Centers (CMHC).

In 2016, during the demonstration period, 67 CCBHCs were certified. Continually in 2018, with the Substance Abuse and Mental Health Services Administration (SAMHSA) CCBHC Expansion Grant Program, more than 500 CCBHCs across 46 states were certified (SAMHSA, 2022). In 2022, President Biden's signature of the Bipartisan Safer Communities Act (BSCA) provided further investment in mental health funding for children and families across the country (CMS, 2024). The BSCA legislation provided:

• Supplemental funding for the Community Mental Health Services Block Grant.

• Funding to support new children and families serving mental health grantees.

• Supplemental funding for states and territories to expand and enhance the 988 Suicide & Crisis Lifeline services.

• Funding to expand the Certified Community Behavioral Health Clinics (CCBHC) program.

Federally Qualified Health Centers (FQHC) that are CCBHCs are prime locations for integrated behavioral and mental health services, since they often disproportionately serve Medicare and Medicaid enrollees and already meet federal standards for services. Medicaid is the single largest payer of mental health services. CCBHCs must meet six program criteria. The six program criteria include general staffing requirements; general requirements of access and availability; general requirements of care coordination; scope of service; data collection, reporting, and tracking; and general requirements of organizational authority and finances.

CCBHCs implement the Integrated Behavioral Health Model (IBHM) which designates that the clinic provides comprehensive mental health and substance use disorder services within a single setting and prioritization is placed on timely access from crisis response, medication-assisted treatment, and increased integration with primary care.

IBHM in primary care addresses staff shortages by engaging primary care providers and behavioral health providers in a coordinated, co-located, or fully integrated primary care setting. The objectives of this model are to increase care coordination and services for co-occurring diagnoses, and studies have shown that the implementation of an IBHM in primary care has led to increases in better health quality and health outcomes for patients while decreasing costs (Goodrich et al., 2013).

While there is much to be improved upon, particularly coordination and collaboration between specialists, the implementation of the IBHM in Primary care at CCBHCs has proven to increase behavioral and mental health access for many vulnerable populations. I am honored to be part of providing such meaningful and impactful service.

References:

CMS (2024). "Biden-Harris Administration Expands Access to Mental Health and Substance Use Services with Addition of 10 New States to CCBHC Medicaid Demonstration Program", HHS, Jun 04, 2024 . Retrieved from https://www.cms.gov/newsroom/press-releases/biden-harris-administration-expands-access-mental-health-and-substance-use-services-addition-10-new

Goodrich et al. (2013). Mental health collaborative care and its role in primary care settings. Curr Psychiatry Rep.;15(8):383.

Horstman et al. (2022).“Integrating Primary Care and Behavioral Health to Address the Behavioral Health Crisis” (explainer), Commonwealth Fund, Sept. 15, 2022. Retrieved from https://doi.org/10.26099/eatz-wb65

Hu et al. (2021). A Brief Report on Certified Community Behavioral Health Clinics Demonstration Program. Social Work in Mental Health; 19: 534-541.

Satcher et al. (2017). Promoting mental health equity: The role of integrated care. Journal of Clinical Psychology in Medical Settings, 24 (3): 182-186.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2022). Key substance use and mental health indicators in the United States: Results from the 2021 National Survey on Drug Use and Health (HHS Publication No. PEP22-07-01-005, NSDUH Series H-57). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/report/2021-nsduh-annual-national-report