Integration of Substance Abuse and Primary Care in FQHCs Learning Collaborative

Submitted by: 11/03/2010
Keywords: FQHC, Integration, Learning Collaborative, NACHC

Integration of Substance Abuse and Primary Care in FQHCs
NACHC/NIATx Learning Collaborative
October 2010–July 2011

The National Association of Community Health Centers (NACHC) and NIATx are partnering on a learning collaborative to give community health centers and their substance abuse treatment organization partners the tools and technical assistance they need to integrate substance abuse treatment services into their operations.

NACHC/NIATx Learning Collaborative Goals

The five partnerships in the collaborative will receive technical assistance on: 1) strategies to contract for substance abuse treatment services; and 2) how to screen for addictions, provide brief intervention, and make referrals to specialty treatment.

Key Features

  • Two-day kick-off event in October 2010
  • Ongoing learning and networking through teleconferences and webinars
  • Individual coach support for each partnership; coach site visit and teleconference calls
  • Stipends from CSAT for travel to face-to-face meetings
  • Prototype sharing and promising practices demonstration: July 2011, Boston

Key Personnel

Co-Project Lead: Mike Lardiere, Senior Advisor, Behavioral Health, NACHC
Co-Project Lead: Todd Molfenter, Deputy Director, NIATx
Project Coordinator: Amy McIlvaine, Education & Training Director, NIATx


Eric Goplerud, Director, Ensuring Solutions to Alcohol Problems, Georgetown University
Bill McFeature, Director, Integrated Behavioral Health Services
Aileen Wehren, Vice President, Systems Administration, Porte/Starke Services, Inc.


FQHC Substance Abuse Treatment Provider Initial Aim
Contra Costa County, California Richmond Health Center, Richmond, California Place behavioral health specialist in the FQHC to conduct brief interventions and outpatient therapy
Greater Prince William Community Health Center, Woodbridge, Virginia Prince William Behavioral Health Services Implement CRAFFT/AUDIT screening tools in FQHC
Improve patient show and continuation rates of referrals to specialty care
Reduce wait time to specialty care
Ohio North East Systems, Inc. Youngstown, Ohio Ohio Health Begin to send the primary care mobile van to residential sites
Place behavioral health specialists in FQHC
Specialty clinic is building a new site and plans to include space for a primary care clinic
The Daily Planet Richmond, Virginia The Healing Place Increase referrals to specialty care
Begin to track outcomes related to ER visits and patient retention
Begin to provide recovery support services to FQHC population
Project Samaritan Health Center, Bronx, New York Palladia Services Reduce the considerable no-show rate for referrals made from specialty care to FQHC for primary care services and psychiatric evaluations by reengineering the referral process

Summary from the Collaborative’s Kick-off October 20–21

The following issues emerged from discussions during the kick-off meeting:

  1. Reimbursement for addiction treatment services at FQHCs is limited to licensed social workers, psychologists, and medical directors. This reduces the quantity of addiction services that can be provided, either by the FQHC or by contracted personnel from specialty treatment providers located at the FQHC.
  2. The ability to bill for primary care services and addiction services on the same day greatly facilitates integration between primary care and behavioral health.
  3. Many states allow for screening for addiction disorders, but have not activated the billing codes.
  4. 42 CFR continues to present a barrier to integration. The Legal Action Center has proposed remedies that provide instruction on how to create data sharing environments.
  5. Beyond 42 CFR issues, information system differences limit the ability to share clinical information.
  6. The approach to integrating primary care and behavioral health care is becoming routine. A common approach for non-acute behavioral health services is to locate a behavioral health specialist in a primary care center, or to locate primary care services in a specialty behavioral health care center. Issues such as leadership support, differences in primary care and behavioral health organizational cultures, and change management proficiency can easily undo integration efforts.
  7. Specialty treatment providers need to continue to provide crisis/detox, intensive outpatient, and residential behavioral services.
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