CIHS Proposes Integrated Care Framework for Youths With Behavioral Health Conditions

Mental illnesses and substance use disorders elevate the risk of premature mortality among adults, largely due to unmanaged general medical conditions. Early identification and treatment of behavioral health disorders can substantially reduce morbidity and premature mortality. Therefore, a critical area of focus for practitioners and policy makers who are advancing integrated care models should be on systems that address the health and well-being of children. To that end, the Center for Integrated Health Solutions (CIHS) has proposed a practical, organizational framework for developing an integrated care system in which the behavioral health needs of children and adolescents are identified and treated in the context of their whole health.

The framework is described in a 33-page report, Integrating Behavioral Health and Primary Care for Children and Youth: Concepts and Strategies. The framework is based on the system of care approach for children with behavioral health conditions and the chronic care model of organizing services for people with chronic health conditions. Organizations that plan to serve as integrated systems should embrace both approaches, and the report lays out their values and principles. Organizations must also decide how they will address the care of subgroups with varying severity levels of general medical and behavioral health conditions. A quadrant model illustrates subgroups with low and high levels of complexity and need. For each of the four subgroups, the report recommends the types of providers who should be involved and a service delivery approach to best meet the needs of children in that subgroup. Descriptions of agencies and practices that are currently using the recommended approach are presented in sidebars.

Any organization that intends to serve as an integrated care system for children with behavioral health issues should ensure that it has five core competencies, according to the report. First, an agency should have in place “family and youth–guided teams with care coordination capability.” An agency with this competency designates a coordinator to communicate, network, and educate—not only with the family and child but also with the multidisciplinary care team. The choice of coordinator depends on the needs and strengths of the family, child, and team. Family members and the child must be key participants and advisors in this process. Second, the agency must develop individualized care plans that address the child’s whole health. The plans should be developed by the care team, with input from primary care and behavioral health providers and the family and child. The plans should incorporate the family’s values and preferences and consider the resources available to them. Third, the agency should ensure that practitioners use evidence-based screening and assessment tools and follow the guidance of the Bright Futures initiative of the American Academy of Pediatrics for well-child visits until age 21.

The fourth and fifth competencies involve agency-level issues. Fourth, the agency should create accountable relationships with other entities. For children with behavioral health conditions, the team is likely to include individuals and organizations outside the integrated care system, such as schools. The agency’s adaptive infrastructure should link to the community and include a broad and flexible array of services that enhance care. The fifth competency is data-informed planning. The agency must have a clinical information system that supports proactive planning and informed decision making on both individual and population levels.

Both clinical and fiscal sustainability are essential to an integrated system. The final section of the report describes a variety of approaches to funding integrated care systems for youths. In addition to several options under Medicaid and the State Children’s Health Insurance Program, the report describes local, state, and federal funding streams that create opportunities for blending financing.

CIHS is jointly funded by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration and managed by the National Council for Community Behavioral Healthcare. The report is available on the CIHS Web site at www.integration.samhsa.gov.