Electronic Thesis/Dissertation


Collaborative Behavioral and Medical Care in Community Health Centers: Trends 2000-2007, Correlates of Capacity, and Elements of Collaborative Care Open Access

Currently, medical care and behavioral health services are administered by two separate delivery systems in many cases, despite the frequent co-occurrence of physical and mental conditions. The need for enhanced access to behavioral health services and better collaboration between medical and behavioral health care providers is evidenced by the high level of unmet need for mental health and substance abuse treatment services, particularly among underserved patients. Using the Area Resource File linked to the Uniform Data Systems (UDS) administrative dataset, this study explores whether on-site mental health and substance abuse capacity in community health centers was associated with county, health center, and patient characteristics in 2007. Trends from 2000 through 2007 in behavioral health capacity and care delivery patterns were also examined. In addition, the 2010 Behavioral Health Assessment survey was linked to the UDS, allowing for closer examination of the elements of collaborative care, including multivariate exploration of the correlates of collaborative care. The findings indicate that being located in the Northeast and Western regions, the availability of behavioral health workforce in the county, and health center characteristics such as larger size were the strongest correlates of capacity in multivariate logistic regression models. In addition, health centers in states with higher odds of employing specialty staff members to treat substance use disorders, offering substance use treatment on-site, and offering 24-hour crisis counseling. Policy options to increase behavioral health treatment capacity in the primary care safety net are discussed, along with ways to increase collaboration between medical and behavioral health providers.

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