Challenges and opportunities for rural certified community behavioral health clinics.

Abstract

In 2014, the Substance Abuse and Mental Health Services Administration's implemented a new pilot program to create Certified Community Behavioral Health Clinics (CCBHC) that would better integrate care and improve substance use disorder and behavioral health outcomes. However, no rural communities had been involved in the CCBHC pilot program. Our program was one of the first attempts at implementing the CCBHC model in a rural setting. Evaluation data, including a community needs assessment, an attestation confirming compliance with the CCBHC criteria, and collection of physical, behavioral, and substance use health outcomes at 6-month intervals, guided an ongoing assessment program. This was further aided by a community advisory board which partnered on programming, suggested interventions and guided data collection. Last, patient satisfaction surveys and interviews were conducted by an outside evaluator to identify any limitations or challenges not otherwise identified. Results indicate that delivery of substance use disorder treatment greatly increased. Access to mental health services, including crises services improved, care coordination expanded, formal partnerships increased, and community involvement was enthusiastic and growing. Nonetheless, securing sufficient workforce was difficult, and the stigma surrounding youth mental health treatment seemed to persist across implementation. The policy context of Utah's Mental Health Authority system created barriers not anticipated by the CCBHC federal model. Effective treatment of youth, workforce recruitment, and policy challenges unique to Utah's Medicaid model created barriers that will vary in their impact on other rural implementation sites. The former two concerns are likely to persist in other rural settings, though the latter may reflect challenges unique to this site. Public Health Significance StatementCertified Community Behavioral Health Clinics (CCBHCs) are a model designed by Substance Abuse and Mental Health Services Administration to incorporate the best practices of care delivery for substance use disorders and related treatments. Therefore, it is essential to develop the model to ensure it is effective in rural settings. This program is outlined here to give other rural care providers key lessons should they wish to implement a CCBHC in their community.