title: A learning collaborative of CMHCs and CHCs to support integration of behavioral health and general medical care.
abstract: OBJECTIVE
  Integration of general medical and mental health services is a growing priority for safety-net providers. The authors describe a project that established a one-year learning collaborative focused on integration of services between community health centers (CHCs) and community mental health centers (CMHCs). Specific targets were treatment for general medical and psychiatric symptoms related to depression, bipolar disorder, alcohol use disorders, and metabolic syndrome.
  
  
  METHODS
  This observational study used mixed methods. Quantitative measures included 15 patient-level health indicators, practice self-assessment of resources and support for chronic disease self-management, and participant satisfaction.
  
  
  RESULTS
  Sixteen CHC-CMHC pairs were selected for the learning collaborative series. One pair dropped out because of personnel turnover. All teams increased capacity on one or more patient health indicators. CHCs scored higher than CMHCs on support for chronic disease self-management. Participation in the learning collaborative increased self-assessment scores for CHCs and CMHCs. Participant satisfaction was high. Observations by faculty indicate that quality improvement challenges included tracking patient-level outcomes, workforce issues, and cross-agency communication.
  
  
  CONCLUSIONS
  Even though numerous systemic barriers were encountered, the findings support existing literature indicating that the learning collaborative is a viable quality improvement approach for enhancing integration of general medical and mental health services between CHCs and CMHCs. Real-world implementation of evidence-based guidelines presents challenges often absent in research. Technical resources and support, a stable workforce with adequate training, and adequate opportunities for collaborator communications are particular challenges for integrating behavioral and general medical services across CHCs and CMHCs.
authors: Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356560, BB1533, Seattle, WA 98195-6560, USA. svannoy@uw.edu
authors: Steven D
authors: SD
authors: Vannoy
authors: Barbara
authors: B
authors: Mauer
authors: John
authors: J
authors: Kern
authors: Kamaljeet
authors: K
authors: Girn
authors: Charles
authors: C
authors: Ingoglia
authors: Jeannie
authors: J
authors: Campbell
authors: Laura
authors: L
authors: Galbreath
authors: Jürgen
authors: J
authors: Unützer
mesh_terms: D002908:Chronic Disease; D003151:Community Health Centers; D003156:Community Mental Health Services; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006305:Health Status Indicators; D006801:Humans; D007858:Learning; D016730:Program Development; D012648:Self Care; D011795:Surveys and Questionnaires; D014481:United States