Literature Collection

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Grey Literature

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Opioids & SU

The Literature Collection contains over 7,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More

Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).

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1
"Big Eight" Recommendations for Improving the Effectiveness of the U.S. Behavioral Health Care System
Type: Journal Article
Authors: M. Karakus, S. S. Ghose, H. H. Goldman, G. Moran, M. F. Hogan
Year: 2017
Source:
Karakus M, Ghose SS, Goldman HH, Moran G, Hogan MF. "Big Eight" Recommendations for Improving the Effectiveness of the U.S. Behavioral Health Care System. Psychiatric Services (Washington, D.c.) 2017;68. https://doi.org/10.1176/appi.ps.201500532.
Publication Place: United States
Abstract: The purpose of this Open Forum is to highlight strategies that can be implemented by federal health care policy makers to improve the delivery of effective behavioral health care services in the public and private sectors. The recommendations can be accomplished by using existing funds or authorities allocated to federal agencies dealing with the behavioral health system. These recommendations do not require new or additional funding and focus on strategies with a track record for success. The strategies described require relatively small changes but have the potential for big impacts.
Topic(s):
Financing & Sustainability See topic collection
,
Healthcare Policy See topic collection
2
"It's more than Just a Job to Them": A Qualitative Examination of Patient and Provider Perspectives on Medication-Assisted Treatment for Opioid Use Disorder
Type: Journal Article
Authors: M. R. Filteau, F. L. Kim, B. Green
Year: 2021
Source:
Filteau MR, Kim FL, Green B. "It's more than Just a Job to Them": A Qualitative Examination of Patient and Provider Perspectives on Medication-Assisted Treatment for Opioid Use Disorder. Community Mental Health Journal 2021. https://doi.org/10.1007/s10597-021-00824-7.
Publication Place: United States
Abstract:

The expansion of access to medication-assisted treatment by states and the federal government serves as one important tool for tackling the opioid crisis. Achieving this goal requires increasing the number of medical professionals who hold DATA Waiver 2000 waived status, which allows providers to prescribe the medication utilized by treatment programs. Waived providers are scarce throughout rural America, placing a potentially large burden on those who do hold a waiver. This paper uses data gathered through qualitative interviews with healthcare workers and patients at MAT clinics in Montana to understand how the relationship between rural healthcare workers and MAT patients contributes to burnout and potential staff turnover in a rural setting. Patients defined quality care via the patient-staff relationship, including expectations of personal support and viewing staff availability as a requirement for their recovery. Healthcare workers, in contrast, refer to their availability to patients as overwhelming and necessary both during and after business hours. These findings illuminate the need to continue expanding MAT access in rural communities, especially in non-specialty care settings including primary care offices and Federally Qualified Health Centers.

Topic(s):
Education & Workforce See topic collection
,
Healthcare Policy See topic collection
,
Opioids & Substance Use See topic collection
3
2019 Recommendations of the AMA Opioid Task Force
Type: Report
Authors: AMA Opioid Task Force
Year: 2019
Source:
Force AMAOT. 2019 Recommendations of the AMA Opioid Task Force. American Medical Association; 2019.
Topic(s):
Grey Literature See topic collection
,
Healthcare Policy See topic collection
,
Opioids & Substance Use See topic collection
Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

4
A bill for an act concerning the provision of integrated health care services, pursuant to the Colorado Medical Assistance Program
Type: Web Resource
Authors: Colorado Health and Environment House Committee
Year: 2011
Source:
Committee CH and EH. A bill for an act concerning the provision of integrated health care services, pursuant to the Colorado Medical Assistance Program 2011.
Topic(s):
Healthcare Policy See topic collection
,
Grey Literature See topic collection
Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

5
A call to maximize impact of the SUPPORT for Patients and Communities Act through standard inclusion of opioid use disorder treatment curricula in medical schools
Type: Journal Article
Authors: A. Shapiro, L. R. Villarroel, P. George
Year: 2019
Source:
Shapiro A, Villarroel LR, George P. A call to maximize impact of the SUPPORT for Patients and Communities Act through standard inclusion of opioid use disorder treatment curricula in medical schools. Advances In Medical Education And Practice 2019;10:581-583, . https://doi.org/10.2147/AMEP.S205946.
Abstract:

Physicians who want to prescribe buprenorphine to treat opioid use disorder require a waiver established by the Drug Addiction Treatment Act (DATA) of 2000, often through completion of an eight-hour training course. This is an issue for a number of reasons, including that opioid overdose deaths continue to rise nationally. However, on October 24, 2018, the SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act was signed into law. This bill allows any physician who graduates in good standing from an allopathic or osteopathic medical school in the United States that incorporates necessary material around opioid misuse in their standard curriculum, without need for any additional training, to prescribe buprenorphine. This perspective piece describes why this is an important first step and what more needs to be done within medical education to combat the opioid epidemic.

Topic(s):
Education & Workforce See topic collection
,
Healthcare Policy See topic collection
,
Opioids & Substance Use See topic collection
6
A collaborative approach to the treatment of pregnant women with opioid use disorders
Type: Government Report
Authors: Substance Abuse and Mental Health Services Administration
Year: 2016
Source:
Administration SA and MHS. A collaborative approach to the treatment of pregnant women with opioid use disorders 2016;(SMA) 16-4978.
Publication Place: Rockville, MD
Topic(s):
Grey Literature See topic collection
,
Healthcare Disparities See topic collection
,
Healthcare Policy See topic collection
,
Opioids & Substance Use See topic collection
Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

7
A collaborative model for integrated mental and physical health care for the individual who is seriously and persistently mentally ill: The Washtenaw Community Health Organization
Type: Journal Article
Authors: Kathleen M. Reynolds, Barbara K. Chesney, Jeff Capobianco
Year: 2006
Source:
Reynolds KM, Chesney BK, Capobianco J. A collaborative model for integrated mental and physical health care for the individual who is seriously and persistently mentally ill: The Washtenaw Community Health Organization. Families, Systems, & Health 2006;24:19-27, . https://doi.org/10.1037/1091-7527.24.1.19.
Topic(s):
Healthcare Policy See topic collection
,
Key & Foundational See topic collection
8
A comparison of Tier 1 and Tier 3 medical homes under Oklahoma Medicaid program
Type: Journal Article
Authors: J. I. Kumar, M. Anthony, S. A. Crawford, R. A. Arky, A. Bitton, G. L. Splinter
Year: 2014
Source:
Kumar JI, Anthony M, Crawford SA, Arky RA, Bitton A, Splinter GL. A comparison of Tier 1 and Tier 3 medical homes under Oklahoma Medicaid program. The Journal Of The Oklahoma State Medical Association 2014;107:157-161, .
Publication Place: United States
Abstract: INTRODUCTION: The patient-centered medical home (PCMH) is a team-based model of care that seeks to improve quality of care and control costs. The Oklahoma Health Care Authority (OHCA) directs Oklahoma's Medicaid program and contracts with 861 medical home practices across the state in one of three tiers of operational capacity: Tier 1 (Basic), Tier 2 (Advanced) and Tier 3 (Optimal). Only 13.5% (n = 116) homes are at the optimal level; the majority (59%, n = 508) at the basic level. In this study, we sought to determine the barriers that prevented Tier 1 homes from advancing to Tier 3 level and the incentives that would motivate providers to advance from Tier 1 to 3. Our hypotheses were that Tier 1 medical homes were located in smaller practices with limited resources and the providers are not convinced that the expense of advancing from Tier 1 status to Tier 3 status was worth the added value. METHODS: We analyzed OHCA records to compare the 508 Tier 1 (entry-level) with 116 Tier 3 (optimal) medical homes for demographic differences with regards to location: urban or rural, duration as medical home, percentage of contracts that were group contracts, number of providers per group contract, panel age range, panel size, and member-provider ratio. We surveyed all 508 Tier 1 homes with a mail-in survey, and with focused follow up visits to identify the barriers to, and incentives for, upgrading from Tier 1 to Tier 2 or 3. RESULTS: We found that Tier 1 homes were more likely to be in rural areas, run by solo practitioners, serve exclusively adult panels, have smaller panel sizes, and have higher member-to-provider ratios in comparison with Tier 3 homes. Our survey had a 35% response rate. Results showed that the most difficult changes for Tier 1 homes to implement were providing 4 hours of after-hours care and a dedicated program for mental illness and substance abuse. The results also showed that the most compelling incentives for encouraging Tier 1 homes to upgrade their tier status were less"red tape"with prior authorizations, higher pay, and help with panel member follow-up. DISCUSSION: Multiple interventions may help medical homes in Oklahoma advance from the basic to the optimal level such as sharing of resources among nearby practices, expansion of OHCA online resources to help with preauthorizations and patient follow up, and the generation and transmission of data on the benefits of medical homes.
Topic(s):
Medical Home See topic collection
,
Healthcare Disparities See topic collection
,
Healthcare Policy See topic collection
9
A conceptual framework for interprofessional and co-managed care
Type: Journal Article
Authors: S. M. Retchin
Year: 2008
Source:
Retchin SM. A conceptual framework for interprofessional and co-managed care. Academic Medicine : Journal Of The Association Of American Medical Colleges 2008;83:929-933, . https://doi.org/10.1097/ACM.0b013e3181850b4b.
Publication Place: United States
Abstract: Interprofessional care has been promoted by some policy makers and health professionals as a response to rising health care costs and threats to patient safety. Proponents suggest that interprofessional models of care can reduce fragmentation and lower costs through improved coordination between different health professionals. These models encourage the collaboration of supplementary skills between different health care professionals. Effective collaborative models of interprofessional care may be influenced by several variables germane to the interaction and structure of the team of health professionals--temporality, urgency, and degree of structured authority--and the author examines the importance of each variable in delivering interprofessional care. Co-managed models of care have also been proposed. Recent state health reform efforts have catalyzed the adoption of co-managed care models by expanding the autonomy of alternative providers through the broadening of scope of practice. These scope-of-practice changes are intended to permit greater diagnostic and therapeutic authority of nonphysician providers. This effort seems aimed at enhancing the competition between provider groups in the market and expanding consumer choices. Herein, the author presents a conceptual framework to describe different models of interprofessional and co-managed care. The author also considers interprofessional and co-managed care models in the context of the health reform movement. Some of the challenges are considered, as policy makers consider the options for facilitating further development of interprofessional models of practice and the implications for curricular modifications at academic health centers.
Topic(s):
Education & Workforce See topic collection
,
Healthcare Policy See topic collection
10
A learning collaborative of CMHCs and CHCs to support integration of behavioral health and general medical care
Type: Journal Article
Authors: S. D. Vannoy, B. Mauer, J. Kern, K. Girn, C. Ingoglia, J. Campbell, L. Galbreath, J. Unutzer
Year: 2011
Source:
Vannoy SD, Mauer B, Kern J, Girn K, Ingoglia C, Campbell J, et al. A learning collaborative of CMHCs and CHCs to support integration of behavioral health and general medical care. Psychiatric Services (Washington, D.c.) 2011;62:753-758, . https://doi.org/10.1176/appi.ps.62.7.753.
Publication Place: United States
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.
Topic(s):
Healthcare Policy See topic collection
11
A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder
Type: Journal Article
Authors: R. L. Haffajee, B. Andraka-Christou, J. Attermann, A. Cupito, J. Buche, A. J. Beck
Year: 2020
Source:
Haffajee RL, Andraka-Christou B, Attermann J, Cupito A, Buche J, Beck AJ. A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder. Substance Abuse Treatment, Prevention, And Policy 2020;15:69+. https://doi.org/10.1186/s13011-020-00312-3.
Abstract:

BACKGROUND: Evidence demonstrates that medications for treating opioid use disorder (MOUD) -namely buprenorphine, methadone, and extended-release naltrexone-are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. METHODS: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods. RESULTS: Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers-such as a lack of addiction treatment specialists-as additional barriers to prescribing medications to treat OUD. CONCLUSIONS: Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.

Topic(s):
Education & Workforce See topic collection
,
Financing & Sustainability See topic collection
,
Healthcare Policy See topic collection
,
Opioids & Substance Use See topic collection
12
A national agenda for research in collaborative care: Papers from the Collaborative Care Research Network Research Development Conference
Type: Report
Authors: B. F. Miller, R. Kessler, C. J. Peek, G. A. Kallenberg
Year: 2011
Source:
Miller BF, Kessler R, Peek CJ, Kallenberg GA. A national agenda for research in collaborative care: Papers from the Collaborative Care Research Network Research Development Conference. vol. AHRQ Publication No.11-0067. Rockville, Md: Agency for Healthcare Research and Quality; 2011.
Publication Place: Rockville, MD
Abstract: The ongoing crisis in health care continues to be driven by the twin concerns of cost and quality. Recent healthcare policy changes promote significant system reorganization (e.g., patient centered medical homes and accountable care organizations) aimed at increasing coordination and comprehensiveness of care as a way to both contain cost and increase quality. Improvements in the coordination between mental health and primary care offer a prominent example of an area of healthcare reorganization that can contribute to both better quality and lower costs. The phenomena and practice of mental health and primary care have been linked inextricably, and a body of research highlights the benefits of integrating mental health into primary care and addresses mental health and physical health simultaneously. However, despite significant positive outcome data on integration, most research on mental health in primary care has been disease specific, using targeted interventions not always indicative of standard clinical practice. Systematic reviews on integrating mental health and primary care have concluded that despite the benefits of integration or the benefits of increased attention to mental health problems in primary care, more research is needed to understand the effects of specific strategies, levels of integration, care processes, or financial models on outcomes. Taking into account these gaps in evidence along with what is already known, this paper reports a research agenda for mental health in primary care created at the Collaborative Care Research Network Research Development Conference in Denver. This manuscript will propose two sets of research questions for the field of integrated mental health and primary care.
Topic(s):
Grey Literature See topic collection
,
Healthcare Policy See topic collection
,
Healthcare Policy See topic collection
,
Grey Literature See topic collection
Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

13
A physician-pharmacist collaborative care model to prevent opioid misuse
Type: Journal Article
Authors: P. Lagisetty, A. Smith, D. Antoku, S. Winter, M. Smith, M. Jannausch, Mi Choe, A. S. B. Bohnert, M. Heisler
Year: 2020
Source:
Lagisetty P, Smith A, Antoku D, Winter S, Smith M, Jannausch M, et al. A physician-pharmacist collaborative care model to prevent opioid misuse. American Journal Of Health-System Pharmacy : Ajhp : Official Journal Of The American Society Of Health-System Pharmacists 2020;77:771-780, . https://doi.org/10.1093/ajhp/zxaa060.
Topic(s):
Education & Workforce See topic collection
,
Healthcare Policy See topic collection
,
Opioids & Substance Use See topic collection
14
A Prescription for Action: Local Leadership in Ending the Opioid Crisis
Type: Report
Authors: National League of Cities, National Association of Counties
Year: 2016
Source:
Cities NL of, Counties NA of. A Prescription for Action: Local Leadership in Ending the Opioid Crisis. Washington, Dc: National League of Cities, National Association of Counties; 2016.
Publication Place: Washington, DC
Topic(s):
Grey Literature See topic collection
,
Healthcare Policy See topic collection
,
Opioids & Substance Use See topic collection
Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

15
A Proactive Response to Prescription Opioid Abuse
Type: Journal Article
Authors: R. M. Califf, J. Woodcock, S. Ostroff
Year: 2016
Source:
Califf RM, Woodcock J, Ostroff S. A Proactive Response to Prescription Opioid Abuse. The New England Journal Of Medicine 2016;374:1480-1485, . https://doi.org/10.1056/NEJMsr1601307.
Publication Place: United States
Topic(s):
Opioids & Substance Use See topic collection
,
Healthcare Policy See topic collection
16
A Review of Integrated Care for Concurrent Disorders: Cost Effectiveness and Clinical Outcomes
Type: Journal Article
Authors: V. Karapareddy
Year: 2019
Source:
Karapareddy V. A Review of Integrated Care for Concurrent Disorders: Cost Effectiveness and Clinical Outcomes. Journal Of Dual Diagnosis 2019;15:56-66, . https://doi.org/10.1080/15504263.2018.1518553.
Publication Place: United States
Abstract: Objective: The recognition of concurrent disorders (combined mental health and substance use disorders) has increased substantially over the last three decades, leading to greater numbers of people with these diagnoses and a subsequent greater financial burden on the health care system, yet establishing effective modes of management remains a challenge. Further, there is little evidence on which to base recommendations for a particular mode of health service delivery. This paper will further summarize the existing treatment models for a comprehensive overview. The objectives of this study are to determine whether existing service models are effective in treating combined mental health and substance use disorders and to examine whether an integrated model of service delivery should be recommended to policy makers. The following two research questions are the focus of this paper: (1) Are the existing service models effective at treating mental health and substance use disorders? (2) How are existing service models effective at treating mental health and substance use disorders? Methods: We used various databases to systematically review the effectiveness of service delivery models to treat concurrent disorders. Models were considered effective if they are found to be cost-effective and significantly improve clinical and social outcomes. Results: This systematic review revealed that integrated models of care are more effective than conventional, nonintegrated models. Integrated models demonstrated superiority to standard care models through reductions in substance use disorders and improvement of mental health in patients who had diagnoses of concurrent disorders. Our meta-analysis revealed similar findings, indicating that the integrated model is more cost-effective than standard care. Conclusions: Given the limited number of studies in relation to service delivery for concurrent disorders, it is too early to make a strong evidence-based recommendation to policy makers and service providers as to the superiority of one approach over the others. However, the available evidence suggests that integrated care models for concurrent disorders are the most effective models for patient care. More research is needed, especially around the translation of research findings to policy development and, vice versa, around the translation from the policy level to the patients' level.
Topic(s):
Financing & Sustainability See topic collection
,
Healthcare Policy See topic collection
,
Opioids & Substance Use See topic collection
17
A tale of two systems: State efforts to integrate primary care and behavioral health in safety net settings
Type: Report
Authors: M. Takach, K. Purington, E. Osius
Year: 2010
Source:
Takach M, Purington K, Osius E. A tale of two systems: State efforts to integrate primary care and behavioral health in safety net settings. National Academy for State Health Policy; 2010.
Topic(s):
Healthcare Policy See topic collection
,
Grey Literature See topic collection
Disclaimer:

This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

18
Access And Cost Barriers To Mental Health Care, By Insurance Status, 1999-2010
Type: Journal Article
Authors: K. Rowan, D. D. McAlpine, L. A. Blewett
Year: 2013
Source:
Rowan K, McAlpine DD, Blewett LA. Access And Cost Barriers To Mental Health Care, By Insurance Status, 1999-2010. Health Affairs 2013;32:1723-1730, . https://doi.org/10.1377/hlthaff.2013.0133.
Topic(s):
Financing & Sustainability See topic collection
,
Healthcare Policy See topic collection
19
Access to primary care services for homeless mentally ill people
Type: Journal Article
Authors: M. Woollcott
Year: 2008
Source:
Woollcott M. Access to primary care services for homeless mentally ill people. Nursing Standard (Royal College Of Nursing (Great Britain) : 1987) 2008;22:40-44, .
Publication Place: England
Abstract: Modernisation of mental health services has been a government priority in recent years with new legislation, increased funding and investment and service reforms. The National Service Framework (NSF) for Mental Health defines national standards to meet the mental healthcare needs of adults up to the age of 65. This article considers standards two and three of the NSF regarding access to primary care services for people with a mental health problem. It discusses whether these standards consider homeless people, who continue to experience significant problems gaining equal access to health care.
Topic(s):
Healthcare Disparities See topic collection
,
Healthcare Policy See topic collection
20
Access to treatment for adolescents with substance use and co-occurring disorders: Challenges and opportunities
Type: Journal Article
Authors: S. Sterling, C. Weisner, A. Hinman, S. Parthasarathy
Year: 2010
Source:
Sterling S, Weisner C, Hinman A, Parthasarathy S. Access to treatment for adolescents with substance use and co-occurring disorders: Challenges and opportunities. Journal Of The American Academy Of Child And Adolescent Psychiatry 2010;49:46; quiz 725-6, 637+. https://doi.org/10.1016/j.jaac.2010.03.019.
Publication Place: United States
Abstract: OBJECTIVE: To review the research on economic and systemic barriers faced by adolescents needing treatment for alcohol and drug problems, particularly those with co-occurring conditions. METHOD: We reviewed the literature on adolescent access to alcohol and drug services, including early intervention, and integrated and specialty mental health treatment for those with co-occurring disorders, examining the role of health care systems, public policy (health reform), treatment financing and reimbursement systems (public and private), implementation of evidence-based practices, confidentiality practices, and treatment costs and cost/benefits. RESULTS: Barriers to treatment, particularly integrated treatment, are largely rooted in our organizationally fragmented health care system, which encompasses public and private, carved-out and integrated systems, and different funding mechanisms (Medicaid versus block grants versus private insurance that include "high deductible" plans and other cost controls.) In both systems, carved-out programs de-link services from other mental health and general health care. Barriers are also rooted in disciplinary differences and weak clinical linkages between psychiatry, primary care and substance use, and in confidentiality policies that inhibit communication and coordination, while protecting patient privacy. CONCLUSION: In this era of health care reform, we have the opportunity to increase access for adolescents and develop new models of integrated services for those with co-occurring conditions. We discuss opportunities for improving treatment access and implementation of evidence-based practices, examine implications of health reform and parity legislation for psychiatric and substance use treatment, and comment on key unanswered questions and future research opportunities.
Topic(s):
Financing & Sustainability See topic collection
,
Healthcare Policy See topic collection