Literature Collection

Background/Objectives: Integrating behavioral health and primary care services is a national public health priority in the US, especially in underserved settings like northern Arizona. This healthcare delivery model is crucial to meet the mental and physical health needs of people with SU/SUDs, particularly those belonging to culturally diverse populations. In collaboration with a behavioral health center in northern Arizona, the current study aimed to assess the perspectives of providers and administrative staff on the implementation of integrated primary care (IPC) services for people with SU/SUDs. Methods: In February 2023, twelve healthcare providers and administrative staff from diverse educational backgrounds were recruited using purposive sampling to capture a range of perspectives on IPC implementation at the behavioral health center. Participants completed individual, semi-structured interviews conducted via Zoom, which were audio recorded and lasted approximately 30 min. The interview recordings were transcribed verbatim using Trint Software, and analyzed on Google Docs using applied thematic analysis. Two researchers coded the transcripts, iteratively developing and refining themes through multiple cycles of review and team discussions. Additional team members provided feedback and verified the themes, with consensus reached through collaborative meetings. This rigorous, iterative approach ensured the reliability and validity of the final thematic framework. Results: We found that IPC supports SU/SUDs recovery by providing holistic care that integrates medical, mental health, and addiction services while addressing social and co-occurring needs. It fosters an empathetic environment where clients do not need to repeatedly disclose their SU/SUDs, improves access to preventive care, and offers continuous support and education. Implementation barriers included workforce shortages, limited internal communication, and insufficient interdisciplinary training. Gaps in culturally centered care were identified, including reliance on Western models, limited representation of Native American and sexual and gender minority staff, and inconsistent use of inclusive practices such as pronouns, traditional healing, and trauma-informed approaches. Additionally, community partnerships with multisectoral organizations help clients access supportive resources beyond the facility, including vision care, clothing, and dental services. Conclusions: The implementation of IPC was seen as important to support the behavioral health center in northern Arizona to foster an empathetic environment where clients with SU/SUDs can have their mental, physical, and social needs addressed, either within the facility or through community partnerships, thereby supporting their recovery. However, progress is hindered by barriers such as workforce shortages, limited internal communication, and insufficient interdisciplinary care training. Additionally, despite regular cultural competency training, gaps remain in culturally centered care for underserved populations, particularly Native American and sexual and gender minority clients.

The aim of this report is to identify and describe existing models of publicly funded integrated service programs.

This article focuses on the planning, process, and outcomes of integrating multiple services into a system that is based on the client's journey. It demonstrates the incorporation of the client voice and shared decision-making throughout the process. This article provides guidance for leaders looking for ways to engage clients in the planning process. The discussion describes the process used by Frontenac Community Mental Health and Addiction Services to implement a client designed and centred, functionally integrated substance use and mental health service using the Mental Health Commission of Canada's recovery-oriented strategy. The reality is that although integrated services are evidence based best practices, in only rare cases has this translated into practice. Key messages are that the client voice and direction can be used successfully in designing an integrated mental health and substance use system.