Some organizations or practices may already have counseling or behavioral therapies integrated in their service model or may be interested in adding these services to complement the MAT program. One advantage of integrated behavioral health care is the ability to provide patients with quick and convenient access to these services.
The following discussion highlights some key considerations for organizations offering internal behavioral health services for patients with opioid use disorder. For a more thorough, detailed guide to integrating behavioral health in primary care, refer to the AHRQ Academy’s Integration Playbook.
Leverage Existing Service Models. Behavioral health services may be integrated into primary care through a variety of models. Examples include:
- Collaborative Care: In this model, primary care treatment for patients with one or more behavioral health disorders is enhanced by adding care management for monitoring patients between visits and regular review of patients, using a registry, by a psychiatrist or other appropriate behavioral health clinician. Care management and consulting psychiatry can be provided either onsite or remotely. Extensive evidence shows the effectiveness of this model, and it can be very cost-effective as it stretches scarce behavioral health staffing resources.
- Behavioral Health Consultant: This model, sometimes also called the Primary Care Behavioral Health (PCBH) model, includes a licensed clinician, typically onsite, who works as part of the care team with the medical staff and is available for warm handoffs and huddles.
When leveraging existing internal behavioral health models, providers should consider that internal barriers may limit these efforts. Stigma against treating patients with opioid use disorder, or using MAT, may exist and need to be identified and worked through. Additional training may be needed for providers to learn about supporting MAT and how to use their existing skill set to help those with substance use disorders.
In the case of the Collaborative Care model, the consulting psychiatrist may not have the expertise to consult on substance use disorder issues. Additional addiction expertise may need to be sought in those situations or in-house local expertise developed. Finally, capacity issues can surface when expanding a service model’s scope. It is important to think through how internal services fit along the spectrum of care and which patients to refer elsewhere.
Refer Patients to Internal Behavioral Health Services. MAT programs should develop or adapt a process to connect patients receiving medications for opioid use disorders to behavioral health services, and vice versa. Practices should establish clear workflows for communications, information sharing, and care coordination.
Documentation in the common medical record is key to integration and care coordination. For example, it should detail the diagnosis, type of treatment to be provided, patient’s engagement in treatment, progress, and any other treatment or care coordination needs.
Whenever possible, providers should do a “warm handoff” between medical and behavior health staff, in which one provider directly introduces the patient to the other provider. Warm handoffs can help facilitate communication between providers, build relationships, and ensure referrals are not lost to followup. Relationships are fundamental to quality care. The goal is for the patient to see behavioral health services as one integrated dimension of their overall care for opioid use disorder, not as a separate and parallel health problem or treatment regimen.
Programs should aim to maximize opportunities for informal and formal interactions between medical and behavioral health staff to promote coordinated care. This approach includes team “huddles” during which providers can help plan patient care and share observations. The whole integrated care team should be involved in coordinating care, tracking patient outcomes, and monitoring patient progress. For more information, refer to Referrals and Care Coordination.