Evaluation of the SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Grant Program

Evaluation of the SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Grant Program: Final Report (Task 13)

Deborah M. Scharf
Nicole K. Eberhart
Nicole Schmidt Hackbarth
Marcela Horvitz-Lennon
Robin Beckman
Bing Han
Susan L. Lovejoy
Harold Alan Pincus
M. Audrey Burnam
Copyright Date: 2014
Published by: RAND Corporation
Pages: 139
https://www.jstor.org/stable/10.7249/j.ctt6wq97z
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  • Book Info
    Evaluation of the SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Grant Program
    Book Description:

    Primary and Behavioral Health Care Integration (PBHCI) is intended to improve the overall wellness of people with serious mental illness by providing integrated health care services in a setting where the population already receives care. This report describes the results of RAND’s evaluation of the PBHCI grants program, including how grantee programs were implemented, whether the program leads to improvements in outcomes, and which program models and features lead to better processes of care and consumer outcomes.

    eISBN: 978-0-8330-8650-1
    Subjects: Health Sciences, Psychology

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-vii)
  4. Figures
    (pp. viii-viii)
  5. Tables
    (pp. ix-x)
  6. Executive Summary
    (pp. xi-xiv)
  7. Acknowledgments
    (pp. xv-xv)
  8. Abbreviations
    (pp. xvi-xviii)
  9. 1. Introduction
    (pp. 19-32)

    This report describes the RAND Corporation’s evaluation of Primary and Behavioral Health Care Integration (PBHCI), one of the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) service grant programs. PBHCI is intended to improve the overall wellness and physical health status of people with serious mental illness (SMI), including individuals with co-occurring substance use disorders, by making available an array of coordinated primary care (PC) services in community mental health centers and other community-based behavioral health (BH) settings. In particular, better coordination and integration of PC and BH services, improved prevention, early identification and intervention to reduce chronic diseases, and...

  10. 2. Methods
    (pp. 33-39)

    This chapter provides an overview of the sample of PBHCI grantees included in the evaluation, the data collection methods, and the measures used to answer Research Questions 1 (Process), 2 (Outcomes), and 3 (Model Features). Additional methodological information about data sources and analysis is provided throughout the report, as well as in the appendix.

    All PBHCI evaluation procedures were reviewed and approved by RAND’s Human Subjects Protection Committee and the federal Office of Management and Budget (OMB).

    At the time that this evaluation was designed, SAMHSA had funded 13 PBHCI grantees. Midway through the evaluation design, RAND received notice that...

  11. 3. Process Evaluation I: Program Structures and Procedures
    (pp. 40-60)

    In this chapter, we describe the first half of the process evaluation, designed to answer Research Question 1,Is it possible to integrate the services provided by primary care providers and community-based BH agencies (i.e., what are the different structural and clinical approaches to integration being implemented)?In particular, the focus of this chapter is on describing the structures and procedures of PBHCI programs of care and assessing how program structures and procedures constitute integrated care. We complete the discussion of the process evaluation in the next chapter, in which we describe the nature and extent of primary and BH...

  12. 4. Process Evaluation II: Consumers, Care Needs, and Service Utilization
    (pp. 61-78)

    In this chapter, we describe the second half of the process evaluation, designed to answer Research Question 1,Is it possible to integrate the services provided by PC providers and community-based BH agencies (i.e., what are the different structural and clinical approaches to integration being implemented)?In the prior chapter, we described the structures and procedures of PBHCI programs of care, along with how these structures and procedures may or may not be supporting integration. In this chapter, we describe how consumers and their needs interface with available PBHCI program services. As described in Chapter One, numerous factors contribute to...

  13. 5. Comparative Effectiveness Study
    (pp. 79-98)

    In this chapter, we describe the results of the comparative effectiveness study, which was designed to answer Research Question 2,Does the integration of primary and BH care lead to improvements in the mental and physical health of the population with SMI and/or substance use disorders served by these integrated care models?This comparative effectiveness study consisted of a quasi-experimental design through which we compared differences in individuals’ physical health and BH outcomes at three intervention (PBHCI) sites and three matched control sites after one year’s time. We hypothesized that consumers served at PBHCI clinics would show greater improvements in...

  14. 6. Model Features Evaluation
    (pp. 99-108)

    In this chapter, we describe the results of Research Question 3,Which models and/or model features of integrated primary and BH care lead to better mental and physical health outcomes?Early on, we learned that grantees implemented “bits and pieces” or combinations of integration models (e.g., Cherokee and Chronic Care) and few were implemented in whole or with direct evidence of fidelity (Scharf et al., 2013). As such, our approach to Research Question 3 focuses on model features whose presence or absence could be assessed with greater objectivity. Further, since there were too few sites in the comparative effectiveness study...

  15. 7. Summary, Conclusions, and Implications
    (pp. 109-119)

    Research Question 1: Is it possible to integrate the services provided by primary care providers and community-based BH agencies (i.e., what are the different structural and clinical approaches to integration being implemented)?

    We addressed Research Question 1 by first examining the array of program structures and features implemented by PBHCI grantees (Chapter Three) and then by describing consumers, their care needs, and the fit between those needs and the PBHCI services used (Chapter Four).

    PBHCI grantees demonstrated variation in the structure of their integrated care programs across several dimensions, including organizational partnerships, the physical location and structure of clinics, multidisciplinary...

  16. Appendix
    (pp. 120-128)
  17. References
    (pp. 129-139)