Building Behavioral Health Homes: Clinician and Staff Perspectives on Creating Integrated Care Teams

  • Tracy Anastas
  • Elizabeth Needham Waddell
  • Sonya Howk
  • Mark Remiker
  • Gretchen Horton-Dunbar
  • L. J. Fagnan


Adults with serious mental illness and substance use disorders have elevated risk of mortality and higher healthcare costs compared to the general population. As these disparities have been linked to poor management of co-occurring chronic conditions in primary care, the behavioral health setting may be a preferred setting for routine medical screening and treatment. This qualitative study describes early stages of integrating care teams in emerging medical homes based in mental health and addiction treatment settings. Clinicians and staff from ten agencies engaged in the Behavioral Health Home Learning Collaborative participated in qualitative interviews exploring local definitions of “behavioral health home” and initial barriers and facilitators to integration. Facilitators included clear staff roles, flexible scheduling, and interdisciplinary huddles and staff trainings. Challenges included workforce, limited use of electronic health records, and differing professional cultures. Participants advocated for new workflows and payment structures to accommodate scheduling demands and holistic case management.



CMS Adult Medicaid Quality Grant Program. This document was developed using data from a project funded by the grant program outlined under the Catalog of Federal Domestic Assistance Number 93.609 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. However, these contents do not necessarily represent the policy or views of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.

The authors acknowledge ongoing program support from Beth Sommers, MPH, CPHQ, Oregon Rural Practice-based Research Network; Rita Moore, PhD, Oregon Health Authority; and Charles Gallia, PhD, Oregon Health Authority. We thank the ten participating Oregon Behavioral Health Homes for their participation in the learning collaborative and associated research.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


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Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  • Tracy Anastas
    • 1
    • 2
  • Elizabeth Needham Waddell
    • 1
    • 2
    • 3
  • Sonya Howk
    • 1
    • 2
  • Mark Remiker
    • 1
    • 2
  • Gretchen Horton-Dunbar
    • 2
    • 3
  • L. J. Fagnan
    • 1
    • 2
  1. 1.Oregon Rural Practice-based Research Network (ORPRN)PortlandUSA
  2. 2.Oregon Health & Science UniversityPortlandUSA
  3. 3.OHSU-PSU School of Public HealthPortlandUSA

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