This study describes on-site behavioral health treatment capacity in health centers in 2007 and examines whether capacity was associated with health center characteristics, county-level behavioral health workforce, and same-day billing restrictions. Cross-sectional data from the 2007 Area Resource File and Uniform Data System were linked with data on Medicaid same-day billing restrictions. Mental health treatment capacity was common; almost four in five health centers provided on-site mental health services. Additional services such as crisis counseling (20 %), treatment from a psychiatrist (29 %), and substance abuse treatment were offered by fewer health centers (51 % provide on-site services and only 20 % employ substance abuse specialists). In multivariate analysis, larger health centers, health centers located in counties with a larger behavioral health workforce per capita, and those located in the West and Northeast were more likely to have behavioral health capacity. Same-day billing restrictions were associated with lower odds of substance use treatment capacity and providing 24 hr crisis counseling services.
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At the suggestion of QRS, the contractor that maintains the Area Resource File for HRSA, a crosswalk was purchased for $99.99 (http://www.zipinfo.com/). The crosswalk contains information from January 2011 and is offered by CD Light, Incorporated.
Surgeon General, United States Public Health Service, Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: Surgeon General, United States Public Health Service, Department of Health and Human Services, 1999.
Kessler R, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Co-Morbidity Survey Replication. Archives of General Psychiatry 2005; 62(6): 593–602.
Substance Abuse and Mental Health Services Administration, US Department of Health and Human Services. 2010–2011 National Survey on Drug Use and Health Model-Based Estimates. Available from: http://www.samhsa.gov/data/NSDUH/2k11State/NSDUHsaeTables2011.pdf
Wang P, Berglund P, Olfson M, et al. Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 2005; 62(6): 603–13.
Edlund M, Booth B, Han X. Who seeks care where? Utilization of mental health and substance use disorder treatment in two national samples of individuals with alcohol use disorders. Journal of Studies on Alcohol and Drugs 2012; 73(4): 635–646.
Mojtabai R, Crum R. Perceived unmet need for alcohol and drug use treatments and future use of services: results from a longitudinal study. Drug and Alcohol Dependence 2012; 127(1–3): 59–64.
Jones E, Lebrun-Harris L, Sripipatana A, Ngo-Metzger Q. Access to mental health services among patients at health centers and factors associated with unmet needs. Journal of Health Care for the Poor and Underserved 2013; (in press)
Roll JM, Kennedy J, Tran M, et al. Disparities in unmet need for mental health services in the United States, 1997–2010. Psychiatric Services 2013; 64(1): 80–2
Mulvaney-Day N, DeAngelo D, Chen C et al. Unmet need for substance use disorders across race and ethnicity. Drug and Alcohol Dependence 2012; 125(Supp 1): S44–50
Baggett TP, O’Connell JJ, Singer DE et al. The unmet health care needs of homeless adults: a national study. Am J Public Health 2010; 100(7): 1326–33
Mauch, D., Kautz, C. and S. Smith. Reimbursement of Mental Health Services in Primary Care Settings. United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. HHS Pub. No. SMA-08-4324, 2008
Substance Abuse and Mental Health Services Administration. Results from the 2005 National Survey on Drug Use and Health: National Findings. NSDUH Series H-30, DHHS Pub. No. SMA 06-4194. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2006.
Thomas K, Ellis A, Konrad T et al. County-level estimates of mental health professional shortage in the United States. Psychiatric Services 2009; 60(10): 1323–8.
Shi L, Stevens G. Vulnerability and unmet health care needs. Journal of General Internal Medicine 2005; 20(2): 148–154.
Office of Minority Health, Department of Health and Human Services. Mental health services in primary care settings for racial and ethnic minority populations. Rockville, MD: Office of Minority Health, 2004
Wells R, Morrissey JP, Lee IH et al. Trends in behavioral health care service provision by community health centers, 1998–2007. Psychiatric Services 2010; 61(8): 759–64.
Shi L, Stevens G, Politzer R. Access to care for U.S. health center patients and patients nationally: how do the most vulnerable populations fare? Medical Care 2007;45(3):206–13.
Health Resources and Services Administration. Uniform data system report, 2011. Available at: http://bphc.hrsa.gov/uds/view.aspx?year=2011
Politzer R, Yoon J, Shi L, et al. Inequality in America: the contribution of health centers in reducing and eliminating disparities in access to care. Medical Care Research and Review 2001; 58: 234–248.
Druss B, Borneman T, Fry-Johnson Y, et al. Trends in mental health and substance abuse services at the nation’s community health centers: 1998–2003. American Journal of Public Health 2006; 96(10): 1779–1784.
Lo Sasso A, Byck G. Funding growth drives community health center services. Health Affairs 2010; 29(2): 289–296.
Centers for Medicare and Medicaid Services, Center for Medicaid and State Operations. Letter: Prospective payment system for FQHCs and RHCs. SHO#10-004, CHIPRA#15. 4 February 2010. Available at: http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SHO10004.pdf
Office of the Inspector General, Department of Health and Human Services. Applying the National Correct Coding Initiative to Medicaid services. OEI-03-02-00790. October 2004.
O’Donohue N, Cummings W. The financial dimension of integration of behavioral/primary care. Journal of Clinical Psychology in Medical Settings 2009; 16: 31–39.
Proser M, Cox L. Health centers’ role in addressing the behavioral health needs of the medically underserved. The National Association of Community Health Centers. September 2004. Available from: http://www.nachc.com/client//BHReport04.pdf
Health Resources and Services Administration. Uniform Data System. Available from: http://bphc.hrsa.gov/healthcenterdatastatistics/index.html
Health Resources and Services Administration. Area Resource File. Available from: http://www.arf.hrsa.gov/
The Arkansas Rural Practice Student Program. Available from: http://medicine.uams.edu/for-medical-school-applicants/rural-practice-programs/rural-practice-scholarship-program.
Vannoy SD, Mauer B, Kern J, et al. A learning collaborative of CMHCs and CHCs to support integration of behavioral health and general medical care. Psychiatric Services 2011; 62(7): 753–8.
Center for Integrated Health Solutions Website. Available from: http://www.integration.samhsa.gov/
Health Resources and Services Administration, Department of Health and Human Services. National Cooperative Agreements Webpage. Available from: http://bphc.hrsa.gov/technicalassistance/partnerlinks/natlagreement.html
Cristofalo M, Boutain D, Schraufnagel T, et al. Unmet Need for Mental Health and Addictions Care in Urban Community Health Clinics: Frontline Provider Accounts. Psychiatric Services 2009; 60(4): 297–305
Mojtabai R. Unmet need for treatment of major depression in the United States. Psychiatric Services 2009; 60(3): 297–305
Agency for Healthcare Research and Quality. Integration of mental health/substance abuse and primary care. Publication No.09-E003. Rockville, MD: Agency for Healthcare Research and Quality, 2008
The authors are grateful to Alex Ross of the Health Resources and Services Administration for his comments on the manuscript draft. The views expressed in this publication are solely the opinions of the authors and do not necessarily reflect the official policies of the Department of Health and Human Services, the Office of the National Coordinator for Health Information Technology, or The Substance Abuse and Mental Health Services Administration, nor does mention of the department or agency names imply endorsement by the US government.
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No authors have a conflict of interest to report, financial or otherwise.
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Jones, E., Ku, L., Smith, S. et al. County Workforce, Reimbursement, and Organizational Factors Associated with Behavioral Health Capacity in Health Centers. J Behav Health Serv Res 41, 125–139 (2014). https://doi.org/10.1007/s11414-013-9364-9
- Health Center
- Behavioral Health
- Behavioral Health Service
- Behavioral Health Provider
- Crisis Counseling