Assessment Tools for Organizations Integrating Primary Care and Behavioral Health
Assessment Tools for Organizations Integrating Primary Care and Behavioral Health
As organizations begin to consider integrating primary and behavioral health care services, it is helpful to have a vision of what integrated care will look like and a plan to get there. Integration assessment tools can help measure your organization’s readiness to embark on a road to integration. They can help your team determine what components will be integrated, what staff and training are required, and what systems and resources you will need to succeed. The results of assessment tools can lead to internal dialogue on the value of integrated care and how best to support the development of systems of care. Each of the tools on this page have unique strengths and features. CIHS does not recommend one tool over another; we encourage you to review each to determine which best suits your organization.
These assessments can provide a jumping off point to identify the logical next steps for organizations to determine areas for workforce development, exploration into the addition of specific clinical services (e.g. SBIRT, MAT, screening), or the adoption or expansion of your health information technology capabilities. Explore our website for resources and information to support organizations in integrating care at all levels and stages.
Tools and Resources
- Organizational Assessment Toolkit For Primary-Behavioral Health Care Integration
- A Standard Framework For Levels Of Integrated Healthcare
- The Integrated Practice Assessment Tool
- Behavioral Health Integration Capacity Assessment
- MeHAF Site Self-Assessment
- Behavioral Health Integration Checklist
- Integrated Behavioral Health Project Tool
- Integrated Treatment Tool
- Behavioral Health Integration in Medical Care (BHIMC): DDCHCS (3.0)
The OATI can help organizations (or organizational partnerships) improve the delivery of integrated primary and behavioral health care to populations with complex needs. OATI’s premise is that all programs in all primary care or behavioral health settings must assess and improve their capability to deliver integrated services within whatever resource base or staffing complement they currently have.
OATI features four self-assessment tools best used together to provide an understanding of your organization’s readiness regarding integrated care:
- Partnership Checklist assesses an organization’s need for a partner, its potential contributions to the partnership, and next steps to develop effective partnerships
- Executive Walkthrough assesses and helps improve the customer experience of individuals with primary and behavioral health needs
- Administrative Readiness Tool assesses and progresses key administrative practices and processes for integrated care delivery
- COMPASS Primary Health-Behavioral Health Tool assesses and enhances clinical policies, procedures, practices, and processes that contribute to integrated care delivery
Special thanks to Ken Minkoff, ZiaPartners, Inc.; David Lloyd, MTM Associates, LLC.; and Jeff Capobianco and Kathleen Reynolds, CIHS, for the development of this toolkit as a whole, and for the creation and testing of specific assessment tools.
How to Use the OATI
First read the description of each assessment and get an understanding of the tools in the OATI overview. Then, view the recorded webinar of Ken Minkoff, MD, an OATI author, to help your team understand how to use the tools in the OATI.
Recordings (synched audio and slides) remain in our archive for one year. For webinar recordings more than one year old, contact us at Integration@TheNationalCouncil.org.
In April 2013, CIHS released A Standard Framework for Levels of Integrated Healthcare, developed by Bern Heath, Pam Wise Romero and Kathy Reynolds. The framework has six levels of integration, with examples listed for each level. You can use this framework both as a guide to develop a vision for integration and as a tool to assess a team’s progress on a continuum of integration areas, including workforce, clinical delivery, consumer experience, practice/organization, and business model. The framework lists advantages and weaknesses of coordinated, co-located, and integrated care.
The IPAT places practices on the level of collaboration/integration defined by the standard framework. It uses a decision tree model rather than a metric model to more accurately mirror the issue brief tables and avoid the need to weigh responses to questions, which may result in an in-between assessment score (e.g., a 3.75 co-location). The decision tree model uses a series of yes/no questions that cascade to a specific level of integrated healthcare determination. Download the PDF or view it on the web.
BHICA helps behavioral health organizations evaluate their processes related to three approaches to integrated care: coordinated care, co-located care, and in-house primary care capacity. It also allows organizations to assess their existing operational and cultural infrastructure to support greater integration. BHICA was developed by the Institute for Health Improvement and the Lewin Group under a contract from the CMS Medicare-Medicaid Coordination Office.
View a video that introduces the assessment tool and how to use it.
The Maine Health Access Foundation developed SSA through a contract with John Snow International to assess levels of integration achieved by organizations funded by the foundation. The SSA tool focuses on two domains: 1) integrated services and patient and family services and 2) practice/organization. Each domain has nine characteristics that you rate on a scale of 1 to 10 depending on the level of integration or patient-centered care achieved.
The University of Washington’s Advancing Integrated Mental Health Solutions (AIMS) Center developed a model of collaborative care for integrating behavioral health into primary care. The model is a team-based approach to care that includes primary care providers, practice-based care managers, and a psychiatric consultant. Their website includes resources for implementation and training in the collaborative care model, including a checklist developed in consultation with national integrated care experts.
The behavioral health integration checklist highlights principles of effective integrated behavioral health care, including a patient-centered care team providing evidence-based treatments for a defined population using a measurement-based treat-to-target approach.
IBHP is an initiative to accelerate the integration of behavioral health services and primary care in California. IBHP developed a tool for readiness self-evaluation with Keith Miles et al. in "Conceptualizing and Measuring Dimensions of Integration in Service Models Delivering Mental Health Care to Primary Care Patients." The assessment instrument measures the level of integration along five basic dimensions: communication, physical proximity of primary and mental health care, temporal proximity of primary and mental health care, integration of mental health expertise/services, and integration with respect to the degree of stigma.
The Integrated Treatment Tool is a planning and evaluation instrument that enables organizations to implement integrated primary and behavioral healthcare services systematically for people with severe mental illness. The Center for Evidence-Based Practices at Case Western Reserve University uses the tool to help organizations plan and evaluate the ongoing process of implementing integrated primary and behavioral healthcare. It measures 13 organizational characteristics, 10 treatment characteristics, and seven care coordination/management components.
The Dual Diagnosis Capability in Health Care Settings (DDCHCS) instrument assesses the degree to which a Federally Qualified Health Center (FQHC) integrates behavioral health and addiction services. The DDCHCS acts as a practical framework for FQHCs to review policies and guide improvement. DDCHCS builds upon similar instruments such as the Dual Diagnosis Capability in Addiction Treatment Index (DDCAT) and the Dual Diagnosis Capability in Mental Health Treatment (DDCMHT), which measure addiction treatment services and mental health treatment services, respectively.
Are there other tools you have used to assess your organization’s readiness to implement integrated care? Email us at firstname.lastname@example.org and let us know.