Promoting the integration of primary and behavioral health care: georgia (pipbhc-GA) - the georgia department of behavioral health and developmental disabilities (dbhdd), established in 2009, provides…

Promoting the integration of primary and behavioral health care: georgia (pipbhc-GA) - the georgia department of behavioral health and developmental disabilities (dbhdd), established in 2009, provides extensive treatment and support services through a vast network of community providers, ensuring comprehensive care for behavioral health and developmental disabilities. Under commissioner kevin tanner's leadership since january 2023, dbhdd maintains a centrally managed, functionally aligned organizational structure that enhances efficiency and accountability. Community-based and recovery-oriented services are primarily provided through a system of 22 community service boards (csbs) throughout the state. Dbhdd supports a crisis and access line 24/7/365 that is also the base for the national suicide prevention lifeline. Mission-driven to lead an accountable and high-quality continuum of care, dbhdd is proposing to develop a novel model, promoting the integration of primary and behavioral health care: georgia (pipbhc-GA), in rural south georgia pursuant to samhsa funding number SM-24-003. Most of georgia is rural with a decreasing population. When compared to those persons living in more diverse and urban areas, there are disparities in mental health access and treatment. Given the inequities of health resources, transportation, broadband service, housing and health insurance, rural georgians suffer from increased rates of both physical and behavioral disorder conditions. The pipbhc-GA project will serve a 19-county area of south georgia with a population of 390,230. Using science-based interventions, two federally qualified health centers (fqhcs) with 20 clinic sites and four csbs in 9 locations will provide comprehensive behavior health care by screening and treating an average of nearly 40,000 persons for behavioral health problems (including substance abuse) each year, for a period of 5 years, through a bidirectional model of services integration. Serving as a gateway to care, all fqhc new and annual visit persons 6 years of age and older will be screened for high-risk behavioral health symptoms. Through a multidisciplinary primary care team, the fqhc will provide immediate intervention for the most common behavioral health problems. Those persons requiring specialty care and sustained support will be referred through a "warm hand-off" to a local CSB. Severe and persistent mental illness and CO-occurring disorders are special, long-term conditions that a person will be managing for life with treatment and supportive care through the CSB. Individuals needing primary care at any point in their CSB treatment will be referred back to the fqhc, which will become their patient-centered medical home. This will be an integration model for rural georgians with a continuum of care from screening/prevention, assessment, diagnosis and treatment to recovery support. CO-occurring somatic and mental health conditions will be in focus and a person's care and recovery will be managed. Over the 5-year duration of the project, pipbhc-GA will establish reliable patterns of collaboration among major community providers (public csbs and private fqhcs), setting a blueprint that could be used throughout the state and nationally. Beginning with measurement-based care, a major cohort of the rural uninsured population will be screened thereby increasing access, identifying gaps in coverage; demonstrating how to analyze data on the social determinants of health characteristics that impact health disparities; developing a behavioral health workforce relevant for rural populations; using information technology for improved quality care management, treatment, program accountability and performance measurement while RE-enforcing the value of services integration among community-based providers for the best possible whole health outcomes for the individual. Dbhdd is requesting $2,000,000 per year for five years.