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A How-To Guide by Amy Forsyth-Stephens of Free Clinic Solutions

Free clinics today face tremendous challenges, including recession-based resource reductions and demand increases, system changes spurred by health care reform, and an increasingly complex patient profile characterized by persons with multiple chronic health conditions.  More than 68 percent of adults with a mental disorder have medical conditions, and 29 percent of adults with medical conditions have mental disorders.  Sadly, persons with comorbid mental and medical conditions are at high risk for receiving poor quality of care. 

Behavioral health care is an increasingly important service that free and charitable clinics provide, however, integrating behavioral health with primary care services can be daunting. Issues of space, staffing, treatment planning, medical records, and outcome tracking must all be addressed.  Models of service integration are available that accommodate free clinics of diverse size, culture, structure, operation, and composition of staff. 

The Integrating Behavioral Health with Primary Care guide available here is intended for free and charitable clinics that are looking to develop behavioral health programs in their clinics.  The guide describes the need for behavioral health integration and the Collaborative Care approach to doing so.  Topics covered include:

  • The importance of integrating behavioral health with primary care
  • Current ability of free clinics to integrate behavioral health and primary care
  • Benefits to treating behavioral health problems within the context of primary care in the free clinic setting
  • The Collaborative Care Approach
    • Considerations when implementing the Collaborative Care Approach
  • Behavioral health conditions that a free clinic can try to address
  • Three Models for Free Clinic Integration of Primary Care and Behavioral Health Services
  • Multidisciplinary treatment teams and an integrated treatment model
  • Considerations for screening behavioral health disorders
  • Four commonly used brief screening tools
    • The Patient Health Questionnaire (PHQ-9)
    • Modified MINI Screen (MMS)
    • The NIDA-Modified Alcohol, Smoking, and Substance Involvement Screening Test (NMASSIST), National Institute on Drug Abuse
    • CAGE Adapted to Include Drugs (CAGE-AID)
  • Psychotropic medications and free clinic patients
  • Community partners for collaboration
  • Available funding sources


Two versions of the guide are available: a shorter version, comprised of brief, concise bulleted sections addressing the topics listed above, and a narrative version, which provides additional background and language.