This article was taken from the February edition of SAMHSA-HRSA newsletter:

Primary & Behavioral Health Care Partnerships — The Courtship   

By Cheryl Holt, Director of Training and Technical Assistance, CIHS
Across the nation, an emphasis on primary and behavioral healthcare integration is leading to initiatives that address the full range of healthcare needs of individuals living with mental illnesses and addictions. The historic silos of care have begun to crack, allowing healthcare professionals in both systems to engage in partnerships to serve vulnerable people with behavioral health problems.

For disparate groups to work together, it takes considerable planning, patience, and commitment. Despite the fact that both primary and behavioral healthcare fall under the “healthcare” umbrella, they can display vast differences in perspective, including major variation in cultures, funding streams, philosophies, and overall treatment approaches. Therefore, collaborations to serve individuals with behavioral health disorders are no easy task for these two groups — yet many across the nation are doing just that. Indeed, the mission of improved care and health outcomes for people with behavioral health problems is far greater than protecting  the systems’ differences, and many provider organizations find it worthwhile to devote the necessary time, energy, resources, and focus to develop strategies to streamline the integration process. Whether services are provided in a primary care or behavioral health clinic, such collaboration will enhance care and health outcomes and that serves everyone’s interests.

The eight steps below are adapted from “Strategies to Preserve Public-Private Partnership ‘Best Practices’: Keys to Genuine Collaboration” by Greg Schmieg and Bob Climko, MD (Behavioral Health Management, May 1998) and describe the foundational steps to a successful behavioral health–primary care partnership:

  1. Establish the Partnership’s Mission
    A successful partnership requires a shared vision. Usually the partnering organizations merge their goals into a partnership mission statement. In addition to imparting this shared mission with all involved, the partners must identify and empower frontline champions who will bring energy to the mission and motivate others.
  2. Identify a Common Language
    Primary and behavioral health care providers speak different languages; a successful partnership requires a common language. Clear communication enhances mutual understanding of cultures, roles, and expectations. Common language will become increasingly important as the partnership progresses; each organization comes to the partnership with notable differences between contract deliverables, medical records, coding, management structure, procedures, and even the language used to describe the individuals served.
  3. Maintain Pacing, Flexibility, and Capacity
    Successful partnerships temper expectations. Regular meetings and ongoing communication around mutual goals and disappointments helps address issues as they arise. In addition, maintaining flexibility helps sustain a healthy partnership.
  4. Develop Shared Solutions
    Compromise is important for successful partnerships. Decision makers must remain open to new ideas and problem solving and develop shared solutions to maximize organizational efficiency and capacity.
  5. Determine Expectations
    New partners should pilot their joint project to allow for evaluation and the adjustment of expectations to ensure both partners are on the same page. In successful partnerships, conflicts are inevitable and are discussed openly on an ongoing basis.
  6. Delegate Trust
    Trust is inherent in a successful partnership. Successful partners focus on building trust and continually solicit feedback from partners at all levels. Face-to-face meetings help establish and maintain such trust and create a forum for the checks and balances that ensure mission fidelity.
  7. Create Empowerment
    Success depends on the involvement of all staff members and stakeholders, as well as the empowerment of champions at all levels. These champions move the mission forward by fostering buy-in among staff. Successful partners create a forum that allows open communication for all those involved to solicit positive and negative feedback — such communication maintains focus on the mission.
  8. Measure Outcomes
    Determine the outcomes to be measured early in the project, and be prepared to modify outcomes as needed. Don’t overlook the benefits of partnership that include more efficient allocation of resources, less duplication of services, increased choice among clients, and the synergistic effect of the partnership resulting in enhancing the lives of those we serve.

These eight steps for success will help bridge the innate differences between primary care and behavioral health organizations, fostering a successful partnership. Poor communication and lack of planning have derailed far too many promising partnerships. Careful preparation at the onset will nurture a productive mission-focused partnership that effectively addresses health disparities among people with behavioral health issues.