Integrated Behavioral Health For Substance Use Disorders And Co-Occurring Mental Health Disorders In Underserved U.S. Settings: A Scoping Review Of Care Models, Implementation, And Outcomes
DOI:
https://doi.org/10.69980/ajpr.v29i1.951Keywords:
Substance-Related Disorders;, Mental Disorders, Delivery of Health Care, Integrated, Implementation Science, Medically Underserved Area, Primary Health Care, Vulnerable Populations, Health Services AccessibilityAbstract
Background: Substance use and co-occurring mental health disorders are common, but only a small percentage of adults with these disorders in the U. S. receive treatment for both conditions. Integrated behavioral health care has been suggested as one approach to address this treatment gap. However, we know little about how integrated models are designed, implemented, and evaluated in settings that serve underserved populations.
Objective: To assess the peer-reviewed and grey literature on integrated behavioral health services for adults with substance use disorders (SUD) and co-occurring mental health disorders (MH) in underserved U. S. settings in order to characterize models of care, frameworks for implementation, reported outcomes, barriers and facilitators to implementation.
Methods: A scoping review was performed following JBI methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidance. Seven bibliographic databases and six governmental websites were searched to identify records published in 2020 onward. Two reviewers screened records and extracted data; descriptive numerical summary and thematic narrative were used to synthesize results.
Results: Of 6,060 records identified, 74 studies including 38,642 participants were eligible. Collaborative Care was the most common model studied (28 studies; 37.8%) and Federally Qualified Health Centers were the most common setting (23 studies; 31.1%). Explicit implementation frameworks were utilized in 50 studies (67.6%). Reduced substance use (55 studies; 74.3%) and improved depression (48 studies; 64.9%) were reported most often. Workforce shortages (42 studies; 56.8%) and multidisciplinary teams (46 studies; 62.2%) were reported most frequently as barriers and facilitators respectively.
Conclusions: Team-based models of integrated behavioral health for co-occurring disorders implemented in safety-net primary care settings continue to prevail in underserved communities where workforce and financing limitations are common. We recommend transparent reporting of implementation efforts and equity-focused evaluation moving forward.
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