Key Features and Characteristics of Success Among Community Based Health Integrated Teams

Introduction:

Holistic approaches that combine mental health, medical needs while also attending to various social determinants of health (SDOHs) are increasingly popular for medically complex populations in the United States. Community Integrated Health Teams (CIHTs) use multidisciplinary care teams that may include clinicians, behavioral health specialists, social workers, and other health-related professionals (Mantel, 2021). The study explored two research questions: What are the key features of CIHTs, and what are the facilitators and barriers to the success of CIHTs?

Methods:

The study used a multi-disciplinary team to employ a qualitative descriptive research design. Twenty-nine professionals from eight CIHTs in seven states were virtually interviewed following a semi-structured interview guide. Professionals interviewed include social workers, nurses, case managers, community health workers, primary physicians, housing coordinators, referral specialists, pharmacists, program managers, and medical directors. Interviews were recorded and transcribed. Analysis was conducted using thematic analysis (Braun & Clark, 2006).

Results:

Regarding structural components of CIHTs, some commonalities emerged. Six of the eight CIHTs served populations of indigent or underinsured patients with complex medical needs, requiring wrap-around services to address their social, mental, and medical vulnerabilities. One indicator of the targeting populations served by these CIHTs is high utilization of emergency room and inpatient care. The other two CIHTs serve people over the age of 65 on Medicare, and homeless people, respectively. All CIHTs had social workers. And seven teams had either case managers or community health workers. Themes regarding the facilitators and barriers to the success were: excellent communication, adaptability, collaboration, and coordination; use of a “high touch professional” can mitigate under-resourced organizations; unstable housing and access to food among patient populations threaten team success; the Covid-19 pandemic forced increased communication and teams with structure thrived.

Conclusion and implications: All the teams assessed social determinants of health and were dedicated to connecting the clients to community health and social resources. Team success required excellent communication, and each team had its own measures for success and its own protocol for communications. On-site integration of medical, behavioral, and social services was viewed as ideal but difficult to implement given that only two CIHTs had primary physicians on their teams and only one team had an onsite behavioral health provider. The absence of onsite behavioral health providers was explicitly mentioned as an important missing piece of the holistic approach to care. All teams cited housing and food shortages as creating barriers to helping patients focus on their healthcare. Features of success and cited barriers in this study extend prior research by (Smith et al., 2018) that reported barriers of non-standardized training of team members and organizational barriers. Our study extends current research by recommending strategies for improved team-based care for medically complex, socially vulnerable populations. Use of social workers within integrated teams can help improve patient center care and in turn, patient’s behavioral health (Fraser, Lombardi, Wu, Zerden, Richman & Fraher, 2018).