The Impact of Certified Community Behavioral Health Clinics on Access and Service Engagement

Background and Purpose: The Certified Community Behavioral Health Clinic (CCBHC) program provides enhanced funding to community mental health centers that offer comprehensive services through 24-hour crisis care, evidence-based practices, care coordination and integration. A primary goal of CCBHCs has been to engage more people with serious mental illness (SMI) and substance use disorders (SUDs) in the full continuum of care. With nearly one billion dollars in federal funding, this represents the largest investment in community mental health since its inception, leading to more than 500 CCBHCs in 46 states. Congressional support has partly been driven by the potential for this model to address the opioid epidemic. However, beyond federally sponsored evaluations, there has been little research on the effectiveness of CCBHCs. This study examines the change in access and service engagement following CCBHC implementation in one large clinic.

Methods: This study utilized administrative data that included all outpatient services delivered by a single clinic in the year before and after CCBHC certification in 2018. The clinic served 10,385 adults in 2017 with 183,977 visits and 10,710 adults with 187,538 visits in 2019. The dataset included client variables and visit types (outpatient mental health, substance use disorder, and opioid use disorder visits). Descriptive data analysis and chi-square analysis were conducted to compare access (number and type of clients per year) and service engagement (average number and type of visits per year) pre-and-post CCBHC implementation.

Results: Overall, there was a significant increase following CCBHC implementation in new clients from 4,951 to 5,584 (P<.001) and in new clients with SMI from 1,330 to 1,768 (P<.001). Among clients with SUD, there was only an increase in new clients with opioid use disorder (OUD) from 150 to 240 (P<.001). Overall, clients experienced an increase in the average number of visits per year from 14.1 to 15.3 (p<.05). Among those with SMI, only new clients had an increase in the average number of mental health visits per year from 3.9 to 5.9 (P<.01). For all SUD clients, the average number of SUD visits increased from 18.26 to 20.4 (p<.05) and for new clients with SUD, the number of SUD visits increased from 12.9 to 16.1. (P<.001). Although a smaller proportion of the clients, there was a large increase in OUD visits for all clients with OUD from 18.4 to 30.1 (P<.001) and for new clients from 11.1 to 25.7 (P<.001) following CCBHC implementation.

Conclusion: The study findings demonstrate that CCBHC implementation was associated with an overall increase in new clients and those with SMI and OUD. On average, new clients with SMI and clients with SUD, particularly those with OUD, had more visits per year. These findings suggest that enhanced funding and support from CCBHC certification can enable clinics to meet the program’s goals of increasing access and service engagement, particularly among people with OUD. More research is needed to understand access and service engagement within CCBHCs nationally and whether CCBHCs improve client outcomes.