Comparing Certified Community Behavioral Health Clinics and Other Mental Health Facilities in Serving Clients with Co-Occurring Disorders: A Latent Class Approach

Background/Purpose: Certified Community Behavioral Health Clinics (CCBHCs) are an innovative model designed to improve access to coordinated comprehensive behavioral health care and has been supported through federal or state programs. CCBHCs play a critical role in providing accessible and comprehensive care to individuals facing co-occurring mental health and substance use challenges. Although CCBHCs are required to provide comprehensive co-occurring services, there has been a paucity of research examining the level of comprehensiveness of service provision among CCBHCs in comparison to other outpatient mental health settings. This study first explores the patterns of comprehensive service delivery among different types of mental health facilities, and then examines whether CCBHCs, compared to Community Mental Health Clinics (CMHCs) and other outpatient facilities, are associated with unique patterns of service comprehensiveness.

Methods: This study used data from the 2021 National Survey of Substance Use and Mental Health Services (N-SUMHSS) and included a sample of 5692 facilities (358 CCBHCs, 1817CMHCs, and 3517 outpatient facilities). We used a Latent Class Analysis (LCA) to identify distinct patterns of services offered for clients with co-occurring disorders (COD). Eight indicators were included: treatment for clients with COD plus serious mental illness (SMI)/serious emotional disturbance (SED), specialized program or groups for co-occurring clients, medication-assisted treatment (MAT) for alcohol use disorder (AUD), MAT for opioid use disorder (OUD), individual counseling, group counseling, case management, and 12 step groups. LCA models with one to six classes were compared using model fit indices. Using the three-step approach, a multinominal logistic regression was fitted to estimate whether CCBHCs are associated with any identified classes after controlling for facility characteristics.

Results: The four-class solution provided the best-fitted model. The largest class (Class 1), “psychosocial and peer support”, is mental health facilities with a high probability of providing individual counseling and peer support (58.6%, N=3336). The second largest class (Class 2), “comprehensive services”, comprises facilities with a high probability of providing all eight types of services (23.3%, N=1330). Class 3, “psychosocial services”, featured facilities with a high probability of offering case management (13.7%, N=779). Class 4, “professional services”, consisted of facilities with a high probability of offering treatment for COD and SMI/SED, specialized program or groups for COD, MAT for OUD and case management (4.3%, N=247). Regressing class membership on facility type and covariates, we found that compared to CMHCs, CCBHCs were more likely to belong to “comprehensive services” than “psychosocial services” (OR=3.717, p<0.01), and also more likely to belong to “comprehensive services” than “professional services” (OR=2.387, p<0.01) controlling for covariates.

Conclusions and implications: This study is one of the first to use a latent class model to investigate the clustering of services for co-occurring clients among outpatient facilities using a national sample. Findings demonstrated that CCBHCs are more likely to offer comprehensive care, including specialized program, MAT, psychosocial services, and peer support. This study provides empirical evidence that CCBHCs have been effective in achieving one of their primary goals, which is to integrate a wide range of behavioral health services for clients with co-occurring disorders.