Examining Integration of Outpatient Substance Use Services in Certified Community Behavioral Health Clinics: A Cross-Sectional Study

Background: Despite increases in the proportion of U.S. mental health (MH) facilities offering substance use disorder (SUD) treatment, a significant integration gap persists. Individuals with co-occurring SUD and MH conditions often encounter structural and stigma-related barriers that limit their access to comprehensive care. Certified Community Behavioral Health Clinics (CCBHCs), established under the Excellence in Mental Health Act, aim to address this gap through additional funding and comprehensive certification criteria designed to expand mental health and substance use integration. Existing evidence suggests CCBHCs provide more comprehensive services, enhance workforce capacity, improve crisis service offerings, and coordinate care more effectively than traditional outpatient mental health settings. However, more research is needed to understand how CCBHCs integrate mental health and substance use care compared to traditional community mental health centers (CMHCs).

Methods: This study used data from the 2023 National Survey of Substance Use and Mental Health Services (N-SUMHSS), including 3,720 facilities: 383 CCBHCs, 988 CMHCs, and 2,349 other outpatient mental health facilities. We assessed three service domains: engagement services (e.g., outreach to persons in the community who may need treatment, interim services for clients when immediate admission is not possible, and transportation assistance to treatment), outpatient SUD treatment (e.g., intake and assessment, outpatient detoxification, medication-assisted treatment (MAT), intensive outpatient treatment and regular outpatient treatment) and recovery services (e.g., employment counseling or training, assistance with obtaining social services and assistance in locating housing). Descriptive statistics compared the proportions of each setting offering these services, and logistic regression analyses were conducted in STATA 19 to estimate the odds ratio of service availability, adjusting for the covariates of ownership type, government funding, and clinic size.

Results: CCBHCs had significantly higher odds of delivering key engagement services, including interim services (OR=2.48, p<0.01), outreach (OR=2.98, p<0.01), and transportation (OR=2.68, p<0.01), compared to outpatient mental health facilities. They were also more likely to provide outpatient SUD treatment services, including outpatient detoxification (OR=3.22, p<0.01) and MAT (OR=1.79, p<0.01). CCBHCs were more likely to offer recovery support services, including employment counseling or training (OR=3.80, p<0.01), assistance with obtaining social services (OR=3.19, p<0.01), and housing supports (OR=3.27, p<0.01). CMHCs did not have significant differences in outpatient SUD treatment. They had higher likelihood in engagement services (e.g., interim services (OR=1.70, p<0.01), outreach (OR=1.71, p<0.01), transportation (OR=1.55, p<0.01) and recovery supports (e.g., employment counseling (OR=1.89, p<0.01), social services (OR=3.19, p<0.01), housing (OR=2.36, p<0.01)).

Discussion: These findings are among the first to use national data to directly compare CCBHCs, CMHCs, and other outpatient MH facilities in their provision of SUD treatment and facilitating services. The increased service availability in CCBHCs suggests that this model not only expands standard outpatient SUD care but also can increase access through engagement and promote recovery by providing employment, social services, and housing. More research is needed to examine whether CCBHCs can more effectively treat individuals with co-occurring conditions by improving service access.