Integrated Primary
Care Services

Since 2010, the Alameda County Behavioral Health Care Services (ACBH) Department, Office of the Medical Director has played a key role in the collaborative development of the County’s Safety Net System’s ability to decrease the morbidity and mortality among residents with mental illness and substance use disorders. By partnering with Alameda County’s Safety Net Community Health Centers, the Medical Director’s Office of Integrated Health Care Services has been able to develop a comprehensive approach that improves access to primary care services for behavioral health consumers.

The ACBH, Integrated Health Care Services are geared toward achievement of the following goals:

Increase the capacity of primary care clinics to provide accessible behavioral health care services to County residents through improved care coordination

Increase the capacity and competence of the County’s Safety Net primary care providers to screen, assess and treat behavioral health conditions of County residents with mild, moderate, and severe Behavioral Health (mental health and SUD) conditions among low-income Alameda County residents

Improve the work force capabilities of County’s Safety Net primary care providers to effectively treat the chronic medical conditions of County residents with serious mental illness by providing Satellite primary care services (PATH Clinics) in three County operated Adult Mental Health Centers serving SMI consumers

The following Integrated Care Services are sponsored by the ACBH, Office of the Medical Director:

  • Contracts with eight Federally Qualified Health Centers (FQHCs) to hire Integrated Behavioral Health Care Coordinators (IBHCCs) to work as part of their Behavioral Health team, assisting complex clients with getting access to primary care services and specialty mental health services. The IBHCCs assist primary care providers and behavioral health clinicians with patients needing help to access referrals to specialty services, tracking and data collection, and monitoring referrals to health and social services.
  • Provide Primary Care Psychiatric Consultation Services to eight FQHCs, SUD Programs, and one HIV Specialty Health Center.  Consultants assist Primary Care Providers, Behavioral Health Clinicians, and Substance Use Disorders Counselors with Behavioral Health assessments, diagnosis, and prescribing psychotropic medications.
  • Provide continuous funding of trainings of safety net primary care providers to prescribe psychotropic medications, diagnose behavioral health conditions, and manage patients with chronic pain conditions.
  • Support Co-Occurring Recovery and Treatment Services for Specialty Mental Health consumers with substance use problems enrolled at three County-operated Adult Mental Health Centers by providing a contract licensed Substance Abuse Counselor to provide consultation to mental health staff, family members, and recovery support activities as needed.
  • Primary Care Services located at the ACBH Eden, Oakland, and Tri-Cities Fremont Mental Health Centers
  • Improves access to primary care services for consumers enrolled in three County operated specialty mental health centers located in North, Central, and South Alameda County.
  • ACBH contracts with Federally Qualified Health Centers (FQHC) to provide physical health services and enhanced Nurse Care Coordination Services on site.
  • Increases and improves timely utilization of Alameda County’s FQHC “Medical Home” services by providing consumers with longer visits with Primary Care Providers when needed.
  • Provides reminder calls for appointments and access to walk-in primary care visits.
  • Provides extra transportation assistance to get clients to their primary care and specialty care referral appointments.
  • Offers regularly scheduled Primary Care Team “Clinic Debrief” meetings at the end of each half day clinic to discuss follow-up care for each client seen; and
  • A Nurse Care Coordinator provides each ACBH client with help getting specialty care referral appointments and prescription refills. 
  • ACBH provides Psychiatrists and Psychiatric Pharmacists to help FQHCs and SUD providers with patients they serve who are moderately to severely impaired by their mental health diagnosis but do not qualify for County “specialty mental health” care services.
  • Assists Primary Care Providers and Behavioral Health Providers with any issue they might have in providing behavioral health care to complex patients by answering treatment, diagnosis, and prescribing questions through the Safety Net provider’s EHR, by phone or in person.
  • Helps new and experienced Primary Care Providers feel more comfortable and competent managing psychiatric disorders and prescribing psychotropic medications.
  • Assists with the development of psychotropic prescribing guidelines and informational materials for primary care providers.
  • Provides educational presentations on different topics in psychiatric care specifically tailored for PCPs and BH providers.