The Penobscot County PBHCI program, a partnership between Community Health and Counseling Services and St. Joseph Healthcare, will serve adults with serious mental illness (SMI) who have or are at risk of chronic diseases. Through the establishment of a co-located, integrated health home in the behavioral health setting, this project aims to improve health outcomes, enhance patient care and reduce costs. Evaluation efforts will be conducted by The Center for Community and Public Health (CCPH) at the University of New England. Health homes provide services including care management, care coordination, health promotion, transitional care, individual and family support and referrals to community and social supports. The Penobscot County PBHCI program incorporates best practice approaches while focusing on the importance of relationship and individual involvement. The foundation of the service delivery model centers on the belief that the individual is the most important person in their care and treatment. The program utilizes a flexible service delivery structure that recognizes the unique challenges preventing the integration of primary and behavioral health care services. The PBHCI program is expected to serve 200 individuals in Year One, increasing annually to 600 individuals by Year Four. The program will: (1) Establish a co-located, integrated health home combining primary care, behavioral health and co-occurring substance abuse disorders, chronic disease management and health promotion activities, to improve the health and wellness of consumers; (2) Through the utilization of the established, integrated health home, improve the health outcomes and care experience for the population of focus; (3) Develop a sustainable, cost effective model of integrated service delivery for individuals with serious mental illness and (4) Disseminate findings from the establishment and utilization of the integrated health home model to strategic political and economic partners.