San Ysidro Health (SYHealth) requests funding to support its Certified Community Behavioral Health Clinic (CCBHC) program in San Diego County. SYHealth’s CCBHC-Improvement and Advancement (I&A) project focuses on the delivery of nine core CCBHC services and enhancing those core services by establishing internal capacity for and integrating reproductive mental health care within its CCBHC program. As a Federally Qualified Health Center (FQHC, SYHealth specializes in providing care to uninsured and Medi-Cal (California’s Medicaid) populations. SYHealth has capacity to serve patients who are living with mild, moderate, and serious mental illness through its FQHC-CCBHC system of care. Notably, this unique dual system of care allows patients to maintain SYHealth as their medical home regardless of where they are in the illness spectrum.
SYHealth’s CCBHC program provides access to the nine core services via in-house and external Designated Collaborating Organization (DCO) resources: (1) crisis mental health services; (2) screening, assessment, and diagnosis; (3) patient-centered treatment planning; (4) outpatient mental health and SUD services; (5) outpatient primary care screening; (6) targeted case management; (7) psychiatric rehabilitation services; (8) peer support services; and (9) community-based mental health services for armed forces members and veterans.
With the integration of reproductive mental health care into its CCBHC services, SYHealth will have improved capacity to serve antenatal, pregnant, and postpartum patients with psychiatric and/or SUD diagnoses. Key I&A activities include: (1) transforming its San Ysidro Behavioral Health (SYBH) Clinic into a one-stop shop for pregnant and postpartum patients, where they can receive co-located mental health and SUD care in close collaboration with their obstetric providers; (2) providing pregnant patients the option to either continue their prenatal care from their referring primary care provider or access routine prenatal care via the CCBHC program’s in-house family physician; (3) leading collaboration efforts with obstetric and other specialty providers if patients need more than routine prenatal care; and (4) adding a Lead Case Manager for reproductive mental health care to ensure that patients are linked to relevant programs and services, notably, California’s Comprehensive Perinatal Services Program (CPSP).
As an existing CCBHC, SYHealth will ensure ongoing compliance with the CCBHC certification criteria while undertaking I&A activities. Project objectives for the 2022-2026 period include the following:
Objective #1: SYHealth will complete CCBHC needs assessments by September 2022 and September 2025 to maintain CCBHC certification compliance.
Objective #2: By September 29, 2026, SYHealth will serve a total of 800 CCBHC patients, including 225 patients receiving reproductive mental health care.
Objective #3: By September 30, 2023, SYHealth will complete the development of its CCBHC Reproductive Mental Health Care Playbook, with written protocols, workflows, and standard of care for delivering multidisciplinary care and care coordination support in FQHC-CCBHC settings.