The need, benefit, and desirability of behavioral health integration in primary care is generally accepted and has acquired widespread positive regard. However, in many health care settings the economics, business aspects, and financial sustainability of practice in integrated care settings remains an unsolved puzzle. Organizational administrators may be reluctant to expand behavioral health services without evidence that such programs offer clear financial benefits and financial sustainability. The tendency among mental health professionals is to consider positive clinical outcomes (e.g., reduced depression) as being globally valued indicators of program success. Although such outcomes may be highly valued by primary care providers and patients, administrative decision makers may require demonstration of more tangible financial outcomes. These differing views require program developers and evaluators to consider multiple outcome domains including clinical/psychological symptom reduction, potential cost benefit, and cost offset. The authors describe a process by which a pilot demonstration project is being implemented to demonstrate programmatic outcomes with a focus on the following: 1) clinician efficiency, 2) improved health outcomes, and 3) direct revenue generation associated with the inclusion of integrated primary care in a public health care system. The authors subsequently offer specific future directions and commentary regarding financial evaluation in each of these domains.
Government reports have stressed the importance of community-based interventions in addressing health inequalities. This article discusses the pivotal role played by a health visitor and school nurse team in identifying the health needs of a local community and working in partnership with local people, key community groups, health and youth workers to address these specific needs. A health needs assessment highlighted the need for a parenting programme to support parents in managing young children's behaviour, a forum for teenagers to socialize and access pertinent health information and health days to raise public awareness of key community health issues. To date the parenting programme and the youth club have been implemented. Evaluation has considered how accessible, appropriate, efficient and effective they have been and the knowledge and skills gained by participants. This community development demonstrates how health promotion works through effective community action.
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