Sean J. Haley, PhD, MPH, Discusses Challenges Faced by Community Health Centers in the Wake of Health Care Reform | Center on Addiction

Sean J. Haley, PhD, MPH, Discusses Challenges Faced by Community Health Centers in the Wake of Health Care Reform

Sean J. Haley, PhD, MPH, Discusses Challenges Faced by Community Health Centers in the Wake of Health Care Reform

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The recent rollout of health care reforms, like the Patient Protection and Affordable Care Act, as well as the Recovery and Reinvestment Act, are encouraging for those looking for addiction treatment. But do the realities match the approved policies? And are these changes being implemented systematically so that patients are actually receiving the benefits?

As part of CASAColumbia’s Addiction Speaker Series, in which leading experts present some of their latest findings, Sean J. Haley, PhD, MPH, Assistant Professor of Health and Nutrition Sciences at Brooklyn College and CUNY School of Public Health, discussed his research on this topic. He has evaluated how prepared community health centers are to handle the growing need for addiction treatment services.

Dr. Haley began his research by evaluating the alcohol and drug abuse screening and treatment services available at community health center sites across the state of New York for adults and adolescents. The new laws mean that health care organizations should be supplied with:

  1. Increased behavioral health staff and resources to handle the anticipated increase in patients
  2. Ongoing behavioral health training and support for both adult and adolescent services
  3. Resources to support communication between providers
  4. Funding to enable medical and behavioral health services to be in one location

Dr. Haley’s research findings showed that although most of the community health centers screened adults for mental health disorders, just about half were screening for substance use, and even fewer were screening adolescents.

“Implementing screening and services related to substance use and addiction in community health centers continues to be an uphill battle, even with the help of reform legislation,” said Dr. Haley.

So what are the biggest challenges to making expanded substance use services a reality?

1. Community health centers treat patients with multiple medical needs. Dr. Haley says that “nearly 50 percent of the patient population has at least one chronic medical condition.” With multiple medical conditions to evaluate, and a waiting room full of patients, health center providers do not always have the time to conduct substance use (or other medical) screenings if a patient is thought to have another pressing issue. 

2. Community health centers are located in underserved areas and patients live in resource poor areas that can exacerbate health burdens. Health centers tend to serve sick patients, including large numbers of newly insured patients, many of whom have gone without regular medical care for some time.

 3. Many community health centers have limited organizational resources for behavioral health. This can mean they have insufficient staff time, space and capacity, to address all problems or link to effective specialty care centers. 

Resource constraints mean that many health centers sometimes must choose between treating the patient’s immediate medical needs (like diabetes or heart problems) and screening them for additional conditions, like addiction.

“Health care reform, including reimbursable screening and related behavioral health services, is a giant leap forward,” says Dr. Haley. “However, insurance expansions alone may not be enough to ensure access for the underserved. If local capacity is not created and maintained to identify and manage both medical and behavioral health conditions, improved affordability alone may make little difference in improving access to services.”  

Increasingly, federal agencies such as the Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) are dedicating resources to just such capacity building. With concentrated resources and continued support, behavioral health parity may become a reality for the underserved.

  Sean J. Haley, PhD, MPH

Dr. Haley is an Assistant Professor of Health and Nutrition Sciences at Brooklyn College and CUNY School of Public Health    

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