prove care coordination that can be used by providers and health care organizations at the locus of care include (1) screening for co-occurring conditions; (2) making a formal determination to either treat, or refer for treatment of, co-occurring conditions; (3) implementing more effective mechanisms for linking providers of different services to enable joint planning and coordinated treatment; and (4) providing organizational supports for collaboration between clinicians on- and off-site. Purchasers and quality oversight organizations can create incentives for providers to employ these strategies through their funding and accountability mechanisms and by exercising leadership within their spheres of influence.

Health Care Provider and Organization Strategies

Screening

Because of the high rates of comorbidity described above—especially among those seeking treatment—screening to detect the presence of comorbid conditions is a necessary first step in care coordination. Screening enables a service provider to determine whether an individual with a substance-use problem or illness shows signs of a mental health problem or illness, and vice versa. If a potential problem is identified, a more detailed assessment is undertaken. Routine screening has been shown to improve rates of accurate mental health and substance-use diagnosis (Pignone et al., 2002; Williams et al., 2002).

The above-mentioned congressionally mandated study of the prevention and treatment of co-occurring substance-use and mental conditions (SAMHSA, undated) identified screening as critical to the successful treatment of comorbid conditions. Similarly, because of the high prevalence of emotional and behavioral problems among children served by child welfare services, screening has been recommended for children in the child welfare system overall (Burns et al., 2004) and especially for those placed in foster care (American Academy of Child & Adolescent Psychiatry and Child Welfare League of America, 2003). The U.S. Preventive Services Task Force also has recommended two types of screening in primary care settings:

  • Screening for alcohol misuse by adults, including pregnant women, along with behavioral counseling interventions.

  • Screening for depression in adults in clinical practices that have systems in place to ensure accurate diagnosis, effective treatment, and follow-up (AHRQ, 2002–2003).

The U.S. Preventive Services Task Force has not addressed the issue of screening for comorbid mental or substance-use conditions among indi-



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