Efforts to improve the integration of behavioral health and
medical care have largely focused on the challenge of doing so
within the formal health care infrastructure of hospitals and primary care practices.
More recent efforts have focused on how to
integrate behavioral and medical care in community-based and
home-based settings.
Many providers and researchers are considering theso-called “5000þ waking hours”1 that patients live
with their chronic medical conditions outside of their clinic visits
and face-to-face time with medical providers;given that 29% of
adults with a medical condition have a co-occurring behavioral
health condition,2 and that many chronic medical conditions have
significant behavioral risk factors,3 some of this attention would be
well spent consider ingpatients’ chronic behavioral health conditions during thesesame hours.Here we describe the main features
of the care delivery models that are being developed to use
community health workers(CHWs)to support a wide range of
patient needs in the community,describe two key challenges to
the sustained success of CHW interventions to support patients’
medical and behavioral health needs,and discuss how improvement science can be utilized to enhance the design and delivery of
CHW programs for patients with both medical and behavioral
needs