Co-location of Services Model

Co-location refers to services that are located in the same physical space (e.g. office, building, campus), though not necessarily fully integrated with one another. Co-location can involve shared space, equipment, and staff for health and human services; coordinated care between services; or a partnership between health providers and human services providers. Co-location can streamline referrals, increase access to care, and increase communication between different providers.

The types of services offered in this model depend on the goals of the program and the needs of the rural community. Offering several services in the same building may reduce stigma for accessing programs and services, such as behavioral health services or Temporary Assistance for Needy Families (TANF).

Services that may be integrated under this model include:

• Health services
• Job training services
• Child welfare and family services
• Counseling
• Housing assistance
• Transportation
• Domestic violence services
• Other health and human services

Examples of Rural Programs that Co-Locate Services

• The Lake County Tribal Health Consortium (LCTHC), located in rural California, co-locates human services, behavioral health, primary care, and prenatal services. LCTHC offers a program called Linkages that aims to help tribal women make healthy choices during pregnancy and reduce the incidence of newborns with prenatal exposure to alcohol, tobacco, and other substances. During intake at the LCTHC's medical clinic, all patients receive screenings for depression, substance abuse, and domestic violence. A human services staff member connects pregnant women who need assistance to several programs offered by LCTHC, including substance abuse counseling, parenting support, and home visiting. The human services department also has weekly case coordination meetings to ensure these individuals are connected to providers and services.
• The Giles Free Clinic, is a Federally Qualified Health Center (FQHC) located in the Appalachian mountains of western Virginia, co-locates primary care, behavioral health, and oral healthcare. The Giles Free Clinic installed a two-operatory dental unit within the same building as the health center, enabling warm hand-offs between medical and dental practitioners during appointments. This program has increased access to oral health and behavioral health services in the community. Co-location has also helped to reduce transportation barriers, as people are now able to travel to one location for their healthcare, behavioral health, and dental appointments. This model is particularly beneficial for children who can be seen by a dentist at the time of their well-child visit.
• Humboldt County, located in a geographically isolated area in northwest California, began investigating the integration of health and human services in the early 1990s. State legislation provided the county authority with funding for the delivery of services through a comprehensive, integrated health and human services system. The first phase of integration brought together six departments, including social services, mental health, public health, employment training, veteran's services and public guardian into one department of health and human services, where services are co-located. Key elements that are essential to the success of the Humboldt County model include: a shared vision for success, focus on the whole person, integrated funding streams with shared resources, reorganization of county functions, community driven transformation, and quality leadership.

Considerations for Implementation

Co-location of services can be a highly resource-intensive model to implement. This model may require minor to major renovations to a facility, new equipment, and/or new staff and partnerships. Co-location requires a facility that has sufficient physical space to accommodate multiple service providers. Rural communities that have implemented this model have co-located services in one building or on the same campus. These communities have found that, when designing the space for co-located services, it is important to create a welcoming, friendly, and bright reception space, and to ensure the co-located offices look and feel integrated. Program planners also recommended creating private meeting spaces in order to protect an individual's confidentiality when addressing sensitive topics (e.g., during a meeting with a domestic violence advocate or a substance abuse specialist). The model is most effective when community members are already familiar with the location or site of the co-located program.

Rural communities that have implemented this model recommended warm hand-offs between providers (e.g., primary care and behavioral health or oral health) to introduce patients to healthcare staff and ensure they feel comfortable. Rural communities also need to identify what kind of health information technology their co-location program will require. For example, some co-location programs require implementing a system that facilitates billing and reimbursement across participating service providers.

Rural communities should consider issues of stigma when developing co-located models. This model can be successful in reducing stigma — for example, reducing stigma associated with visiting a behavioral health specialist by integrating behavioral health services into a primary care office. However, this model can also increase stigma in some cases — for example, if early intervention services are co-located on the same campus as adult day care services. Outreach and education can help to address stigma.

The benefits of this model are the efficiencies achieved by bringing multiple providers and services together. This model has the potential to increase access to primary care, behavioral healthcare, and oral health and strengthen the rural health system for vulnerable populations. Further, rural communities may co-locate child and family services to help families struggling with substance abuse and domestic violence.

Resources to Learn More

Colocating Health Services: A Way to Improve Coordination of Children's Health Care?
Document
Provides a description of co-located services, considerations for implementation, and benefits of implementation. The brief also includes important considerations for developing a co-location framework.
Author(s): Ginsburg, S.
Organization(s): The Commonwealth Fund
Date: 7/2008

Health Extension Toolkit
Website
This online toolkit describes implementation considerations for health extension models. Offers different modules within each chapter and helpful tools for states, academic health centers, professional societies, and Tribal Nations.
Organizations(s): The Commonwealth Fund, Agency for Healthcare Research and Quality (AHRQ), University of New Mexico Health Sciences Center