You can build a state-of-the-art health facility that gives patients an opportunity to receive substance use and primary care services under one roof, but that doesn’t mean successful integration will happen overnight for everyone in need. The supervising substance abuse clinician at Boston’s Whittier Street Health Center acknowledges that optimal integration requires more than just a centralized location.
“There are good days and bad,” says Ragan McNeely. “There are patients who use the combination of services well and those who don’t.”
McNeely adds, “Sometimes we’ll have a patient say, ‘I have so many different appointments, and thank God they’re in one building.’ But sometimes we’ll have a patient who will tell their [primary care] doctor something that they won’t tell us. That’s the only person they’ll confide in.”
McNeely says opportunities to offer effective and integrated substance use treatment services have been enhanced since the Whittier Street Health Center moved to its new location in the Roxbury area in January. The 79,000-square-foot building has the kind of space for multiple group sessions that the center’s previous location lacked. “We’re going to try to get AA and NA meetings in here,” says McNeely.
The $37 million facility was financed in part with federal stimulus funding. Operators are seeking certification of the clinic as a Leadership in Energy and Environmental Design (LEED) Silver building. The building serves a high-need community, with Roxbury ranking last among 16 Boston neighborhoods on several health outcome measures for adults and children.
The clinic has 3.5 full-time substance abuse clinicians, all with at least a master’s-level training background. A primary care practitioner who believes that a clinic patient might need substance use services will generally refer the person to the clinic’s intake coordinator to determine what benefits the individual could access for treatment.
McNeely says some individuals can receive same-day counseling sessions at the time of their primary care visit, although the general goal in non-urgent situations is to schedule an appointment with a substance use clinician within a week.
The patients seen for substance use needs range from young adults to the elderly, and McNeely says most are dealing with polysubstance use. Many have had a criminal justice history.
While the Whittier Street operation exhibits several signs of integration, including through its single medical records system, it also pays heed to the individualized needs of those with substance use problems. Its sturdy construction means that “there is more of a sense of confidentiality here,” McNeely says. “We now have separate waiting areas for our patients.”