Integrated Care is a popular catchphrase that many healthcare organizations use these days, yet what does it mean? Well, depending on your perspective, it can mean many different things. (Be sure to scroll down for a video synopsis of how Harbor Care defines integrated care).

Unnecessarily bureaucratic processes re-traumatize people by forcing them to relive (often painful) memories. This is why we promise: once a person enters any of the many programs within Harbor Care, they are automatically “in the system.”

What is it?

A quick search on Google may lead you to this journal article: “Understanding Integrated Care” by Nick Goodwin, co-Founder and CEO of the International Foundation for Integrated Care. In it, Goodwin – like many of us – seeks to define what Integrated Care is, across disciplines. He says that while there are many different definitions – based on the experience of healthcare providers, healthcare management, or social scientists – the one that he prefers is based on the perspective of the patient.

By working together through shared treatment planning, Harbor Care’s programs are able to coordinate a comprehensive array of interventions, treatment options, and solutions that address people’s unique needs.

This is person-centered coordinated care. Goodwin says it exists when a patient can say, “I can plan my care with people who work together to understand me… allow me control, and bring together services to achieve the outcomes important to me.” [7]

At first glance, this seems fairly easy to understand. Goodwin digs in a little deeper, however, expanding on what we think we know about Integrated Care:

“A number of new ideas have emerged that have taken our understanding of integrated care along a different path. The two most fundamental of these include: first, the recognition that engaging and empowering people and communities should be a central component to any integrated care strategy; and second, that integrated care strategies might be most powerful where they become population-oriented and focused on promoting health, for example by bringing together health and social care with other players such as housing, schools, community groups, industry, and so on.”

We should pause to thank Goodwin here, because he’s given an excellent introduction about what we do at Harbor Care – provide healthcare in concert with a range of supports, including housing, employment counseling, case management, behavioral health, oral health, substance misuse treatment, in-home health care, veterans’ services, and a host of other services. In short, our approach is Housing + Integrated Care = Success.

If we can take another moment for self-congratulation, we’ve been saying since 1980 that housing is healthcare… but let’s return to today, and how Integrated Care works from the client’s perspective. This is where the phrase “No Wrong Door” comes in.

No Wrong Door

As our clients know, we don’t hand a person in distress a blind referral to another service. We won’t ask them to share their life and their story again and again, to fill out form after form, and wait and wait for care.

Unnecessarily bureaucratic processes re-traumatize people by forcing them to relive (often painful) memories – sharing them over and over with people they’ve often just met. This is why we promise: once a person enters any of the many programs within Harbor Care, they are automatically “in the system.” A new client’s needs are assessed to ensure first that they have safe housing, and then move on from there.

And after 40 years of doing this kind of work, we know that more often than not, if a person doesn’t have a safe, secure place to stay, none of their other struggles will resolve, because that basic human need – safe shelter – remains unmet.

Because of the range of services we can offer people, we might connect a client who enters our doors to high-quality housing and residential services, primary and behavioral healthcare, dental care, substance use disorder treatment, home care, HIV/AIDS care, veteran services, or specialized supports designed to help individuals and families who are experiencing or are at risk of homelessness.

Embracing Complexity

This sounds like a lot, and it is. How can Harbor Care have this breadth of scope? Well, we do because it’s necessary; human beings are complicated. We each have our own unique and complex network of needs. When we experience a difficulty, it’s rarely an isolated issue, and when we reach out, we often need more than one type of service.

For example, research shows that roughly half the individuals experiencing a dependence upon a substance such as alcohol or opioids during their lifetime will also experience a mental disorder, such as anxiety, depression, and attention deficit hyperactivity disorder, whereas only 20% of the general population will experience one. Conversely, half of those experiencing a mental disorder will also form a dependence upon a substance, whereas only 10% of the general population will do so.

Primary health and behavioral health are also closely linked. The American Psychiatric Association states that roughly 70% of those receiving Behavioral Healthcare also have a medical condition, such as persistent headaches, insomnia, or diabetes. On the flip side, 33% of all adults receiving medical care also have behavioral health challenges such as anxiety or depression; the rate among individuals experiencing homelessness is exponentially higher.

Housing, healthcare, and HIV are linked in the same way. HIV has become a manageable disease for those who have stable housing, employment, and healthcare; however, one cough or sneeze for someone with HIV can turn into a lengthy, debilitating illness.

With so few safety nets in place, individuals who don’t have access to Integrated Care can easily spiral in complex ways when they face instability in one area of their lives just as another part becomes manageable. For many people, a job loss – especially for those without sick leave – often means losing healthcare, as well as jeopardizing housing. For unsheltered individuals, accessing and managing the daily medication regimen needed to maintain viral suppression is difficult if not impossible, and so they become sicker.

Housing stabilization literally means the difference between life and death for many people who require services. For example, in San Francisco 74% of all HIV-positive individuals and 91% of those who received at least one lab test achieving viral suppression have positive outcomes; however, this figure fell to just 33% among people living without shelter. Moreover, HIV+ individuals experiencing homelessness - something Harbor Care helped effectively end in Greater Nashua many years ago - experience a 27-fold higher risk of death than those with stable housing.

Shared Treatment Planning

For these reasons, Harbor Care is working hard to achieve the highest level of integrated care as defined by the US Department of Substance Abuse and Mental Health Services Administration - Level 6 (see a snapshot of what this level of care means below, in our gallery). Through this model of care, each client is assessed for a broad range of needs when they enter into any form of care and supports at Harbor Care. For example, staff may need to arrange for their HIV+ client to have stable housing, their behavioral health client to gain recovery housing or peer recovery support coaching, and their veteran client to receive stable employment. Each client has streamlined access to the full continuum of health and social services at Harbor Care, and an integrated care team to ensure they receive the care they need, when they need it, with the least amount of hassle possible.

By working together through shared treatment planning, Harbor Care staff are able to coordinate a comprehensive array of interventions, treatment options, and solutions that address people’s unique needs. Harbor Care provides tools for people to overcome – not only the one acute crisis that brings them through our doors – but the constellation of other issues that exacerbate one another.

By focusing on each person’s unique set of needs, Harbor Care’s holistic, whole-person approach provides those in need with a real opportunity for a healthy, fulfilling life. We’re proud to acknowledge that those we serve – empowered and motivated to create their own best outcomes – are making our community stronger.

And, this model speaks for itself – our outcomes, as demonstrated on our Impact page, are tangible evidence at our Integrated Care model at work.

Because of our successful model of Integrated Care, the U.S. Department of Housing and Urban Development recently selected Harbor Care to be the first EnVision Center in New England. Check out the Harbor Care video below for more information on our unique approach to serve the whole person.