Complex care serves individuals who are repeatedly cycling through healthcare, social service, and other systems but who do not derive lasting benefit from those interactions. The Camden Core Model, our signature complex care program, serves people with complex needs in Camden, NJ. To improve the quality of our patients’ care, a clinical psychologist assessed their psychiatric, substance use, and social needs.
We found a wide range of behavioral health and social needs, including high rates of active mental health and substance use diagnoses, physical and emotional trauma, and housing instability. Furthermore, we learned that while most patients had recently seen their primary care provider, very few were currently receiving treatment for their behavioral health diagnoses. These findings underscore the need for policies and incentives that support integrated medical-behavioral healthcare, and which strengthen connections between primary care practices and social service providers.