Co-location of Services Model

Co-location refers to services that are located in the same physical space (for example, office, building, campus), though not necessarily fully integrated with one another. Co-location can involve shared space, equipment, and staff; coordinated care between services; or a partnership between organizations. 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
• 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 use, and domestic violence. A human services staff member connects pregnant women who need assistance to several programs offered by LCTHC, including substance use counseling, parenting support, and home visiting. The human services department also has weekly care coordination meetings to ensure these individuals are connected to providers and services.
• The Giles Free Clinic, a Federally Qualified Health Center (FQHC) located in the Appalachian mountains of western Virginia, co-located 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 increased access to oral health and behavioral health services in the community. Co-location 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 was particularly beneficial for children who could be seen by a dentist at the time of their well-child visit.
• Florissa provides critical developmental and behavioral services to children and their families in rural Illinois. Florissa is co-located within KSB Hospital to streamline services for patients who typically visit multiple providers and services.
• Charles A. Cannon Jr. Memorial Hospital and Appalachian Regional Behavioral Hospital is a co-located Critical Access and behavioral health hospital. The co-location allowed the hospital to meet the increasing demand for behavioral health beds in the community, and successfully reduced long wait times in the emergency department for inpatient psychiatric admission.

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 (for example, during a meeting with a domestic violence advocate or a substance use 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 (for example, 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 may co-locate child and family services to help families struggling with substance use and domestic violence. Successful collaboration of child and family services requires workflow redesign to ensure that staff share case information and coordinate services. Rural communities implementing co-location programs for domestic violence advocates and substance use specialists should be aware of state certification requirements and policies surrounding home visits. Some programs that co-locate domestic violence advocates in child and family services offices are supported through federal Family Violence Prevention and Services Act funds.

Co-locating services can be particularly challenging for Critical Access Hospitals (CAHs), which are required to maintain a specific minimum distance from other acute care hospitals. Some CAHs, like the Charles A. Cannon Jr. Memorial Hospital and Appalachian Regional Behavioral Hospital, successfully received exemptions to the CMS rule that prevented CAHs from operating within certain distances of other hospitals.