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:
Job training services
Child welfare and family
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
Health Services: A Way to Improve Coordination of Children’s Health Care?
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
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
Organizations(s): The Commonwealth Fund, Agency for Healthcare Research and Quality (AHRQ), University of
New Mexico Health Sciences Center