With growing research-based evidence of clinical and cost improvements, the integration of behavioral health and primary care in the safety net public health care system is moving from the realm of early adopters and program innovators to the mainstream. This chapter is designed to provide readers with useable information on behavioral health care integration in the safety net health care system, the characteristics of people who depend upon that system, and the elements of workable integrated care models that can be brought to scale. The chapter reviews the clinical, delivery system, and cost outcomes associated with fragmented, siloed care versus integrated care. The chapter outlines the history of safety net care systems and the divergent legislative, financing and regulatory factors that established and preserved separation between community health centers and community behavioral health organizations. Recent public policy initiatives that promote care integration and adoption of integrated behavioral health care models in public health settings are discussed. Five case examples were drawn from the ranks of federally qualified community health centers and community behavioral health organizations to illustrate the opportunities and challenges in adoption of integrated care in the safety net. Essential components of sustainable integrated care initiatives are analyzed and include: organization and governance, organizational and staff culture, clinical systems and protocols, practice management and financial systems, and practice-based quality improvement and evaluation.

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