In the Strengthen Foundations domain, three transformation concepts are described. Shift the Culture outlines the preliminary steps necessary to foster an environment actively seeking transformational shift in organizational culture. Ready the Environment focuses on developing health center-wide systems to support behavioral health integration. Build the Team focuses on establishing new roles for behavioral health clinicians (BHCs) and community health workers (CHWs) in the integrated primary care environment and building clinical skills across the care team.

Within this domain, discrete implementation activities include, but are not limited to, the following:

• Ensure that the executive leadership and organizational structure of the health center supports the goal of fully integrated behavioral and medical health care
• Identify clinical and administrative champions empowered to lead transformational change within the health center
• Initiate activities aimed at proactively engaging patients and families in the transformation process
• Optimize the revenue cycle for behavioral health services by identifying a billing champion, setting standard productivity expectations, and implementing processes to consistently monitor coding, billing, and denials
• Prepare electronic medical record (EMR) systems to support integrated behavioral healthcare by collecting discrete data, generating monthly reports, and enhancing EMR functionality for the end-user
• Ensure adequate physical space for the integrated care team
• Augment staffing in accordance with established staffing ratios for BHCs and CHWs, identify early childhood-focused care team members, and participate in clinical training activities