Hope and Healing: A Latent Analysis of Co-Occurring Needs and Service Utilization Among Urban Families In a Ccbhc Clinic

Background and Purpose

Detroit families who seek behavioral health services often face several challenges simultaneously, including mental health conditions, trauma histories, unstable housing, and limited access to primary care. Most behavioral health systems treat these needs separately, which leads to fragmented care that does not fully support families. Certified Community Behavioral Health Clinics (CCBHCs) are certified mental health clinics that provide a full range of services to anyone who needs them, regardless of income, age, or where they live. Established by the Protecting Access to Medicare Act of 2014, the CCBHC model aims to address the shortage of accessible, high-quality mental health care. The model has expanded through SAMHSA grants and state demonstrations, with over 500 clinics operating across the U.S. (SAMHSA, n.d). The CCBHC model in Detroit, led by the Centers for Family Development and social work researchers, was created to provide integrated, family-centered care across its nine core services. However, there is still limited understanding of the specific profiles of families served by CCBHCs. This study examines what patterns of co-occurring social needs, mental health conditions, and service use appear among CCBHC clients, and how these patterns can guide more targeted and equitable behavioral health services.

Methods

Data collection concludes on June 10th, 2026, and analysis will be completed by August 1st, 2026. A latent class analysis (LCA) will be conducted to identify subgroups of CCBHC clients sharing similar profiles of social needs, mental health diagnoses, and service utilization. LCA is a person-centered technique that classifies individuals into mutually exclusive groups based on observed patterns, without requiring any prior assumptions. Indicator variables spanned three domains: social needs (housing, food, childcare), diagnosis category (ADHD, internalizing, externalizing), and service type received. Models specifying two through six classes were estimated in Mplus, with selection based on BIC, entropy, and the BLRT.

Hypothesized Results

Grounded in syndemic theory and the ACE framework, three to four classes are anticipated. A High-Need Multi-Domain class (~25%) is expected to capture adults with co-occurring housing instability, depression, and adjustment disorders requiring wraparound services. A Youth Neurodevelopmental class (~35%) is anticipated, given that youth represent 76% of clients and ADHD is the most common diagnosis, with service use centered on family therapy and brief psychotherapy. A Trauma-Exposed Adult class (~20%) would reflect the adult pattern of depressive and mood disorders co-occurring with housing insecurity. A Lower-Complexity Single-Domain class (~20%) may capture clients with fewer co-occurring needs and limited service breadth.

Implications

These findings carry important clinical and equity implications for social workers serving high-need families. Rather than siloed services, families need the coordinated, comprehensive care CCBHCs are built to provide. Youth-focused work should include caregivers, as family-based interventions consistently produce stronger outcomes for children with externalizing disorders. For trauma-exposed adults facing housing instability and depression, integrated treatment to address these challenges together rather than one at a time. Social workers are positioned to respond through integrated treatment and standardized screening of social determinants of health, thereby strengthening service delivery for the individuals who need it most.