Primary Care Behavioral Health Provider Training: Systematic Development and Implementation in a Large Medical System

Optimising and personalising behavioural healthcare in the US Department of Defense through Primary Care Behavioral Health

Over the past 25 years, one way the US Department of Defense (DoD) has worked to optimise and personalise the delivery of behavioural healthcare is by integrating behavioural health providers into primary care settings. Using the Primary Care Behavioral Health (PCBH) model for integration allows behavioural health providers to see service members and their families for brief and targeted appointments. These appointments are focused on ensuring that the patient receives the care that is needed, while reducing the barriers (eg, delays in receiving care, negative stigma, isolated from other medical care) that are often associated with seeking behavioural healthcare. We review the primary components of the PCBH model, detail the history of how the DoD implemented the PCBH model, review the training methods used by the DoD and briefly describe some of the research that has been conducted by the DoD evaluating the PCBH model.

Current Landscape of Psychologists in Academic Health Centers: Roles and Structural Models

With mental health needs consistently increasing in our communities and medical centers, we want to ensure that institutions are aware of the benefit and value that psychologists bring to their system and provide several pathways for consideration and structure to understand how to support the salaries and careers of psychologists working within AHCs. Leadership and administration within Academic Health Centers (AHC) often do not understand the value and measurement of productivity for psychologists being added to the medical teams. The current article aims to present varied structural models and demonstrate how productivity is reviewed for psychologists across different institutions and departments. The authors will outline the many roles that psychologists serve within academic health centers as well as the value those roles bring to the system. The overarching goal is to provide an educational article that serves as a tool for recruitment of psychologists that leaders and faculty can refer to when approaching administration in AHCs to understand the systems and roles of psychologists within medical settings. This information can be utilized to help create new positions for psychologists, aid in recruitment efforts and provide transparency for faculty currently working within AHCs who may not be aware of the varied opportunities.

Current Practices in Clinical Supervision in Primary Care

The purpose of this study was to examine current clinical supervision practices within primary care settings. We used a descriptive survey design, which blends quantitative and qualitative data, and examined the current state of clinical supervision practices and approaches in primary care and the type of training the behavioral health consultants received to provide supervision to pre-licensure level behavioral health trainees. Ninety-four participants completed the survey in 2022. Seventy-one percent of respondents felt they had adequate training to be an effective integrated behavioral health (IBH) supervisor; however, most training came from sources, such as workshops, continuing education, or supervision of supervision. Further efforts to establish universal competencies and formal training programs are needed to meet the growing need for IBH services in primary care.

Clinical Psychologists as T-Shaped Professionals

The modern world is becoming increasingly integrated, and disciplines are frequently collaborating with each other. Following this trend, clinical psychologists are also often working within multidisciplinary teams and in settings outside of traditional mental health. To be competent and effective in these contexts, clinical psychologists could benefit from skills outside of psychology. The current psychology training model provides depth of training in psychology but could be improved by providing the breadth of training required of modern clinical psychologists working in these contexts. Other disciplines, such as engineering, business, and social work, have improved their breadth of training through the adoption of the T-shaped model. This model of training allows individuals to simultaneously acquire the depth of knowledge required for their discipline and the breadth required to work effectively in multidisciplinary contexts. This article discusses areas in which clinical psychologists could benefit from broad training and recommendations to implement the T-shaped model.

Acceptability of and intention to use the Unified Protocol delivered in group format in the Spanish Public Health System

BACKGROUND

The high prevalence of emotional disorders leads to a high demand for mental care which results in high costs and long waiting lists in public mental health settings. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is a recent emotion-regulation-based intervention that can be a cost-effective solution in public mental health settings due its transdiagnostic approach and the possibility to apply it in group format. However, the acceptability by mental healthcare professionals (MHCPs) delivering the UP in group format has not been explored.

METHODS

Thirty-three MHCPs, grouped into MHCPs without previous experience and MHCPs with experience in delivering the UP, were asked about aspects of acceptability and intention to use. Quantitative analysis was carried out to explore MHCPs acceptability. Furthermore, qualitative opinion about UP were collected through a SWOT (strengths, weaknesses, opportunities, threats) analysis to explore MHCPs opinion of delivering the UP intervention in a group format, within the Spanish Public Mental Health System.

RESULTS

The results showed high scores in all acceptability dimensions and intention to use in the future. SWOT analysis showed strengths and opportunities focusing on its transdiagnostic nature and the cost-effective benefits of group treatment, and weaknesses and threats related to the limited material and human resources.

CONCLUSIONS

Findings indicate high acceptability of the UP by MHCPs working within the Spanish Public Mental Health System and also identified areas for improvements. In order to enhance the dissemination and implementation of the UP, it is essential to consider MHCPs' perceptions and to be open to their suggestions.

The Behavioral Health Consultant: Roles and Responsibilities

With the scarcity of mental health services, integration of behavioral health into pediatric primary care increases the accessibility and availability to mental health services to a broad range of patients and their families while bridging the gap of physical and mental health. Encouraging whole-person care, the role of the behavioral health consultant serves as a proactive and preventative means fostering early intervention and detection, as 50% of all lifetime mental health disorders begin by the age of 14 years.

The Primary Care Behavioral Health (PCBH) Model: An Overview and Operational Definition

The Primary Care Behavioral Health (PCBH) model is a prominent approach to the integration of behavioral health services into primary care settings. Implementation of the PCBH model has grown over the past two decades, yet research and training efforts have been slowed by inconsistent terminology and lack of a concise, operationalized definition of the model and its key components. This article provides the first concise operationalized definition of the PCBH model, developed from examination of multiple published resources and consultation with nationally recognized PCBH model experts. The definition frames the model as a team-based approach to managing biopsychosocial issues that present in primary care, with the over-arching goal of improving primary care in general. The article provides a description of the key components and strategies used in the model, the rationale for those strategies, a brief comparison of this model to other integration approaches, a focused summary of PCBH model outcomes, and an overview of common challenges to implementing the model.

Building the plane in the air…but also before and after it takes flight: considerations for training and workforce preparedness in integrated behavioural health

Collaborative approaches to healthcare that integrate behavioural and biomedical interventions are more likely to enhance patient outcomes as well as provider satisfaction with care delivery than siloed approaches to care. The recognition for specific and targeted training for these models is growing among all health professions, although many in the field have not received systematized, interprofessional, and competency-based training that adequately prepared them for the work of integration. This article reviews some of the fundamental principles of biopsychosocially-oriented, team-based approaches to care that integrate behavioural and biomedical perspectives and delineates the need for targeted training efforts. It describes which specific elements must be addressed within it in order to promote effective integration, and highlights the array of options for training currently in existence. This review provides an overview of current models of training offered in the US, and concludes with a discussion of the challenges and barriers that may render training either ineffective or difficult to achieve.

Education programs for medical psychiatry collaborative care: A scoping review

OBJECTIVE

To understand the current state of collaborative care education programs reported in the literature.

METHODS

Following Arksey and O'Malley methodology for scoping reviews, data was abstracted in following domains: article details, program details, program outcomes, and implementation factors. Numerical summaries were calculated where necessary. Implementation factors underwent a qualitative thematic analysis.

RESULTS

This review identified 40 unique collaborative care education programs. Most programs (n = 25; 62.5%) were delivered to a multi-disciplinary group of learners through didactic (n = 34; 85.0%) and/or in vivo (n = 32; 80.0%) training methods. The majority of programs focused on clinical knowledge/skill acquisition (n = 38; 95.0%) as opposed to attitudes towards mental health and collaboration (n = 27; 67.5%). Implementation factors fell within four themes: program development, supportive environment, necessary resources, and clinical change agents/leaders.

CONCLUSION

Despite the growing evidence for collaborative care, few collaborative care education programs are reported in the literature. Key elements of collaborative care education programs include: routine multi-disciplinary interaction, curriculum focus on attitudes; clinical change agents and leaders to accelerate implementation; and a user-centred design development process. Future implementations can learn from these experiences to avoid potential barriers and focus on enabling successful programs to enhance care.

Training the Doctors: A Scoping Review of Interprofessional Education in Primary Care Behavioral Health (PCBH)

Primary care behavioral health (PCBH) is a model of integrated healthcare service delivery that has been well established in the field of psychology and continues to grow. PCBH has been associated with positive patient satisfaction and health outcomes, reduced healthcare expenditures, and improved population health. However, much of the education and training on PCBH has focused on developing behavioral health providers to practice in this medical setting. Less attention has been paid to physician team members to support and practice within an integrated environment. This is problematic as underdeveloped physician team members may contribute to low utilization and attrition of behavioral health consultants. A scoping review was conducted to examine the training of physicians in this domain since 2006. Twenty-one studies were identified, predominantly in Family Medicine training programs. Although PCBH training was generally well received, more program evaluation, formalized curriculum, and faculty development are needed to establish best practices.

Legislative and Policy Developments and Imperatives for Advancing the Primary Care Behavioral Health (PCBH) Model

The Primary Care Behavioral Health (PCBH) practice model continues to gain converts among primary care and behavioral health professionals as the evidence supporting its effectiveness continues to accumulate. Despite a growing number of practices and organizations using the model effectively, widespread implementation has been hampered by outmoded policies and regulatory barriers. As policymakers and legislators begin to recognize the contributions that PCBH model services make to the care of complex patients and the expansion of access to those in need of behavioral health interventions, some encouraging policy initiatives are emerging and the policy environment is becoming more favorable to implementation of the PCBH model. This article outlines the necessity for policy change, exposing the policy issues and barriers that serve to limit the practice of the PCBH model; highlights innovative approaches some states are taking to foster integrated practice; and discusses the compatibility of the PCBH model with the nation's health care reform agenda. Psychologists have emerged as leaders in the design and implementation of PCBH model integration and are encouraged to continue to advance the model through the demonstration of efficient and effective clinical practice, participation in the expansion of an appropriately trained workforce, and advocacy for the inclusion of this practice model in emerging healthcare systems and value-based payment methodologies.