Training The BHC
Published on Apr 13, 2016
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PRESENTATION OUTLINE
Training The BHC Workforce
Neftali Serrano, PsyD, COEIntegratedcare.org
The challenge of training and supplying a BHC workforce for every patient centered medical home in America is substantial.
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Objectives
- Describe the current state of training
- Describe the ideal future state of training
- Determine site specific pathways and conditions for a sustainable workforce
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Practice is far ahead of formal training programs.
The current state is that practice sites have growing needs for qualified BHCs and there are relatively few institutionalized pathways for supplying this workforce. Therefore sites must invent their own pathways.
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Current State:
Trial & Error.
Certificate.
Reach Out.
Most professionals at present either attempt to make the transition to primary care on their own, do self-study or some form of a distance-learning certificate and/or reach out to other organizations for formal or informal technical assistance.
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Training BHCs: What We Have Learned
- Hiring (selection) is key
- Core competencies, not licensure (review tools)
- Organizational/ implementation support is key
There is consensus among established BHCs that temperamental flexibility and openness to the model of care is the most important factor to the success of a professional making this transition. There is greater consensus as well as to the core competencies for BHCs. The need for organizational transformation has also been recognized as crucial.
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What TA Support Looks Like
Although this talk is not centered on the provision of technical assistance, considering technical assistance as part of the growth of a BHC in a program that is still early in development is key. In other words, a new program, hiring a new BHC, doesn't just need a qualified BHC, they need help with organizational/ programmatic aspects.
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TA Support 101
- 10-20 Hours of Didactic
- 20 Hours of onsite shadowing
- Documentation review
- 10-20 Hours of additional general support
This is the perspective of the Center of Excellence used on lived experience. More research is needed in this area to ascertain exactly how much and what type of TA leads to success.
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Doesn't Include Organization Transformation TA
One way to address or measure the core competencies of organizational readiness and support for integrated care is to use a tool like the MeHAF.
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The Future State?
A Transformed Educational System
The need for academic centers to make the transition to primary care behavioral health is pressing.
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Integrating Integration
- Standardized coursework for all MH professionals
- Trained faculty (see new APA toolkit)
- Track-based supervised experiences
- Credentialing strategy
- Increased connection between practice sites and training programs
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Primary Care Trained MH Professionals
&
Specialty Care Trained MH Professionals
The goal of a transformed educational strategy for mental health disciplines should be dual tracks, with a primary care emphasis and specialty care emphasis. This mirrors the structure of training in medicine.
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Sustainability
A crucial guiding concept to creating BHC positions and developing BHCs is considering sustainability from the outset. This include sustainability from the vantage point of the organization as well as the individual BHC.
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Create A Nourishing Job
- Tap into passion and talent
- Develop leadership
- Provide administrative time commensurate with leadership expectations
- Focus on passion not productivity
The BHC role will not sustain itself financially in most instances yet organizations often start thinking about the position with productivity in mind. Ironically, the best way to achieve maximum productivity is to create an environment where productivity is not the goal but rather a by-product of the mission-driven BHC.
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Sample Cadence
- Shadowing
- Documentation training
- Core components training starting with introduction
- Independent work with curbside training
- Reverse shadowing
- Maintenance shadowing
- Periodic reviews using checklist
BHCs need a great deal of support in their first 6 months but also need ongoing maintenance of skills.
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Hive Approach:
Rotate BHCs for Maximal Development
This is a difficult concept for specialty mental health professionals to grasp and is one of the key differences with specialty care. The patient relationship in the PCBH model is with the care team, not the individual BHC, thus allowing BHCs to rotate clinics and see each other's patients. This in turn allows for consistency of delivery of services.
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Metrics For BHC Performance
- Provider satisfaction
- Population penetration
- Diversity of referrals by diagnosis
- Core competency assessments
Establishing metrics helps the BHC team understand their population based goals and reinforces that perspective.
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Sustaining Growth
- BHCs are always in development
- Fostering leadership
- Program development
- Clinical pathway development
- Engagement in training future BHCs
There are effective "worker bee" BHCs, but in my experience many of the best BHCs need a variety of responsibilities to be fulfilled in their work.
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Resources
- Training tools: http://www.behavioralconsultationandprimarycare.com/second-edition/
- Program development ebook: The Implementer's Guide To PCBH (iTunes)
- Modular graduate course (APA): Bill Gunn, PhD: wgunn@crhc.org Barbara Ward-Zimmerman, PhD: bward.zimmerman@cox.net
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Resources cont...
- CFHA.net
- Certificate Programs: UMASS, UMICH
- ASU DBH Program
- Center of Excellence: coeintegratedcare.org
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