Early career professionals play an important role in the future of integrated primary care behavioral health. Integrated care has evolved over the past two decades but this continues to be a young field as it relates to primary care practice transformation. As more integrated primary care practices are established, the health care system will continue to need psychologists who are trained to practice as an effective team member.
A specific model of integrated care that can have the greatest level of integration is the Primary Care Behavioral Health (PCBH) consultation model. This is a population-based approach to addressing behavioral health issues that present in primary care (e.g., depression, anxiety, substance misuse) as well as the management of behaviorally influenced physical health conditions (e.g., diabetes, chronic pain, obesity).
A key component to population-based care within the PCBH model is the use of a behavioral health consultant or “BHC.” The BHC is responsible not only for providing brief consultations (e.g., 20 to 25 minute brief behavioral interventions) for patients but also impacts the primary care patient population by: 1) providing education to the primary care team (e.g., primary care providers, nursing, social work) on behavioral health issues in primary care through close proximity to the primary care team (e.g., seeing patients in exam rooms, charting in the nurses’ station rather than working in a private office); and 2) creating clinical pathways for common health conditions in primary care which may include group visits and classes.
How does the PCBH model connect to under-served populations?
Under-served populations (e.g., low income, transient, indigent) have had difficulty getting behavioral health services due to many reasons, such as lack of access to care, transportation and stigma.
A recent article in the Journal of the American Medical Association reported under-served populations historically have received inadequate treatment for depression – a treatable condition connected to rising health care costs. In a recent study, lower income patients had improvement in their global assessment of functioning in as few as five visits. By building PCBH services within primary care practices that provide care for the under-served, access to adequate, whole person care can be improved.
Behavioral health positions within primary care settings are on the rise. How can early career professionals prepare for a position as a BHC? Here are some tools to help you get started:
- Join an integrated care organization: There are organizations that focus on the integrated care such as the Collaborative Family Healthcare Association. These organizations have annual conferences as well as continuing education opportunities throughout the year to help you gain the necessary knowledge to be an effective integrated care professional.
- Find a local networking group: Practicing within an integrated care setting can be isolating at times, especially if you are the lone behavioral health professional in your clinic. Seeking out other providers in your community or region may help you build a local network of like-minded professionals for ongoing support.
- Seek out continuing education trainings that focus on behavioral health practice within primary care: There are organizations and institutions that provide ongoing trainings (e.g., webinars, classes, certificate programs) on behavioral health practice within primary care. Here are a few examples: Center for Integrated Primary Care (UMass Medical School), University of Michigan School of Social Work (Certificate in Integrated Behavioral Health and Primary Care) and the Eugene S. Farley Jr. Health Policy Center (University of Colorado).
- Read! If you have not worked within the PCBH model, a book to start with would be Behavioral Consultation and Primary Care by Patti Robinson, Ph.D., and Jeff Reiter, Ph.D. This will help establish a foundation of understanding of this approach to behavioral health in primary care settings.
- Shadow: Do you know of other psychologists practicing within the PCBH model? Ask to shadow them. Reading about the model is a great first step but seeing it in practice will expose you to the nuances of practice.
Integration is happening and effectively trained early career psychologists are necessary to be agents of change in this evolving health care system.
References available from author
Stacy Ogbeide, Psy.D., is a behavioral health consultant and licensed psychologist in an integrated primary care behavioral health setting and an assistant professor with the Family Medicine Residency Program in the Department of Family and Community Medicine at the University of Texas Health Sciences Center San Antonio. Her email is: firstname.lastname@example.org