Building and Sustaining the Primary Care Building and Sustaining the Primary Care Behavioral Health Workforce: Behavioral Health Workforce:

A Practice-Based Training ModelA Practice-Based Training ModelNatalie Levkovich

Chief Executive Officer

Health Federation of Philadelphia

Suzanne Daub, LCSW

Director of Behavioral Health

Delaware Valley Community Health, Inc.

Collaborative Family Healthcare Association 14th Annual ConferenceOctober 4-6, 2012 Austin, Texas U.S.A.

Session # F3aOctober 5, 2012

Faculty Disclosure

I/We have not had any relevant financial relationships during the past 12 months.

Objectives

Describe the core components and strategies of the

practice-based training program

Distinguish between academic and practice-based

training and their respective roles

Identify the benefits of long-term participation in a

practice-based training program

Describe evaluation results based on surveys

conducted with participants in the training program

Learning Assessment

A learning assessment is required for CE credit.

Attention Presenters:Please incorporate audience interaction through a

brief Question & Answer period during or at the conclusion of your presentation.

This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy

accreditation requirements.

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!

Health Federation of Philadelphia

The Health Federation of Philadelphia is a

large network of federally qualified

community health centers in the

metropolitan Philadelphia region

The development and coordination of the

Primary Care Behavioral Health initiative

was implemented under the auspices of the

Health Federation

Network Growth 2006 - 2012

Collaborative Model Building

The Health Federation, with the full participation and contribution from participating health centers and practicing BHCs, designed the clinical model, the payment and policy advocacy strategy, and the training program for the clinical workforce

Each component was developed incrementally and informed by the others

Collaborative Model Building

The payment and credentialing model through Medicaid was developed to fit and support the model and was fully adopted by the local MA MCO and State Medicaid Office

o The training program followed the parallel process of the clinical model; i.e., its design was driven by providers’ need and readiness for change, and implemented in step-wise fashion

Core Training Module

All staff orientation to PCBH Principles

Core Training Module: BHC Practice Habits

General Orientation to the Practice

Setting – system of care and resources

Definition of Population-Based Care

Role and Mission of the Behavioral Health

Consultant within the Primary Care Team

SOAP Note documentation

Acculturation into the Primary Care

Lexicon and Culture

Core Training Module: BHC Practice Habits

Behavioral Issues with Commonly

Encountered Chronic Medical Diseases

Common Intervention Frameworks

Functional/Strategic Patient Care

Self-care

BHC Leadership

Core Training Module:Primary Care Provider Orientation

Signs and symptoms of BH conditions

commonly encountered in primary care for

adults and adolescents Basic psychopharmacology Additional topics as requested

Ongoing Training Topics:BHC

BH-PCP Communication

Adapting Established Interventions to Primary Care

Co-Management of Mental health and medical diagnoses

Group Medical Care

Prevention, psycho-education

Pediatric interventions

Women’s health/reproductive health

Geriatric, Cognitive and Memory

Cultural competency

Ongoing Training Topics: BHC

Use of assessments Care management Practical

Psychopharmacology Working with SPMI

Managing psychiatric crisis in PCBH

Collaborating with psychiatry

Supervising and mentoring

Self-care

Observation: shadowing and being

shadowed

Ongoing professional development:

monthly network meetings with didactic

presentations and group discussion

Group supervision

Web-based (Google Groups): posting of

notes for review and correction by trainer

Training Modalities

Expert training provided by a consultant, Neftali Serrano, PsyD (primarycareshrink.com)

Periodic on-site observation

Use of video and webinar

Maintenance of print resource

and DVD library

Gradually, training capacity is being developed and

transferred to internal trainers

Contracted with FDU to use video training on specific

topics – will better match model and experience level

Benefits of the Practice-Based Primary Care Behavioral Health Training Program

Vehicle for model replication and fidelity

Efficient workforce deployment

Initial and ongoing professional development

Support for BHC professional identity

Remedy for professional isolation

Leadership development

Collective advocacy and quality improvement

Satisfaction of participants, based on 2012 survey

21 survey respondents out of 36 BHCs in the network (60%)

Length of time in the network:

28.6% more than two years

9.5% 1 – 2 years

61.9% 6 mos. to 1 yr.

Having a structure for ongoing BHC development is useful in:

95% Fostering professional development and promoting identity as a BHC

90% Providing a structured opportunity to reflect on clinical practice

90% Promoting consistency of practice habits across the network

87% Developing peer support, reducing isolation and promoting collegiality

57% Developing leadership skills (e.g. as a trainer/supervisor within the network)

Rate the value of learning opportunitiesVery Valuable/Moderately Valuable

90% Ongoing professional development

85% New BHC orientation

81% Expert consultation

80% Virtual communities through Google

75% Cross Shadowing

67% Training others

Are these network opportunities more or less valuable to you as you gain experience?

75% Equally or more valuable

Are most training topics relevant and useful?

80% said yes/but…

“Topics are good, however, a lot of the

trainers aren’t tailoring their topics to

match the experience level (too

elementary) and nature of BHC work

(speaker unfamiliar with BHC model)”

Does group supervision fulfill a need?

80% said yes/but…

“I think more benefit could be derived

from supervision. I have the impression

that many of the participants are unsure

of the purpose, practice and potential

benefits of the supervision groups”

Future plans based on survey – Leadership Development

Build capacity to handle ongoing training using current network expertise and resources:

Plan for train the trainer seminar

Plan to develop mentoring relationships between

more experienced trainers and people with

interest, but less experience/confidence

Formal training on reflective supervision

General Recommendations

Practice-based training programs to be

established in more communities

Partnership with academic training programs

Partnership with certification programs

Funding support