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