Building and Sustaining the Primary Care Behavioral Health Workforce: A Practice-Based Training Model Natalie Levkovich Chief Executive Officer Health Federation of Philadelphia Suzanne Daub, LCSW Director of Behavioral Health Delaware Valley Community Health, Inc. Collaborative Family Healthcare Association 14 th Annual Conference October 4-6, 2012 Austin, Texas U.S.A. Session # F3a October 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 the evaluation 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

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 opportunities Very 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