Session # F3a
October 5, 2012
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 14th Annual Conference
October 4-6, 2012 Austin, Texas U.S.A.
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 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
Training Modalities

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
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