(016) Establishing a Comprehensive Behavioral Health Clinician Training Program for Collaborative Care in a large New England Health System

Abstract:

Background: Collaborative Care (CoCM) is an evidence-based model of integrated care designed to treat behavioral health conditions in a primary care setting (Archer 2012; AIMS 2021). At Beth Israel Lahey Health, CoCM is currently operational at 56 practices, serviced by 26 independently licensed (LICSW/LMHC) Behavioral Health Clinicians (BHCs). Although the cohort represents diverse professional training and experience, few had any previous work experience or training in the model. Specific training in COCM is needed to develop a necessary workforce for rapid program expansion.

Methods: We developed a comprehensive orientation and learning collaborative for the continuous training of BHC to develop necessary skills to treat patients in the context of CoCM.

BHCs in CoCM engage in an orientation that includes:

Use of EHR, data registry, and documentation with “open notes”;

Shadowing peer BHCs in CoCM practice;

Observed practice communicating distinct features of CoCM to patients and providers;

Facilitated review of internal and external training materials on screening instruments, brief psychotherapeutic interventions, successful skills in CoCM, and measurement-based assessments and treatment;

Practiced case review for clinical discussions to inform treatment planning, enhanced skills training in recognizing medical co-morbidities, and emphasis on diagnostic rigor.

Continuous education that includes:

Monthly “Learning Collaborative" - didactic seminars on assessment techniques and modalities of treatment specific to CoCM.

Supervised case-review with directed feedback by a senior program director

Annual skill and confidence self-assessments have been utilized since 2020 to monitor BHC abilities and comfort assessing and treating patients in CoCM.

Discussion: Our model of training facilitates BHC in acquiring strong technical foundation for delivering CoCM in primary care. BHCs have regular training opportunities to learn and practice treatments that meet the diverse and evolving needs of their patient panels. Annual self-assessments have shown a trending increase in BHC confidence and perceived productivity in meeting patient’s treatment needs. Targeted continuous education supports BHC enhancing necessary skills to care for increasingly complex patients.

Conclusion: Both initial and continuous training is required for BHCs engaged in CoCM. Baseline needs assessment and ongoing inquiry can identify areas requiring increased training to manage populations within CoCM. We present a model for the implementation of such a training program across a large multisite health system.

References:

AIMS Center University of Washington. (2021). Impact: Improving Mood -- Promoting Access to Collaborative Treatment.

Archer J et al.. Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews 2012;10.

Presenting Author(s)

Lisa B. Gelormini, MSW, LICSW

Program Director
BILH Behavioral Services
Danvers, MA, United States

Co-Author(s)

Samantha L. Karwin, MS, LMHC

Regional Program Director
Beth Israel Lahey Health
Danvers, MA, United States
Elizabeth Attaya, MS

Operations Coordinator
Beth Israel Lahey Health
Wakefield, MA, United States
David Van Norstrand, MD, PhD

Director, Consult Psychiatry
Lahey Hospital & Medical Center
Somerville, Massachusetts, United States
Nizelky C. Genao, N/A, n/a

VP, Strategic Planning, Innovation, and Integration
Beth Israel Lahey Health Behavioral Services
Danvers, Massachusetts, United States
Patrick Aquino, MD, FACLP, DFAPA (he/him/his)

Chair, Division of Psychiatry & Behavioral Medicine
Lahey Hospital & Medical Center
Burlington, MA, United States