Chronic Disease, Mental Health, Provider Communication Skills, Substance Use 12.04.2019

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Integrating Behavioral Health Into Primary Care with Training

As healthcare leaders face opioid and mental health crises, integrating behavioral health into primary care is seeing promising results. Here’s how they’re doing it and why.

Integrating Behavioral Health Training

Behavioral health training is gaining attention as healthcare leaders face an unprecedented opioid epidemic and mental health crisis. One in seven Americans will face substance addiction—a chronic disease that is taking lives every day. Every 19 minutes, an American dies from opioid or heroin overdose. This epidemic costs the U.S. economy $442 annually. To put that in perspective, $245 billion is spent on diabetes.

Behavioral health has long been treated independently of physical health, but the opioid epidemic and substance abuse issues we’re facing today are prompting more healthcare facilities to adopt an integrated health model. Integrating behavioral health into primary medical care has the power to reduce spending and improve health outcomes.

What is Behavioral Health?

The term “behavioral health”, according to the Substance Abuse and Mental Health Services Administration (SAMHSA), can be defined as “the promotion of mental health, resilience and wellbeing; the treatment of mental and substance use disorders; and the support of those who experience and/or are in recovery from these conditions, along with their families and communities”.

Behavioral health treatments, such as counseling and specialized psychotherapies, work to help people with mental health concerns or substance use disorders by changing their behaviors, thoughts and emotions. Treatments vary by person and situation but may sometimes include medication to provide relief and manage symptoms.

The Case for Behavioral Health Integration in Primary Care

Keeping behavioral health and primary care separate is a practice that the Institute of Medicine concluded was leading to inferior care nearly 20 years ago.

Mental health conditions take a physical toll on the human body. As many as 80% of patients struggling with behavioral health disorders find their way to emergency rooms, and most will leave without receiving treatment for their behavioral health condition. Even if they are referred to an external mental health or substance abuse treatment facility, the odds of them following through are low.

By integrating behavioral healthcare with primary care, more people can receive the treatment they need, which will not only improve health outcomes but also decrease spending.

Treatment of mental health and substance use disorders can lower the amount of repeat hospital visits, and is also associated with decreased use (and associated costs) to other human service systems. This includes child welfare, criminal justice, education, and housing services.

Better health outcomes … decreased spending … better access to care … there’s a lot to gain from behavioral health integration.

But what exactly is integrated care?

“Integrated care” can have a lot of meanings. In this context, The Agency for Healthcare Research and Quality defines Integrated Behavioral Health Care (IBHC), as:

The care a patient experiences as a result of a team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population.

This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization.

As patient-centered care becomes increasingly important, and more clinics are being paid based on health outcomes, integrated behavioral healthcare is the clear choice. It is cost-effective and has the power to help more people receive the treatment they need.

The U.S. Department of Health and Human Services agrees. As part of its effort to combat the U.S. opioid crisis, it awarded more than $200 million to health centers providing integrated behavioral health services.

What Integrated Care Looks Like

It’s clear that integrated behavioral healthcare is the right choice, but what exactly does that look like?

SAMHSA has developed Core Competencies for Integrated Behavioral Health and Primary Care, which includes:

  • Interpersonal Communication
  • Collaboration and Teamwork
  • Screening and Assessment
  • Care Planning and Care Coordination
  • Intervention
  • Cultural Competence and Adaptation
  • Systems Oriented Practice
  • Practice-Based Learning and Quality Improvement
  • Informatics

These core competencies are meant to provide a framework for healthcare organizations as they work toward an integrated healthcare model, as well as educators who are teaching future healthcare professionals who will work in these environments.

In integrated care settings, healthcare professionals need to have the ability to communicate and collaborate with other providers and family members. They require the knowledge and skills to confidently perform screenings for mental health conditions and substance use disorders, and understand how to respond to them with intervention or treatment. Just like any other type of healthcare, they need to continually strive to improve patient satisfaction and quality of care.

How Do We Get There?

For behavioral healthcare to be integrated into primary care, there must be a skilled workforce ready. The problem is, most healthcare professionals did not receive behavioral health training, and primary care physicians were not trained in psychology.

Behavioral Health Training: SBIRT

Some of the most successful models for behavioral health integration in the primary care setting put a heavy focus on behavioral health training for primary care providers. Because behavioral health and primary care have been two separate worlds, primary care providers need behavioral health training to learn how to screen and treat mental health conditions such as depression, anxiety and substance use disorders.

Simulation-Based Behavioral Health Training

Simulation-based trainings are an efficient and effective way to provide the training today’s healthcare professionals need to thrive in an integrated healthcare setting.

These virtual behavioral health trainings can be implemented:

  • In classrooms for future health professionals
  • In residency programs within health systems
  • As part of professional development programs for health professionals
  • As continuing education credit for health professionals
Behavioral Health Training with Kogniot
Kognito’s At-Risk in Primary Care

Kognito’s At-Risk in Primary Care and At-Risk in Primary Care: Adolescents are interactive role-play simulations that are research-proven and CE-certified. They prepare nurses, physicians, social workers, and students to screen patients for substance use and mental health conditions, conduct brief interventions using motivational interviewing techniques, and coordinate referrals or follow-up care.

In a longitudinal study with 877 health professionals, completing At-Risk in Primary Care was shown to:

  • Significantly increase preparedness (knowledge and skills).
  • Improve the likelihood that health professionals would perform a screening and manage the treatment of patients who exhibit signs of mental health disorders and substance use.
  • Increase the number of patients receiving a screening, brief intervention, or referral to treatment for substance use or mental health by up to 139%.

Through these simulation trainings, healthcare professionals and students role-play real scenarios. The virtual patients respond based on how the user chooses to steer the conversation, and a virtual coach provides individualized feedback. This experience is designed to teach users the knowledge and skills needed to:

  • Screen patients for depression and substance use using evidence-based tools
  • Recognize risk factors and warning signs of substance use, depression, and suicidal ideation
  • Conduct brief interventions using motivational interviewing techniques
  • Engage in collaborative treatment planning with patients
  • Coordinate referrals to treatment or follow-up care

Having the ability to communicate with and help screen and treat patients with behavioral health disorders isn’t a skill learned overnight. However, with practice and appropriate behavioral health training, healthcare professionals in primary care settings can confidently work with these patients and help improve their wellbeing.

By integrating behavioral healthcare in the primary care setting, healthcare centers are leading the effort of facing the opioid epidemic and mental health crisis. Increased funding and training will only lead to more success stories, and we can’t wait to share them.


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