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On Boarding New Behavioral Health Consultants into Primary Care

Posted By Wendy Bradley, Tuesday, February 12, 2013

For many therapists, social workers, and psychologists working in the culture of a primary care is completely foreign. At Southcentral Foundation (SCF) in Alaska, this is no exception. SCF is a fully integrated level 3 medical home, so ensuring that a Behavioral Health Consultant (BHC) is the right fit for the clinic, has a comprehensive orientation and gets on-going training support is imperative aspect to the success of the program.

To promote a systematic approach to BHC recruitment, selection, and development, SCF documented the BHC role, knowledge, skills, abilities, and qualifications in a formal BHC job description. BHCs are licensed mental health professionals qualified to offer services in the full range of conventional counseling situations, such as depression, substance abuse, family relationships, and child development, as well as in the behavioral management of medical conditions, such as diabetes and chronic pain. Requirements include a master’s degree or doctorate in a mental health field; at least one year of supervised clinical work experience; and training in behavioral medicine and health psychology, as well as social systems and familial aspects of psychological and medical conditions.

Attributes associated with success include flexibility, resourcefulness, and initiative, since BHC effectiveness depends on providing prompt access and a focused and individualized response in order to meet customer-owner and primary care provider (PCP) needs. A key focus of the BHC interview and selection process is ensuring that every new hire is a good fit – not only with customer-owners, but also with all members of the integrated care team (ICT). Of candidates interviewed, some 20-30 percent demonstrate the combination of characteristics that predict a good fit: good people skills, team orientation, knowledge and experience in a variety of situations, good judgment, and the ability to think on one’s feet.

This systematic process of
hiring for fit, orienting new
BHCs and providing on-going support have been the
foundation for continuity
and consistency in the
program and has created
the environment for
continued success.

SCF has created a comprehensive set of BHC core competencies. These core competencies embrace the dual roles of the BHC (behavioral provider and care team consultant), the required knowledge and skills required (for assessment, triage, intervention, outcomes analysis and documentation), and best practices to meet the cultural and age-specific needs of SCF customer-owners. These core competencies provide the foundation for BHC orientation during the first 12 weeks on the job, as well as ongoing performance evaluation and improvement.

A newly hired BHC shadows other BHCs for six weeks, starting the first week with the clinical supervisor, and then working with the BHC peer mentor. The mentor is responsible for the BHC’s orientation, training and ongoing support. A new hire may also be assigned to shadow a PCP in order to gain insight into ways BHCs interact with medical providers to gain their trust and build their knowledge. During the last week, the clinical supervisor and BHC mentor, and then the other BHCs in rotation, shadow the new BHC. During peer shadowing in the orientation period, the new hire also becomes familiar with SCF’s care guidelines and documentation practices. This approach to orientation serves as an active mechanism for knowledge transfer to the new employee, with on-the-job reinforcement including opportunities to demonstrate learning and get immediate feedback.

Performance Management and Improvement

BHCs use four methods – peer shadowing, chart reviews, peer supervision, and annual work plans – to ensure that BHCs share best practices while establishing consistency in the approaches used across the group. All four methods provide opportunities to review and reinforce the BHC core competencies and fundamental principles of BHC integration, such as the principle that the primary customer of the BHC is the PCP and that the primary competency of the BHC is assessment, not therapy. Since 2009, three BHC mentors work alongside the clinical supervisor to ensure consistency in the use of these methods.

Mentors shadow BHCs on a rotating schedule, using a shadowing checklist to observe and evaluate the demonstration of competencies in the four phases of a BHC visit. Representative competencies include refining the reason for referral to the BHC (Introduction Phase), assessing customer-owner strengths (Assessment Phase), discussing options (Intervention Phase), providing the PCP with a concise overview and recommendation (Follow-up Phase), and concluding the interaction – all within 20 minutes. Although BHCs use the feedback to improve their knowledge and skills, findings are not used in the formal evaluation process. BHCs also complete quarterly chart reviews using a chart review checklist to examine several charts from each BHC. This approach promotes consistency of documentation.

Peer supervision is a one-on-one discussion and case review facilitated by the clinical supervisor that supports the delivery of quality behavioral health care, including clinician self-care. For example, if the customer-owner says something that triggers issues for the BHC personally, these review opportunities provide the BHC with an outlet for discussion. Lastly, BHCs work with their managers and clinical supervisors to design individual BHC work plans based on the BHC core competencies as well as each BHC’s areas of interest and potential innovation. These work plans and agreed-upon goals serve as the basis for the BHC’s annual performance review.

BHC performance evaluation follows SCF’s organization-wide performance management model. It includes an annual meeting of each BHC and supervisor to develop an individual performance action plan, with goals and timelines, and a year-end supervisor appraisal of the individual’s performance against the plan. A key tool in BHC performance planning is the progression checklist, which outlines the competencies required for promotion (e.g., from BHC I to BHC II), and provides a tracking mechanism to document training and experience on the job.

This systematic process of hiring for fit, orienting new BHCs and providing on-going support have been the foundation for continuity and consistency in the program and has created the environment for continued success.

Wendy Bradle
Wendy Bradley LPC is clinical improvement advisor at
Southcentral Foundation in Alaska. She developed and provided clinical oversight to behavior health integration in primary care--the program has been successfully established for the past 8 years


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