How do medical providers generally respond to working with BHCs/BHPs within the PCBH model?
Author: Bridget Beachy
Many BHCs conduct program evaluations in order to formally assess their services, with many of them having very positive findings. At one particular large community health care system, the program evaluation revealed a very positive reaction of medical providers to BHC services. Specifically, 100% (50 out of 50) of PCPs who filled out the survey “agree” that they would recommend BHC services to their colleagues, with 94% saying they “strongly agree.” Furthermore, 100% of PCPs reported being satisfied with the BHC services provided to their patients as well as the quality of the BHC consults they receive, with 68% “strongly” agreeing.
Baker, M., Beachy, B., Bauman, D., Wilson, A., & Tiernan, K. (2014, October). Stress, psychological flexibility, and behavioral health satisfaction: An assessment and intervention study with primary care providers. Presentation at the 16th Collaborative Family Healthcare Association annual conference. Washington, D.C.
As a BHC/BHP what are some strategies for improving engagement and communication with medical providers?
- Provide quick assessments of patient problems, relay clear diagnostic information to the PCP, provide useful interventions based on treatment goals aimed at increasing functional restoration when working with patients.
- TEACH, TEACH, TEACH – Take the time to explain the philosophy and referral process clearly to the PCPs; Teach the PCPs the specific interventions or strategies you use (e.g., behavioral activation, deep breathing, mindfulness, values work, etc.); Use patient education materials, newsletters, chart notes, and hallway meetings to promote just what BHCs “do”.
- Make yourself available by sitting in the medical provider pods in order to increase the frequency of contacts with the PCP:
- If working in a separate office, keep your door open when you are not seeing patients
- Educate your providers and team about your “open door” policy – that is they can gain access to you at any time even if that means communicating with you during a consultation
- Engage in “hot spotting” (i.e., short case presentations at team meetings illustrating a case and the intervention you implemented) during monthly team meeting.
- Be knowledgeable about a broad spectrum of medical disorders.
- Engage in co-visits (i.e., medical provider and BHP meet with a patient together).
- Clear scheduled appointments and work alongside primary care provider for a half or full day.
Bray, J.H. (2004). Training primary care psychologists. Journal of Clinical Psychology in Medical Settings, 11, 101-107.
Cummings, N.A., O’Donohue, W.T., & Ferguson, K.E. (Eds). (2003). Behavioral health in primary care: Beyond efficacy to effectiveness. Cummings Foundation for Behavioral Health: Health utilization and cost series. (Vol. 6). Reno, NV: Context Press
Robinson, P., & Reiter, J. (2007). Behavioral consultation and primary care: A guide to integrating services. New York: Springer.
Robinson, P. & Strosahl, K. (2009). The Primary Care Behavioral Health model: Lessons learned. Journal of Clinical Psychology in Medical Settings,16, 58-71.
Strosahl, K. & Robinson, P. (2007). The Primary Care Behavioral Health Model: Applications to Prevention, Acute Care and Chronic Condition Management. In Kessler, R. (Ed.), Case Studies in Integrated Care. NY: Springer.
What can a BHC/BHP do if there is a medical provider who is resistant or reluctant to work with a BHC?
Communicating in a concise, jargon-free way, accentuating only the most pertinent information of a case is another good way to gain respect and have successful interactions while working among the often overstretched primary care providers.
Fortunately, a number of medical schools across the country are incorporating team based training into their curriculum. However, in some cases, change can take time or put strain on a system. Resistance to change is a fairly common human reaction, so do not be alarmed if there are some growing pains. Once the medical provider can see that you, as a BHC, can help support them or even take tasks off their plate – their perception may change more rapidly than one would think. In the meantime, it is helpful to incorporate your style of communicating to match that of the fast-paced primary care setting. Also, see question two for more strategies for improving team-based communication.
Robinson, P. & Strosahl, K. (2009). The Primary Care Behavioral Health model: Lessons learned. Journal of Clinical Psychology in Medical Settings, 16, 58-71.