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BHC vs. Traditional Therapist Handout
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4/28/2020 at 3:54:07 AM GMT
Posts: 11
BHC vs. Traditional Therapist Handout

Hello CFHA!  

Hope everyone is healthy and safe out there. 💖 

Quick question: does anyone have a ready made handout or graphic that simply breakdowns the differences between a Primary Care BHC and a traditional, long-term therapist/counselor etc? 

Thank you!

Norma


Hi Norma - this is a great question, as it is *very* commonly misunderstood, often with significant negative consequences for the BHC’s value. I’ll give you my take. 

As I train it, the main differences have to do with ownership of care and the BHC’s f/u structure. Specifically... 

…as a consultant, the PCP “owns” care; the consultant’s role is to help the PCP to provide that care. (Therapists, by contrast, own the patient’s mental health care - that is, they alone make decisions about how to intervene with the patient.)  

…re f/u structure:  therapists follow patients to remission (or at least plan to). But consultants follow along with the PCP just until the patient is starting to improve and has a clear plan in place for continued improvement. At that point, the consultant backs out of the planned f/u (but of course can always be brought back into care as needed). 

Think of how a psychiatry consultant is used when a PCP has a medication question. The psychiatrist joins the PCP in care for a (typically) short time. S/He assesses the patient, maybe gets the patient started on meds, then continues to follow the pt along with the PCP until the pt starts to improve and is stable with their meds plan. At that point, the psychiatrist backs out of planned f/u and the pt continues with the PCP alone, who continues the plan. If you substitute the BHC for the psychiatrist in this scenario, and substitute behavioral interventions for meds…then you have the BHC role. 

Hopefully this makes sense. I’m also attaching a slide I’ve used for years that breaks down the differences further. I think the initial attribution for the slide goes to Kirk Strosahl.  

I should also add that - very importantly - being a consultant should *not* imply any restrictions on the BHC in terms of the types of interventions delivered or the history gathered/visit content. I all too commonly see BHCs refusing to talk about potentially very important topics with patients such as past trauma history, or relationship problems, saying “I’m only a consultant, you can see a therapist to talk about those issues,” or some such statement. Unfortunately, BHCs who practice this way are depriving themselves of important clinical information, and thus often end up delivering simplistic symptom-reduction interventions that have little if any meaning to the patient (e.g., breathing instruction given to almost every patient). So, please don’t do that…that’s not what being a consultant is about. :)   

Stay safe and be well -  

Jeff


Thank you, Jeff! I work as a BHC in a clinic that specializes in teen health but is housed in women's health, but due to COVID, I'm going to be seeing more adult pt's via Telehealth, and I wanted to present my higher-ups with a clearer distinction of my role since my clinics aren't fully integrated. I want to make myself as available as possible to my teen population and these new pt's in need, but I have little control over where my referrals come from in my health system. It's overwhelming at times, so I'm trying the "top down" approach where I email the primary care staff a chart like the one you and another CFHA member sent me (thanks, again Phillip!) and see if I can clear things up with the PEDs and OB/GYN docs so patients aren't getting the "wrong idea" about what services I can provide since I am not in clinic (I'm working remotely via phone and just getting into Zoom) to meet these pt's via warm-hand off. :(

Norma


Hi Norma,


These resources from Jeff and Sandy are fantastic on this topic!


I wanted to share a few slides I have used with clinicians, teams, and leaders that align with Jeff & Sandy's guidance.


The metaphor of "spear fishers" and "net fishers" has worked well when I have used it.  See attached PDF.


I emphasize both types of "fishers" have been long present in the medical continuum of care.


This often opens up the conversation for why both types of fishers haven't been present in the behavioral health continuum of care (i.e. we have only been spear fishing in BH).


Especially now, we strengthen each other,


Julie


Norma,

I would love to hear the feedback from SLP.  My first clinic as a BHC was one that primarily served people of Mexican heritage.  

It is where I first came to understand that the context of primary care provides behavioral health the opportunity to serve all people. 

It is a realization that still deeply resonates with me and energizes me to continue in this work we do.:)


Saying that, these slides were written for clinicians, teams, and leaders...but the metaphor may help with the people we care for...let me know what ideas bubble up!!


Oh, and in terms of consultant vs. therapist...I agree with Jeff this is a super important concept to understand and work from as a BHC.


I have noticed some things over time about this that I wanted to additionally share.


In clinics with suboptimal BHC staffing for the amount of people served...it is extremely important to understand how to work as a consultant....as one would need to be equipped with strategies to maintain access to oneself...if we are about anything as BHCs we are about access... and primary care loves us for that...so do the people we serve.


One way to maintain access is to take on a consultant/educator role and "upskill" the primary care clinician (PCC) and the team.  Being a consultant in the lives of the people we serve is also a useful way to conceptualize our work.


Being a consultant to the PCC and team is one of many strategies we have as BHCs to ensure access and "spread BHC knowledge around."  


In the early days of our work as BHCs, we were likely all working in clinics with suboptimal BHC staffing levels (from what we understand now is more optimal). This is why the consultant function was so very important... particularly as we got started in PCBH.


The consultant function IMHO is still super important because most clinics still have suboptimal BHC staffing when considering the population intended to serve.  Particularity, many clinics are in the early stages of adopting the BHC service. In those early stages BHC staffing is generally less than what we in the field would think to be optimal.  In every clinic a BHC goes to there is a period of "proving it."  That is just the reality of this work.  When we prove it more of us are hired and staffing becomes more optimal.


Also, a key feature of BHC work is tremendous appreciation for providing a cost-effective service.  Being a consultant that can "upskill" others enhances the reach of the service and its cost-effectiveness. 


In team-based clinics with what I would say would be approaching more optimal BHC staffing the BHC can breathe a bit easier around the consultant concept...as one has greater ability "to spread BHC knowledge around" when not severely understaffed to the need/demand. But the consultant concept is still important...just not as critical as it is when starting in the understaffed state...it is super important in the early adoption phase of our work.


Lastly, when primary care changes...as I have seen it change... 


As BHCs become essential team members...and the staffing becomes more optimal...the focus on PCC as the primary customer lessens...the focus changes to shared biopsychosocial care made possible by an optimally staffed interprofessional team.


Hope that helps,


Julie




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