The blending of behavioral health and primary care has transformed the roles, responsibilities, and practices of clinicians on integrated health care teams. While models of integration may differ in structure and process, each approach requires the clinician to take on new functions and tasks to shift toward comprehensive, team-based care. For many clinicians, this movement represents a natural evolution of their part in patient- and family-centered health. A number of resources are available to clinicians engaged in or interested in the integration of behavioral health and primary care.
Learn more about the various models of integrated care.
Expanded Roles of Clinicians in Integrated Care
Clinicians in integrated settings have a broad scope of practice to meet the needs of primary care, including management of chronic and acute health conditions, behavioral health concerns, and health risk and lifestyle change behaviors. The full definition of integrated behavioral health and primary care is in the Lexicon (page 2).
The clinician role also needs improved communication, collaboration, and care coordination with the other members of the health care team. The AHRQ Academy developed a Guidebook that identifies the key professional practices that are common among exemplary integrated primary care organizations.
For example, because substance misuse often presents first or only in primary care, providers need to assess the situation and intervene appropriately. Providers should take into consideration the complex and interconnected physical, social, and psychological aspects of the issue and consult with behavioral health specialists when available. Notably, the epidemic of opioid addiction has encouraged adoption of a clinical approach involving the integration of medication-assisted treatment and behavioral health into primary care settings. A review in Annals of Internal Medicine summarized the range of functions needed by all clinical team members in this model of care.1
Individual Competencies Clinicians Need in Integrated Care Settings
A number of competencies have been identified as important for clinical practice in integrated settings. The AHRQ Academy conducted a Literature Review to highlight the competencies providers and practices need in order to advance integration efforts and provide comprehensive care. Competencies for primary care providers, psychiatrists, behavioral health providers, and care managers have also been reviewed by the:
- Eugene S. Farley, Jr. Health Policy Center (PDF - 852.29 KB),
- SAMHSA-HRSA Center for Integrated Health Solutions,
- AIMS (Advancing Integrated Mental Health Solutions) Center,
- American Psychological Association, and
- American Psychiatric Association.
Team-Based Competencies Clinicians Need in Integrated Care Settings
Integrated behavioral health and primary care is anchored in interprofessional practice. The clinician does not work independently but rather contributes to a dynamic in which the “whole of the team” is greater than the sum of its parts (e.g., individual team members). Characteristics of effective clinical teams include an understanding of roles, responsibilities, values, and ethics for interprofessional practice and communication.2, 3 The Substance Abuse and Mental Health Services Administration further explores the Essential Elements of Effective Integrated Primary Care and Behavioral Health Teams (PDF - 2.01 MB).
- Korthuis PT, McCarty D, Weimer M, et al. Primary care–based models for the treatment of opioid use disorder: a scoping review. Ann Intern Med 2017;166:268-78. http://annals.org/aim/article/2589794/primary-care-based-models-treatment-opioid-use-disorder-scoping-review. Accessed March 28, 2017.
- Core competencies for interprofessional collaborative practice: report of an expert panel. Washington, DC: Interprofessional Education Collaborative; May 2011. https://www.aamc.org/download/186750/data/core_competencies (PDF - 1.16 MB). Accessed March 28, 2017.
- Core competencies for interprofessional collaborative practice: 2016 update. Washington, DC: Interprofessional Education Collaborative; July 2016.