Effective and financially sustainable implementation of integrated behavioral health care is challenging in primary care settings.1 For primary care providers to adopt an integrated behavioral health model on a widespread basis, education and training of the workforce is essential. A sufficiently and adequately trained workforce with the competencies and skills needed to deliver integrated care is critical to the success of integration.
Integrated Care Team
Integrated care team members may include:
- Primary care
- Physicians, physician’s assistants, and nurse practitioners
- Behavioral health
- Social workers, psychiatrists, psychologists, mental health counselors, substance abuse counselors, and family and marriage therapists
- Allied health professionals or paraprofessionals
- Health educators, care coordinators, depression care coordinators, community health workers, promotores de salud, peer coaches, or patient navigators
Skills and Education
To successfully deliver integrated behavioral health care, members of the integrated health team need to be adequately prepared. The current behavioral health and primary care workforce lacks the cultural understanding, skills, attitudes, and leadership needed.2 To identify relevant skills, the AHRQ Academy conducted a Literature Review of provider- and practice-level competencies needed to provide comprehensive integrated care.
In part, the lack of skills among the workforce is due to insufficient educational and hands-on training opportunities available in integrated behavioral health care.3 In the past, the traditional educational and training model of medical care has not focused on a collaborative, comprehensive, and team-based approach. Medical care and behavioral health care have been in separate silos in terms of organization, service delivery, and payment. Most of the health care workforce has not been trained on how to work together to provide effective integrated services.4
Both the behavioral health workforce and the primary care workforce are experiencing significant stresses and demands. For example, patients of federally qualified health centers (FQHCs) have more behavioral health needs than typical primary care patients. Yet, estimates show that most FQHCs can’t offer adequate behavioral health services because they lack sufficient access to behavioral health professionals.5 The shortage of specialty mental health professionals is particularly acute in the underserved and rural areas served by FQHCs. Similarly, some analysts (PDF - 526.13 KB) project up to a 25 percent increase in the shortage of primary care physicians by 2025.
Several key factors will affect workforce adequacy over the next decade, especially for primary care practitioners. They include:
- Aging of Americans and corresponding increased demand for health care services;
- Changes brought by health care reform, including the number of insured Americans;
- Aging of practicing physicians and nursing workforce and the corresponding retirement rate;
- Evolution of health care technology; and
- Increasing student debt for medical school graduates, causing many to choose specialty rather than primary care practice.
Key research and reports related to these workforce demands include:
- Primary and Behavioral Healthcare Integration: Guiding Principles for Workforce Development (PDF - 833.31 KB) - Substance Abuse and Mental Health Services Administration (SAMHSA)-Health Resources and Services Administration (HRSA) Center for Integrated Health Solutions
- Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues (2013) - SAMHSA
- Vital Signs: Taking the Pulse of the Addiction Treatment Profession (2012) -- SAMHSA’s Addiction Technology Transfer Center Network
- National Projections of Supply and Demand for Selected Behavioral Health Practitioners: 2013-2025 (2016) (PDF - 451.74 KB) - HRSA Bureau of Health Workforce
- HRSA Health Workforce Projections
- Integrating Behavioral Health and Primary Care Services: Opportunities and Challenges for State Mental Health Authorities (2005) (PDF - 503.5 KB) - National Association of State Mental Health Program Directors
- An Action Plan for Behavioral Health Workforce Development (2007) - Annapolis Coalition on the Behavioral Health Workforce, under contract to SAMHSA
- Strategies To Support the Integration of Mental Health Into Pediatric Primary Care (2009) (PDF - 356.54 KB) - National Institute for Health Care Management
- The State of the Behavioral Health Workforce: A Literature Review - American Hospital Association
- Alexander CL, Arnkoff DB, Glass CR. Bringing psychotherapy to primary care: innovations and challenges. Clin Psychol Sci Pract 2010;17(3):191-214.
- Primary and Behavioral Healthcare Integration: Guiding Principles for Workforce Development. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions; n.d. http://www.integration.samhsa.gov/workforce/Guiding_Principles_for_Workforce_Development.pdf. Accessed May 18, 2017.
- Hall J, Cohen DJ, Davis M, et al. Preparing the workforce for behavioral health and primary care integration. J Am Board Fam Med 2015;28(Suppl 1):S41-51. https://www.ncbi.nlm.nih.gov/pubmed/26359471. Accessed June 2, 2017.
- Blount FA, Miller BF. Addressing the workforce crisis in integrated primary care. J Clin Psychol Med Settings 2009;16:113.
- Teevan Burke B, Miller B, Proser M, et al. A needs-based method for estimating the behavioral health staff needs of community health centers. BMC Health Serv Res 2013;13(245):1-12. http://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-13-245. Accessed June 2, 2017.