Clinicians

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.

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

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),
• Center of Excellence for Integrated Health Solutions,
• AIMS (Advancing Integrated Mental Health Solutions) Center,
• American Psychological Association, and
• American Psychiatric Association.

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).