Training for Integrating Behavioral Health Into Primary Care

As behavioral health services in primary care settings become more widely implemented across the country, the need for skilled providers in this area grows. In response to this demand, initiatives to cross-train behavioral health providers are underway. The goal of these training programs is to ensure these providers can successfully integrate their various disciplines into the primary care field.

“Training for behavioral health providers in primary care is in the early stages of developing an infrastructure. There are a few training programs or tracks specifically for work in primary care, but not many,” says Dr. Alexander Blount, a Professor of Family Medicine and Psychiatry at the University of Massachusetts Medical School and the Director of Behavioral Science for the Department of Family Medicine and Community Health.  

Why the Gap in Training Exists

There are several barriers to bringing behavioral health workers into primary care. Many of the obstacles are rooted in current academic training.

Current Curriculum Training

“One obstacle is that there is no curriculum in undergraduate or graduate psychology in primary care,” says Dr. Blount. He has taught the psychosocial aspects of primary care to Family Medicine residents and directed his department's 2-year Fellowship in Primary Care Psychology for years. As Program Director of the University’s Certificate Program in Primary Care Behavioral Health, Dr. Blount helps train behavioral health clinicians from all over the country on how to work successfully in primary care.

To illustrate the drawbacks of the current curriculum training, Dr. Blount uses the psychology field as an example. Psychologists may have training to address a variety of health conditions but, as Dr. Blount points out, “their training may be health psychology, but it is not primary care and there is very little awareness in academic psychology that there is anything missing.” Further, Dr. Blount says, “health psychology is essentially a specialty topic that works in specialty settings and tends not to understand the differences of primary care. They (psychologists) miss the curriculum, which creates a lack of urgency on the part of health-oriented academia.”

Focus on Politics Instead of Workplace Tools

Also, in academia, there is a greater focus on the politics and needs of that discipline, rather than on the workplace. “People commonly say that they received training, but there wasn’t a job to follow. This is one area where there really are jobs, and there will be more jobs, but it has not yet entered the consciousness of those who design programs in academia. People don’t know what they don’t know, so somebody who has not been through the certificate program may ask for a talk to get a program started and doesn’t have a sense of the body of knowledge and experience needed,” Dr.Blount says. 

Training Solutions and Resources

Recognizing the importance of primary care for a redesigned health care system, Dr. Blount highlights the need for generalizable skills. “Primary care is an area in which skills are modular, not disciplinary, so social workers, psychologists, nurses, anybody could be successful in primary care if they get the specific set of skills. People always say, ‘Do you want a social worker or do you want a psychologist for this?’ and I say ‘Which social worker, which psychologist?’ because nobody is prepared just because they have the right discipline. There isn’t a right discipline.”

The certificate program Dr. Blount directs was created in response to some of the problems he saw when watching behavioral health providers start to work in primary care.

“Simply learning on the job results in a lot of failures and half-successes because if behavioral health providers act in primary care the way they acted in the mental health center, in terms of the way they see patients and relate to their colleagues, it is going to fail. One of the problems with the usual way of developing workforce is that it is an academic area and it tends to result in reports rather than in new workers. There are a number of States and the Federal Government that consider this a very concerning and urgent issue.”

For primary care and behavioral health integration to become a reality, there must be a better trained workforce that is prepared for a setting that is unlike the one in which they were trained to work.

For more information:

Blount A, Miller BF. Addressing the workforce crisis in integrated primary care. J Psychol Med Settings 2009;16:113-9.

Blount AS, DeGirolamo S, Mariani K. Training the collaborative care practitioners of the future. Fam Syst Health. 2006;24:111-9.