Email UpdatesRecent Collaborative Family Healthcare Association (CFHA) blog posts have featured approaches to supervision of behavioral health professionals in primary care. Part I, featured in March by the Academy, was written by staff at Cherokee Health Systems.
Part II, featured here, was written by staff at Access Community Health Centers, a federally qualified health center that provides integrated primary care services at three locations in Madison, Wisconsin. They have been identified by the Agency for Healthcare Research and Quality as a Service Delivery Innovation. They began providing integrated care once they realized that many patients who are referred to behavioral health services in the community do not follow up on these referrals. To deliver their care, Access Community Health Centers employs five full-time psychologists, three full-time social workers, and a part-time consulting psychiatrist. All of these employees work together with the primary care provider to provide care and monitor health, though the primary care provider (PCP) maintains decision making authority.
Due to the pace and intensity of behavioral health in primary care, trainees need specialized supervision to foster and monitor progress. Over the past 9 years, Access Community Health Centers has taken trainees from various backgrounds: clinical psychology, counseling psychology, rehabilitation psychology, Marriage & Family Therapy programs, social work programs, and some fellowship positions for PhDs and PsyDs. Live shadowing allows for the supervisor to be present for the visit with a patient, and this can make visits more efficient, as the trainee and supervisor work together to provide the best care for the patient.
The typical training scenario includes many steps. Trainees first shadow a behavioral health provider, and then a PCP. Next, they begin to see patients on their own but still work with supervisors beforehand to plan and organize visits. There is also discussion about staying flexible for the patient’s needs and to help address issues the PCP expects. Supervisors either shadow these visits or speak with trainees afterwards to review notes. Trainees meet with their supervisors before presenting their findings and thoughts to the PCP. Trainees are coached to focus on one or two issues with the patient at each visit, which requires the trainee to be able to assess and triage needs and prioritize options.
Trainees also learn how to work in a primary care environment. They are trained in how to efficiently communicate with PCPs, and they work alongside with them so as to gain an appreciation for their needs. Primary care setting supervision works best when it mirrors the pace and culture of the clinic itself.
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Access Community Health Centers, an AHRQ Service Delivery Innovation