Literature Collection

PURPOSE: This study aimed to develop and validate a competency framework for a bachelor-level social worker, or related degree type, to work in integrated behavioral healthcare settings under clinical supervision. In Washington state, a new bachelor-level certification called a Behavioral Health Support Specialist or BHSS includes social work, psychology, and related degree programs. METHODS: Focus group interviews with stakeholders from across Washington State (n = 49) were conducted in addition to a confidential survey. A thematic analysis of data and validity check preceded interpretation of results. RESULTS: Qualitative data generated salient recommendations to shape a competency framework tailored to integrated care, and other behavioral health settings. Survey data helped gauge the degree of endorsement for a new mental health provider for integrated care in Washington State. DISCUSSION: Participants recommended specific action steps related to scope of practice, differentiation from other non-specialists, work setting expansion, supervisor qualifications, and ethics to align the competency framework with real-world practice. CONCLUSION: A BHSS competency framework supports the development of a new professional role to prepare a bachelor level social worker to deliver evidence-informed psychosocial interventions under supervision within integrated care settings.

Background Complex Mental Health Difficulties (CMHD) describes long-term difficulties with emotional regulation and relationships, including personality disorders, complex trauma and dysthymia. People with CMHD often experience episodic and crisis-related care. Aim To understand how general practices can better recognise people with CMHDs and provide the best care. Design and Setting A concurrent mixed-methods study was conducted with three components: two qualitative studies and a database study. Methods PPIE People with lived experience of CMHD were consulted throughout the study. Qualitative interviews with GPs and people with CMHD were conducted and transcripts analysed using thematic analysis. Database study A retrospective case-control analysis was conducted using the Connected Bradford database. Integration of results was conducted using 'following the thread' and triangulation methods. Results GP interviews: Four overarching themes were identified: (1) The challenges of CMHD; (2) Role expectations; (3) Fragmented communication, fragmented care; (4) Treatment in the primary care context. Lived experience interviews: Four main themes were identified: (1) "How I got here"; (2) Varied care experiences; (3) Traversing mental health services; (4) "Being Seen". Database study: Approximately 3,040 (0.3% of the database population) records met our criteria for CMHD, suggesting significant under-coding. The most informative feature was the count of unique psychiatric diagnoses. Triangulation: Five meta-themes were identified (i) Complexity of mental health difficulties; (ii) Experience of trauma; (iii) Diagnosis; (iv) Specialist services; and (v) GP services. Conclusion The current organisation of care and lack of an acceptable language for CMHD means that patients' needs continue to go unrecognised and "unseen".

BACKGROUND: Community pharmacists frequently care for patients with complex medical and social needs; however, specific evidence on pharmacist perceptions of what makes a patient encounter complex has not been clearly characterized. There is a need to better understand specific factors that contribute to patient encounter complexity and demonstrate how pharmacists in community settings care for these individuals. OBJECTIVES: The objectives of this programmatic case study were to: (1) elucidate factors that contributed to patient encounter complexity as a part of a Medicaid Managed Care Organization comprehensive medication management payer program in community pharmacies and (2) curate a series of patient case vignettes that provide evidence of pharmacists care for patients with complex medical and social needs within community pharmacies. METHODS: This qualitative programmatic case study utilized data from semi-structured interviews with community pharmacists who provided comprehensive medication management services to Medicaid patients in Pennsylvania. Pharmacists described their most complex patient encounter. Interviews were transcribed and independently coded by 2 investigators. The coded texts were grouped into categories, and a cross-case inductive thematic analysis was performed to identify complexity factors. RESULTS: Thirty pharmacists provided 48 patient case vignettes and 3 complexity factors emerged: (1) care coordination; (2) behavioral health support; and (3) social determinants of health. Representative patient case vignettes were selected to illustrate these factors. CONCLUSION: Pharmacists, who participated in a community pharmacy Medicaid Managed Care Organization payer program, provided care to patients with complex health needs. In addition to medication-related problems, specific factors that increased pharmacist perception of encounter complexity were care coordination with other health care providers, behavioral health support, and addressing social determinants of health.