Professional competencies and training needs of professional social workers in integrated behavioral health in primary care
TL;DR: Results indicate that social workers feel prepared for general practice in IBH settings, but would benefit from additional training in IBh-specific competency areas identified in the survey, which can help guide social work training to improve workforce preparedness for practice inIBH settings in the wake of health care reform.
Abstract: The Affordable Care Act has led to a widespread movement to integrate behavioral health services into primary care settings. Integrated behavioral health (IBH) holds promise for treating mild to moderate psychiatric disorders in a manner that more fully addresses the biopsychosocial spectrum of needs of individuals and families in primary care, and for reducing disparities in accessing behavioral health care. For behavioral health practitioners, IBH requires a shift to a brief, outcome-driven, and team-based model of care. Despite the fact that social workers comprise the majority of behavioral health providers in IBH settings, little research has been done to assess the extent to which social workers are prepared for effective practice in fast-paced primary care. We conducted a survey of social workers (N = 84) in IBH settings to assess the following: (1) Key competency areas for social work practice in IBH settings and (2) Self-rated preparedness for effective practice in IBH settings. Online snowball sampling methods were used over a period of 1 month. Results indicate that social workers feel prepared for general practice in IBH settings, but would benefit from additional training in IBH-specific competency areas identified in the survey. Findings can help guide social work training to improve workforce preparedness for practice in IBH settings in the wake of health care reform.
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TL;DR: This paper defines integrated health and how the PPACA promotes integrated health care through system redesign and payment reform and considers how social workers can prepare for health care reform.
Abstract: With the passage of the Patient Protection and Affordable Care Act (PPACA) and ongoing health care reform efforts, this is a critical time for the social work profession. The approaches and values embedded in health care reform are congruent with social work. One strategy is to improve care for people with co-morbid and chronic illnesses by integrating primary care and behavioral health services. This paper defines integrated health and how the PPACA promotes integrated health care through system redesign and payment reform. We consider how social workers can prepare for health care reform and discuss the implications of these changes for the future of the profession.
102 citations
Cites background from "Professional competencies and train..."
...In an early study of competencies and training needs of social workers in integrated health care, Horevitz and Manoleas (2013) identified 19 competencies....
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TL;DR: The findings suggest that, compared to routine services, integrated primary care provided by interprofessional teams that include social workers significantly improves the behavioral health and care of patients.
Abstract: Objective: Behavioral and physical health services are increasingly being integrated, with care provided by interprofessional teams of physicians, nurses, social workers, and other professi...
57 citations
Cites background or methods or result from "Professional competencies and train..."
...Social workers fulfill many roles across fields of health (Horevitz & Manoleas, 2013; Muskat, Craig, & Mathai, 2017; Stanhope et al., 2015)....
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...Consistent with prior reports (e.g., Horevitz & Manoleas, 2013; Steketee, Ross, & Wachman, 2017; Wells, Kristman-Valente, Peavy, & Jackson, 2013; Wodarski, 2014), three social work functions or specializations were identified: behavioral health intervention, care management, and community…...
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...The scope of social work practice was coded using task-analysis items adapted from Horevitz and Manoleas (2013)....
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...However, based on pilot testing and a prior report from Horevitz and Manoleas (2013), our list appears to have content validity for much of social work practice in integrated care....
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TL;DR: Preliminary feasibility and acceptability data on the use of virtual patient (VP) simulations to develop brief assessment skills within an interdisciplinary care setting are presented and preliminary evidence for an association between engagement in VP practice simulations and improvements in diagnostic accuracy and clinical interviewing skills is offered.
Abstract: This study presents preliminary feasibility and acceptability data on the use of virtual patient (VP) simulations to develop brief assessment skills within an interdisciplinary care setting. Results support the acceptability of technology-enhanced simulations and offer preliminary evidence for an association between engagement in VP practice simulations and improvements in diagnostic accuracy and clinical interviewing skills. Recommendations and next steps for research on technology-enhanced simulations within social work are discussed.
44 citations
Cites background from "Professional competencies and train..."
...…training; virtual patients; virtual worlds With the implementation of the Patient Protection and Affordable Care Act (2010), there has been a growing demand for social workers who are well prepared to work in fast-paced, integrated care settings (Horevitz & Manoleas, 2013; Lundgren & Krull, 2014)....
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...Social workers within these teams, often situated in primary care settings, are being called on more and more frequently to conduct brief behavioral health assessments (Sampson, Parrish, & Washburn, 2016; Horevitz & Manoleas, 2013)....
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TL;DR: A case vignette is included to demonstrate how interprofessional teams can use the skills of social workers to offer brief, evidence-supported interventions and inform team-based care.
Abstract: Although the debate on US health care reform is ongoing, existing policy has expanded access to preventative and treatment services through new models of integrated care. This has resulted in the creation of interprofessional healthcare teams comprised in part of social workers who undertake brief behavioral health intervention, care management, and service referral. To promote patient care and population health, integrating social workers onto interprofessional teams requires educating all members of the healthcare team on the roles and functions of social workers. A case vignette is included to demonstrate how interprofessional teams can use the skills of social workers to offer brief, evidence-supported interventions and inform team-based care. Suggestions are offered for moving forward to increase the participation of social work in IPE and practice settings.
34 citations
TL;DR: It is indicated that virtual patient simulations have sufficient levels of usability and acceptability as a tool for developing brief clinical interviewing skills, and that participants found this method of instruction to be a valuable adjunct to traditional classroom or field based training.
Abstract: This mixed-methods pilot investigation evaluated the use of virtual patient simulations for increasing self-efficacy and diagnostic accuracy for common behavioral health concerns within an integrat...
33 citations
Cites background from "Professional competencies and train..."
...These simulations would be particularly helpful for training students from different disciplines to work as part of integrated care teams (Horevitz & Manoleas, 2013)....
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...…classroom training alone may not build the requisite self-efficacy needed for future mental health professionals to efficiently work within fast-paced emergency and primary care settings (Holden, Meenaghan, Anastas & Metery, 2002; Horevitz & Manoleas, 2013; Pinquart, Juang, & Silbereisen, 2003)....
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...…implemented, more counselors, psychologists, and in particular social workers,will be working as part of integrated primary care teams in an attempt to address physical and behavioral health concerns concurrently (Dudding, Hulton, & Stewart, 2016; Horevitz & Manoleas, 2013; Lundgren & Krull, 2014)....
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...However, the extant literature focusing on “best practices” for teaching brief mental health assessment skills within community-based integrative care settings is currently lacking (Horevitz & Manoleas, 2013)....
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References
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01 Nov 2008
TL;DR: There is a reasonably strong body of evidence to encourage integrated care, at least for depression, and there is no discernible effect of integration level, processes of care, or combination on patient outcomes for mental health services in primary care settings.
Abstract: Objectives To describe models of integrated care used in the United States, assess how integration of mental health services into primary care settings or primary health care into specialty outpatient settings impacts patient outcomes and describe barriers to sustainable programs, use of health information technology (IT), and reimbursement structures of integrated care programs within the United States. Data sources MEDLINE, CINAHL, Cochrane databases, and PsychINFO databases, the internet, and expert consultants for relevant trials and other literature that does not traditionally appear in peer reviewed journals. Review methods Randomized controlled trials and high quality quasi-experimental design studies were reviewed for integrated care model design components. For trials of mental health services in primary care settings, levels of integration codes were constructed and assigned for provider integration, integrated processes of care, and their interaction. Forest plots of patient symptom severity, treatment response, and remission were constructed to examine associations between level of integration and outcomes. Results Integrated care programs have been tested for depression, anxiety, at-risk alcohol, and ADHD in primary care settings and for alcohol disorders and persons with severe mental illness in specialty care settings. Although most interventions in either setting are effective, there is no discernible effect of integration level, processes of care, or combination, on patient outcomes for mental health services in primary care settings. Organizational and financial barriers persist to successfully implement sustainable integrated care programs. Health IT remains a mostly undocumented but promising tool. No reimbursement system has been subjected to experiment; no evidence exists as to which reimbursement system may most effectively support integrated care. Case studies will add to our understanding of their implementation and sustainability. Conclusions In general, integrated care achieved positive outcomes. However, it is not possible to distinguish the effects of increased attention to mental health problems from the effects of specific strategies, evidenced by the lack of correlation between measures of integration or a systematic approach to care processes and the various outcomes. Efforts to implement integrated care will have to address financial barriers. There is a reasonably strong body of evidence to encourage integrated care, at least for depression. Encouragement can include removing obstacles, creating incentives, or mandating integrated care. Encouragement will likely differ between fee-for-service care and managed care. However, without evidence for a clearly superior model, there is legitimate reason to worry about premature orthodoxy.
420 citations
TL;DR: Delivery of evidence-based CBT and medication using the collaborative care model and a CBT-naive, midlevel behavioral health specialist is feasible and significantly more effective than usual care for primary care panic disorder.
Abstract: Objective: To implement and test the effectiveness of a combined pharmacotherapy and cognitive-behavioral intervention for panic disorder tailored to the primary care setting. Design: Randomized, controlled study comparing intervention to treatment as usual. Setting: Six primary care clinics associated with 3 university medical schools, serving an ethnically and socioeconomically diverse patient population. Participants: Two hundred thirty-two primary care patients meeting DSM-IV criteria for panic disorder. Comorbid mental and physical disorders were permitted, provided these did not contraindicate the treatment to be provided and were not acutely life threatening. Intervention: Patients were randomized to receive either treatment as usual or an intervention consisting of a combination of up to 6 sessions (across 12 weeks) of cognitivebehavioral therapy (CBT) modified for the primary care setting, with up to 6 follow-up telephone contacts during the next 9 months, and algorithm-based pharmacotherapy provided by the primary care physician with guidance from a psychiatrist. Behavioral health specialists, the majority inexperienced in CBT for panic disorder, were trained to deliver the CBT and coordinated overall care, including pharmacotherapy. Main Outcomes Measures: Proportion of subjects remitted (no panic attacks in the past month, minimal anticipatory anxiety, and agoraphobia subscale score 10 on Fear Questionnaire) and responding (Anxiety Sensitivity Index score 20) and change over time in World Health Organization Disability Scale and short form 12 scores. Results: The combined cognitive-behavioral and pharmacotherapeutic intervention resulted in sustained and gradually increasing improvement relative to treatment as usual, with significantly higher rates at all points of both the proportion of subjects remitted (3 months, 20% vs 12%; 12 months, 29% vs 16%) and responding (3 months, 46% vs 27%; 12 months, 63% vs 38%) and significantly greater improvements in World Health Organization Disability Scale (all points) and short form 12 mental health functioning (3 and 6 months) scores. These effects were obtained in spite of similar rates of delivery of guideline-concordant pharmacotherapy to the 2 groups. Conclusion: Delivery of evidence-based CBT and medication using the collaborative care model and a CBTnaive, midlevel behavioral health specialist is feasible and significantly more effective than usual care for primary care panic disorder. Arch Gen Psychiatry. 2005;62:290-298
289 citations
Book•
01 Jan 1998
TL;DR: This volume makes the case for this approach to integrated primary care, shows how to implement it, and describes some successful programs.
Abstract: Integrated primary care, now instituted in many areas of the country, is both the service that integrates medical and mental health primary care and the practice of defining the problem brought by a patient without using "medical" or "mental" as inevitable distinctions. This volume makes the case for this approach, shows how to implement it, and describes some successful programs. It will be attractive to medical managers, plan administrators, physicians, and mental health providers.
185 citations
"Professional competencies and train..." refers background in this paper
...In a majority of settings, patient visits with the behavioral health specialist typically last approximately 30 minutes with an average of 1–10 visits (Blount, 1998; Collins & Fund, 2010; Pomerantz et al., 2010)....
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...It allows patients to feel that, for almost any problem, they have come to the right place” (Blount, 1998, p. 1)....
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TL;DR: A review of the evidence shows that many forms of behavioral health services, particularly when delivered as part of primary medical care, can be central to such an improvement.
Abstract: The health care system in the United States, plagued by spiraling costs, unequal access, and uneven quality, can find its best chance of improving the health of the population through the improvement of behavioral health services. It is in this area that the largest potential payoff in reduction of morbidity and mortality and increased cost-effectiveness of care can be found. A review of the evidence shows that many forms of behavioral health services, particularly when delivered as part of primary medical care, can be central to such an improvement. The evidence supports many but not all behavioral health services when delivered in settings in which people will accept these services under particular administrative and fiscal structures.
169 citations
TL;DR: Concerns remain about whether patients treated in the general medical setting are receiving treatment concordant with evidence-based guidelines, psychotherapy, adequate medication monitoring, and appropriate intensity of treatment.
Abstract: 1167 T important role of general practitioners in prescribing antidepressant medications and treating depression has been documented. However, the extent to which general practitioners are prescribing other types of psychotropic medications has received less emphasis. This study used data from August 2006 to July 2007 from the National Prescription Audit (NPA) Plus database of IMS to examine this question. IMS collects transaction information each month from approximately 36,000 retail pharmacies, representing about 70% of all retail pharmacies, which when weighted represent all prescriptions filled in retail outlets in the United States. Using a separate sample of retail pharmacy transactions that includes the physician’s Drug Enforcement Administration number, IMS assigns physician specialty information to obtain an estimate of the total number of prescriptions filled in retail pharmacies by medical specialty. As shown Figure 1, of the 472 million prescriptions for psychotropic medications, 59% were written by general practitioners, 23% by psychiatrists, and 19% by other physicians and nonphysician providers. General practitioners wrote prescriptions for 65% of the anxiolytics in the sample, 62% of the antidepressants, 52% of the stimulants, 37% of the antipsychotics, and 22% of the antimania medications. Conversely, psychiatrists and addiction specialists wrote prescriptions for 66% of the antimania medications, 49% of the antipsychotics, 34% of the stimulants, 21% of the antidepressants, and 13% of the anxiolytics. Pediatricians were included as general practitioners and wrote 25% of all stimulant prescriptions but only 3% of all other types of psychotropic medications (data not shown). Prescribing of psychotropic medications by nonpsychiatrists improves access to treatment. However, concerns remain about whether patients treated in the general medical setting are receiving treatment concordant with evidence-based guidelines, psychotherapy, adequate medication monitoring, and appropriate intensity of treatment. Psychotropic Drug Prescriptions by Medical Specialty
137 citations