Essential Skills for Family Medicine Residents Practicing Integrated Behavioral Health

Abstract

Background and Objectives: There are several trends compelling physicians to acquire team-based skills for interprofessional care. One underdeveloped area of team-based skills for physicians is integrated behavioral health (IBH) in primary care. We used a Delphi method to explore what skills were needed for residents to practice integrated behavioral health. Methods: We conducted a literature review of IBH competencies and found 41 competencies across seven domains unique to physicians. Using a modified Delphi technique, we recruited family medicine educators to rate each competency as “essential,” “compatible,” or “irrelevant.” We also shared findings from the Delphi study with a focus group for additional feedback. Results: Twenty-one participants (12 physicians, nine behavioral health providers) completed all three rounds of the Delphi survey resulting in a list of 21 competencies. The focus group gave additional feedback. Conclusions: Participants chose skills that required physicians to share responsibilities across the entire care team, were not redundant with standard primary care, and necessitated strong communication ability. Many items were revised to reflect team-based care and a prescribed physician role as a team facilitator. Next steps include determining how these competencies fit with a variety of medical providers and creating effective training programs that develop competency in IBH.

Primary Care Behavioral Health Training in Family Medicine Residencies:

“…20 This finding is consistent with literature identifying communication and teamwork as critical competencies for physicians working in integrated behavioral health. 11 Future research may explore these links more directly, and could inform critical interventions for this population. When exploring how PCBH content was delivered, findings suggested that while disease-specific processes may often be taught in a didactic fashion, the majority of integrated care specific content was delivered through practice based placements.…”

“…Although the Accreditation Council for Graduate Medical Education (ACGME) Milestones recognize the critical role behavioral health plays in family medicine, and behavioral faculty are a mainstay of residency training programs, 12 there is little systematic understanding of training in integrated behavioral health service delivery models. 11,13 A recent scoping review identified that while a large number of training programs in family medicine, internal medicine, and pediatrics include interprofessional training in behavioral health, there is little formal identification of service delivery models or intentional curriculum on health care team integration. 13 This is a critical gap, as education and shared goals are key aspects of building successful health care teams.…”

“…10 However, there is less agreement on broader training focusing on how family physicians can work with and leverage these behavioral health assets as part of their health care team. 11 From the Uniformed Services University, Bethesda, MD.…”

Workforce Development in Integrated Care: A Scoping Review

“…Most common were behavioural health clinicians specialising in mental health conditions, including psychologists, social workers and medical practitioners. Other groups were leaders [20,21], managers [21], primary care professionals [22], expert clinicians [23][24][25][26][27], healthcare students [5], medical graduates [23,28], physicians [29], social service providers in the community [26], health and social care workers or behavioural health providers [29][30][31][32] and educators and academics [23,20]. For example, one study described an integrated care training programme for social workers alongside community social service providers [26].…”

Self-reliance and Collaboration

“…Featured in this issue of Family Medicine is an important article about the integration of behavioral health and primary care. 3 In this paper, Matt Martin, PhD, and colleagues have described how they used a Delphi process and focus groups to identify a list of essential competencies for family medicine residents to master before entering practices with integrated behavioral health teams. The methods used in this study are rigorous and the results are of broad importance to all family medicine educators.…”