Performance of Mental Health Counselors in Integrated Primary and Behavioral Health Care

Abstract

Integrated primary and behavioral health care (IPBH) is becoming a preferred mode of service delivery in the United States. Integrated care includes the participation of medical and mental health professionals, such as mental health counselors. The clinical outcomes of these professionals need to be studied to determine their effectiveness in such settings. We examined the performance of 10 mental health counselors on the clinical outcome of 1,747 clients treated in an IPBH center. Analyses using growth curve modeling and pre‐post test design revealed that mental health counselors were effective overall, but they differed in client dropout rates and efficiency in reducing clients' initial symptoms. We used the analyses to rank order counselors based on their effectiveness. Counselors who were the most effective varied in their efficiency but demonstrated the lowest client dropout rates. Implications for future research and counseling practice were discussed.

Counselor performance in treating anxiety and depressive symptoms in integrated care: A client outcomes study

“…Recently, Ulupinar et al. (2021) found performance differences among mental health counselors in an IPBH program and provided evidence for high therapist effects in such program. The outcome measures of these previous studies were the composite scores of psychometric assessments such as the Outcome Questionnaire‐45 (OQ 45, Lambert et al., 2004) and Behavioral Health Measure‐20 (BHM‐20, Kopta & Lowry, 2002).…”

“…Integrated Primary and Behavioral Healthcare (IPBH) combines psychotherapy, primary care and psychiatric care to provide holistic and collaborative services for mental illnesses (Vanderlip et al., 2016). Counselors and other mental health providers are increasingly becoming a part of IPBH teams and are collaborating with primary care staff on shared caseload of clients with mental health issues (Lenz et al., 2018; Ulupinar et al., 2021). IPBH has been investigated for its effectiveness in outcome studies and clinical trials over the past three decades (Katon et al., 1995; Schmit et al., 2018; Unützer et al., 2002).…”

“…Medical doctors, counselors, other behavioral specialists, and psychiatrists determine the course and intensity of treatment in this model of care using a biopsychosocial framework (Vanderlip et al., 2016). Research have shown that the role of mental health counselors in IPBH is crucial to the achievement of client treatment goals as they are the behavioral specialists of the team who deliver evidence‐based psychosocial interventions and they would incorporate more wellness‐based and culturally sensitive approaches to differential treatment options (Ulupinar et al., 2021). Consequently, their performance in delivering those interventions matters greatly for therapeutic success.…”

“…MLM is not a new method and has been used extensively in educational research since 1980s (Raudenbush & Bryk, 2002). MLM has become popular in counseling and psychotherapy outcome research over the past two decades (e.g., Ulupinar et al., 2021; Banham & Schweitzer, 2016; Kim et al., 2006) because there are similarities between educational settings and clinical settings in terms of data structure. Multilevel data occur when individual observations are nested within teachers, classrooms or schools in educational settings, or when individual observations are nested within counselors, therapeutic modalities or treatment centers in counseling settings.…”

“…The therapist effect refers to the variability among psychotherapists in their performance and account for 5%-10% of therapeutic outcome (Saxon et al, 2017). Recently, Ulupinar et al (2021) investigated a caseload treated by an IPBH team and found differences in the recovery trajectories of clients based on the mental health counselors from whom they received counseling interventions. They also found that clients of high-performing IPBH counselors benefited more than clients of low-performing counselors.…”