Monday, April 4, 2016

Behavioral Health Counselor Roles and Responsibilities

Useful Traits Of Primary Care Behavioral Health Counselors
Behavioral health counselors must be able to function in the face-paced primary care environment. To be effective, they should: * be flexible enough to deal with noise, frequent interruptions, and constant changes in scheduling; * be able to offer brief, targeted interventions usually lasting less than 30 minutes; * be comfortable with short-term counseling, often lasting less than eight visits; * function well in a team-approach accept the fact that they are not in charge of the clients’ care; * be behaviorally, rather than personality, focused; 

* be able to perform consultations and give provider feedback “on the fly”; * be able to effectively communicate and interact with primary care providers. Therapists used to more traditional, long-term, in-depth psychotherapy approaches may experience a “culture shock” in the primary care environment and may need to make significant adjustments in their therapeutic style and way of thinking to be effective in this milieu. Back to top

Some Desirable Skill Sets For Behavioral Health Counselors
(based in part on Integrated Behavioral Health Care, A Guide to Effective Intervention by William O’Donohue, 2006): * proficiency in the identification and treatment of mental disorders; * ability to think in terms of population management, addressing a large clientele in the most efficient ways possible, using Approaches like stepped care and group psychotherapy; * knowledge of evidence-based behavioral assessments and interventions relevant to medical conditions, e.g., disease management; treatment adherence; and lifestyle change; * ability to make quick and accurate clinical assessments; * care-management skills and knowledge of local resources for outside referrals; * skill in targeted, brief psychotherapy and in running group sessions; * knowledge of basic physiology, psychopharmacology and medical terminology; * familiarity with the stepped care model (clients move along different levels of intervention depending on past responses); * ability to document services in a way that is useful both to the primary care provider and to management for quality-improvement services; * consultation liaison skills.

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Goals Of Primary Care Behavioral Health Counselors
(taken from Open Door Community Health Center’s Behavioral Health Program, 2005) Taken as a whole, the primary behavioral health care model is designed to increase the total proportion of eligible patients that receive appropriate mental and behavioral health services. To do this, the behavioral health counselor may assist primary care providers in: * Recognition and treatment of mental disorders and psychosocial problems; * Early detection of “at risk” clients, with the aim of preventing further psychological or physical deterioration; * Prevention of relapse or morbidity in conditions that tend to recur over time; * Prevention and management of addiction to pain medicine or tranquilizers; * Prevention and management of work and/or functional disability; * Obtaining quality clinical outcomes with high prevalence mental disorders; * Efficient and effective treatment and management of clients with chronic emotional and/or health problems; * Management of clients who use medical visits to obtain needed social support; * Improving the quality of primary care provider interventions without the aid of behavioral health consultation; * Efficiently moving clients into appropriate mental health specialty care when indicated. Back to top

Common Job Functions Of Primary Care Behavioral Health Counselors The following is, in part, adapted from the sample job description included in “Providing Behavioral Health Services in a Community Center Setting” promulgated by the Washington Association of Migrant and Community Health Centers, 2002 (some of these functions may overlap): * assists the primary care provider in recognizing, treating and managing mental health and psychosocial issues and acts as a contributing member to the primary care team; * conducts client intakes, focusing on diagnostic and functional evaluations, then makes recommendations to the primary care provider concerning the * clients’ treatment goals and plan;

* provides consultation and training to the primary care providers to enhance their skill and effectiveness in treating mental health problems; * provides brief, focused intervention for clients who are in need of mental health services; * gives primary care providers timely feedback the client’s about care, treatment recommendations and progress via documentation in the client’s record and verbal feedback; * advises the primary care provider about which clients are better served at the primary care setting and which should be referred to specialty mental health facilities or elsewhere; * initiates follow-up to ascertain how clients are doing and to determine if any changes in treatment approaches are indicated; * develops, where indicated, relapse prevention plans and helps clients maintain stable functioning; * assists in the detection of “at risk” clients and in the development of plans to prevent worsening of their condition; * monitors and coordinates the delivery of health services for clients as related to behavioral health care, including linking with other treatment providers not only within the primary care setting but, with the clients’ permission, outside it as well; * assists, to the extent feasible, in the clients’ community functioning by helping with public benefits, vocational rehabilitation, social support, housing, etc; * documents the clients’ progress and diagnostic informationj in the treatment chart; * keeps the primary care providers fully informed of the clients’ needs and progress and works with providers to formulate treatment plans; * works, where indicated, to effect behavioral changes in clients with, or at risk for, physical disorders and helps them make healthier lifestyle choices; * provides clients with self-management skills and educational information needed so they can be full participants in their own treatment and recovery; * helps the clients, where indicated, to cope with chronic conditions like pain and diabetes; * provides consultation to clinic management and other team members about behavioral services and suggested areas of outcome and program evaluation; * assists the clients in complying with any medical treatment initiated by the primary care provider, such as offering strategies to cope with medication side effects. For an example of how a Behavioral Counselor might introduce him/herself to the client, see Sample Introductory Script. Back to top

Sample Job Description For Behavioral Health Consultant
The following was taken from Cherokee Health Systems in Tennessee: Job Title: Behavioral Health Consultant.
Education/License: Licensed Social Worker (Masters) or a licensed Clinical Psychologist (Doctoral). Position Requirements:
* Has excellent working knowledge of behavioral medicine and evidence based treatments for medical and mental health conditions. * Has ability to work through brief client contacts as well as to make quick and accurate clinical assessments of mental and behavioral conditions. * Is comfortable with the pace of primary care, working with an interdisciplinary team, and has strong communication skills. * Has good knowledge of psycho-pharmacology.

* Has the ability to design and implement clinical pathways and protocols for treatment of selected chronic conditions. Role:
* Management of psychosocial aspects of chronic and acute diseases. * Application of behavioral principles to address lifestyle and health risk issues. * Consultation and co-management in the treatment of mental disorders and psychosocial issues. Back to top

Types Of Primary Care Behavioral Health Services
The following description of a consultation service model was taken, with slight modifications, from the Primary Behavioral Care Services Practice Manual 2.0, 2002 by Kirk Strosahl: * Triage/Liaison Services – Initially screening visits usually of 30 minutes or less to determine appropriate level of need for mental health care. * Behavioral Health Consultation – Intake visits of usually 15 to 30 minutes for clients referred for general evaluation. The focus is typically on diagnostic and functional evaluation, problem-solving, and recommendations for treatment and forming limited behavioral change goals. The visit may involve assessing clients at risk because of some life stress event, educating clients about community and/or clinic resources, or referring them to more appropriate treatment resources. In all cases, the visits will result in consultative feedback given to the clients’ primary care provider. * Behavioral Health Follow-up – Secondary visits by a client to support a behavioral change plan or treatment started by a primary care provider on the basis of earlier consultation – often occurring in tandem with primary care visits. * Compliance Enhancement – Visits designed to help the client adhere to an intervention initiated by the primary care provider – often spaced at longer intervals. * Behavior Medicine – Visits designed to assist clients in managing a chronic medical condition or to tolerate invasive or uncomfortable medical procedures. The focus may be on lifestyle issues or health risk factors among clients at risk (ie, smoking cessation, weight loss) or may involve managing issues related to progressive illness such as end-stage COPD, etc. * Specialty Consultation - Designed to provide consultative services over time to clients whose situation requires ongoing monitoring and follow-up; applicable to patients with chronic psychosocial issues and/or physical problems requiring longer term management. While the visits are structured like regular behavioral health consultations, they are less frequent and spread out over a longer period of time. The focus should be on restoring adaptive functioning rather than eliminating an acute mental disorder. * Disability Prevention/Management - Visits designed to assist clients on medical leave from job to return to work quickly. The focus is on coordinating care with primary care provider, job site and client with emphasis on avoiding “disability building” treatments. * Psycho-educational Classes - Brief group treatment designed to promote education and skill-building that either replaces or supplements individual consultative treatment. Often a psycho-educational group can serve as the primary psychological intervention, as many behavioral health needs are best addressed in this type of group treatment. * Conjoint Consultation: Visits with primary care provider and client designed to address an issue of concern to both, often involving a conflict between them. * Telephone Consultation - Planned, scheduled intervention contacts or follow-ups with patients that are conducted by the behavioral health counselor via telephone, rather than in-person. * On-Demand Behavioral Health Consultation - Usually unscheduled, primary care provider- initiated contact, either by phone or face to face, generally in an emergent situation requiring immediate or short-term response. * On-Demand Medication Consultation - Usually unscheduled, primary care provider-initiated contact regarding a medical or medication issues, either by phone or face to face, generally in an emergent situation requiring immediate or short-term response. * Care Management - Designed to coordinate delivery of medical and/or mental health services through multi-disciplinary involvement. Can also involve assisting the client with resources in the community. * Team Building -Conference with one or more members of the health care team to address peer relationships, job stress issues or process of care concerns. * Medical Provider Consultation: Face-to face-visits with the primary care provider to discuss client care issues; they often take the form of “curbside” consultation. * Team Education – Training provided to the primary care providers and other clinic staff about identification and treatment of mental disorders; the relationship of medical and psychological systems; and the services and procedures offered by the behavioral health program, including appropriate candidates for referral. The Washington Association of Migrant and Community Health Centers, in their “Providing Behavioral Health Services in a Community Health Center Setting” Manual, 2002, framed behavioral functions in the following grid, offered here as an example of how services could be rendered: Behavioral Health Service Type| Estimated % of Patient Contacts| Key Service Characteristics| General Behavioral Health Consultation Visit| 60-70%| * Brief, general in focus; oriented around a specific referral issue from health care provider. * Visit length (15-30 min) matches pace of primary care. * Designed to provide brief interventions and support medical and psychosocial interventions by the primary care team member. * May involve conjoint visit with primary care provider * May involve primary focus on psychosocial condition or working with behavioral sequelae of medical conditions. | Behavioral Health Psycho-education Visit| 10-20%| * Employs psycho-educational approach in classroom or group modality. * Program structure is often manualized, with condensed treatment strategies; emphasis on patient education and self-management strategies. | Telephone Visit| 10-20%| * Same parameters as the General Behavioral Health Consultation Visit, but handled via telephone. | Behavioral Health Case Conference| 10%*| * Reserved for high-utilizers and multi-problem patients. * Emphasis is on developing and communicating a health care utilization plan to contain excessive medical utilization, and on giving primary care providers effective behavioral management strategies and community resource case management. * Goal is to maximize daily functioning of patient, not necessarily symptom elimination. | Medication Consult| 30%*| * Reserved for use by consulting psychiatrist. * Provides assessment and review of pharmacological regimen. |

*These services do not necessarily involve direct client contact. Back to top

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