Preparing the Workforce for Behavioral Health and Primary Care Integration
Preparing the Workforce for Behavioral Health and Primary Care Integration
复制标题
DOI：
10.3122/jabfm.2015.s1.150054
复制
发表时间：
2015-09-01
影响因子：
2.9
通讯作者：
Miller, Benjamin F.
中科院分区：
文献类型：
--
作者：
Hall, Jennifer;Cohen, Deborah J.;Miller, Benjamin F.
目的：确定组织如何准备临床医生一起工作，整合行为健康和初级保健。方法：对19个美国实践进行观察性交叉病例比较研究，其中11个参与了共同推进护理，8个来自整合劳动力研究。实践在规模、所有权、地理位置和提供综合护理的经验方面各不相同。多学科团队收集数据（来自直接实践观察的现场记录、半结构化访谈和实践领导者报告的在线日记），然后使用基于理论的方法分析数据。结果：组织很难找到具有在综合实践中工作所需的技能和经验的临床医生。较新的整合实践低估了培训和组织社交（船上）新临床医生所需的时间和资源。通过试验和错误，实践了解到临床医生需要相关培训才能有效地作为综合护理团队工作。如果初级保健临床医生和其他从业人员也缺乏与行为健康临床医生合作和提供综合护理的经验，那么专门针对行为健康临床医生和新员工的培训工作就是不完整的。组织解决员工需要额外准备的方法包括聘请顾问提供培训，派遣员工参加外部培训计划，举办住院或实习培训计划，或创建自己的内部培训计划。通过制定培训手册，帮助新员工入职；广泛的阴影过程；在这些内部培训项目中，为新的和成熟的临床医生和工作人员提供持续的教育、指导和支持机会。结论：培训能力和实践经验机会不足仍然是提供有效的行为健康和初级保健整合所需的劳动力的主要障碍。在培训能力增长到满足需求之前，实践必须付出相当大的努力和资源来培训他们自己的员工。
Purpose: To identify how organizations prepare clinicians to work together to integrate behavioral health and primary care.Methods: Observational cross-case comparison study of 19 U.S. practices, 11 participating in Advancing Care Together, and 8 from the Integration Workforce Study. Practices varied in size, ownership, geographic location, and experience delivering integrated care. Multidisciplinary teams collected data (field notes from direct practice observations, semistructured interviews, and online diaries as reported by practice leaders) and then analyzed the data using a grounded theory approach.Results: Organizations had difficulty finding clinicians possessing the skills and experience necessary for working in an integrated practice. Practices newer to integration underestimated the time and resources needed to train and organizationally socialize (onboard) new clinicians. Through trial and error, practices learned that clinicians needed relevant training to work effectively as integrated care teams. Training efforts exclusively targeting behavioral health clinicians (BHCs) and new employees were incomplete if primary care clinicians (PCCs) and others in the practice also lacked experience working with BHCs and delivering integrated care. Organizations' methods for addressing employees' need for additional preparation included hiring a consultant to provide training, sending employees to external training programs, hosting residency or practicum training programs, or creating their own internal training program. Onboarding new employees through the development of training manuals; extensive shadowing processes; and protecting time for ongoing education, mentoring, and support opportunities for new and established clinicians and staff were featured in these internal training programs.Conclusion: Insufficient training capacity and practical experience opportunities continue to be major barriers to supplying the workforce needed for effective behavioral health and primary care integration. Until the training capacity grows to meet the demand, practices must put forth considerable effort and resources to train their own employees.