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Task sharing improves access to mental health care in many countries, but little formative research has examined uptake in the United States. This Open Forum proposes the development of nonspecialist professional roles to deliver low-intensity behavioral interventions for common mental health conditions in U.S. settings such as primary care. Using data from a multilevel stakeholder assessment, the authors discuss findings and challenges associated with such a role. Key themes from stakeholder surveys concerned scope of practice, competencies, pragmatic concerns, and training needs. Although stakeholders generally found this role to be acceptable and feasible, the themes raised will be critical to developing and implementing such a role.

Integrating behavioral health in primary care improves quality of care and outcomes for patients with comorbid conditions. Shortage of a trained behavioral health workforce limits adoption. Professional psychology training programs contribute to recruitment, retention, and development of skilled providers, who value and deliver behavioral health services in primary care. This study interviewed a cohort of established psychology training programs in real-world, state-wide clinical primary care settings and identified their strategies and challenges with teaching practices and program resources that impact the robust quality of training.Between December 2020 and March 2021, we conducted semistructured interviews with 12 licensed psychologists who oversaw nine integrated primary care psychology training programs at the internship and postdoctoral levels across Washington State. Data were analyzed using a thematic approach.Programs taught psychology trainees about integrated primary care via extensive onboarding, modeling and shadowing, structured learning environment, interprofessional education opportunities, flexible and cross-disciplinary supervision, and a psychologically safe space. Teaching challenges included balancing scheduled and curbside supervision, pivoting to telehealth, and aligning trainee expectations and program requirements. Training programs were funded through different and multiple sources, but most lacked a stable funding mechanism, compounded by barriers for psychology trainees to bill for services, a lack of control over organization's budgeting decisions, and instability in funding renewal.Synergistic support from program, organization, and system/policy levels are needed to align teaching activities with clinical practice environments and invest in the growth and sustainability of psychology training programs on integrated primary care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

We present the case of a 60-year-old woman who presented to primary care with chronic mixed depressive and hypomanic symptoms consistent with schizoaffective disorder. Patients with serious mental illness such as psychotic disorders are ideally referred for treatment in specialty psychiatric settings; however, many patients with serious mental illness receive their care in primary care settings due to patient preference or unavailability of psychiatric services. Top experts in the CL field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. The Collaborative Care Model (CoCM) can support primary care providers in managing patients with serious mental illness. Key teaching topics include the application of the CoCM to patients with psychotic disorders, clinician- and systems-level facilitators and barriers to CoCM implementation, and quality improvement within the CoCM. Specifically, the differential diagnosis when a patient is not improving should include systems-level considerations.

Integrated care is a common approach to leverage scarce psychiatric resources to deliver mental health care in primary care settings.Describe a formal clinical fellowship devoted to professional development for the integrated care psychiatrist role.The development of a formal year-long clinical fellowship in integrated care is described. The curriculum consists of an Integrated Care Didactic Series, Integrated Care Clinical Skill Experiences, and Integrated Care System-Based Leadership Experiences. Evaluation of impact was assessed with descriptive statistics.We successfully recruited 3 classes of fellows to the Integrated Care Fellowship, with 5 program graduates in the first 3 years. All 5 graduated fellows were hired into integrated care and/or telepsychiatry positions. Integrated Care fellows had a high participation rate in didactics (mean attendance = 80.6%; n = 5). We received a total of 582 didactic evaluations for the 151 didactic sessions. On a scale of 1 (poor) to 6 (fantastic), the mean quality of the interactive learning experience was rated as 5.33 (n = 581) and the mean quality of the talk was 5.35 (n = 582). Rotations were rated with the mean overall teaching quality of 4.98/5 (n = 76 evaluations from 5 fellows).The Integrated Care clinical fellowship serves as a model for training programs seeking to provide training in clinical and systems-based skills needed for practicing integrated care. Whether such training is undertaken as a standalone fellowship or incorporated into existing consultation-liaison psychiatry programs, such skills are increasingly valuable as integrated care becomes commonplace in practice.

Integrated behavioral care, and in particular, the collaborative care model, has been working to improve access and treatment for people with mental health disorders. Integrated care allows for adaptable, scalable, and sustainable practice that addresses the mental health needs of the public. During the pandemic several challenges emerged to delivering integrated care. This disruption happened at a systems level, team-based care level, scope of care level, and patient access level. This article looks through the lens of those various levels to identify and some of the lessons learned to help build a more resilient and flexible integrated care program.

Washington was the first state to require all licensed general medical and behavioral health care professionals (HCPs) to complete training in suicide assessment, management, and treatment. Results from pretest and posttest surveys of 873 HCPs participating in All Patients Safe, a 6-hour online training course, are presented. Improvements in knowledge and attitudes about suicide and confidence in treating at-risk individuals were observed, demonstrating the effectiveness of delivering large-scale training to HCPs to fulfill state requirements. Future work should examine the impact of training on clinical practices and the role of training in improving patient care.

Introduction: The Collaborative Care Model (CoCM) has a robust evidence base and is widely accepted as an effective strategy to treat common mental health disorders in primary care. With the growing adoption of the newer CoCM billing codes in healthcare systems, there has yet to be an in-depth analysis of the impact of the implementation of these codes. Aim: To examine the feasibility of implementing Collaborative Care billing codes and the impact on clinical and process-of-care outcomes as well as revenue. Setting: This study was done in a large, urban academic health system, in primary care clinics with established Collaborative Care programs. Comparisons were made between clinics that billed psychotherapy codes (N=4) and clinics that billed CoCM billing codes (N=4). Program Description: This quality improvement study was designed to evaluate the implementation of the new CoCM billing codes by comparing clinics using different billing strategies. Program Evaluation: We employed a retrospective observational study design, examining data before and after the CoCM billing implementation. Primary outcomes for this study were the amount of services delivered and the estimated revenue generated. Additionally, we examined the amount and type of activities billed under CoCM. Qualitative data was obtained through clinician interviews to understand their perspective of this type of large-scale billing implementation.Discussion: The results of this study demonstrate that implementation of the CoCM billing codes is operationally feasible, and there was no significant difference in the amount of services or revenue generated. These preliminary findings indicate that adopting new billing codes did not have an adverse impact on the delivery of patient care or revenue, though further evaluations are needed to understand the longer-term impact of CoCM billing on clinic operations and reimbursement.