Preparing the Workforce for Integrated Healthcare

Integrated healthcare is recommended to deliver care to individuals with co-occurring medical and mental health conditions. Identifying the knowledge necessary for behavioral health providers to practice in integrated settings, and determining whether a computer application is an effective strategy to disseminate this knowledge, are essential steps to transitioning these individuals to integrated healthcare delivery systems. A literature review of U.S. based publications from 1999 to 2015 identified 68 articles that met inclusion criteria and identified specific knowledge for integrated healthcare settings. A survey completed by 154 behavioral health providers working in integrated healthcare settings examined the extent to which respondents agreed the specific domains of knowledge identified in the systematic review were necessary for practice in integrated healthcare settings. An internet based computer application was developed and tested through a rapid prototyping method with two focus groups and 5 individual interviews. Nielson’s usability heurstics were used to evaluate data from focus groups and interviews and changes were incorporated in development of the computer application. The computer application was evaluated through an experimental pre-test/post-test design in which the knowledge of screening measures of 15 masters level social work students was tested. The results of the literature review provided evidence that behavioral health providers require specific knowledge of medical diagnoses, psychiatric diagnoses, screening instruments and intervention skills. A first-order, four-subscale model of this knowledge was confirmed by a CFA model in the survey sample. The computer application developed through the focus groups and interviews is an introduction to integrated healthcare concepts, reinforces the integrated nature of physical and behavioral health, and puts evidence-based knowledge at the point of care. When compared to an asynchronous training session in the experimental investigation, ANCOVA results revealed no significant differences on post-test knowledge of screening measures between the two groups. Outcomes of training on an integrated healthcare topic using a computer application are comparable to those using an asynchronous instructional method. Further research is needed to evaluate the impact of computer application use in real-world practice settings.