Behavioral Health Care Manager

Training Objectives

As a behavioral health care manager (BHCM), your use of specific clinical skills helps to effectively treat patients within the Collaborative Care model (CoCM). The evidence is clear that your use of the skills outlined in this training, as well as working with fidelity to the model, will promote good outcomes for your patients.

 

Within CoCM, you will routinely communicate with all members of the treatment team- the PCP, your psychiatric consultant, other treatment professionals, and most importantly, the patient.

 

This training will not only build upon your existing clinical skill set, but will also deepen your understanding of the CoCM workflow and clinical protocols. In addition, you will learn about the roles and responsibilities of the other CoCM treatment team members. The training plan included here will support you in your treatment of patients within CoCM, facilitating excellent care for your patients.

 

Training Plan

The first step in the training process is determining which clinical skills you feel strongest in and which skills you think you would need some assistance to further develop. You and your clinical supervisor should review the BHCM Skill Assessment and use the BHCM Training Plan to develop a schedule to complete the relevant training tasks. This training will prepare you to treat patients within CoCM. Additional coaching and skill development is available following program launch and throughout ongoing implementation.

 

Overview of BHCM Training: Skill Assessment, Training Plan, and Supervision Plan

We recommend beginning BHCM training activities 2 – 3 months prior to patient enrollment.

 

 

Collaborative Care Basics - click to expand

As a BHCM, you should begin with these Collaborative Care Basics to gain an understanding of CoCM, the panel review process, the clinical workflow, and the roles of each team member. You will learn more about your own role in particular, including a sample “week in the life” of a full-time BHCM.

 

After completing the self-paced learning tasks, you should schedule live training sessions via your training specialist or clinical supervisor to work through the additional tasks.

Collaborative Care Overview: The Model and the Team Members
Collaborative Care Workflow

Clinical Workflow (Review- 5 min.)

Pitching the Program to Patients and Providers
Live Training- To be scheduled with trainer
  1. Pitching CoCM to patients and providers: Practice and role-play (30 min.)
  2. Review of self-paced learning materials, including Q&A (30 min.)

Collaborative Care Intermediate Skills - click to expand

Now that you have completed the Collaborative Care Basics, you are ready for Collaborative Care Intermediate Skills. These training tasks will deepen your understanding of CoCM. You will learn and practice the structured diagnostic assessments that are so important to CoCM and the panel review processes, as well as strategies for documenting your patient contacts and working within the patient registry. You will also receive training in the outcome measures that are routinely used to screen and monitor patient progress. Lastly, you will get to learn and practice two key clinical components of CoCM- self-management planning and relapse prevention planning.

 

After completing the self-paced learning tasks, you should schedule live training sessions via your training specialist and/or clinical supervisor to work through the additional tasks.

Collaborative Care Intake and Assessment
Collaborative Care Intake- Webinar (Watch- 49 min.)

BHCM Intake Checklist (For review and clinical use- 10 min.)

BHCM Clinical Assessment Tools (Review- 5 min.)

Documentation

EHR Documentation Guide (Review- 15 min.)

Note: Additional time will be needed to build in templates to the EHR. Depending on your organization, this may be done by the BHCM or another staff member.

Outcome Measures
Copies of all outcome measures can be found at MCCIST “Resources for Providers” (Review- 20 min.)
Levels of Care
CoCM Levels of Care (Review- 5 min.)

This document was developed by a cross-system Michigan Medicine and IHA workgroup. Your organization will determine what levels of care you are able to and would like to provide within your CoCM program. MCCIST can support this decision-making.

Relapse Prevention Planning
Live Training- to be scheduled with trainer
  1. Collaborative Care Intake and Assessment: Practice and role-play (1 hr.)
  2. Collaborative Care Intake and Assessment: Live shadowing (1 hr.)
  3. Panel review: Case presentation practice and role-play (30 min.)
  4. Panel review: Live shadowing (1-2 hrs.)
  5. Patient registry: Demo, training, and entering test patients (as applicable) (1 hr.)
  6. Psychopharmacology: Quiz and review (30 min.)
  7. Outcome Measures: Review and role-play, including the MoCA (30 min.)

Clinical Skills - click to expand

Psychopharmacology and Medication Monitoring

Introduction to Psychopharmacology for Non-Prescribers- Webinar (Watch- 1:55 hrs.)

Introduction to Psychopharmacology for Non-Prescribers- Slides (Review)

Click here to watch a video by UW-AIMS that illustrates one method of providing patient education about an antidepressant. (Watch- 4 min.)

Commonly Prescribed Psychotropic Medications (UW-AIMS Reference)- Consider posting in your work-space

Commonly Prescribed Psychotropic Medications for Pregnancy (UW-AIMS Reference)- Consider posting in your work-space

Click here to take a brief quiz to test your knowledge!

AIMS Common Psychotropic Medications

Diagnostic Knowledge of Common Behavioral Health Conditions

BHCMs should be knowledgeable about diagnostics for common behavioral health conditions seen in collaborative care, including depressive, anxiety, bipolar, and posttraumatic stress disorders. This DSM-5 Diagnostic Criteria Desk Reference for Collaborative Care Programs  is available for BHCM study, review, and ongoing reference.

Psychoeducation for Common Behavioral Health Conditions
Behavioral Activation

Resources

Behavioral Activation- Webinar (Watch- 1 hr.)

Behavioral Activation Webinar Slides (Review- PowerPoint presentation)

Behavioral Activation Cross-Site Training- March 2019 Slides (Review- PowerPoint presentation)

Adult Patient Manual for Behavioral Activation, CBT Group Program for Depression – Patient educational resource and workbook via the Michigan Medicine Department of Psychiatry

Behavioral Activation Tool (Worksheets to utilize with patients)

The 10 Core Principles of Behavioral Activation

Behavioral Activation Quick Guide

SPIRIT Project Training Videos

The Study to Promote Innovation in Rural Integrated Telepsychiatry
(SPIRIT) involves Collaborative Care treatment of patients with PTSD and bipolar disorder. SPIRIT training videos typically frame interventions and discussions around these diagnoses; at the same time, these concepts and approaches are often applicable to patients with mild-to-moderate behavioral health conditions, such as depression and anxiety.

  1. Behavioral Activation- Goal Setting and Value Assessment Role Play (Watch- Role play from 0:00-33:00; debrief follows)
    • Strategies to note:
      • Looking backward and looking forward to understand what the patient has enjoyed in the past and what they might like their life to look like in the future
      • Understanding fears, including worst possible outcomes
      • Engagement and affirmations
      • Introducing the idea of a behavioral activation tracking system, including documenting one’s mood before and after engaging in an activity
      • Qualifying language: “Where can we push toward change just a little bit and gather some momentum?”
      • Explaining behavioral activation as “trial and error,” and letting patients know that not every activity will be the perfect fit- and that’s okay
      • Framing the goal of behavioral activation: “With behavioral activation, we aren’t looking to bite off more than we can chew right away, but rather build some momentum to get you to the point where you can resume some of the things that matter to you.” (paraphrased)

Literature

Lejuez et al., 2011 – Ten Year Revision of the Behavioral Activation Treatment for Depression Manual – This is a helpful resource for a detailed, 10-session, manualized behavioral activation intervention.

Dimidjian, et al. 2006 – Randomized Trial of Behavioral Activation, Cognitive Therapy, and Antidepressant Medication in the Acute Treatment of Adults With Major Depression

Egede, et al. 2009 – Rationale and design-Telepsychology service delivery for depressed elderly veterans

Gawrysiak, et al. 2009 – Behavioral Activation for Moderately Depressed University Students- Randomized Controlled Trial

Motivational Interviewing

Resources

The following books are highly recommended for learning about and developing Motivational Interviewing skills:

Motivational Interviewing (3rd Edition) by Miller & Rollnick

Building Motivational Interviewing Skills: A Practitioner Workbook (2nd Edition) by David Rosengren

A comprehensive list of books to learn more about Motivational Interviewing can be found here: https://motivationalinterviewing.org/books

 

The following “Five Questions” handout may be useful to providers in their clinical work with patients. These five questions are referenced in the Motivational Interviewing (3rd Edition) text by Miller & Rollnick, referenced above, and capture the spirit of Motivational Interviewing.

Five Questions (Miller & Rollnick)

 

In-Person Training

We highly encourage live training in Motivational Interviewing from a qualified trainer. An in-person interactive training session will be beneficial for clinicians working to learn and develop these skills. Click here to locate a qualified Motivational Interviewing trainer, a member of the Motivational Interviewing Network of Trainers (MINT):

https://motivationalinterviewing.org/trainer-listing

Once clinicians have attended live training(s) in Motivational Interviewing, it is also highly recommended to continue with “booster” sessions to continue developing and practicing skills. These might include case reviews, worksheet completion, group exercises, role plays, or review of recorded MI sessions with patients (with proper patient consent). It is recommended that these sessions be led by a skilled  MI practitioner, either within your agency or via an external, qualified trainer. Further instruction for ongoing skill development via these “booster” feedback sessions can be found in Miller & Rollnick’s 3rd Edition MI text, referenced above.

 

Motivational Interviewing Demonstration Videos:

Stephen Rollnick is one of the founders of Motivational Interviewing. This YouTube video, among his other video examples found online, is a good example of Motivational Interviewing in brief consultation.

Alan Lyme is a member of the Motivational Interviewing Network of Trainers (MINT). This video is a good example of a Motivational Interviewing session, among his other video examples found online.

Motivational Interviewing Tip Sheet

SBIRT
Senior-Specific Training

Principles of Geriatric Mental Health for Collaborative Care Settings- Webinar (Watch- 40:00 min.) – Presentation by Dr. Donovan Maust, Geriatric Psychiatrist with Michigan Medicine and the VA Ann Arbor Health System

Principles of Geriatric Mental Health for Collaborative Care Settings- Webinar Slides

 

 

Additional Training Activities

Supervision

This document outlines a supervision plan that has been shown to promote good patient outcomes, fidelity to the evidence-based model, and a fluid caseload. The Clinical Supervisor for the CoCM should facilitate oversight of the BHCM, in conjunction with additional management as appropraite within the clinic structure.

BHCM Supervision Plan

Additional information on training for Clinical Supervisors can be found here.

 

Continuing Education

Continuing education and coaching can enhance your ability to treat patients through CoCM. We encourage you to attend the Michigan Medicine Integrated Behavioral Health Learning Collaborative in order to learn more about emerging topics that are relevant to CoCM.

Click here for more information on the Integrated Behavioral Health Learning Collaborative.