Behavioral Health Integration and the Workforce: the Cambridge Health Alliance Experience

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By Leah Zallman, MD, MPH

Behavioral health integration has caught the national eye for its potential to improve patient outcomes and patient satisfaction, in addition to reducing costs.  Behavioral health integration is a healthcare delivery approach that is geared towards addressing mental and behavioral health concerns in primary care.   Early success of these programs has led to increased attention to the immense need for developing a sufficiently and adequately trained workforce to deliver integrated care. Indeed, these programs require large investments in the workforce, and the work of integration requires a cultural shift in how healthcare institutions care for their patients.  And yet, relatively little attention has focused on how the workforce is responding to the work of integration – to what degree the workforce feels more supported in caring for patients with mental health conditions, is more satisfied with their work, or alternatively, is more burned out by the high levels of effort this entails.

Informed by 25 years of care integration, one of our partners, Cambridge Health Alliance, has embarked on an innovative and extensive behavioral health integration program.  We have been working with Cambridge Health Alliance to better understand how this program is affecting their workforce through annual surveys of their primary care and behavioral health staff. Together, we have learned that primary care providers feel more knowledgeable about how to care for these patients, across a variety of measures. We have also learned that staff report higher degrees of systems integration –for example, more primary care providers report talking with their mental health colleagues on a regular basis, which is mirrored by an increase in behavioral health providers’ report that they speak with their primary care colleagues on a regular basis.

First and foremost, this experience has highlighted the power of a well conceived and enacted program, like Cambridge Health Alliance’s behavioral health integration team, to change the workforce experience.  And it has also highlighted how thoughtful, prospective evaluation of the workforce experience can provide programs like Cambridge Health Alliance with meaningful data that helps shed light on the workforce experience.