A qualitative study of strategies and challenges in training behavioral health workforce for integrated primary care

Context: COVID-19 has underscored the need to accelerate behavioral health (BH) integration in primary care, where many patients seek mental health services. Expanding BH integration requires a strong and sustainable BH workforce trained to work in primary care. Psychology internship is a critical period of development when doctorate-level therapists receive supervised clinical experiences with integrated primary care.

Objective: To explore the strategies and challenges of teaching psychology trainees to practice BH in primary care.

Study Design: Qualitative study.

Setting: Nine out of 11 psychology internship and postdoctoral fellowship programs across the Washington State that provide integrated primary care training were recruited. Response rate was 82%.

Population studied: Twelve training leads and supervisors completed semi-structured interviews between December 2020 – March 2021.

Outcome measures: Interviews focused on participant experiences with providing educational training and supervision to psychology trainees practicing integrated primary care. Data were analyzed using grounded theory approach.

Results: Four strategies emerged – orient trainees with extensive onboarding to the culture, context, and function of primary care; provide a psychologically safe space for open dialogues that facilitate professional identity development; model the skills needed to collaborate with primary care teams; and create a structured environment for trainees to practice the skills. Training leads and supervisors also reported three challenges – strategies to address trainees’ difficulties with acculturating to the culture of primary care; loss of opportunities to shadow and interact with primary care providers due to telemedicine during COVID-19; and limitations of the traditional supervision structure to accommodate the unpredictable and urgent crises experienced by trainees in fast-paced primary care settings.

Conclusion: Future recommendations include early exposure to primary care during psychology graduate training, a hybrid model of fixed and flexible supervision schedules, and intentional efforts to define and balance in-person and remote teaching for different types of training needs.