Integrated Behavioral Health Training for Primary Care Clinicians: Five Lessons Learned From a Negative Study

Introduction: There are very few studies examining the effectiveness of integrated behavioral health training for primary care clinicians. The purpose of this article is to review the findings of a negative study examining the effectiveness of medical resident training in integrated behavioral health and offer specific ideas for future research in workforce development. Methods: Twenty-three family medicine residents from a community-based residency program in the mid-Atlantic region completed a required rotation in which they consulted with behavioral health in primary care, observed psychotherapy, read behavioral medicine books, and received individual instruction. Fourteen residents completed a survey pre- and postrotation, and all 23 residents completed a semistructured interview postrotation. Results: Survey findings demonstrate that resident attitudes about collaboration and behavioral health consultants did not significantly change as a result of the rotation. Findings also show that internal referral orders for behavioral health services dropped sharply after the rotation. Qualitative data suggest that residents value integrated behavioral health. Discussion: There are five lessons to learn from this negative study: learning outcomes should match learning activities, residents benefit from direct observation, longitudinal data help measure change over time, collaborative care curriculum evaluation deserves collaborative partnership with other training sites, and evaluating the resident and the behavioral health provider offers a systems viewpoint and new insights. Future research should identify core knowledge and skills for primary care clinicians working in settings with integrated behavioral health and evaluate the long-term effectiveness of a curriculum based on those competencies.