Overview
BHSS Clinical Training Program Updates
Learning Objectives
- Recognize the impact of public feedback, academic discourse, and policy development on the educational and training framework for a new behavioral health profession.
- Identify changes to the BHSS Clinical Training Program facilitated by subject matter experts and affirmed by the BHSS Project Team.
Impact of Feedback
The BHSS Project Team receives continuous feedback on the BHSS Clinical Training Program. These sources include public commentary on V1 of the BHSS Implementation Guide, public commentary on draft rules related to BHSS credentialing with the Department of Health (DOH), on-going input from subject matter experts (SMEs) across Washington state, and discussion that occurs within the UW Department of Psychiatry and Behavioral Sciences.
The BHSS Project Team maintains a record of all feedback, reviews it monthly, and prioritizes identified recommendations or concerns. The values that guide prioritization are the same values that the BHSS program shares with the University of Washington and UW Medicine. These values are:
- Integrity, respect, and compassion
- Equity, diversity, and inclusion
- Collaboration and teamwork
- Innovation
- Excellence
In general, the BHSS Project Team systematically reviews feedback, deliberates issues, and will communicate updates in V2 of the Implementation Guide due in late 2024. When certain changes are relevant to DOH rulemaking or the ability of education partners to successfully adopt the BHSS Clinical Training Program, this chapter serves the purpose of communicating significant changes prior to the release of V2.
Changes to UW BHSS Clinical Training Program Effective 2.01.24
Chapter 4: Curriculum Outline
Meta-Competency 2: Helping Relationship
| Previous: | Change: |
| 2a. Develop supportive and effective working alliance with patients and their support networks. | Add 2d. Utilize a trauma-informed care framework in all aspects of a helping relationship. |
| 2b. Engage patients to enhance their participation in care. | |
| 2c. Facilitate group psychoeducation. |
Rationale
This competency had been listed since Focus Group feedback advised to include it in Fall 2022. We temporarily removed 2d to reflect on appropriate placement in the competencies. Since trauma-informed care is a framework for patient engagement and not a treatment, we decided to keep this competency in MC-2: Helping Relationship.
Next Steps
- The learning objectives for this competency have already been developed and will be restored in Version 2.
- The change has been communicated to DOH.
Meta-Competency 7: Intervention
| Previous: | Change: |
| 7 a. Integrate motivational interviewing strategies into practice. | 7a. No Change |
| 7 b. Provide psychoeducation to patients and their support network about behavioral health conditions and treatment options consistent with recommendations from the healthcare team. | 7b. No Change |
| 7c. Apply brief, evidence-based strategies for common mental health presentations, based on cognitive behavioral principles and behavioral activation. | 7c. Employ distress tolerance strategies including problem solving and relaxation techniques to reduce the impact of acute stress on patient mental and behavioral health. |
| 7d. Apply brief, evidence-based strategies for mild-to-moderate depression, based on cognitive behavioral principles and behavioral activation. | 7d. Apply brief, evidence-based treatment for common mental health presentations including depression, based on behavioral activation principles. |
| 7e. Apply brief, evidence-based strategies for mild-to-moderate anxiety, based on cognitive behavioral principles and behavioral activation. | 7e. Apply brief, evidence-based treatment for common mental health presentations including anxiety, based on cognitive behavioral therapy (CBT) principles. |
| 7f. Utilize a screening, brief intervention, and referral (SBIRT) approach appropriate to patient alcohol or substance use problems. | 7f. Apply harm reduction strategies for substance use concerns including the delivery of screening, brief intervention, and referral to treatment (SBIRT). |
| 7g. Demonstrate a clear understanding of the evidence base for brief intervention strategies that focus on symptom reduction. | 7g. Demonstrate a clear understanding of the evidence base for brief treatment that focuses on symptom reduction. |
Rationale
7c. A reviewer and consultant perceived 7c as redundant with 7d and 7e. 7c was originally constructed to serve as a foundation for learning brief intervention strategies prior to focusing on the treatment of depression and anxiety. Our subject matter expert (SME) team had once considered replacing 7c with Trauma-informed Care or some form of trauma intervention. Trauma-informed care is a framework for all care team members to guide interaction with patients whether patients have experienced trauma (SAMHSA, 2023). Therefore, the SME team decided trauma-informed care will remain in MC2: Helping Relationship. Literature on primary care behavioral health and trauma treatment (Cigrang, et al., 2011; Cigrang et al. 2015) does advise a focus on acute stress, a symptom of trauma as a relevant brief intervention in healthcare settings. Focusing on acute stress versus trauma treatment seems to be an appropriate scope of work for the bachelor level BHSS. Distress tolerance strategies accompanied by problem solving and relaxation techniques will be highly utilized across settings (integrated care, crisis and specialty mental health).
7d/e: We separated behavioral activation and CBT to identify these approaches as distinct interventions. Additionally, the term “strategies” was replaced with “treatment” to indicate that scope of practice differs from non-specialist behavioral health practice such as peers and case managers. We also dropped the low-moderate categorization to decrease confusion regarding scope of practice.
7f. In late Fall of 2023, we received consultation from a Washington State University subject matter expert (SME) in addiction studies. The SME recommended inclusion of harm reduction strategies as an appropriate intervention for bachelor level providers and especially needed in integrated healthcare settings.
7g. Replaced “brief intervention strategies” with “brief treatment” for the same reason noted in 7d/e.
Next Steps
- Learning objectives will be reviewed and amended for MC7-d and MC7-e.
- Learning objectives will be developed for MC7-c and MC7-f.
- The changes to MC7 have been communicated to the Department of Health during rulemaking.
