By Sarah Cunningham, Ph.D.
May 6, 2021

U.S. Air Force photo by Airman 1st Class Abbey Rieves

Research findings indicate that behavioral health technicians (BHTs) may be underutilized in Military Health System (MHS) behavioral health clinics, often occupying primarily administrative roles. However, BHTs are uniquely positioned to serve as behavioral health care extenders and operational support by virtue of their specialized training and status as peers to fellow enlisted service members. Some BHTs may not be integrated into the key clinic functions for which they are qualified because of a lack of understanding among clinic leaders of their skills and training. The optimization of BHTs in outpatient behavioral health clinics has the potential to greatly improve service members' access to quality care and reduce burden on providers.

The Psychological Health Center of Excellence Behavioral Health Technician Work Group suggests there are four primary barriers to optimizing utilization of BHTs:

• Time – BHTs have limited time to engage in training, and providers have limited time to provide supervision.
• Trust – Providers may lack sufficient knowledge of BHT training background to fully trust BHT clinical skills.
• Training – Training and proficiency standards for BHTs vary across services, and subsequent on-the-job training varies across clinics.
• Policy – DOD lacks enterprise-wide policies for the integration of BHTs into clinical care.

Scientific literature indicates that providers, BHTs, and the overall clinic/system can benefit from the integration and utilization of BHTs into clinical care. Potential benefits include:

Improved integration and optimization can be accomplished by the formal training of BHTs, providers, and clinic leaders in how best to optimize the role of BHTs in clinical practice.

The Defense Health Agency Practice-Based Implementation (PBI) Network helps to facilitate the rapid translation of research into clinical practice in the MHS. It pilots evidence-based practices, policies, and programs at MHS locations throughout the U.S. and overseas. To promote and support the optimization of BHTs in MHS behavioral health clinics, the PBI Network is launching the BHT Optimization Pilot.

Participants in this pilot will receive live interactive virtual trainings in how to optimize the contributions of BHTs in core clinical functions, and in strategies for best integrating BHTs into care delivery. Participants also will receive a suite of electronic tools which will guide the clinical supervision of BHTs and will provide regular consultations with an implementation expert. To participate in the pilot, sites are required to: 1) be outpatient behavioral health clinics; 2) have leadership support; and 3) provide the following:

• One internal facilitator who meets the following requirements:
  • Have authority to make clinic-level changes to facilitate the integration of BHTs into clinical care delivery
  • Be responsible for working with the PBI Network and local pilot participants to develop, implement, and monitor clinic action plans and problem solve any implementation challenges
  • Participate in regular facilitation calls with PBI Network facilitators and coordinate with pilot participants to support pilot implementation
• At least two BHTs (exceptions may be made on a case-to-case basis)
• One licensed provider who will provide supervision to pilot BHTs

Results from this pilot will be shared with the Behavioral Health Clinical Community and other relevant stakeholders to support further training and utilization of BHTs in the MHS.

If you're interested in participating in the BHT Optimization Pilot or have questions, please email the PBI Network.

Dr. Cunningham is a licensed clinical psychologist and evidence-based practice subject matter expert who provides contract support to the Psychological Health Center of Excellence. Her specialties include evidenced-based treatment delivery for comorbid substance use disorders and PTSD as well as women and minority mental health.