Senior Airman Rajonda Davis (left), 59th Medical Operations Squadron mental health technician, discusses concerns with Capt. Abby Fields, 59th Medical Operations Squadron psychologist, during a mock Behavioral Health Optimization Program visit at Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, photo by Staff Sgt. Kevin Iinuma/U.S. Air Force

commentary

(The RAND Blog)

October 15, 2019

Review of Behavioral Health Technician Training, Policies, and Practice Identifies New Opportunities

Senior Airman Rajonda Davis (left), 59th Medical Operations Squadron mental health technician, discusses concerns with Capt. Abby Fields, 59th Medical Operations Squadron psychologist, during a mock Behavioral Health Optimization Program visit at Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland

Photo by Staff Sgt. Kevin Iinuma/U.S. Air Force

by Stephanie Brooks Holliday, Bradley Blair, Aimee Ruscio, Kimberly A. Hepner

Across the Military Health System (MHS), there are more than 2,200 behavioral health technicians (BHTs). BHTs are trained to be an essential part of the mental health clinical team, serving as provider extenders who work alongside and support licensed mental health providers. However, there have been concerns that BHTs do not always have the opportunity to put their skills to maximum use. This raises important questions: What are the factors that affect BHT roles across the enterprise? And how can the MHS most effectively incorporate BHTs into mental health care settings?

The Psychological Health Center of Excellence (PHCoE) asked the RAND Corporation to assess the current functional operation and utilization of BHTs within the MHS, with the ultimate goal of developing recommendations for optimizing the use of BHTs. Since the beginning of the study, RAND has collaborated with the Behavioral Health Technician Workgroup (BHTWG)—a group facilitated by PHCoE that focuses on improving and standardizing BHT utilization.

The first phase of this study involved a review of BHT training, practice, and opportunities for ongoing professional development. The RAND team conducted a review of Department of Defense and service branch policies regarding the use of BHTs; reviewed the training curriculum at the Medical Education and Training Campus (METC), where BHT training takes place; and held discussions with key stakeholders from across service branches, including licensed mental health providers and BHTs. They also conducted a review of published literature, including literature focused on the use of provider extenders in both military and civilian contexts.

The RAND team documented a number of findings about the training and roles of BHTs. Training at METC covers a wide range of topics in a relatively brief training period (about 17 weeks), at which point BHTs enter the field. Though they are trained for a range of responsibilities—including screening and assessment, interventions, outreach, and case management—BHT roles can vary widely once they are in the field. The specific responsibilities expected of BHTs can depend on supervisor preferences, the nature of the assignment, and whether they are in garrison versus deployed or in operational settings. Though there are some opportunities for ongoing professional development, these vary across services and sometimes are not well-defined in policy. In turn, this means that there may be times that BHT capabilities are not being used in the most effective or efficient way.

To address these challenges, RAND developed a number of preliminary recommendations for optimizing the BHT role within the MHS. These included tailoring the METC curriculum to focus on the conditions and clinical skills most relevant to the populations that BHTs will see in the field; developing more specific requirements for on the job training; and providing guidance to mental health providers for more effective supervision.

PHCoE's BHTWG has begun taking preliminary steps to incorporate recommendations provided by the RAND team. The BHTWG recently developed and released The Healthcare Provider's Practice Guide for the Utilization of Behavioral Health Technicians (PDF), which provides recommendations for how mental health providers can optimize technician usage and provide more effective supervision. The BHTWG has identified the need for policies that support clinical use of BHTs to their fullest capacities, ongoing training, and supervision. Cultivating and maintaining a workforce of highly trained BHTs is expected to increase access to mental health care at home station. Additionally, it is of critical importance to the enterprise's ability to provide mental health care in deployed, operational, and austere environments.

RAND will continue this study by conducting a survey of BHTs and licensed mental health providers later this year. The goal of this survey is to better describe the variability in BHT roles and responsibilities based on clinical setting, ongoing training, and supervision needs, and barriers to effectively integrating BHTs into clinical practice settings. The BHTWG encourages BHTs and licensed mental health providers who are selected for the survey to participate. The BHTWG stands poised to use the results of the survey to inform future policies and initiatives related to BHTs in the MHS.

Understanding Behavioral Health Technicians within the Military: A Review of Training, Practice, and Professional Development is available at www.rand.org. If you are interested in receiving updates on BHTWG efforts and future products, please contact dha.ncr.j-9.mbx.phcoe-bhtwg@mail.mil.


Stephanie Holliday is a behavioral scientist at the nonprofit, nonpartisan RAND Corporation. Master Sgt. Bradley Blair is an Air Force certified alcohol and drug abuse counselor (CADC). Aimee Ruscio is a major in the U.S. Army. Kimberly Hepner is a senior behavioral scientist and a licensed clinical psychologist at RAND.

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