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Research Questions

  1. What types of roles do BHTs fulfill, and how do BHTs function in different military health contexts?
  2. What type of training and ongoing professional development do BHTs receive, and does their training prepare them for their intended roles?

Since as far back as World War II, behavioral health technicians (BHTs) have been used to increase the capacity of the military behavioral health workforce and ensure that service members who need behavioral health care have access to high-quality, efficient services. The demands that BHTs face have undoubtedly evolved alongside the changing needs of the military, but it is unclear whether this valuable component of the Military Health System (MHS) mental health care workforce is adequately prepared to fulfill these roles or whether the MHS is making the best use of BHTs' skills. This report provides preliminary insights on selection, training, roles, and responsibilities. Though BHT training is based on the expected roles and responsibilities of BHTs, there may be opportunities to better align the curriculum with the demands of BHTs in the field and the needs of the population they serve. In addition, findings suggest that BHTs may not consistently have the opportunity to apply the full extent of their clinical training, and there is a need to better understand how factors such as setting, supervisor preferences, and availability of ongoing training affect their roles. The recommendations presented provide preliminary suggestions on ways to optimize the training and roles of BHTs in the field, with the goal of ensuring that the MHS can continue meeting the need for high-quality mental health care among service members and their families.

Key Findings

BHT selection and training vary by service branch

  • Each service relies on unique selection and screening processes.
  • In 2010, the Army, Navy, and Air Force agreed to use a consolidated training program with a standardized curriculum; this is followed by service-specific coursework and practicum training.
  • The breadth and pace of the curriculum do not allow for detailed coverage of topics essential to clinical practice.
  • The MHS offers limited guidance on supervision, ongoing training, and professional development of BHTs.

BHT roles and responsibilities are inconsistent

  • BHTs are expected to fulfill a wide range of roles in garrison and in deployed settings.
  • BHTs appear to be used inconsistently across the MHS; the full extent of their clinical training may not always be leveraged.
  • Setting, supervisor preferences, and clinic administrative demands can produce significant variation in roles and responsibilities for BHTs across the MHS.
  • It is unclear whether and to what extent they are prepared to fulfill the roles expected of them, especially in deployed or operational settings.

Recommendations

  • Establish a consistent set of selection criteria and candidate assessment processes to ensure fit with the career field.
  • Align the curriculum with demands of BHTs in the field and with the needs of the population they serve (e.g., the conditions encountered most often).
  • Standardize expectations for involvement in clinical activities and ongoing training, clinical supervision, and professional development in the field.
  • Consider drawing from best and innovative practices in the civilian sector for incorporating care extenders into clinical care.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Behavioral Health Technician Selection and Training

  • Chapter Three

    Behavioral Health Technician Roles and Responsibilities

  • Chapter Four

    Summary and Recommendations

  • Appendix A

    Policy and Curriculum Documents Reviewed

  • Appendix B

    Literature Review Search Terms

This research was sponsored by the Psychological Health Center of Excellence (PHCoE) and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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