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Research Questions

  1. What tasks do military BHTs perform and with what frequency?
  2. How do BHTs view their proficiency in performing these tasks, and how do those views compare with those of MHPs?
  3. Do BHTs receive adequate training and supervision to perform clinical tasks?
  4. What factors relate to BHTs' satisfaction with their work?
  5. What barriers do BHTs face in developing and using their skills, and what changes could reduce these barriers or otherwise improve BHT training and integration across the Military Health System?

Behavioral health technicians (BHTs), who are enlisted service members with the technical training to work alongside licensed mental health providers (MHPs), are an important part of the Military Health System (MHS) workforce. However, each service branch has different training requirements for BHTs, making it difficult to identify common qualifications across the BHT workforce and ensure that the MHS is making the best use of their skills. Building on prior RAND research that found inconsistencies in how BHTs were integrated across the force, researchers conducted what might be the largest survey to date of BHTs and MHPs. The results provide insights on BHTs' practice patterns, training and supervisory needs, and job satisfaction, as well as barriers to better integrating BHTs into clinical practice and steps that the MHS could take to optimize BHTs' contributions to the health and readiness of the force. Posing parallel sets of questions to BHTs and MHPs allowed comparisons of these groups' perspectives on these topics. The results revealed differences in views by service branch, time in practice, deployment history, and other characteristics. The researchers drew on these findings and recommendations to identify opportunities to optimize the BHT role.

Key Findings

There can be substantial variability in BHTs' responsibilities and skills, including time spent on clinical tasks

  • BHTs engage in a wide variety of tasks, including screening and assessment, psychosocial interventions, treatment planning and monitoring, and outreach and resilience activities.
  • Both BHTs and MHPs reported that BHTs perform screening and assessment activities most often, yet there was some variation in the amount of time BHTs spend on other clinical tasks, depending on their branch of service and current assignment.
  • BHTs spent about one-third of their time in an average week on patient care–related responsibilities, although this varied significantly across service branches.

BHTs and MHPs differed in their perceptions of BHTs' proficiency and barriers to training and skill development

  • BHTs and MHPs generally agreed that BHTs are most proficient at screening and assessment-related tasks, but BHTs rated their own proficiency higher than MHPs rated BHTs' proficiency.
  • More than three-quarters of MHPs indicated that further education on how best to utilize BHTs' skills could improve the effectiveness of BHTs in the Military Health System.

BHTs and MHPs agreed that BHT training, supervision, and satisfaction could be improved

  • BHTs and MHPs reported that BHTs spend insufficient time on training activities, especially continuing education.
  • More than half of MHPs reported that BHTs receive inadequate supervision or that they were not sure whether BHTs receive adequate supervision.
  • BHTs who indicated that they received inadequate supervision reported being less satisfied with their work and their supervisor.

Recommendations

  • Standardize expectations for BHTs' scope of practice and educate MHPs on BHT roles. This could include issuing specific guidelines regarding the skills that BHTs are expected to maintain regardless of setting, with a focus on high-frequency tasks. Such guidance should also address low-frequency or out-of-scope BHT tasks and how BHT time is allocated between administrative and clinical tasks to ensure that they have adequate opportunities to exercise their clinical skills. Such guidance could also be used to educate MHPs on the BHT role and skills.
  • Provide clinical support tools to structure BHT tasks. Survey respondents suggested using templates, checklists, or forms to structure clinical tasks. Such tools could also help align expectations for BHT performance across settings and supervisors.
  • Standardize and communicate expectations for supervision through policy guidance. Such guidance would promote standardized expectations for BHTs' skills and performance, as well as expectations or requirements for MHPs who supervise BHTs.
  • Expand continuing education for BHTs, such as by developing a BHT-specific continuing education curriculum. Continuing education and on-the-job skill development are critical components of successful progression along the BHT career path. Given that Air Force BHTs and MHPs were less likely to indicate that too little time was allocated to BHT continuing education, the Air Force could serve as a model for the other services.

This research was sponsored by PHCoE and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

This report is part of the RAND 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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