Primary care psychology in a military treatment facility: The Internal Behavioral Health Consultant (IBHC)

Abstract

Born out of the Air Force’s Behavioral Health Optimization Project (Wilson PG, The air force experience: Integrating behavioral health providers into primary care. In: Frank RG, McDaniel SH, Bray JH, Heldring M (eds). Primary care psychology. American Psychological Association, Washington, DC: 169-185, 2004), the Department of Defense (DoD) issued Instruction Number 6490.15 in August of 2013 entitled, “Integration of Behavioral Health Personnel (BHP) Services Into Patient-Centered Medical Home (PCMH) primary care and other primary care service settings” to have an Internal Behavioral Health Consultant (IBHC) integrated with primary care at all Military Treatment Facilities. Some facilities are located in remote locations or in areas where it is not feasible to have a full-time IBHC. In these cases, behavioral healthcare can be provided using secure videoconferencing equipment, creating a virtual office for the patient and doctor. The goal is for the primary care physicians to have immediate access to a behavioral health consultant to provide expertise and interventions to improve the health and quality of life of their patients. Within the Navy system, IBHCs meet on a monthly basis via teleconference to discuss issues pertaining to the position, patient care, and practice improvement. Additionally, IBHCs throughout the DoD participate in monthly training sessions provided through the use of a DoD-sponsored Webinar platform. Speakers present on a variety of topics related to behavioral healthcare best practices. The IBHC has a deep well of resources available online through several DoD and other governmental websites. These sites provide best practice guidelines, evidence-based interventions, patient information handouts, assessment materials, and more to assist the IBHC to deliver efficient and quality healthcare. While it can typically take 2 weeks or more for a patient to get in to see their primary care provider, an IBHC can usually see patients on the day of referral. To decrease simple follow-up appointments, a secure email service is used to communicate with patients for information and quick checks. The IBHC uses a database to record patient appointments and identify population trends, including reason for visit, referring provider, and presenting problem. These and other factors are then used to guide program development, patient care, and provider education.