July 2012 Member Profile: Michelle Laraia, PhD, PMHNP

Nationally there has been an increasing focus on integrated care, yet there is no widely recognized set of competencies for psychiatric mental health providers and primary care providers on this approach. APNA member Michelle Laraia, PhD, PMHNP, working as a consultant for the Annapolis Coalition on the Behavioral Health Workforce*, is part of a core team of consultants who are managing an important Center for Integrated Health Solutions* initiative which aims to rectify this gap. The Competency Development for Behavioral Health & Primary Care Integration team is working to develop two sets of core competencies on integrated care: one set for the psychiatric mental health work force and one for the primary care workforce.  These competencies will be broadly applicable to diverse settings and populations. Their intended purpose is to serve as a resource for provider organizations which shapes job descriptions, orientation programs, supervision, etc. for professionals providing an integrated care approach.

A retired academician, Laraia currently manages an alternative health center in Portland, Oregon and over the past few years has been invited to consult with the Annapolis Coalition on several projects related to integration and competency development – thus her involvement in this project. She provides the following background on the project:

Over the past few decades, a number of critical facts regarding the US health care system have been widely documented amid growing national concern. To name just a few relevant to the Integration Competency Project include:

  1. The incidence and prevalence of mental illness in the US has been increasing steadily;
  2. There is a rapidly increasing appreciation of not only the wide spread prevalence of comorbid illness in the population but also the significant complexity that this infuses into virtually all health care settings;
  3. The behavioral health workforce is insufficient to adequately address the care of the burgeoning population of people with behavioral health problems;
  4. The Primary Care System is considered by many to be the “de facto” mental health care arena for the vast majority of people with behavioral health problems in the US;
  5. To address these issues, there is a growing local and national impetus to integrate the health care of people within single or closely connected health care settings;
  6. Successful integration of behavioral health and primary care activities, regardless of the definition and model one prefers, requires specific well defined approaches that are rarely included in formal or ongoing  education of the entire US health care workforce;
  7. To date, there are only a few documented examples of the cross training of behavioral health and primary care practitioners to prepare them to successfully navigate this changing face of health care;  
  8. Despite the increasing national focus on integrated care, there is no widely recognized set of competencies on this service approach for either the behavioral health or primary care workforce. 

The myriad components of these issues, in addition to the spiraling costs of health care and the essentially unchecked increase in the both the numbers and longevity of the global population, have been widely considered to be reaching crisis proportions both in the US and internationally. Many potential solutions have been suggested, debated, trialed and documented in a rich and rapidly growing literature. One suggested approach includes the provision of assistance in the form of “competencies” for all health care practitioners faced with such daunting issues in todays’ increasingly integrated health care settings.

There are currently several types of integrated care being utilized throughout health care. “There is broad consensus that the optimal model of integration involves the co-location of behavioral health and primary care staff, whether in behavioral health or primary care settings,” Laraia explains. “Consultation between primary care and behavioral health staff is a second type of integration."  The third type is the most commor and involves simple referral. "But [is] considered far less than ideal by many experts due to a host of limitations," she says.

Laraia’s team is composed of herself: Consultant to the Coalition and a former Associate Professor, School of Nursing, Oregon Health and Science University; Michael Hoge, PhD, Senior Science and Policy Advisor for the Coalition and Professor of Psychiatry at Yale University School of Medicine; John Morris, MSW, Executive Director of the Coalition and a former Professor at the University of South Carolina School of Medicine; and Ann McManis, Director of Operations for the Coalition. They have made great progress on the initiative. Thus far they have conducted a literature review and interviewed key informants from across the country. These informants represent a broad range of health care disciplines and settings and are “experts in the significant changes that integration imposes on the practice of health care in both behavioral health and primary care settings.” The team is now at work writing the actual competencies for the behavioral health and primary care settings.

As for the outcome she envisions for the project, Laraia says: “With formal Competencies for the Integration of Behavioral Health and Primary Care to guide practitioners, stakeholders, and funding streams in the integrated care of individuals and families with increasingly complex symptoms, diagnoses, and treatments, it is anticipated that this will contribute to better outcomes for patients, increased competence of practitioners, updated and relevant educational programs, and streamlined and efficient screening, assessment, diagnosis, and treatment of the growing population of persons with behavioral health problems and general health problems in any health care setting.”  
 


*The Center for Integrated Health Solutions (CIHS) is a SAMHSA-HRSA funded technical assistance center operated by the National Council for Community Behavioral Healthcare.  www.integration.samhsa.gov

*The Annapolis Coalition on the Behavioral Health Workforce (www.annapoliscoalition.org) is a non-profit organization dedicated to improving the recruitment, retention, training and performance of the prevention and treatment workforce in the mental health and addictions sectors of the behavioral health field. As part of this effort, it seeks to strengthen the workforce role of persons in recovery and family members in caring for themselves and each other, as well as improving the capacity of all health and human service personnel to respond to the behavioral health needs of the individuals they serve. The Coalition has a decade of experience advising federal agencies and commissions on workforce issues and providing technical assistance to states and non-profit organizations on practical workforce improvement initiatives.  It also has extensive experience in competency development.