The Scope of Work determined through the proposal development process will establish the specific service delivery process for each primary practice site. Typically, IBHIs service delivery follows the sequence below.

Organizational Preparation

Changing how an organization conducts its business is as much about culture change as it is about learning new skills and creating new operational processes. It is therefore essential that everyone within your organization is "on board" with the goals and objectives that IBHI services are designed to achieve. Since each IBHI client organization has a unique history and its own internal dynamics, it is essential that we customize how we prepare your organization for change. There will be resistance to change; there will be a desire for improvement. Together, IBHI and key client managers and staff will design a communication and educational strategy that is a fit for your organization. From the Chairperson of your Board to the office Receptionist, all staff will learn about the purpose and goals of integration, how this will affect your practice's way of doing business, and how it will specifically affect their roles and responsibilities.

Training

There are several nationally recognized programs which provide training to behavioral health clinicians (e.g., counselors, marriage and family therapists, nurses, psychiatrists, psychologists, social workers) who plan to work in primary care settings. These programs are designed to provide student-centered distance learning which focuses on information that is directly relevant to the professional development and learning objectives of the student.

Multiple teaching modalities are employed, to create a program combining rigor and flexibility. These modalities include:

• Videotaped lectures
• Use of online resources
• Online chats and discussion boards
• Traditional readings
• Case formulation and presentation

Major topics include basic concepts in integrated primary care, attributes of the care provider, practice standards, assessment, and program development. In addition to required readings and videotapes lectures, students participate in online discussions and chats. Some programs require homework. IBHI stays apprised of the advantages and disadvantages of each program and adivises each client regarding which program will be the best fit for their BHCs.

Wrap-around Consultation

While training with specific staff is occurring, IBHI consultants will work with key managers as well as non-clinical staff to facilitate the team building, operations redesign, and skills building that is essential to integrating behavioral health services into primary care practices. Limiting the training exclusively to behavioral clinicians to do this work without changing operational practices, will not produce systemic change.  If the rest of the primary care practice is not on board and not ready to put these new skills to work, integration will fail. IBHI's "wrap-around" consultative services are individualized for each client organization. The services delivered flow directly from discussions of each organization's self-assessment survey.

To facilitate the consultation process, we recommend setting up a Project Team to validate work in progress during the engagement.  This team would most typically include our client's senior managers. We also recommend that a Project Sponsor be assigned from this team who will provide strategic and management direction, project oversight, decision making, stakeholder identification, and project closure validation.  Finally, we recommend that a Project Manager from the team be appointed who will oversee internal communication related to our consultation and coordinate the day to day activity, as needed, to meet consultation milestones and objectives.

Outcome Monitoring

The finalized IBHI proposal will include agreed-upon metrics which define "success" for the services IBHI will provide. These metrics will tie to the primary care practice's self-assessment prior to the start of services. In short, our objective is to help get our clients to a "4" rating on each of the benchmarks for which we are providing assistance. We ask our clients to reassess their organization's integration capabilities in conjunction with key milestones in our work. If it is determined that we have not achieved the results anticipated for a given benchmark at a given point in time, then adjustments will be made to both IBHI's services and our client's responsibilities based on our collective analysis of the results. It is rare for a change process as significant integrating behavioral health into primary care to unfold without some unanticipated challenges during the process. We need to anticipate that these will occur and create processes for working with one another that can creatively respond to these challenges. The relationships we build with one another will be the key to our success.