Technicians for Behavioral Health – Enhancing the Reach of Behavioral Health Care in the Military

Behavioral health technicians are military personnel who work alongside licensed mental health providers such as psychiatrists, psychiatric nurses, psychologists and social workers. They are caregivers who help the military health system (MHS) streamline and improve the delivery of behavioral health care.

BHTs perform a wide range of duties in garrison and operational settings, including clinical care, case management, operations, and administrative leadership. RAND researchers recently conducted a survey of BHTs and MHPs to shed light on BHT practice and inform MHP decisions to optimize BHT integration.

The survey focused on the tasks BHTs perform most frequently and the quality of those tasks. This summary presents key findings from the survey and strategies for how MHP providers can maximize the potential of the BHT role.

Main tasks of the BHT

BHTs can be trained to perform a wide range of clinical tasks. In the survey, BHTs were asked to indicate how often they performed 22 individual tasks. The results highlighted a number of important tasks, clinical activities that BHTs perform frequently and for which they are likely to receive extensive training. All of these key tasks were related to patient screening:

• Conducting a risk assessment
• Using the Behavioral Disorders Data Portal, an online application used to collect patient data
• Conducting intake surveys
• Measuring/assessing symptoms
• Sequencing of inpatients

Tasks for further integration of BHT into clinical care

The study also identified tasks that BHTs perform less frequently that could be performed by BHTs with additional support, training, or supervision.

Interventions (Psychosocial)

MHPs expressed reservations about BHTs providing psychosocial interventions, particularly evidence-based psychotherapy for mental health or substance use disorders. However, 82% of BHTs and 70% of MSPs felt that BHTs could have a greater impact if they were trained to provide treatment for a range of diagnoses.

BHTs could run psychoeducation groups, for example, for smoking cessation or sleep hygiene. BHTs could also provide supportive counseling, focusing on evidence-based approaches suitable for non-health professionals, such as problem-solving therapy and motivational therapy.

Monitoring patient’s ways

In civilian healthcare, it is common for healthcare professionals to monitor patients’ progress. In the context of military behavioral disorders, this may include assessing patient progress over time by measuring symptoms (i.e., measurement-based treatment).

In addition to implementing interventions through the behavioral health information portal, BMEs could track symptoms over time. BMEs could also track patient progress by reviewing self-monitoring records (e.g., sleep logs) or other patient tasks.

How can the MHS help BHTs optimize their support to clinical care?

1. Provide BHTs with clinical support tools and templates

Clinical support tools and templates can be used to structure clinical tasks and ensure that BHTs and MHPs agree on what BHT tasks should include. For screening tasks, such as intake interviews, this could be a standard interview form that BHTs receive in their initial training. For psychosocial interventions, this could include training BHTs in specific evidence-based practices that address common needs, such as problem-solving therapy.

In cases where patient progress is monitored by symptom measurement, this could include clinically supportive advice on how to interpret changes over time, identify meaningful trends, or define clinical thresholds. BSEs and HCPs could use clinical support tools (e.g., screening tools, pocket guides, patient worksheets) provided by the Center of Excellence in Mental Health.

About 90% of BHT and MHP professionals believe that BHT skills can vary considerably even within the same position.

2. Identify specific supervisory expectations

The MHS has sought to harmonize supervisory expectations for BHT staff, for example, by clarifying when MHS should directly supervise or monitor the clinical activities of BHT staff, such as in crisis situations or when patient safety is at stake.

However, in other situations, supervising providers may use supervision at their discretion. It would be helpful for supervising healthcare professionals to formalize their expectations regarding BHTs, such as the frequency and form of supervision, from the beginning of employment.

MHS could also develop plans to ensure that BHTs follow evidence-based practice on an ongoing basis (e.g., by observing psychoeducation groups from time to time). Better communication and supervision is likely to improve the quality of BHT practice and maximize in-service training of BHTs.

3. Develop continuing education for BHTs

Basic technical training for BHTs is designed to be brief and provide basic knowledge and skills. Additional skills are expected to be developed on the job and through continuing education. These events can ensure that BHTs are competent in their core tasks and support the development of new skills through content tailored to the BHT’s level of experience.

From June to August 2020, RAND researchers surveyed a stratified random sample of licensed BHTs and MHP. The BHTs consisted of active duty military (mental health professionals, 68X), Navy (BHTs, L24A), and Air Force (mental health technicians, 4C0X1).

The MHP included active duty civilians and DOD/U.S. government civilians who had worked with a BHT in the previous 12 months. The MHP included licensed psychiatrists, mental health nurses, doctoral-level psychologists, and senior-level providers (i.e., licensed social workers and psychologists). The adjusted response rate was 42% for BHTs and 37% for MHPs.