Military Technicians for Behavioral Health

Understand and optimize the System

Behavioral health technicians (BHTs) are military personnel who are expected to provide clinical support services alongside independent, licensed behavioral health providers. When optimally integrated, BHTs can enhance the mental health capacity of military personnel and ensure that military members have access to high-quality, effective services.

BHTs are trained to conduct behavioral health screenings and assessments, provide psychosocial interventions and case management, and provide prevention and coping services. Their duties may depend on the nature of their role.

RAND wanted to help the U.S. Department of Defense better understand the role of BHTs and how they can better support the health behaviors of troops. RAND researchers examined relevant training programs, policies, and literature to document the training and roles of BHTs and identify strategies to improve the selection, preparation, and ongoing professional development of BHTs.

BHTs must perform a wide range of duties, but training is short and fast

Ground and Air Force BHTs receive professional training immediately after basic training, while Navy BHTs receive paramedic training after basic medical training. All BHTs attend a nine-week Medical Education and Training Camp (METC) that teaches fundamentals (e.g., ethics, psychopathology) and clinical skills (e.g., interviewing, psychological testing, and counseling). This is followed by refresher courses and clinical training.

The total duration of BHT training ranges from 14 to 17 weeks, depending on the service. In this short time, instructors must cover a wide range of topics while ensuring that BHT instructors gain enough experience to prepare them to work in the clinical setting.

Through selection, training, and other means, we can better prepare BHTs to meet the mental health needs of soldiers

Selection

Selection procedures and requirements vary from service to service. Current selection processes do not always adequately assess the suitability of BHTs, and it is unclear whether current criteria are effective in identifying disqualifying factors.

Recommendation: establish uniform selection criteria that meet the requirements of the BHT position.

Although there may be differences from service to service, key criteria should assess essential mental health attributes, such as communication skills. These criteria could be assessed using the interviews used by the Air Force. These interviews could ask applicants how they would react in job-related BHT situations.

Training

Training must balance the need to cover a broad range of topics with the need to gain clinical experience before taking on a new assignment. Training will include both didactic and practical elements, and instructors will be able to incorporate interactive and applied exercises to present course material in a variety of ways.

Recommendation: tailor the curriculum to the roles of nurse educators and the needs of the populations they serve.

The curriculum could focus on the psychological situations nurses most often encounter and use standardized tools, such as intake forms, that can be used in the clinical setting. The curriculum could also include key evidence-based interventions that can be applied to different settings and populations, such as problem-solving therapy.

Responsibilities

Once recruited, BHTs are assigned to garrison or outreach roles. Research shows that BHT workers do not always have access to their full capabilities, but BHT workers do not have standard roles in all services and care settings.

There is a need to align expectations and ensure that BHTs are adequately prepared for their roles.

Further research is needed to examine how factors such as the setting, management preferences, and clinical management requirements influence the role of nurses. Although some variation is to be expected, it is important that nurses are prepared to fulfill their roles in all settings.

This is especially important when nurses are seconded or work in an operational setting, as their role and involvement in clinical activities may expand significantly.

Mentoring, education, and professional development

On-the-job education and mentoring are essential to developing and maintaining the competencies of staff in general medical schools. However, the requirements vary from service to service, and there are not always standards for the delivery of this training. Leaders may not be aware of the support needed by staff in mainstream schools to develop and maintain their competencies.

Develop guidelines for ongoing training and supervision, and consider the use of the best civilian practices.

Clearer requirements for clinical practice, ongoing training, and supervision of mental health providers would give BHTs more opportunities to use and develop their skills. Civilian patients increasingly serve as health coaches to facilitate behavior change and assess progress toward treatment goals. BHTs are likely to be useful in similar roles in military installations.