The Internal Behavioral Health Consultant (IBHC)

The Internal Behavioral Health Consultant (IBHC)
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Overview

The internal behavioral health consultant (IBHC) is a behavioral health provider integrated into primary care clinics to provide care for a wide range of behavioral health conditions, chronic medical problems and adverse health behaviors. IBHCs are psychologists and social workers who have received specialized training to work as consultants to primary care managers (PCMs). They provide focused assessment, prevention, intervention and consultative recommendations to assist PCMs in providing high quality care for patients, with a goal of improving quality of life and overall health. To accomplish this, IBHCs meet with patients over the course of several appointments to help address their behavioral health concerns and assist them with behavioral changes to optimize their own health.  For patients who may require more intensive services (e.g., extensive evaluation, traditional therapy or prolonged care), IBHCs can help link them to specialty mental health care. Click here to find out more about being an IBHC.

Conceptual Distinctions of Primary vs. Specialty Behavioral Health Care Models

Dimension IBHC Specialty Mental Health
1. Model of care Population-based Client-based
2. Primary customer PCM, then patient Client, then others
3. Primary goals
  • Promote PCM efficacy
  • Support small patient change efforts
  • Prevent morbidity in high risk patients
  • Achieve medical cost offset
Resolve client's mental health issues
4. Service delivery Part of primary care services A specialized service, either in or out of primary care
5. Who is "in charge" of patient care PCM Therapist
6. Primary modality Consultation model Specialty treatment model
7. Team structure Part of primary care team Part of specialty MH team
8. Access standard Determined by PCM preference Determined by client preference
9. Cost per episode Potentially decreased Highly variable, related to client condition

Services provided by the IBHC

IBHCs provide services to include the following:

  • Helping patients replace maladaptive behaviors with adaptive ones, providing skill training through patient education strategies, and developing specific behavior-change plans that fit the fast pace of primary care.
  • Providing focused assessment and intervention with patients (typically in the context of a 15 to 30 minute appointment) geared to aid the patient and team with managing or improving a presenting problem.
  • Screening and assessment of patients who have or are at risk for developing physical or mental health conditions, with the aim of enhancing resilience and preventing further psychological or physical deterioration.
  • Same-day services for patients who are suspected of having behavioral health symptoms that put them at risk of harming others or themselves.
  • Preventing relapse or morbidity in conditions that recur.
  • Preventing and managing addiction to prescription medications such as pain medicine or tranquilizers.
  • Preventing, reducing and managing work and other functional limitations among primary care patients with chronic disease or persistent physical symptoms.
  • Reducing symptoms and maximizing social and work function for those with high-prevalence disorders.
  • Treating and managing patients with chronic emotional and health problems or with high frequency medical appointments.
  • Helping patients transition to specialty mental health care.
  • Providing suicide screening and assessment within primary care per service directives.

It is important to note that PCBH is not a barrier to referring a patient to specialty mental health care. Patients needing a higher level of care should be referred appropriately; however, even in these cases, it is recommended that PCMs discuss the patient with an IBHC to ensure proper referral and for interim care.

Location of IBHCs

Primary Care Medical Homes (PCMHs) with an enrolled population of at least 3,000 individuals are authorized to have a full-time IBHC.

Additional IBHC Tools

  • IBHC Introductory Script: a brief description of the role of the IBHC in team-based care, the nature of the consultative services provided by the IBHC, and the limits of confidentiality. IBHCs across DoD memorize this script and use it at the start of each new patient encounter as part of the informed consent process.
  • IBHC Core Competency Tool: a tri-service, standardized method for assessing the key clinical practice, practice management, consultation, documentation, team performance and administrative skills required for successful practice as an IBHC. IBHCs must demonstrate proficiency on each competency in order to function as an IBHC in DoD.
  • IBHC Peer Review Form: contains the peer review items required for use in the peer review process for IBHC medical record documentation.
  • IBHC Patient Handouts: developed for IBHCs to assist with patient education and intervention for a range of common behavioral health problems, chronic medical conditions and adverse health behaviors.