Transdisciplinary Care: Opportunities and Challenges for Behavioral Health Providers

Integrated care and integrated care models have been in the forefront of much recent discussion in both local and national forums. The idea that care can be delivered in teams has evolved from integrated care to the development of transdisciplinary care teams. A major contributor to the development of team-based care was Project IMPACT (Improving Mood—Promoting Access to Collaborative Treatment for Late-Life Depression), which addressed geriatric depression in primary care settings and created the foundation for integrated care.¹ Following IMPACT, the model for utilizing a team-based approach became recognized as an effective method for treating chronic illness in primary care settings.

The IMPACT research project demonstrated for the first time that community health settings provide the majority of the nation's mental health services, due primarily to the fact that the public chooses to seek care where there is less stigma and where they have existing relationships. At the same time, primary care providers began to acknowledge that they lacked both the expertise and the resources to do an optimal job of either identifying or treating the mental health disorders they encountered in these practices. These providers have, for the most part, readily embraced integrated and team-based models.¹

The original work in integrated care focused predominantly on the inclusion of behavioral health services in primary care settings, but as the work evolved, it became clear that there were other disciplines (such as dentistry and community outreach) that played central roles on the team and were crucial to improving health outcomes. Integrated models have now begun to develop a new conceptual model known as transdisciplinary care. In transdisciplinary care, the focus continues to be on team based care, with all disciplines viewed as having an equally important role in the patient's care, and with each team member having expanded knowledge of the role that each discipline plays on the team.²

Workforce and training.

The recently enacted health reform legislation calls for the expansion of community health centers with a goal of increasing care recipients to 40 million patients.³ Coupled with the advancement of the patient-centered medical home model,⁴ these developments will require a team-based approach to chronic illness management.

It is predicted that community health centers will deliver a majority of the country's mental health services and be the largest employer of behavioral health providers over the next decade.⁴ Efforts are underway to determine the number of behavioral health providers that will be required to meet community health center expansions, in addition to the continued development of integrated and transdisciplinary care models such centers. The ability to train and recruit behavioral health providers to work in these settings is critical. There is an immediate need to ensure that curriculums (both in short training programs and at educational institutions) reflect upcoming workforce needs and the specialized training necessary to fill those needs. First, however, mental health provider and academic communities must better understand the concept of transdisciplinary care and embrace the clinical models being developed in community health settings as clinically effective models for the delivery of mental health services.

A greater understanding of transdisciplinary care throughout the mental health community will lead to the recognition of the numerous opportunities transdisciplinary care offers. It is widely recognized that care teams are successful at improving both health and mental health outcomes,¹ and such practices are evidence-based.¹ Unfortunately, the education and training of a mental health provider seldom includes training for a role on an interdisciplinary care team, or even any team at all.

Disciplinary diversity can create dynamic teams, but recruiting and retaining qualified staff is often challenging and may be affected by local and regional workforce short-ages. Many areas of the country, both rural and urban, struggle to hire and maintain qualified psychiatrists and other behavioral health providers. The behavioral health needs of expanding community health settings are going to dramatically exacerbate this problem for many communities.⁵

During the last few years, best practices and benchmarks have begun to emerge surrounding the delivery...