An old Chinese proverb will prove useful in your first week: If you wish to succeed, consult three old people. Who are the “old people” that the BHC needs to consult? They include senior providers, particularly those with strong interests in behavioral health, and if possible the senior leaders in the clinic or healthcare system (e.g., the CEO, CFO, other administrators). Relationships with the clinic medical director, the clinic manager, and the director of nursing are also pivotal to success and should be formed early on. During the first week, schedule time with as many of these individuals as possible to discuss the new service. It is also important to locate a more experienced BHC, if possible, and plan to meet or talk by phone. Note that finding someone actually working within an integrated model of the type described here is crucial. Simply finding a MH provider in a PC setting might not be too difficult, but if that person is utilizing a colocated or other type of model, she will probably have a very different approach and philosophy.

Day 1 of the new job will probably involve a tour of the clinic and introductions to staff. Afterward, activities will usually focus on basic orientation. Many, but not all, clinics will have a provider orientation process established. The processes of those that do will probably be geared toward physicians and so may have parts that do not apply to a BHC. Practice patience while explaining repeatedly that you are not a physician (assuming you are not). During orientation, be sure to acquire a staff directory, set up email and voicemail, get keys, order business cards, and learn to use the phone system, instant messaging, and the EHR. Obtain a list of regular clinic meetings from the medical director and/or manager and discuss which ones to attend. Attending at least one of each of the clinical team meetings during the first week or two (e.g., the diabetes team, depression team, or whatever other clinical groups the clinic might have) can be very helpful. Also consider staying late one day, as providers are most likely to have time to talk at the end of the day; staying late will also demonstrate your willingness to work hard, like your PCP colleagues, for whom staying late is a common occurrence. In addition to all of these tasks, be sure to find time for the tasks in the following paragraphs.

The beginning of the second week is the time to start seeing patients and fine-tuning practice support tools and strategies for completing visits in a timely manner. Visits for the first 2–3 weeks are usually scheduled for 1 hour, to allow for time to learn the EHR and clinic workflows. Assure that copies of the BHC brochure are available for initial visits with patients as well as copies of any behavioral outcome measures. Practice of scoring and providing feedback statements helps the BHC become more efficient and effective with these important patient visit activities. Patients will be more likely to see completion of the measures as meaningful if they receive feedback and see the BHC use them in a helpful manner. If helpful, keep copies of the life context questions and the functional analysis questions (see Chapter 9) nearby during initial visits, to improve adherence to the structure of the initial visit. Try charting during the first visits, even if only using radio buttons and drop-down lists. Remember, exposure is the cure for fear of charting during patient contacts, so starting this earlier rather than later is important. Evaluate your first few chart notes with the PCBH Chart Review Tool from Chapter 9.

When not busy, walk through the halls. Let other team members know you are available to assist in a variety of ways, including making calls and drafting letters. Demonstrate that you are a team player. Continue to meet staff and provide copies of the BHC brochure. Reflect on PCP/RN responses to the survey: What groups or classes might be helpful? What are the priorities in terms of starting an initial pathway? Is there a simple pathway that might be acceptable to most PCPs (e.g., offering all patients with more than two chronic diseases a same-day visit with the BHC to talk about a lifestyle goal)? Attend a provider meeting if possible and provide an update on the start of BHC services. Give them ideas about how they can help, based on the experiences of the first couple of weeks. Continue to shadow PCPs/RNs when an hour or more is free. This is a great way to get to know other people on the team and gain a better understanding of how the BHC service can fit into the workflow.