Impact of an Integrated Care Clinical Experience on Skills and Confidence of Nurse Practitioner Students

Purpose:  Approximately one in four adults, and one in five youth between the ages of 13 and 18, experience some form of mental illness (MI) in a given year. The majority receive assistance from providers outside of behavioral health specialties, particularly in primary care settings. In addition, those with severe forms of MI face an increased risk of serious medical co-morbidities and significantly shorter life spans than the general population. Experts have increasingly called for the integration of behavioral health and primary care to more effectively treat mental, substance-use, and general health problems. The integration of behavioral health services into primary care has been found to have improved outcomes both clinically and financially. However, finding clinical staff with the necessary skills and knowledge to bridge the behavioral and primary care systems has been difficult, and there have been few reports of the effectiveness of educational programs that aim to prepare future healthcare providers in the provision of evidence-based integrated care (IC). The purpose of this mixed methods pilot study was to determine the impact of a comprehensive didactic and clinical education experience that prepares nurse practitioners to deliver effective integrated care services in community-based primary care settings.

Methods:  An innovative educational program was developed to provide coordinated clinical practicums for dyads of Family Nurse Practitioner (FNP) and Psychiatric-Mental Health Nurse Practitioner (PMHNP) students. Three pairs of students have been matched with preceptors working within primary care centers or School-Based Heath Centers (SBHCs), and will be providing direct care to under-served clients across the lifespan for a 14-week semester. Services offered include primary medical, behavioral health, and dental care, along with a wide range of supportive services such as intensive case management, prenatal education and lactation support services, and family violence prevention and education. The unique educational model of pairing a FNP student with a PMHNP student is expected to result in maximum cross-disciplinary learning as well as better role preparation, along with demonstrated skills in delivering effective integrated care by the completion of the clinical rotation. Students are scheduled to be evaluated by their preceptor at the end of the practicum on their integrated care skills and competencies using the 26-item, Likert style Integrated Care Competency Assessment Tool (ICCAT). They will also complete a self-report on their experience of the integrated care practices at the clinical site using either the Primary Care Provider (PCP) Self-Report Questionnaire or the Behavioral Health Provider (BHP) Self-Report Questionnaire, and participate in a Focus Group that will elicit information about their experiences in the program. Finally, students will self-report, at the beginning and end of the practicum, on their level of comfort with providing integrated care by use of an analogue scale.

Results:  Analysis of the results from the ICCAT, the Self-Report Questionnaires, the analogue scales and the Focus Group will be shared; the overview will determine the impact of the innovative clinical educational experience.

Conclusion:  Results from the pilot study are expected to indicate that the students both enjoyed and benefitted from the innovative educational program.