Behavioral Health Assessment Officers: Managing Care for Mental Health and Substance Use Disorders in Rural Emergency Departments

The Behavioral Health Assessment Officer (BHAO) model is a strategy to increase mental health and substance use disorder (SUD) resources in rural emergency departments (EDs). A BHAO is a licensed behavioral health provider who practices in a rural ED. Typically, this provider is a licensed clinical social worker (LCSW), licensed mental health counselor (LMHC), or licensed marriage and family therapist (LMFT). The BHAO evaluates patients identified at screening to have behavioral health concerns and manages their care.

As appropriate, the BHAO provides naloxone kits and training and makes referrals to treatment programs for individuals with SUD who are ready, willing, and able to accept the referral. To connect patients with community resources effectively, the BHAO builds relationships with treatment organizations and other local service providers. Attentive to the needs of the unique rural community they serve, BHAOs listen to community voices, understand local strengths and barriers, and navigate resources with skill.

Through this role, a rural hospital can increase its mental health and SUD resources without having a psychiatrist onsite. BHAOs manage most of their caseload without needing to consult with a psychiatrist. In cases of higher complexity, BHAOs have a provider-to-provider telehealth consultation with a psychiatrist at a hub location outside the immediate area. If needed, the psychiatrist may then have a video visit with the patient and provide a second opinion.

In this model, telehealth is also used to build a community of behavioral health professionals in rural areas. BHAOs at different hospitals and the psychiatrist they consult with gather for regular huddles to learn from one another. These huddles, often held via videoconferencing, offer both educational opportunities and a professional network that doesn’t rely on travel.