Health improvement practitioners in New Zealand

Health improvement practitioners (HIPs) are an emerging workforce in New Zealand. These roles are modelled on the behavioural health consultant roles in the United States. The HIP roles have been piloted in New Zealand, alongside other roles such as health coaches and dedicated mental health and addiction support workers working in an integrated primary mental health and addiction service approach.

A health improvement practitioner is part of a general practice team and holds a registration under one of the following: Health Practitioners Competency Assurance Act (HPCA), dapaanz,  Social Work Registration Authority (SWRB) and New Zealand Association of Counsellors (NZAC) who has completed the Te Whatu Ora accreditation to work in the health sector.

In addition, people who are employed as a health improvement practitioner must hold a current annual practicing certificate, preferably have worked in mental health and addiction, and have training in providing talking therapies,

Being based in a general practice, there are no barriers as to who can see a HIP if the person is enrolled in the practice. Appointments are available every day for 20-30 minutes. Half of the day is for booked appointments and half is for un-booked appointments to allow for same-day referrals.

Their work is population-based, meaning people do not require a previous or current mental health or addiction diagnosis to make an appointment. They work in a team approach with the general practice team and can also provide group sessions for a range of issues such as insomnia, gout, anxiety, or cardiovascular disease.

General practice staff can do ‘warm handovers’ with the health improvement practitioner who can make a time to see a person on the same day they are visiting the practice.

Tara Mueller, a health improvement practitioner based at Bush Road Medical Centre in Whangarei talks about her role.

The health improvement practitioner programme is designed for people who are new to the HIP role. To attend you need to have employment as a HIP in a general practice. HIP training is designed to develop the knowledge and skills for the health improvement practitioner (HIP) role and to provide support to apply this in daily practice. For this to be successful there are three components to the programme.

Training workshop –a four-day face to face training, or eight half-days virtual training

Pre-practicum -one day shadowing an experienced HIP and one day with a HIP trainer establishing relationships with the primary care team

Practicum -one day of observed practice with a trainer at three and six months, attendance at regular webinars and ongoing coaching.

Te Pou has been rolling out health improvement practitioner training since February 2020, using an American behavioural health care model developed by Patti Robinson. Throughout 2020, a review was undertaken to align the content of the HIP training to a New Zealand context, reflecting adult learning principles. Based on the feedback we received, some changes were incorporated, and the new programme structure was delivered from January 2021. Te Pou also works with a group of experienced and dedicated HIP trainers in New Zealand to deliver this training.

The learning outcomes are:

• Consistently practices within the primary care behaviour health model.
• Use behavioural health techniques and tools to explore diverse people’s health situations and progress them towards improved health and hauora.
• Work collaboratively to offer and promote integrated care within a primary care context.

Topics include:

• What is a HIP?
• Evidence supporting the HIP roles
• The New Zealand context
• HIP visits
• Initial visit
• Follow up visit
• Culture and primary care
• Trauma
• Focussed acceptance commitment therapy (FACT)
• Psychological flexibility
• Integrating into a GP practice
• Tools and techniques
• Other services
• Risk
• HIP wellbeing
• Addiction
• Persistent pain
• Kernels of behavioural change
• Psychological distress
• Childhood challenges
• Long-term conditions

Watch this video to learn more about the HIP training from Marcia Sasano, a master HIP trainer and Te Pou’s training lead for the integrated primary mental health and addiction programme.

Patti Robinson, from Mountain View Consulting in the US, talks about the development of the approach to integrated primary mental health and addiction services in primary care including the role of the health improvement practitioner.