QBHS Pilot Program Results
Qualified Behavioral Health Specialist Training Pilot
September 2024 – March 2026
Executive Summary
The QBHS pilot trained 8 behavioral health specialists to deliver evidence-based care in pediatric primary care settings. Results demonstrate measurable clinical improvement for patients and significant skill development for trainees.
Patient Demographics
169 total patients · Average age: 17.9
Age Distribution
Gender
Race / Ethnicity
Presenting Conditions
Patient Outcomes
52% average PHQ-9 reduction · 30/53 patients ≥50% improved
PHQ-9 (Depression)
Mean score by session – declining = improvement
PSC-17 (Pediatric)
Mean score by session – declining = improvement
Dose-Response Relationship
More sessions produce stronger outcomes
Client Satisfaction (CSQ-8)
29.3
out of 32 across 18 responses
Top Performers
30
of 53 active patients with ≥50% improvement
Trainee Overview
8 trainees across 2 cohorts (excludes trainees with insufficient data)
| Trainee | Cohort | Patients | PHQ-9 Reduction | Knowledge Δ | Prior MH Exp. |
|---|---|---|---|---|---|
T3 Trainee 3 | 1 | 13 | 38% | +6 | No |
T2 Trainee 2 | 1 | 22 | 50% | +5 | No |
T1 Trainee 1 | 1 | 59 | 37% | +-1 | Yes |
T7 Trainee 7 | 2 | 6 | 22% | +4 | No |
T4 Trainee 4 | 2 | 15 | 44% | +3 | No |
T8 Trainee 8 | 2 | 6 | 93% | +6 | No |
T6 Trainee 6 | 2 | 13 | — | +-4 | No |
T5 Zoe Shook | 2 | 33 | 41% | +-2 | No |
Knowledge Growth
Pre- vs. post-training assessment scores · Avg gain: +2.1 pts
Satisfaction Over Time
Aggregate mean (1–5 scale) · Avg: 82.4
Burnout Indicators
1 of 8
trainees reported elevated burnout during the pilot
Clinical Skill Development
MBS scores (Sep 2025 – Jan 2026) · 702 total supervision hours
Mean Improvement Across All Trainees
IPS (Intervention Skills)
GS (General Skills)
IPS Scores Over Time
GS Scores Over Time
MBS Hours by Trainee
Each session = 2 hours
Credentialing
8 credentialed · Avg competencies: 48.1
Competency Scores
Basic (lighter) and advanced (darker) skills
Feelxs AI Clinical Assessment
AI-powered evaluation of clinical competency across 7 simulated therapeutic scenarios · 12 therapeutic domains scored on 0–4 scale
Clinical Scenarios
Trainees responded to 7 standardized video vignettes depicting challenging therapeutic moments. Each scenario is scored across 12 domains.
David, a father who recently lost his teenage son, resists his therapist's suggestion to attend a grief support group. He feels no one could understand his pain and that "moving on" dishonors his child's memory.
Rachel, an ICU nurse experiencing severe burnout, tells her therapist that sessions are making things worse. She reveals she cries for an hour after each appointment and questions whether therapy is right for her.
James, a Fortune 500 CEO, challenges his therapist's qualifications, questioning how someone without executive experience could possibly understand the pressures of running a billion-dollar company.
A 15-year-old client vents about strict parents and casually mentions involvement in illegal activity with friends. The therapist must balance building rapport with addressing safety and mandatory reporting obligations.
Margaret, a 78-year-old widow who has outlived most of her friends and family, insists her young therapist (age 22) cannot possibly understand the depth of her loneliness and accumulated losses.
A pregnant client rejects standard prenatal care recommendations, expressing distrust of the medical establishment based on prior negative experiences. The therapist must navigate safety concerns while respecting autonomy.
A community activist experiencing burnout breaks down in rage during a session, challenging whether traditional therapy models are equipped to address systemic trauma and ongoing community violence.
Overall Candidate Scores
Mean feelxs score across all 7 simulated scenarios (0–100 scale)
Performance by Scenario
Individual scores across 7 clinical vignettes – color indicates performance tier
| Trainee | Grieving Father | Burned-Out Nurse | High-Achieving Client | Teen & Crime | Elderly Client | Pregnant Client | Activist in Rage | Mean |
|---|---|---|---|---|---|---|---|---|
| Trainee 5 | 39 | 73 | 56 | 73 | 61 | 79 | 84 | 66.4 |
| Trainee 7 | 67 | 63 | 37 | 69 | 37 | 69 | 52 | 56.3 |
| Trainee 6 | 58 | 0 | 75 | 62 | 67 | 79 | 43 | 54.9 |
| Trainee 8 | 50 | 48 | 73 | 42 | 50 | 67 | 48 | 54 |
| Avg | 53.5 | 61.3 | 60.3 | 61.5 | 53.8 | 73.5 | 56.8 | 57.9 |
Scenario Difficulty Ranking
Average score across all trainees per scenario – lower scores indicate more challenging vignettes
Aggregate Domain Performance
Average scores across 12 therapeutic domains (all trainees, all scenarios) – normalized to 0–100%
Domain Profile Comparison
Per-trainee average domain scores (0–4 scale) overlaid for comparison
Individual Trainee Profiles
Detailed domain breakdown and scenario analysis per trainee
Trainee 5
7 scenarios assessedProvider demonstrates exceptional rupture repair skills by immediately acknowledging their misstep and validating the client's perspective. The response shows humility and genuine curiosity about the client's needs.
Provider offers surface-level validation but completely misses the depth of the father's grief and resistance. The response lacks therapeutic substance and fails to engage with the core emotional content.
Trainee 7
7 scenarios assessedProvider handles the disclosure competently, prioritizing safety while maintaining rapport. The approach is measured and appropriate though somewhat clinical in tone.
Provider's response is tone-deaf to the depth of loss and isolation expressed. The generic approach to depression fails to honor the specific experience of aging and progressive loss.
Trainee 6
7 scenarios assessedThe provider skillfully balances validation of the client's autonomy with appropriate concern for safety. They demonstrate exceptional warmth and empathy while navigating this sensitive topic with cultural awareness.
The provider's response inadvertently confirms the client's concern about therapy being disconnected from her reality. The attempt to assert her 'right to be fragile' misses the point of her critique about systemic issues.
Trainee 8
7 scenarios assessedProvider handles the challenge well by acknowledging their limitations while maintaining therapeutic stance. Shows good boundary management and non-defensive posture.
Provider fails to address critical safety issues and illegal behavior. The response inappropriately validates dangerous activities and misses mandatory reporting considerations.
Scenario Clinical Analysis
Key clinical insights and contextual considerations per scenario
Grieving father resists attending support group
Provider recognizes the importance of readiness and autonomy in grief work, using exploration rather than pushing. However, the response lacks the emotional attunement needed for profound grief - the language is somewhat intellectualized rather than heart-centered.
Provider appropriately recognizes that David's resistance to 'moving on' is valid given the recency and magnitude of his loss. The exploration approach respects his autonomy while maintaining therapeutic engagement.
Burned-out nurse feels therapy is deepening her hopelessness
The provider demonstrates understanding of therapy process by normalizing initial discomfort while maintaining hope. The shift to collaborative goal-setting shows good clinical judgment in responding to client feedback.
Appropriately addresses the burnout context by acknowledging the compounded difficulty of processing trauma while continuing to work in a traumatic environment. Shows sensitivity to the nurse's emotional exhaustion.
High-Achieving Client Belittles Therapist's Background
The provider demonstrates sophisticated understanding of how to navigate identity-based mistrust by neither minimizing the client's concerns nor becoming defensive. The reframe toward universal stress management skills while still honoring the client's unique position shows clinical wisdom.
The provider appropriately addresses the CEO's power dynamics and high-stress context without being intimidated. They validate his unique stressors while establishing their competence to help, showing cultural awareness of executive-level pressures.
Teen Vents About Parents and Mentions a Crime
The provider demonstrates sophisticated understanding of adolescent engagement by validating the excitement while addressing safety. The shift to exploring the mother's perspective shows good clinical thinking about family dynamics.
Appropriately navigates the adolescent's minimization of risk without becoming another authority figure. Shows cultural competence in understanding teenage rebellion while maintaining therapeutic boundaries.
Elderly Client Insists Therapist Can't Understand
The provider appropriately uses self-disclosure about their limitations while maintaining therapeutic stance. The focus on 'seasons of loneliness' attempts to find common ground without minimizing the client's specific losses, though this could be more skillfully executed.
The provider shows awareness of the age and life experience gap but could more explicitly honor the weight of multiple losses in late life. The quick pivot to 'finding community' may not fully acknowledge the irreplaceable nature of lifelong relationships.
Pregnant Client Rejects Prenatal Care Advice
The provider shows excellent clinical judgment by supporting the client's autonomy while introducing safety planning as collaboration rather than opposition. The 'How does that sound?' ending reinforces client agency.
Appropriately respects the client's negative experiences with medical providers while still addressing safety. Shows cultural sensitivity to alternative birth choices while maintaining ethical responsibility.
Burnt-Out Activist Breaks Down in Rage
The provider's immediate acknowledgment that their suggestion was 'silly' shows sophisticated understanding of rupture repair. The curiosity about 'therapy isn't built for people like me' demonstrates clinical acumen in exploring systemic barriers.
Shows excellent cultural humility in recognizing the mismatch between traditional therapy approaches and activist burnout. Appropriately addresses the power differential and validates the client's lived experience of urgency.
Feelxs uses AI-powered analysis of video-recorded clinical simulations to evaluate 12 therapeutic domains on a 0–4 Likert scale. The overall feelxs score (0–100) synthesizes domain performance, contextual appropriateness, and clinical judgment. Assessments were conducted across 7 standardized vignettes covering grief, burnout, power dynamics, adolescent risk, aging, prenatal autonomy, and activist rage.
Synthesis
Training quality mapped to patient outcomes
Training Quality vs Patient Outcomes
Supervision Readiness Scorecard
| Trainee | IPS | GS | Cred. | PHQ-9 ↓ | Hours | Status |
|---|---|---|---|---|---|---|
T2 Trainee 2 | 21 | 28 | ✓ | 50% | 124 | Supervision Ready |
T1 Trainee 1 | 21 | 30 | ✓ | 37% | 114 | Supervision Ready |
T8 Trainee 8 | 21 | 30 | ✓ | 93% | 28 | Supervision Ready |
T3 Trainee 3 | 17 | 26 | ✓ | 38% | 112 | Near Ready |
T4 Trainee 4 | 20 | 27 | ✓ | 44% | 90 | Near Ready |
T6 Trainee 6 | 20 | 28 | ✓ | — | 48 | Near Ready |
T5 Zoe Shook | 20 | 26 | ✓ | 41% | 44 | Near Ready |
T7 Trainee 7 | 21 | 28 | – | 22% | 42 | Developing |
Confidential · Prepared by ExS · 2026
Scale definitions: PHQ-9 (Patient Health Questionnaire, 0–27, depression severity); PSC-17 (Pediatric Symptom Checklist, 0–34, psychosocial impairment); CSQ-8 (Client Satisfaction Questionnaire, 8–32, higher = more satisfied); IPS (Intervention-specific Performance Scale, 0–30); GS (General Skills, 0–30).
All trainee identities have been anonymized. Patient data is reported in aggregate only.