Transcript Title of Presentation - Collaborative Family Healthcare Association

Workforce Readiness and
Integrated Behavioral Health
William B. Gunn Jr. PhD
Nancy B. Ruddy PhD
Collaborative Family Healthcare Association 13th Annual Conference
October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.
Faculty Disclosure
Please add the commercial interest disclosures
that you reported on your signed Disclosure form:
I/We have not had any relevant financial relationships
during the past 12 months.
Need/Practice Gap & Supporting
Resources
There is a gap between the demand for professionals who have
training in integrated care and the number of professional training
programs who offer training. Curriculum competencies for training
environments have been proposed, but are not widely known
outside PC circles.
We do not really know where training is occurring, and how training of
behavioral health professionals varies in those sites that offer it.
Many, if not most, behavioral health training programs are in the “precontemplation” phase regarding development of curricula and
training opportunities in primary care behavioral health
Objectives
Identify barriers to interdisciplinary training
List strategies to enhance curricula and clinical experiences
to prepare students to work in an integrated healthcare
system.
Identify potential training partners.
Describe strategies to increase attention to and
understanding of integrated healthcare opportunities in
the behavioral health training community
Expected Outcome
Participants will be able to describe primary care
behavioral health curriculum and competencies.
Participants will be able to identify potential partners for
training future professionals who work in integrated
healthcare.
Participants will develop a plan for how they can
facilitate primary care behavioral health training in
their home setting.
Barriers to Training
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Funding mechanisms
Primary Care skills may not coincide with
requirements for accreditation
Curriculum in graduate programs already full
Faculty have no experience in Primary Care
Lack of awareness of faculty and students
about Primary Care
PC training settings have other priorities
Raising Awareness in Guilds
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PC an emerging field –
viable career
Psychotherapy on the
decline
Must learn to function
in healthcare: less
marginalized
Collaboration w PC as
way to build
independent practice
PC based professionals
in guild leadership roles
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Articles in widely read
guild publications
Presentations at general
guild conferences
Presentations to
training programs,
program directors
PC is an opportunity to
EXPAND what we do
APA Initiatives to Increase
Training in Primary Care
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APA BEA Task Force & Div 38 PC
Psychology Training Committee
 Survey to assess current
training
 Development of colloquia
power points
 Collection of teaching
resources
 “Match-making” psychology
doctoral programs to family
medicine residencies
 Development of PC
competencies
 “Tips for a successful
practicum in PC”
Benefits to Behavioral Health
Training Programs
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Interdisciplinary training
Training in brief interventions
Training in evidence based care
Training in consultation
Opportunity for program evaluation
experience
Differentiate program from others
Benefits to Primary Care Training
Settings
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Emphasizing the “win-win” aspect for PC:
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Does not take a lot of resources
Consistent with PCMH Certification
Improves patient care, provider satisfaction
In training settings,
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prepares medical professionals to work in
multidisciplinary teams
Enhances teaching of biopsychosocial model
Improves access to MH care for indigent pts
Convincing Trainees to Explore
Primary Care
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May be where jobs are in future
Different way to practice
Interdisciplinary, team care
Work in medical setting and see general
populations
See a large volume of patients
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Diverse Patients (culturally, socioeconomically)
Diverse Presenting Concerns
Diverse Assessment & Intervention Strategies
Recruiting Students to PC
Practicum
Is Primary Care For You?
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Do you want to be a generalist?
Do you like being part of a team?
How well do you tolerate uncertainty and change?
Do you feel comfortable asking questions?
Do you like going outside your comfort zone?
Do you find the interplay of biological and
psychological factors interesting?
Do you believe that brief interventions are
meaningful and effective?
Preparing Supervisors,
Developing Curricula
Ensuring Students Get PC Training
that Prepares them for
integrated services
Changing Skill Sets for the Future
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Teams/Systems Concepts
Relevant Knowledge &
Experience
Cross Disciplinary Work
Prevention & Health
Behaviors
Chronic Illness
Management
Relational therapy skills
Program
Evaluation/Research
knowledge
What additional skills/experiences should
students have to work in primary care?
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Brief assessment & interventions
Understanding of mind/body connections
Knowledge of psychotropic medications
Basic medical knowledge
Substance Abuse assessment/treatment
Chronic disease management models
Functional Assessment
Understanding of medical training & culture
Sample Curriculum:
Detailed learning objectives in:
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Biological Processes
Cognitive, Affective, Behavioral and
Developmental Components of Health
Relational & Sociological Components
Health Policy and Systems
Common Primary Care Problems
Assessment and Intervention
McDaniel, Belar, Schroeder, and Hargrove, 2002,
Competencies Established
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Enhancing Preparation Among EntryLevel Clinical Health Psychologists:
Recommendations for “Best Practices”
Masters, Thorn, and France, 2009
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Primary Behavioral Health Program,
Kurt Strosahl, the Behavioral Health
Consultant
Strosahl, 2001
Interprofessional Training
Resources
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Internet sites: PCPCC.net,
integratedprimarycare.com etc
Print resources (handout)
Core Competencies for Interprofessional
Collaborative Practice – Report of an Expert
Panel, May 2011
Sponsored by Associations of Nursing, Osteopathic Medicine, Pharmacy,
Dental Education, Public Health
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Team-Based Competencies - Building a
Shared Foundation for Education and Clinical
Practice – Conference in February 2011
Sponsored by HRSA, RWJF, the ABIM Foundation and the
Interprofessional
Education Collaborative
Training Site Considerations
Opportunities for Training
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Primary care residencies in family
medicine, internal medicine and
pediatrics
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Federally Qualified health Centers
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VA system
Defining the Experience
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Orientation to the Medical Environment
Biopsychosocial Care
Warm handoffs & Hallway consults
Assessment & Intervention w/ Med Trainee
Development of Screening programs
Direct Intervention w/o Referral
Group Medical Appointments
Crisis Intervention in PC
Substance Abuse Assessment & Intervention
Ongoing consultation w/o direct pt care
Psychotropic Medication Consults
Program evaluation
Setting the Stage
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Establish institutional agreement with MH training
program – need legal review
Help support staff see benefits, troubleshoot issues
Schedule student for maximum interaction &
minimum logistical issues
Require student to read about PC practice before
starting training experience
In a med training setting, determine which med
training opportunities helpful
Get equipment to allow for supervision
Computer access (esp. w EHR)
Occupational Health Issues
Students’ status, title, etc.
Educating Medical Providers
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Appropriate referral
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NOT traditional psychotherapy
NOT punting patient
Clear about student’s skill & training
Discussing with patients, how to
introduce student etc
Ensuring respect & collaboration
Orienting the MH student
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Orient to medical setting – observing
med providers, support staff, MH staff
Introducing to EVERYONE
In residency setting, shadow residents
on rotations, call etc.
Computer training
Documentation review
PC ethical considerations
Skills to Review
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How to talk to medical providers
Respectful curiosity
BRIEF assessment, intervention
Importance of “face time”
Medical Focus
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Chronic Disease Management
Health Behavior Interventions
Supervision Considerations
Supervisor Availability
 Attend to case mix
 Need to address student experience of PC – not their
comfort zone
 New skill set for trainee: may have increased need
for content review
 Discuss ethical issues in PC
 Consult with student’s program re:
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Supervision requirements
Feedback process (for you & student)
Due process, grievance procedures
Practica
Pros
 Free (no stipends)
 Institutional agreements easy to create
 Do not have to go through accreditation
process
 Earlier exposure for students
Practica
Cons
Very green clinicians and may be
overwhelmed by the environment
Student juggling academics with clinical
work, more distracted, competing
demands
Need supervisor of the same guild
Activities may not map onto requirements
for graduation/internship/licensure
Internship
Pros
Full year experience better than a
rotational experience
Must go through accreditation process
(psychology)
Sets stage for entry level jobs for trainees
Internship
Cons
Need supervisor of the same guild
Must be paid (psychology)
If no exposure prior to internship, may
not be invested
Activities may not accrue hours necessary
for licensure
Post-Doctoral
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Get students who are very invested
Financial issues
Supervision can be somewhat looser
More experienced clinicians
More flexibility to do nonclinical
experiences
Learning Assessment
What are three competencies that a behavioral health professional
needs to develop to successfully practice in primary care?
Name two learning resources that a behavioral health training
program can use to teach students about practicing in primary
care.
What are three barriers to the integration of primary care concepts
and skills in the training of future behavioral health providers?
List two things you will do when you return to your home system
to facilitate the training of behavioral health professionals in
primary care.
Session Evaluation
Please complete and return the
evaluation form to the classroom
monitor before leaving this session.
Thank you!