Primary Care Behavioral Health

The Center for Integrated Primary Care has been training mental health professionals to provide services in primary medical care settings for over fifteen years.

The program consists of 36 hours of didactic and interactive training and is delivered in 6 full-day workshops, one Friday per month for 4 months. The program consists of 7 workshops. Participants can choose Child Workshop or Serious Mental Illness Workshop (see below). A Certificate of Completion of training in Primary Care Behavioral Health is awarded for each program. Participants can take all 7 workshops, there is no change in the Certificate of Completion (mailed out w/in 45 days if 100% attendance is submitted).

Program Curriculum

 Primary Care Culture, Behavioral Health Needs and Working with Physicians

 Evidence-based Therapies and Substance Abuse in Primary Care 

 Child Development and Collaborative Pediatric Practice

 Integrating Care for People with Serious and Persistent Mental Illness 

 Behavioral Health Care for Chronic Illnesses, Care Management and An Overview of Psychotropic Medication in Primary Care 

 Behavioral Medicine Interventions: health Behavior Change and Relaxation Response Techniques

 Families and Culture in Primary Care, Advice on Implementation

Certificate Program in Primary Care Behavioral Health

Curriculum

•Primary Care Culture, Behavioral Health Needs and Working with Physicians

Faculty: Alexander Blount, EdD and Ron Adler, MD

As a service to the integration of participants into a primary care practice, every paid participant may bring one primary care physician from their practice (or perspective practice) to Workshop I (only), the orientation to behavioral health in primary care, at no charge. In this way, the program is a preparation of clinicians and an intervention in organizational readiness at the same time. The last four hours of Workshop I are specifically targeted at physicians’ experience, though they are welcome for the whole day. All physicians in attendance will be asked to fill out a registration form and to agree to do an evaluation form.

Culture and Language of Primary Medical Care (2 hours)

  • Primary care’s role in health system
  • Primary care vs. specialty medical care
  • Content and sequence of the basic medical interview
  • Recommended preventative care expected of primary care physicians
  • Role play primary care interview with associated decision-making

Goal: Feel comfortable and oriented in a primary care setting.

Behavioral Health Needs in Primary Care (1 hour)

  • Mental health and substance abuse rates
  • Behavioral health needs
  • Chronic illness mental and behavioral health needs
  • “Ambiguous” illnesses
  • Cultural impact on illness presentations
  • A typical morning in practice
  • Example of common “complex” cases

Goal: Conceptualizes how a behavioral health professional can help in a wide variety of primary care cases.

Consulting with MDs (3 hours)

  • Common physician perceptions of role of a BHP
  • Ways of impacting those perceptions
  • How physicians want to be approached
  • Determining what input from BHP is useful to the PCP
  • Terms for types of collaborative care
  • Co-located patterns of care
  • Integrated patterns of care
  • Practice dual interview
  • Practice talking in front of the patient for a hand off

Goals: Effectively uses the curb-side consultation model to communicate with a physician. Can speak sensitively and with clarity about a patient’s situation with a physician in front of the patient.

•Evidence-based Therapies and Substance Abuse in Primary Care

Faculty: Jeffrey Baxter, MD and Alexander Blount, EdD

Substance Abuse in Primary Care (3 hours)

  • Chronic illness vs. failure of will
  • Role of SA in common illnesses and health behaviors
  • The CAGE and other quick screens
  • Physician training in identifying and treating substance abuse
  • Chronic pain and the dilemmas of pain medication
  • What a Behavioral Health Provider can add to the care in each case
  • Evidence based approaches to substance abuse in primary care.

Goals: Can identify substance abuse problems of patients presenting medical complaints. Can work collaboratively to help patients with SA problems.

Evidence-based Therapies (3 hours)

  • Role of “evidence” in making treatments credible
  • Types of evidence available for approaches we use
  • CBT and the therapies of patient activation
  • Family and other multi-person approaches in primary care
  • The role of solution focused interviewing in patient and provider change
  • Role plays to practice
  • Working in brief visits and brief treatments

Goals: Able to briefly assess, engage and intervene with adults with behavioral health needs in primary care, using methods supported by evidence. Able to briefly assess, engage and intervene with children with behavior problems using methods supported by evidence.

•Child Development and Collaborative Pediatric Practice

Faculty: Alexander Blount, EdD, Kathleen Braden, MD

Child Development (1 hour)

  • The role of “milestones” in organizing pediatric decision making
  • Early developmental milestones and the office assessment of them
  • Interaction of experience and biology in developmental problems
  • Common developmental disorders

Screening Instruments for Primary Care (2 hours)

  • Screening vs. diagnosis vs. outcome
  • Pediatrics: The Vanderbilt, the Connors, Pediatric Symptom Checklist
  • Communicating with parents and physicians about screening results

Goal: Able to screen children for developmental problems.

Collaborative Pediatric Practice (3 hours)

  • The unique nature of pediatrics: doctor/patient relationship is (at least) a triangle
  • Engaging parents in promoting health without making them feel judged
  • Difficult situations in normal care: bedtime, toileting, feeding, interface with school and learning
  • Learning problems and ADHD
  • Special roles for Behavioral Health in pediatric practice
  • Pediatrics: When you might suggest considering medication
  • Speaking to parents and children about medication
  • Common medications given to children, indications, actions and side effects

Goal: Able to guide parents on behavioral issues in a culturally acceptable and effective manner.

•Integrating Care for People with Serious and Persistent Mental Illness

Faculty: Alexander Blount, EdD, and Sherry Pagoto, PhD

Reviewing Recovery: Social Articulation and the Experience of People with Serious Mental Illness
(2 hours)

  • We don't know what to call them: stigma vs. possibility
  • Evidence about their health: the famous 25 years
  • The problem that this population presents for the health system
  • The problem that the health system presents for this population
  • General approaches to contextual rehabilitation: constructing a "unit"

Goal: Participants will be able to define "social articulation" and use the concept to understand clients' common maladaptive behaviors in medical care settings.

The Elements of a System that Integrated Behavioral Health and Medical Care (2 hours)

  • Solving the problems of integrating behavioral and medical care: practices and cultures
  • Care management: The tool of the PCMH and the CMHC

Goal: Participants will be able to describe the elements of an integrated system.

Teaching Healthy Behaviors and Coping with Chronic Illness (2 hours)

  • An evidence-based curriculum and the adaptation for people struggling with serious mental illness

Goal: Participants will be able to deliver a structured experience in health promotion for people with serious mental illness.

•Behavioral Health Care for Chronic Illnesses, Care Management and An Overview of Psychotropic Medication in Primary Care

Faculty: Christine Runyan, PhD and Kathryn Lee, MD

Chronic Illnesses Across the Lifespan (3 hours)

  • Symptoms, mechanisms and treatments of:

Asthma
Diabetes
Heart disease
Irritable bowel syndrome

  • Behavioral health needs and mental health co-morbidities for each illness
  • Behavioral treatments in evidence based protocols for chronic illnesses
  • Group medical visits

Goal: Able to describe an evidence-based biopsychosocial approach for chronic illnesses in primary care.

Building a Care Management Program in Primary Care (2 hours)

  • Adults: The chronic illness care movement
  • Organizing a care management program
  • Enlisting physicians in screening
  • Multi-illness screens, informal screens, PHQ-9, QIDS, SF – 12 & 36, the Duke
  • Decision-tree for determining next steps after screening
  • Developing a database and reminder system for patients
  • Making patient education part of the program

Goal: To be knowledgeable about adult screening instruments and able to discuss its use with physicians and patients.

Goal: To be able to begin a care management program in primary care.

Psychotropic Medication Overview (1 hour)

  • Getting past the either-or of meds vs. therapy
  • BHP role in assessing side effects and communicating with prescriber
  • Talking with adults about medication
  • Common medications used in adult primary care, indications, actions and side effects
  • The necessary role of psychiatry in primary care: consultation and treatment

Goals: To knowledgeably discuss common psychotropic medications with a patient, including indications, effects and side effects. Able to appropriately recommend initiating medication to a primary care physician.

•Behavioral Medicine Interventions: Health Behavior Change and Relaxation Response Techniques

Faculty: Alexander Blount, EdD, Daniel Mullin, PsyD, and Ronald Adler, MD

Health Behavioral Change Strategies (2 hours)

  • Building the doctor/patient relationship for better health
  • Stages of Change model
  • Motivational interviewing
  • Matching approaches to stages of change
  • Health behavior change interviewing practice for smoking and obesity

Goal: Able to conceptualize the stage of change of a patient in relation to a health behavior problem and to match motivational approaches to that stage.

Treating the Somatizing Patient (1 hour)

  • Is the concept of somatization useful?
  • Teamwork in providing care
  • Language that engages the patient
  • The use of uncertainty in uncertain situations

Goal: Able to discuss bodily symptoms that have no medical findings with patients in a way that promotes curiosity and coping in relation to the illness.

Behavioral Medicine Skills (3 hours)

  • Role of relaxation response therapies
  • Sleep promotion skills
  • Progressing relaxation and autogenics
  • Hypnotic methods without trance
  • Biofeedback

Goal: Able to teach patients techniques to calm their bodies’ reactivity.

•Families and Culture in Primary Care, Advice on Implementation

Faculty: Alexander Blount, EdD, Warren Ferguson, MD and Carlos Cappas, PsyD

Underserved Populations, Culture and Primary Care (3 hours)

  • Impact of culture on health practices and health beliefs
  • Particular health problems of underserved populations
  • Looking for a way to improve cultural “fit” when problems arise
  • Promoting cultural curiosity and appreciation
  • Using interpreters
  • Examples from the Worcester Rainbow: multiple Latino groups, Vietnamese, Albanian, Ghanaian

Goal: Able to adapt the approach to specific patients based on knowledge of cultural factors.

Working with Families in Primary Care (2 hours)

  • The family’s role in health
  • The importance of a family perspective in addressing problems in health behavior
  • Opportunities in regular care (pediatric and adult) to engage family members
  • Critical points in care where family involvement is necessary
  • Steps in conducting a medical family meeting

Goal: Able to effectively and sensitively conduct a family medical meeting.

Summary (1 hour)

Questions about implementation and

Testimonials

"The Certificate Program in Primary Care Behavioral Health equipped me with countless invaluable skills for integrated practice in a family medicine setting. These tools have helped me become a more efficient and effective member of an interdisciplinary team in two different settings. I still frequently reference the program materials when faced with new or challenging situations.”

Samantha P. Monson, MA
University of Colorado Denver School of Medicine
September 2007 Participant