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Primary Care Behavioral Health

Certificate Program Curriculum

Course Director:  Alexander Blount, EdD

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).

Primary Care Culture, Behavioral Health Needs and Clinical Routines of Collaboration

Faculty: Alexander Blount, EdD and Ronald Adler, MD

10:30am - 12:30pm

Culture and Language of Primary Medical Care and its role in the New Healthcare System (2 hours)

  • Updating the transformation in healthcare nationally
  • Primary care’s role in health system
  • Design and function of the Patient Centered Medical Home
  • Primary care vs. specialty medical care
  • Content and sequence of the basic medical interview
  • Recommended preventative care expected of primary care physicians
  • Cultural differences of physicians and behavioral health clinicians

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

 12:30 -1pm                        Lunch

 1:00-3:00

Behavioral Health Needs in Primary Care (1 hour)

  • 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

Working in teams in primary care (1 hour)

  • Terms for types of collaborative care
  • Making the huddle work
  • Schedule mining for cases
  • Being there – proximity and protocol

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

3:00 – 3:30pm       Afternoon Break       

3:30 – 5:30pm      
Clinical Routines of Collaboration
(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
  • 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.

 


 Substance Abuse, Chronic Pain, and Evidence Based Therapies in Primary Care

Faculty:  Jeffrey Baxter, MD, Christine Runyan, PhD, Jeanna Spannring, PhD, and Alexander Blount, EdD

10:30am - 12:30pm

Substance Abuse in Primary Care (2 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.

 12:30 – 1:00pm                 Lunch

1:00-3:00pm

Chronic Pain in Primary Care, Medical Interventions (1hour)

  • Dilemma of pain, right to treatment vs. danger of abuse
  • Pain medications, actions and indications
  • Contracting and monitoring for safety
  • Addressing dangerous patterns of use

Chronic Pain in Primary Care, Behavioral Interventions (1hour)

  • Engaging patients in behavioral treatment
  • Interventions the whole team can use
  • Group approaches
  • Relaxation response therapy targeted at pain

Goals: Can design a safe and caring approach to chronic pain.

3:00 – 3:30pm       Afternoon Break

3:30 - 5:30pm

Evidence-based Therapies (2 hours)

  • Role of “evidence” in making treatments credible
  • Types of evidence available for approaches we use
  • CBT and the therapies of patient activation
  • The role of solution focused interviewing in patient and provider change
  • Videos of different methods of interviewing
  • 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 Interviewing, Screening and Collaborative Pediatric Practice

Faculty:  Alexander Blount, EdD, Peter Sell, DO
 

Available for Pre-viewing on the Course Site:

Basics of Child Development and Child Interviewing (1 hour)

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

 10:30am - 11:30pm

Physician, Behavioral Health clinician and Parents (1 hour)

  • 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.

Screening Instruments for Primary Care (1 hour)

  • 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 and behavioral problems.

12:30 – 1:00pm     Lunch

1:00-3:00pm

Collaborative Pediatric Practice (2 hours)

  • Learning problems and ADHD
  • Building teamwork with schools, parents and community agencies
  • 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.

3:00 – 3:30pm       Afternoon Break

3:30 – 5:30pm

Challenging Populations (1 hour)

  • Child abuse and neglect
  • Developmentally disabled
  • Very sick kids

Collaborative Practice for Adolescents (1 hour)

  • The honoring adolescent privacy while supporting family cohesion
  • Engaging parents in promoting health without making them feel judged
  • Addressing the increased role of behavioral risks
  • Working closely with outside agencies
  • Identifying and addressing depression, anxiety, trauma, health behavior needs and substance abuse in adolescents

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

 


 Integrating Care for People with Serious and Persistent Mental Illness, and Geriatric Behavioral Health Services in Primary Care

Faculty: Alexander Blount, EdD, Marie Hobart, MD, Nelly Burdette, PsyD, Paula Hartmann-Stein, PhD

 10:30am - 12:30pm

Facilitating the delivery of healthcare to 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.

12:30 – 1:00pm           Lunch

 1:00 – 3:00pm

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.

 3:00 – 3:30pm Afternoon Break

 3:30 -5:30pm

Behavioral Health services in primary care for elderly people(2 hours)

  • Changes in behavioral approaches necessitated by advancing age
  • Legal requirements and consideration in delivering care to geriatric populations

Goal: Participants will be able adapt their care for the specific needs and requirements of a geriatric population.

 


 Screening and Psychotropic Medication in Primary Care

Collaborative Care and Care Management for Depression

Behavioral Health Care for Chronic Illnesses

Faculty:  Christine Runyan, PhD and Kathryn Lee, MD

 10:30-12:30

Screening in Primary Care and Psychotropic Medication Overview (2 hours)

  • Know the difference between screening and diagnosing
  • Understand the evidence based recommendations (USPSTF) for screening for BH conditions in primary care.
  • Become familiar with commonly used screening tools for select BH conditions and how to use them
  • Multi-illness screens, informal screens, PHQ-9, GAD-7, PC-PTSD, the Duke
  • Decision-tree for determining next steps after screening
  • 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 be able to recommend the optimal screening tools for a primary care setting and how to use these tools in practice. 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.

 12:30 – 1:00pm           Lunch

 1:00 – 3:00pm   

Collaborative Care and Building a Care Management Program for Depression in Primary Care

(2 hours)

  • Adults: The chronic illness care movement
  • Collaborative Care (IMPACT model and review of the evidence)
  • Organizing a care management program
  • Enlisting physicians in screening
  • Developing a database and reminder system for patients
  • Making patient education part of the program      
  • The role a care management program can have in building a larger BHC integrated program
  • The role a depression care management program can have in a larger care management program in a practice

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

 3:00 – 3:30pm Afternoon Break

 3:30 - 5:30pm

Chronic Illnesses Across the Lifespan (2 hours)

  • Symptoms, mechanisms and treatments of:
  • Asthma
  • Diabetes
  • Heart disease
  • Irritable bowel syndrome
  • Behavioral health needs and mental health co-morbidities for each illness
  • Innovations for Chronic Illness Care - Group Medical Visits

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

 


 Behavioral Medicine Techniques and Medically Unexplained Symptoms

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

 10:30 – 12:30pm

    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.

 12:30 -1:00pm      Lunch

 1:00-3:00pm        

Treating the Patient with Medically Unexplained Symptoms (2 hour)

  • Is the concept of somatization useful?
  • Teamwork in providing care
  • Language that engages the patient
  • The use of uncertainty in uncertain situations
  • Case example of MUS case
  • Fibromyalgia, IBS and other “functional” illnesses

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.

 3:00-3:30pm         Afternoon Break

 3:30 – 5:30pm      

Behavioral Medicine Skills (2 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 and Issues of Implementation

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

 10:30 – 12:30pm

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.

 12:30 -1:00pm                        Lunch

 1:00 – 3:00pm

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.

 3:00 – 3:30pm             Afternoon Break

 3:30 – 5:30pm

            Issues of Implementation (2 hours)

  • Questions about implementation and finance
  • Role of leadership
  • Core change teams
  • Payment systems
  • Evolving a new program
  • Other questions and discussion

 

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