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 after the program has ended. 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).

ANNOUNCING A NEW MINI COURSE FOR PHYSICIAN LEADERS AND ADMINISTRATORS

"Creating and Managing an Integrated Primary Care Practice"
(First Workshop of the PCBH course only)

Integrated Care

Faculty: Alexander Blount, EdD and Ronald Adler, MD

10:30am - 12:30pm     Introduction to Integrated Primary Care (2 hours)

  • Healthcare crisis in the US and current transformation processes (PCMH, ACO)
  • Role of Primary Care (PC) in healthcare transformation nationally and in each health        system.
  • Integrated Primary Care (IPC) is best thought of an expansion and enriching of Primary Care rather than as a changing of venue for mental health or substance abuse services.
  • Behavioral Health (BH) needs in PC and how these
    needs are presented
  • Program types for adding BH services for PC
    patients
  • Cost and outcome evidence related to truly integrated models when compared to coordinated and co-located models.

 12:30 -1pm                        Lunch

 1:00-3:00     Transforming the Organization  (2 hours)

  • Role of leadership in successful integration.
  • Envisioning the future model of integrated practice and setting goals.
  • The advantage of using the transformation to IPC as a platform for Patient Centered Medical Home transformation.
  • Make up of the Leadership Team (LT) that shepherds the organization through the process of integration (administrator, physician “champion”, behavioral health lead, nursing lead, office administration lead).
  • Areas of research that the LT needs to undertake.
  • Planning for the transformation of workflows
    with minimal disruption.

3:00 – 3:30pm       Afternoon Break

3:30 – 5:30pm       Transforming Clinical Practice  (2 hours)

  • How LT members can bring Clinical Team (CT) members into the workflow change.
  • From “physician led team” to “team supported physician"
  • The advantages of leveraging screening into a new workflow.
  • Role clarity and task flexibility in successful teams.
  • How team members learn to pass a relationship with the patient to other team members.
  • The roles of BHC, Care Manager (CM) and Care Coordinator (CC) on the team, especially where there is not a different person for each role.
  • Team work-practices that save time and increase patient activation and patient team membership.
  • Evolving documentation to maximize financial return.

 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 - 11:30am     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 Katharine Barnard, 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 (2 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)

  • Participants will be asked to submit any questions about how to improve integrated practice in advance, and the session will address these questions during the last two hours of the course.