ArticlePDF Available

Training the Collaborative Care Practitioners of the Future

Authors:
Alexander Blount at Integrated Primary Care. Inc
Alexander Blount
  • Integrated Primary Care. Inc
Silvia DeGirolamo
Silvia DeGirolamo
Silvia DeGirolamo
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Kathy Mariani
Kathy Mariani
Kathy Mariani
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Download full-text PDF
Read full-text
Download citation

Abstract

To prepare family medicine residents to function in the type of practices envisioned in the Future of Family Medicine Report, a residency needs to teach the skills of collaborative practice with behavioral health providers. This requires residents to have the experience of practicing with behavioral health providers who are peers, in addition to learning from behavioral science faculty. This article describes the development of a fellowship in primary care psychology within a department of family medicine and community health as an intervention on the training of residents for collaborative practice. It also sets out the structured routines of exchange between residents and fellows, as well as between behavioral science and medical faculty members, designed to maximize the experience of and learning from collaboration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Content uploaded by Alexander Blount
Author content
All content in this area was uploaded by Alexander Blount on May 23, 2016
Content may be subject to copyright.
A preview of the PDF is not available
A preview of this full-text is provided by American Psychological Association.
Learn more
Content available from Families Systems & Health
This content is subject to copyright. Terms and conditions apply.
... This approach is posited to "normalize" the presence of the BHP as part of the healthcare team and normalize behavioral healthcare (A. Blount et al., 2006;Solano et al., 2009). For patients with certain complexities (e.g., medical comorbidities, trust concerns), including the PCP in discussions of behavioral health is beneficial, as patients view PCPs as a trusted source of information regarding physical health (Hall et al., 2002). ...
... Results from this study indicated that crucial elements (e.g., discussions on health behavior change, motivational enhancement, health-related psychoeducation) occurred during the conjoint visit that benefitted by having both providers present. Dual interview conjoint visits have been used in different clinics (e.g., A. Blount et al., 2006;Porcerelli et al., 2013Porcerelli et al., , 2019, and were found to be feasible, acceptable, and satisfactory by those who participated in them. Notably, the Blount et al. (2006) article described dual interviews that were a required part of a training program to teach teamwork, share skills, and promote integrated care behavior between family medicine residents and psychology fellows. ...
... Dual interview conjoint visits have been used in different clinics (e.g., A. Blount et al., 2006;Porcerelli et al., 2013Porcerelli et al., , 2019, and were found to be feasible, acceptable, and satisfactory by those who participated in them. Notably, the Blount et al. (2006) article described dual interviews that were a required part of a training program to teach teamwork, share skills, and promote integrated care behavior between family medicine residents and psychology fellows. Trainees likely have more flexibility to accommodate conjoint visits; however, the article reports that in settings where the program was implemented, dual interviews gained popularity with each passing year. ...
Brief Conjoint Visits Between an Embedded Behavioral Health Provider and Primary Care Team Member: When Are They Used and What Are the Barriers and Facilitators?
Article
Full-text available
  • Jul 2023
Introduction: Conjoint visits utilize the expertise of primary care providers (PCPs) and behavioral health providers (BHPs) to address complex comorbidities in patients. The objectives were to describe the use and features of conjoint visits and identify barriers and facilitators as described by BHPs in integrated settings. Method: Three hundred and forty-five BHPs who worked in integrated primary care, a majority identifying as female and white, completed an online survey between October 2018 and July 2019. Results: Results indicated common reasons for conjoint visits were for mental or behavioral health concerns. Though they reported high comfort using conjoint visits (M = 4.3/5), 56.5% of BHPs participated in them less than monthly or never. Using a constant comparison approach, qualitative data were coded to reveal six categories of barriers and five categories of facilitators to conjoint visits. The most common barriers were a result of a lack of systemic support, such as 73.5% reporting lack of time, while the most common facilitators were coordination (60.7%) and interprofessional communication (39.3%). Discussion: Although conjoint visits are used infrequently, findings suggest it is not because they are unhelpful as providers generally found this type of appointment favorable. Rather, they and their teams lack time, training, and support needed for implementation. This research provides an introduction for researchers or clinicians to better understand the use of conjoint visits for patients with high needs and complexities. Future work focused on addressing barriers cited by providers regarding conjoint visits would increase providers’ ability to use this form of care when it is needed.
View
... A summary of the program details can be found in Table 2. Twentyfive (62.5%) programs had a multi-disciplinary group of learners [29][30][31], with ten (25.0%) programs consisting of physician-MHP dyads [29][30][31]41,42,46,[52][53][54]56]. Three (7.5%) programs included other sectors [39,40,49] (e.g., education, fire, police) in addition to primary care staff. ...
... Less than half of the programs reported teaching measurementguided care (element 3) (n = 11; 27.5%) [33,34,37,[44][45][46]50,51,[57][58][59]64] and evidence-based care (element 4) (n = 17; 42.5%) [33,34,41,42,[44][45][46][48][49][50][51][56][57][58][60][61][62]64]. The counts for elements 3 and 4 are conservative estimates as some articles did not explicitly state whether their programs taught measurementguided (n = 5; 12.5%) [36,41,47,56,60] or evidence-based care (n = 13; 32.5%) [30,[36][37][38][39]43,47,54,55,59,63,65,66]. ...
... Interruptions in primary care is a commonly reported example of an unspoken cultural norm that required explanation [52,54,[58][59][60]. Practicing in a collaborative culture provides supervisors with the opportunity to mentor trainees [33,64] and model collaborative behaviours to shape the perceptions, beliefs, and behaviours of the learners [42,51,56,57,60,61,63,67]. ...
View
... 22 Although co-location eliminates some barriers to access, our case study illustrates the move toward fully integrated behavioral health care, in which the behavioral health provider is treated as a member of the practice, takes part in team meetings, and shares workspace, infrastructure, records, and support systems. [19][20][21] Since 2017, social worker and PMHNP student trainees have been embedded to provide SBIRT within the framework of the Collaborative Care Model. This approach accounts for shifts in the demands in behavioral health care and the impact of the COVID-19 pandemic in community primary care and behavioral health organizations. ...
... (2) Use cross-disciplinary practicum experiences and increase trainee competencies with real-life application incorporating medical program managers and field supervisors to enhance sustainability. [20][21][22] (3) Deliver an enhanced, patient-centered, integrated care coordination model that boosts physical and mental health outcomes and increases retention and engagement in MAT. 9,11 (4) Respond to the pandemic by using a low-threshold MAT model and adopting a more flexible approach to MAT services to individuals with OUD, transitioning to a telehealth model of care in combination with in-person appointments. ...
Lessening the Impact of Opioid Misuse at a Federally Qualified Health Center in New York: Outcomes of an Integrated Workforce Training Program
Article
Full-text available
  • May 2023
  • PUBLIC HEALTH REP
The COVID-19 pandemic has placed an unprecedented burden on patients, health care providers, and communities and has been particularly challenging for medically underserved populations impacted by the social determinants of health, as well as people with co-occurring mental health and substance use risks. This case study examines outcomes and lessons learned from a multisite low-threshold medication-assisted treatment (MAT) program at a federally qualified health center in partnership with a large suburban public university in New York to integrate and train Health Resources & Services Administration Behavioral Health Workforce Education and Training-funded graduate student trainees in social work and nursing in screening, brief intervention, and referral to treatment and patient care coordination, including social determinants of health and medical and behavioral comorbidities. The MAT program for the treatment of opioid use disorder has a low threshold for entry that is accessible and affordable, reduces barriers to care, and uses a harm reduction approach. Outcome data showed an average 70% retention rate in the MAT program and reductions in substance use. And, while more than 73% of patients reported being somewhat or definitely impacted by the pandemic, most patients endorsed the effectiveness of telemedicine and telebehavioral health, such that 86% indicated the pandemic did not affect the quality of their health care. The main implementation lessons learned were the importance of increasing the capacity of primary care and health care centers to deliver integrated care, using cross-disciplinary practicum experiences to enhance trainee competencies, and addressing the social determinants of health among populations with social vulnerabilities and chronic medical conditions.
View
... this fragmentation (Blount & Bayona, 1994;Blount, DeGirolamo, & Mariani, 2006;Blount & Miller, 2009;Hall et al., 2015;Institute of Medicine, 2001). Differences in the traditional scheduling patterns for primary care clinician appointments (i.e., focused 15-min encounters) compared with behavioral health clinicians (i.e., 45-50 min, multiple sessions) further create cultural distinctions in how care is structured . ...
... For instance, most medical and behavioral health clinicians historically have been educated and trained in siloed environments without access to interprofessional team development (McDaniel, Belar, Schroeder, Hargrove, & Freeman, 2002). Although local and national training programs are emerging and competencies have been articulated for interprofessional practice (McDaniel et al., 2014), the majority of medical and behavioral health professionals are not trained to work in integrated settings (Beacham et al., 2017;Blount et al., 2006;Blount & Miller, 2009;Hall et al., 2015;McDaniel, 1995;McDaniel et al., 2002McDaniel et al., , 2014. Moreover, implementation of integrated care models requires robust leadership to change culture, redesigned clinical workflows This document is copyrighted by the American Psychological Association or one of its allied publishers. ...
Payment Reform in the Patient-Centered Medical Home: Enabling and Sustaining Integrated Behavioral Health Care
Article
Full-text available
  • Jan 2017
The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy.
View
... There has been a growing recognition of such complex needs and the biological, psychological, social, and cultural aspects of medicine in the healthcare sciences curriculum (Quintero, 2014). There is also a greater appreciation for the collaborative care and practice model that brings together medical doctors, pharmacists, nurses, and other healthcare professionals together for patient care (Blount et al., 2006). The collaborative care model attempts to implement change in small and manageable cycles, appreciating the complexity involved. ...
PERSONAL VIEW An urgent need to teach complexity science to health science students
Article
Full-text available
  • Oct 2022
The article highlights the urgent need to teach complexity science to health science students.
View
... Commonly referred to as dual interviewing (Blount, DeGirolamo, & Mariani, 2006), medical and mental health providers can provide treatment positioned towards positive behavioral change in tandem (e.g., smoking cessation). Systematic surveys of dual interviews have bolstered this notion by uncovering high rates of collaborative practice between the same clinic providers. ...
Behavioral Health Assessments and Interventions of Psychology Trainees and Residents During Dual Interviewing: Replication and Extension
Article
Full-text available
  • Jun 2019
  • J CLIN PSYCHOL MED S
The integration of psychologists and other behavioral health providers in primary care practice continues to evolve and reshape approaches to patient care. This study is a replication and extension of a 2013 study describing dual interviewing encounters involving psychology trainees and family medicine residents within an integrated primary care clinic as it relates to behavioral health assessments and interventions. Psychology trainees provided descriptions of 400 collaborative patient encounters involving 337 single and 63 repeat encounters. Psychology trainees coded the frequency of behavioral health assessments and interventions by the psychology trainee, family medicine resident, or both. Seventy-eight percent of encounters contained an assessment, and 20% contained interventions. Compared to the 2013 study, there were significantly fewer behavioral health interventions offered and a significantly greater number of psychoeducation/supportive interventions offered collaboratively. It was discovered that discussions between psychology trainees and family medicine residents immediately after patient encounters occurred 50% of the time and involved issues of case conceptualization. These informal discussions may be an important source of behavioral health education for family medicine residents. This study adds to efforts to better understand what occurs during these encounters.
View
... Some graduate programs in psychology have included training for work in primary care through coursework and/or practicum (Beacham, Kinman, Harris, & Masters, 2012). Various organizations have intensive training programs, ranging from shadowing consultations with established BHCs, regular consultation groups, and ongoing supervision, such as those occurring at the Health Federation of Philadelphia (Daub, Levkovich, Serrano, & Gallagher, 2010;Levkovich & Daub, 2012), the U.S. Air Force (Dobmeyer, Rowan, Etherage, & Wilson, 2003), and predoctoral internships and postdoctoral training fellowships for psychologists (Blount, DeGirolamo, & Mariani, 2006;Hunter & Peterson, 2001). Likewise, professional conferences, including the Collaborative Family Healthcare Association and the Society of Behavioral Medicine, provide ongoing BHC training and information on current research initiatives (Robinson & Reiter, 2007). ...
Special Ethical Considerations for Behavioral Health Consultants in the Primary Care Setting
Article
Full-text available
  • Jun 2017
The growing movement of integrating behavioral health services in medical settings aims to increase ease of access to behavioral health services. Behavioral health consultants (BHCs), who are embedded within primary care clinics, provide a variety of psychological services (screening, brief interventions, and referral to specialized treatment settings) in a novel manner relative to traditional outpatient behavioral health treatment. These alterations in service delivery present unique ethical challenges to effective patient care in primary care behavioral health (PCBH) practice. This article discusses potential ethical dilemmas and challenges that are faced in PCBH. Confidentiality, privacy and informed consent are discussed, given the complex level of communication within primary care clinics. The potential for having multiple relationships with coworkers is reviewed. The need for BHC’s to provide sufficient clinical intervention and assessment, and how these may be limited in scope in BHC practice, is discussed. Finally, the complexity of obtaining competence for practice in primary care is explored. We discuss how ethical guidelines apply to this work, and also aim to address where further clarity is needed and context-based ethical decision-making is warranted. Case studies are provided to help illustrate the novel challenges faced by BHCs in integrated medical settings.
View
Building the plane in the air…but also before and after it takes flight: considerations for training and workforce preparedness in integrated behavioural health
Article
  • Mar 2019
Collaborative approaches to healthcare that integrate behavioural and biomedical interventions are more likely to enhance patient outcomes as well as provider satisfaction with care delivery than siloed approaches to care. The recognition for specific and targeted training for these models is growing among all health professions, although many in the field have not received systematized, interprofessional, and competency-based training that adequately prepared them for the work of integration. This article reviews some of the fundamental principles of biopsychosocially-oriented, team-based approaches to care that integrate behavioural and biomedical perspectives and delineates the need for targeted training efforts. It describes which specific elements must be addressed within it in order to promote effective integration, and highlights the array of options for training currently in existence. This review provides an overview of current models of training offered in the US, and concludes with a discussion of the challenges and barriers that may render training either ineffective or difficult to achieve.
View
Training the Doctors: A Scoping Review of Interprofessional Education in Primary Care Behavioral Health (PCBH)
Article
Full-text available
  • Sep 2019
  • J CLIN PSYCHOL MED S
Primary care behavioral health (PCBH) is a model of integrated healthcare service delivery that has been well established in the field of psychology and continues to grow. PCBH has been associated with positive patient satisfaction and health outcomes, reduced healthcare expenditures, and improved population health. However, much of the education and training on PCBH has focused on developing behavioral health providers to practice in this medical setting. Less attention has been paid to physician team members to support and practice within an integrated environment. This is problematic as underdeveloped physician team members may contribute to low utilization and attrition of behavioral health consultants. A scoping review was conducted to examine the training of physicians in this domain since 2006. Twenty-one studies were identified, predominantly in Family Medicine training programs. Although PCBH training was generally well received, more program evaluation, formalized curriculum, and faculty development are needed to establish best practices.
View
View
Integrated Primary Care: Organizing the Evidence
Article
Full-text available
  • Jul 2003
The evidence for bringing behavioral health services into primary care can be confusing. Studies are quite varied in the types of programs assessed, what impacts are assessed, what kind of therapy is offered, for what populations, and on how broad a scale. By organizing the evidence into categories: whether the program is coordinated, co-located or integrated, whether for a targeted or non-targeted patient population, offering specified or unspecified behavioral health services, in a small scale or extensive implementation, programs can be compared more easily. By noting what sorts of impacts are reported-improved access to services, clinical outcome, maintained improvement, improved compliance, patient satisfaction, provider satisfaction, cost effectiveness or medical cost offset-the most comprehensive overall assessment of this important approach to patients’ needs can be encouraged.
View
Toward a system of integrated primary care
Article
Full-text available
  • Jan 1994
  • Fam Syst Med
Argues that the biopsychosocial model of health care will not replace the biomedical model until it is translated into an organization and a set of practices that will support and validate it. This situation is explained by considering the health care system as a self-maintaining system. One example of a setting in which an alternative model, organization, and practice have been attempted is described. This example is a health care center that provides services at the individual, family, and community level and serves primarily a Latino population. The organization and practice of this center are described, and the case of the treatment of a 38-yr-old woman with both medical and social problems is presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
View
Training for Collaborative Family Healthcare
Article
Full-text available
  • Jul 1996
Discusses the importance of providing collaborative family healthcare, and questions the current state of training for collaboration in 1996. It is hoped that Families, Systems & Health will provide an outlet to dispense information about training in Collaborative Family HealthCare. Three appendices are provided, covering (1) Generic Core Competencies for All Professionals Training in Collaboration, (2) Core Competencies for Training Healthcare Providers to Collaborate, and (3) Core Competencies for Training Mental Health Professionals to Collaborate. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
View
Training for Collaboration: Internships for Family-Therapy Students in a Medical Setting
Article
Full-text available
  • Apr 1988
  • Fam Syst Med
Describes the authors' involvement as family-therapy supervisors and trainees in a family medicine training program. This arrangement provided a collaborative context in which the 2 cultures of medicine and therapy convened for training. The primary goal for the family therapy intern was to participate in supervised family therapy; the student learned about physicians' training and participated in the joint care of families by physicians and therapists. The possibilities and difficulties of working within this framework are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
View
Training Health Professionals To Collaborate
Article
Full-text available
  • Jan 1997
We discover what we believe when we have to teach it. Late spring of 1997, Susan traveled to Germany to celebrate the German publication of Medical Family Therapy and to continue a collaboration with internists in the medical schools in Aachen and Freiburg. Our Aachen colleagues asked her to speak about the training we believe to be important for Collaborative Family Healthcare. Building on the early discussions at Wingspread in 1994 about training (McDaniel & Campbell, 1996), the following editorial is based on her German talk. We publish it in this issue in conjunction with the white paper by the nursing Panel on Interdisciplinary/Transdisciplinary Education and accompanying commentaries. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
View
Integrated primary care: The future of medical and mental health collaboration.
Article
Full-text available
  • Jan 2000
Integrated primary care unifies medical and mental health care in a primary care setting. This book explains this practice as the most fully realized form of collaboration between medical and mental health providers and presents several different models for its practical application. Contributions to this book describe best practices in integrated care and spend as much effort showing how to successfully develop and implement these programs in different settings as they do arguing for their usefulness. It is intended as a comprehensive manual that will be welcomed by both mental health and medical providers and administrators. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
View
View
The de Facto US Mental and Addictive Disorders Service System
Article
  • Feb 1993
  • ARCH GEN PSYCHIAT
• After initial interviews with 20 291 adults in the National Institute of Mental Health Epidemiologic Catchment Area Program, we estimated prospective 1-year prevalence and service use rates of mental and addictive disorders in the US population. An annual prevalence rate of 28.1% was found for these disorders, composed of a 1-month point prevalence of 15.7% (at wave 1) and a 1-year incidence of new or recurrent disorders identified in 12.3% of the population at wave 2. During the 1-year follow-up period, 6.6% of the total sample developed one or more new disorders after being assessed as having no previous lifetime diagnosis at wave 1. An additional 5.7% of the population, with a history of some previous disorder at wave 1, had an acute relapse or suffered from a new disorder in 1 year. Irrespective of diagnosis, 14.7% of the US population in 1 year reported use of services in one or more component sectors of the de facto US mental and ad- dictive service system. With some overlap between sectors, specialists in mental and addictive disorders provided treatment to 5.9% of the US population, 6.4% sought such services from general medical physicians, 3.0% sought these services from other human service professionals, and 4.1% turned to the voluntary support sector for such care. Of those persons with any disorder, only 28.5% (8.0 per 100 population) sought mental health/addictive services. Persons with specific disorders varied in the proportion who used services, from a high of more than 60% for somatization, schizophrenia, and bipolar disorders to a low of less than 25% for addictive disorders and severe cognitive impairment. Applications of these descriptive data to US health care system reform options are considered in the context of other variables that will determine national health policy.
View
View
Models of collaboration: A guide for mental health professionals working with health care practitioners.
Article
  • Jan 1996
As health care undergoes rapid and momentous changes, health care providers must transform their practices and find new ways to treat patients and their families. How does a primary care physician treating chronic illness address the problem of family conflict? How does a psychotherapist bring an awareness of acute medical conditions into the treatment of mental health problems? Most important, how do health and mental health practitioners in diverse health care settings build bridges among themselves so that patients and families receive the best treatment possible? As the authors of this volume illustrate . . . the answer lies in a collaborative approach. New models of collaboration are being developed to facilitate effective health care delivery. The road to implementing these models is not yet complete, but in this book the authors add a bold voice to the contemporary search for answers to our health care crisis. "Models of Collaboration" places patients and their families front and center in the treatment of mind and body and shows us how to form effective practitioner–patient–family alliances where dialogue and understanding are paramount. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
View