Competencies in Innovative Training Models: The Move to Integrated Primary Care Training Settings

1. Competencies in Innovative Training Models:  The Move to Integrated Primary Care Training Settings Lisa Kearney, PhD, ABPP, Parinda Khatri, PhD, Laura Shaffer, PhD May 2, 2014 2014 APPIC Annual Conference Austin, TX

2. Why Psychology Training in Primary Care?

3. Objectives • Describe core competencies necessary for psychology trainees practicing in integrated primary care settings; • Describe complementary applications  of competencies across a variety of integrated primary care settings; • Discuss key steps and strategies for developing integrated care training sites

4. What is Integrated Primary Care? • Psychologists work with medical providers in shared system • Psychologist part of care team for all patients • Psychologist always available for consultation and interventions with patients • One integrated treatment plan covers full spectrum of patient’s needs • Shared medical record • Hunter, Goodie, Oordt, & Dobmeyer, 2009

6. Psychology in Primary Care:Scope of Practice Ψ • Consultation with the primary care team • Brief consultation with primary care patients • Prevention through the use of behavioral principles to address lifestyle and health risk issues • Management of psychosocial factors impacting disease • Episodic interventions or on-going co-management • Consultation and coordination with specialists

7. Role of Psychology Trainee in Primary Care • Management of psychosocial aspects of chronic and acute diseases • Application of behavioral principles to address lifestyle and health risk issues • Consultation and co-management in the treatment of mental disorders and psychosocial issues • Training and support of providers and staff

8. Examples of Existing Programs

9. VHA Handbook 1160.01 requires that VA Medical Centers, very large CBOCs, and large CBOCs integrate mental health services into primary care venues by providing both co-located collaborative care and care management (349 facilities total) provided within the VA’s patient centered medical home • Over 3 million patient encounters with a mean of 55,000 /month • Key Outcomes: • Integration of mental health in VA primary care increases recognition of mental health diagnoses (Zivinet al. 2010) • Improved psychotropic prescribing practices by PCPs (program evaluation data) • Veterans with a same-day mental health encounter directly in primary care had greater treatment initiation than those with positive screens who only receive primary care treatment (Szymanski et al., 2012) • Integration of mental health in VA primary care reaches demographic subgroups less likely to use specialty mental health care (Johnson-Lawrence et al., 2012) • Patients who received integrated care services were significantly more likely to stay engaged in specialty mental health treatment when referred (Wray et al., 2012)

10. Cherokee Health Systems: Integrated Primary • And Behavioral Healthcare • 24 Clinics, 14 Counties, 63, 224 Patients, 681 employees • Psychologists, Primary Care Providers, Clinical Social Workers, • Psychiatrists, Nurse Practitioners, Case Managers

11. The CHS Psychology Internship 4 Interns Required 12 month placements as embedded behaviorists in primary care Didactics in Primary Care Psychology, Behavioral Medicine, Psycho-pharmacology, Family Medicine Participation in Multidisciplinary Treatment Team

12. General Pediatrics clinic in university medical system 20 rooms, 1100 – 1200 visits/month 5 FTE MD, 2 FTE NP, 0.2 FTE PhD Psychology Intern on site 1 ½ days per week Combination of integrated visits with brief psych-only follow ups Other learners: pediatric residents, medical students, psychology practicum student

13. CORE Competencies andComplementary Applications

14. Competencies for Psychology Practice in Primary Care (APA, 2013)

15. SCIENCE Science Related to the Biopsychosocial Approach

16. SCIENCE Research/Evaluation

17. SYSTEMS Leadership/Administration

18. SYSTEMS Interdisciplinary Systems

19. SYSTEMS Advocacy

20. Test your PC IQ What percentage of all people seeking mental health services do so exclusively in primary care?

21. PROFESSIONALISM Professional Values and Attitudes

22. PROFESSIONALISM Individual, Cultural & Disciplinary Diversity

23. PROFESSIONALISM Ethics in Primary Care

24. PROFESSIONALISM Reflective Reflective Practice/Self‐assessment/Self‐care

25. RELATIONSHIPS Interprofessionalism

26. RELATIONSHIPS Building and Sustaining Relationships in PC

27. Test your IPC IQ What do you call it when one provider on the team brings another provider from the team into the visit to provide an additional service?

28. APPLICATION Practice Management

29. APPLICATION Assessment

30. APPLICATION Intervention

31. APPLICATION Clinical Consultation

32. EDUCATION Teaching

33. EDUCATION Supervision

34. Key steps and strategies

35. Have a Vision

36. Align with Key Players

37. Be likeable

38. Be Helpful

40. Test your IPC IQ Which of the following has NOT been shown to be a benefit of Integrated Primary Care?

41. Resources • Doctoral training programs in primary care: http://www.apa.org/ed/graduate/doctoral-directory.pdf • Internship programs in primary care: http://www.apa.org/ed/graduate/doctoral-directory.pdf • Postdocs in primary care: http://www.apa.org/ed/graduate/doctoral-directory.pdf • Report of BEA Task Force on Primary Care Psychology Training: http://www.apa.org/ed/graduate/task-force-report.pdf • Recommendations for Education and Training in Primary Care Psychology: http://www.apa.org/education/grad/primary-care-training.pdf • Foundations for Integrated Care: Behavioral Health Solutions for Primary Care (VA Training Manual): http://www.mirecc.va.gov/cih-visn2/foundations.asp • Competencies for Psychology Practice in Primary Care (APA) http://www.apa.org/ed/resources/competencies-practice.pdf

42. Questions? Cherokee Health Systems