Department of Family Medicine and
Community Health
University of
Certificate Program in Primary Care Behavioral Health
Alexander Blount, EdD, Director
The Department of Family Medicine and Community Health has been training mental health professionals to provide services in primary medical care settings for over fifteen years. Its Post-Doctoral Fellowship in Primary Care Psychology is one of the most respected programs of its type in the nation. In 2007, the Department will launch a program designed to train licensed mental health professionals to function successfully as behavioral health providers in primary care. The program consists of 56 hours of training, including didactic and experiential components. Participants who complete the whole program will be given a Certificate of Completion.
The program costs $1200 payable in advance. It will be limited to 20 participants. Teaching is done by the physicians and
psychologists of the Department, lead by Alexander Blount, EdD, Director of
Behavioral Science, Chair of the Collaborative Family Healthcare Association
and author of Integrated Primary Care:
The Future of Medical and Mental Health Collaboration, WW Norton,
1998. Interested professionals should
contact Dr. Blount at blounta(at sign)ummhc.org. All programs will take place at
Didactic Program
Workshop 1: Primary Care Culture & Needs -
Faculty: Ronald Adler, MD & Alexander Blount, EdD
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: Reports feeling 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:
Be able to conceptualize a way 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: Be able to give an effective curb-side consult to a physician.
Be able to speak about a patient’s situation with a physician in front
of the patient.
Workshop 2: Evidence-based Therapies and Substance Abuse in Primary
Care –
Faculty: Jeffery
Substance Abuse in Primary Care (3 hours)
-
Levels of
substance abuse in PC practices
-
Substance abuse
presents as everything but SA
-
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 BHP can
add to the care in each case.
Goals: Identify substance abuse problems for patients presenting
medical complaints
Be able to 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
-
The role of solution focused interviewing in patient and provider change
-
Working in brief visits and brief treatments
-
Family and other multi-person approaches in primary care
-
Family interviewing in pediatrics
-
Role plays to practice “adding value today”
Goal: Be able to briefly assess, engage and intervene to help patients
with depression and anxiety and children with behavior problems using methods
supported by evidence.
Workshop 3: Behavioral
Health Care for Chronic Illnesses Across the Lifespan and 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 tasks in development and office
assessment of them
- Interaction
of experience and biology in developmental problems
- Common
developmental disorders
Goal: Be able to do a generalist assessment
for developmental problems
Collaborative Pediatric Practice (2 hours)
-
The unique nature
of pediatric practice: 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
Goal: Be able to give
anticipatory guidance on behavioral issues to parents in ways acceptable to
them.
Chronic Illnesses Across the Lifespan (3 hours)
- Symptoms,
mechanisms and treatments of:
Asthma
Diabetes
Heart disease
Irritable bowel syndrome
-
The special role of pain
-
Behavioral health needs and mental health co-morbidities for each
illness
-
Evidence for behavioral therapies
-
Group medical visits
Goal: Be able to describe an
evidence-based biopsychosocial approach to at least one chronic illness.
Workshop 4: The
Toolbox -
Faculty: Alexander
Blount, EdD, Kathleen Braden, MD, & Ron Adler, MD
Screening Instruments for Primary Care and Methods of Care Management (3 hours)
- Screening
vs. diagnosis vs. outcome
-
Pediatrics: The Vanderbilt, the
Connors, Pediatric Symptom Checklist.
-
Communicating with parents and physicians about screening results
-
Adults: The chronic illness care
movement
-
Organizing a care management program
-
Multi-illness screens, informal screens, PHQ-9, QIDS, SF – 12 & 36,
the Duke
-
Decision-tree for determining next steps after screening
Goal:
Be able to administer, score and discuss one child screening instrument
and one adult instrument.
Psychotropic Medication Overview (3 hours)
- Getting
past the either-or of meds vs therapy
- Pediatrics: When you might suggest considering medication
- Speaking to parents and children about
medication
- Common medications given to children,
indications, actions and side effects
- 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
- Role of
psychiatry in primary care: consultation and treatment
Goal:
Be able to discuss common psychotropic medications knowledgeably with a
patient, including indications, effects and side effects. Be able to recommend medication initiation to
a primary care physician.
Workshop 5: Behavioral Medicine Techniques –
Faculty: Alexander Blount, EdD, 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
Goal: To be 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:
To be 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)
- Relaxation-based
therapies
-
Sleep promotion skills
-
Hypnosis and hypnotic methods without trance
-
Biofeedback
Goal: To be able to teach patients techniques to
calm their bodies’ reactivity.
Workshop 6: Specific
Populations within Primary Care –
Faculty:
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: Be able to describe ways
to adapt the way patients are approached that are based on knowledge of
cultural factors.
Working with Families in Primary Care (3 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: To be able to conduct a
family medical meeting.
The Department of Psychiatry at the
Experiential Program
Shadowing primary care physician in patient care – 2 half days
Shadowing primary care behavioral health clinician – 2 half days
One case discussion meeting in the practice, One group medical visit
Total time: about 20 hours (No CEUs provided for Experiential Program)