Transcript Integrated Behavioral Health Care with Underserved Patients

Integrated Behavioral Health
Care with Underserved Pts: The
VCU PC Psychology Program
Benjamin Lord, M.S.
Virginia Commonwealth
University
Our Program
Virginia Commonwealth University includes
PhDs in both Clinical and Counseling
psychology
The Clinical Psychology Program includes
specialty tracks in Child Psychology and in
Behavioral Medicine
All PhD students do practicum training in the
community after their first year in the program
– Community Mental Health Clinics
– University Counseling Services
– Primary Care Psychology at VCU Medical Center
VCU Primary Care Psych: A Hx
Clinic was started in 2008
Place psychology PhD students in the
Primary Care clinic at VCU Medical
Center
– Work with MD residents
– Work with underserved, indigent patients
“Coping with Chronic Disease Clinic”
Began with 3-4 students performing
consultations and advertising services
several days per week
CURRENTLY:
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16 PC Psych students at any given time
Expansion to Pediatric Primary Care
3 PhD LCP Supervisors
Psychiatry Liason
3 Official clinic days with scheduled visits
Consultation services 5 days per week
Monthly didactic training for MD residents
Team-Based Learning
Provided approximately 950 sessions to
190 individual patients
Dr. Bruce Rybarczyk
Director of Clinical Training
Founder of VCU PC Psychology
The Four Needs
Training PhD students in psychology to
develop or work in future integrated care
settings
Improving access to mental and
behavioral health services for the
underserved
Train medical residents to use mental and
behavioral health services
Research the integrated care model to
show when and how it works
Our Training Model: Learn one,
See one, Do one, Teach one
Developing Competency in
Integrated Care
When and Where Does Training
Happen?
Training Opportunities
– Counseling Skills
Course
– Behavioral Health and
Health Psych Courses
– PC Psychology Course
– Group Supervision
– On-site peer and faculty
supervision
– Shadowing
– “On the Job” Training
– Workshops/TeamBased Learning
Trajectory of a PC
Psych Student
1st year
– Counseling skills course
– Attend “Group Sup”
– Shadow 2nd semester
2nd year
– Begin seeing patients
solo
3rd year+
– Consultation and
leadership
Mental and Behavioral Health
Services
Assessment, Treatment, and
Referral
Who are we serving?
Over 50% minority
Over 20% rural, low
income
80+ %ile on SRRS-R
Behavioral Health
Problem areas:
Insomnia, Chronic Pain,
Smoking Cessation,
managing diabetes
Mental Health Problem
Areas: Depression,
Anxiety
Avg: 4-5 sessions
Referral Methods:
Traditional: Pt. is scheduled for an
initial session by PCP
Same-Day Consultation: PC
Psychologist is requested to
participate in pt’s PCP appointment
VCU Medical Center, where PC
Psychology operates
Services We Provide
Mental Health
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Depression
Anxiety
Panic Disorder
Somatization
Adjustment
Risk Assessment
Brief Cognitive
Evaluations
Interventions are brief, problemfocused, and generally based on
cognitive-behavioral principles
Behavioral Health
– Pain management
– Behavioral Treatment
of Insomnia
– Smoking Cessation
– Medication adherence
– Diabetes management
– Diet/Weight loss
– Coping with chronic
disease
Assessment Tools
SRRS-R
– Life Stressors
PHQ-9
– Depression
GAD-7
– Anxiety
ISI
– Insomnia
MPQ-SF
– Pain
Behavioral Measures
– Cigarettes smokes per
week
– Weight
– A1C
The QPD
Quick Psychodiagnostic
assessment tool for primary care
Self-administered on portable tablet
Screens for:
QPD Tablet: An easy screening tool for
use by both PC Psychology and medical
residents
Training with Medical
Providers
Enhancing Integration with
Residents and Staff
Three Major Projects
Team-Based Learning
– Large training activities
– Focus on one topic (adherence, pain, depression)
– Troubleshoot in teams (MDs, Pharmacists,
psychologists, pastoral counselors)
The “Clinic Minute”
– 5min didactic presentations
– Developed based on requests by attendings and
medical residents
– Interpersonal skills; Adult ADHD; Chronic Pain
Mandatory Shadowing
– 2nd year residents do rotations where they sit in on PC
Psychology sessions and participate in brief didactic
presentations
Researching our model
Some Preliminary Data
Current Research Projects
Success with Team-Based Learning
– Evaluate outcomes of our TBLs in terms of the
educational goals and attitudes toward working in a
team
Success with Residents
– Surveyed residents attitudes toward PC Psychology,
the amount of contact with PC Psych, and their
attitudes toward integration
Success with Patients
– Currently analyzing data on outcomes from our
screening and assessment measures
– Also conducted patient satisfaction research w/
sample of 20 patients
TBL DATA
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Medicine
Pharmacy
Psychology
Total
Value
Efficiency Physicians
Role
Figure 1. Mean percentage of maximum possible subscale score by
profession for TBL 1: Adherence
TBL DATA
90
80
70
60
50
40
30
20
10
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Medicine
Pharmacy
Psychology
Chaplain
Total
Value
Efficiency Physicians
Role
Figure 2. Mean percentage of maximum possible subscale score by
profession for TBL 2: Depression
TBL DATA
90
80
70
60
50
40
30
20
10
0
TBL 1:
Adherence
TBL 2:
Depression
Value
Efficiency
Physicians
Role
Figure 3. Mean percentage of maximum possible subscale score by TBL
session (excluding chaplain participants who did not attend both sessions)
**Difference in Value was significant p<.01
Resident Survey
N = 58 medical residents
Referral rates: 58% referred btw 1 and 7
patients in 30 days
75% satisfied or very satisfied with PC
Psychol
Patient Satisfaction Questionnaire Results
Satisfaction Question
Mean
rating
Q1
My clinician seemed warm supportive and concerned
3.8
Q2
My clinicain seemed trustworthy
3.8
Q3
My clinician treated me with respect
3.7
Q4
My clinician did a good job of listening
3.7
Q5
I was able to express my feelings during the visit
3.7
Q6
I talked about the problems that are bothering me
3.7
Q7
The approach my provider used made sense
3.7
Q8
I learned some new ways to deal with my problems
3.7
Q9
I believe the visit was helpful to me
3.8
Q10
Overall, I was satisfied with today's visit
3.7
Q11
I plan to do what I told the clinician I would do before I come to the clinic for
my next visit
3.7
Q12
I intend to use what I learned in today's visit
3.7
Q13
At times, my provider didn't seem to understand how I felt
3.8
Q14
At times, I felt uncomfortable during the visit
0.8
Q15
I didn't always agree with my clinician
0.5
Q16
Number of visits with PC Psychology
5.2
PHQ-9 Scores
20
19
18
2 sessions
3 sessions
4 sessions
5 sessions
6 sessions
17
16
15
14
13
pretx
posttx
GAD Scores
17
16
2 sessions
3 sessions
4 sessions
5 sessions
6 sessions
15
14
13
12
11
pretx
posttx