An Integrative Training Model 3 2 06 (Stfm 2005 Austin.Tx)


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  • An Integrative Training Model 3 2 06 (Stfm 2005 Austin.Tx)

    1. 1. An Integrative Training Model: Creating Healthcare Partnerships between Resident Physicians & Behavioral Science Trainees Craig S. Travis, Ph.D. Director of Behavioral Sciences Mount Carmel Family Medicine Residency Holly H. Miller, M.S. Ph.D. Candidate Counselor Education Ohio University (26th Annual STFM Conference on Families and Health, March 1-5, 2006)
    2. 2. Trends… <ul><li>Biopsychosocial approach </li></ul><ul><li>Collaborative care model </li></ul><ul><li>Mind/Body connection </li></ul><ul><li>APA public education campaign </li></ul>( Engel, 1977; Blount, 2003; Miller, Hall, & Hunley, 2004; Talen, Fraser, & Cauley, 2002; APA, 2006 )
    3. 3. Objectives <ul><li>Importance of integrated training </li></ul><ul><li>Understand the multiple roles of behavioral science trainees conducting internships in residency programs. </li></ul><ul><li>Strategies to infuse integration: meeting ACGME Core Competencies. </li></ul><ul><li>Creating healthcare partnerships post training to meet inclusive care needs of the healthcare consumer. </li></ul>
    4. 4. Effective Collaboration <ul><li>Improves quality of care </li></ul><ul><li>Improves efficiency of care </li></ul><ul><li>Enhances satisfaction of patients and providers </li></ul><ul><li>If integration is to be the future of healthcare, physicians and behavioral health students in training must gain experience in integrated settings </li></ul>( Hemmings, 2000; Katon et al.,1995; deGruy, 2000; Patterson, Bischoff, & McIntosh-Koontz, 1998 )
    5. 5. <ul><li>The way you understand a problem affects how you fix it </li></ul>
    6. 6. <ul><li>Unhealthy habits </li></ul><ul><ul><li>account for 50% of preventable death </li></ul></ul><ul><ul><li>account for 70% of preventable health care costs </li></ul></ul><ul><li>Mental health diagnosis </li></ul><ul><ul><li>Depression ranks among the most frequent diagnosis in PC </li></ul></ul><ul><li>PCP prescribe the most psychotropics </li></ul><ul><li>Up to 75%-90% of all PC visits are stress related </li></ul>(APA, 1997; Arch. Fam Med., 1997; JAMA, 2004) Why integrative training?
    7. 7. Why integrative training? <ul><li>Current diseases… </li></ul><ul><ul><li>develop over many years </li></ul></ul><ul><ul><li>have multiple causes (not just biological) </li></ul></ul><ul><ul><li>are chronic </li></ul></ul><ul><li>Therefore, we need a different view of cause & treatment. </li></ul>(CDC, 2005) 4.4 Accident 5 5.1 Chronic Obstructive Pulmonary Diseases 4 6.7 Stroke 3 22.8 Cancer 2 28 Heart Disease 1 % Cause of Death (2002) Rank 6 Stroke 5 8 Heart Disease 4 9 Gastritis, duodenitis, colitis, enteritis 3 11 Tuberculosis 2 12 Influenza & Pneumonia 1 % Cause of Death (1900) Rank
    8. 8. Estimated contributions of different factors to health status. (Kaplan, Sallis, Jr., & Patterson,1993).
    9. 9. Benefits to integration <ul><li>Conditioning principles </li></ul><ul><li>Behaviorist to think physical health </li></ul><ul><li>Behaviorists learn psychopharmacology </li></ul><ul><li>Better communication between treating practitioners </li></ul><ul><li>Meets physician needs </li></ul><ul><li>Meets beh sci trainee needs </li></ul><ul><li>Meets community needs </li></ul>
    10. 10. The Multiple Roles of Behavioral Science Trainees Clinical, Consultation, and Education
    11. 11. Behavioral Science Trainees: Multiple Roles <ul><li>Clinical Role </li></ul><ul><li>Consultation Role </li></ul><ul><li>Educational Role </li></ul><ul><li>Research Role </li></ul>(Haley et al., 1998)
    12. 12. Strategies to Infuse Integrative Training Using Behavioral Science Trainees to Meet The ACGME Core Competencies
    13. 13. “ I’m gonna make him an offer he can’t refuse” <ul><li>Rebuttal for each “no” </li></ul><ul><ul><li>Back it up with evidence </li></ul></ul><ul><li>Barriers to Integration </li></ul><ul><ul><li>Financial </li></ul></ul><ul><ul><li>Time </li></ul></ul><ul><ul><li>Space </li></ul></ul><ul><ul><li>Attitudes </li></ul></ul><ul><ul><li>Language </li></ul></ul><ul><li>Selling points </li></ul><ul><ul><li>Part of education </li></ul></ul><ul><ul><li>MCHS mission statement </li></ul></ul><ul><ul><li>Quicker referral </li></ul></ul>(Kainz, 2002)
    14. 14. Infusion <ul><li>Training model </li></ul><ul><ul><li>Phase I: Orientation & Overview </li></ul></ul><ul><ul><li>Phase II: Establishing Skills, Roles, & Practice Levels </li></ul></ul><ul><ul><li>Phase III: Maintaining & Expanding Clinical Skills </li></ul></ul><ul><ul><li>Phase IV: Termination & Transfer </li></ul></ul>(McDaniel, Belar, & Schroeder, 2002)
    15. 15. Using the ACGME Core Competencies <ul><li>Interpersonal & Communication Skills </li></ul><ul><ul><li>Collaborative office visits (joint interview) </li></ul></ul><ul><ul><li>Video-taping residents </li></ul></ul><ul><ul><li>Consultation between disciplines (BS and MD) </li></ul></ul><ul><li>Professionalism </li></ul><ul><li>Patient Care and Medical Knowledge </li></ul><ul><ul><li>Only on Behavioral/DSM content </li></ul></ul>
    16. 16. Creating Healthcare Partnerships Post Residency Meeting the Inclusive Care Needs of the Healthcare Consumer
    17. 17. Key Factors for Partnerships <ul><ul><li>Build key relationships </li></ul></ul><ul><ul><li>Integration experience </li></ul></ul><ul><ul><li>Discuss integration research outcomes </li></ul></ul><ul><ul><li>Be a team member </li></ul></ul><ul><ul><li>Persist in marketing services </li></ul></ul><ul><ul><li>Share psychological expertise </li></ul></ul><ul><ul><li>Be available </li></ul></ul><ul><ul><li>Learn the PC culture </li></ul></ul><ul><ul><li>Attend to ethical issues </li></ul></ul><ul><ul><li>Plan around financial issues </li></ul></ul><ul><li>Establishing </li></ul>
    18. 18. Key Factors for Partnerships <ul><ul><li>Areas of special interest </li></ul></ul><ul><ul><li>Developing consistent plans for integrated practice </li></ul></ul><ul><ul><li>Shared community services </li></ul></ul><ul><ul><li>Professional presentations on integration & outcomes of partnerships. </li></ul></ul><ul><li>Established </li></ul>
    19. 19. Q & A Time