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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)

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Trends…

Biopsychosocial approach

Collaborative care model

Mind/Body connection

APA public education campaign

(Engel, 1977; Blount, 2003; Miller, Hall, & Hunley, 2004; Talen, Fraser, & Cauley, 2002; APA, 2006 )

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Objectives

Importance of integrated training

Understand the multiple roles of behavioral science trainees conducting internships in residency programs.

Strategies to infuse integration: meeting ACGME Core Competencies.

Creating healthcare partnerships post training to meet inclusive care needs of the healthcare consumer.

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Effective Collaboration

Improves quality of care Improves efficiency of care Enhances satisfaction of patients and

providers

If integration is to be the future of healthcare, physicians and behavioral health students in training must gain experience in integrated settings

(Hemmings, 2000; Katon et al.,1995; deGruy, 2000; Patterson, Bischoff, & McIntosh-Koontz, 1998 )

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The way you understand a problem affects how you fix it

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Unhealthy habits account for 50% of preventable death account for 70% of preventable health care costs

Mental health diagnosis Depression ranks among the most frequent

diagnosis in PC PCP prescribe the most psychotropics Up to 75%-90% of all PC visits are stress related

(APA, 1997; Arch. Fam Med., 1997; JAMA, 2004)

Why integrative training?

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Why integrative training?

Current diseases… develop over many

years have multiple causes

(not just biological) are chronic

Therefore, we need a different view of cause & treatment.

Rank Cause of Death (2002) %

1 Heart Disease 28

2 Cancer 22.8

3 Stroke 6.7

4 Chronic Obstructive Pulmonary Diseases 5.1

5 Accident 4.4

Rank Cause of Death (1900) %

1 Influenza & Pneumonia 12

2 Tuberculosis 11

3 Gastritis, duodenitis, colitis, enteritis 9

4 Heart Disease 8

5 Stroke 6

(CDC, 2005)

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Estimated contributions of different factors to health status.

30%

20%

40%

10%

Other Factors Genetic Behaviour Medical Care

(Kaplan, Sallis, Jr., & Patterson,1993).

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Benefits to integration

Conditioning principles Behaviorist to think physical health Behaviorists learn psychopharmacology Better communication between treating

practitioners Meets physician needs Meets beh sci trainee needs Meets community needs

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The Multiple Roles of Behavioral Science Trainees

Clinical, Consultation, and Education

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Behavioral Science Trainees: Multiple Roles

Clinical Role

Consultation Role

Educational Role

Research Role

(Haley et al., 1998)

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Strategies to Infuse Integrative Training

Using Behavioral Science Trainees to Meet The ACGME Core Competencies

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“I’m gonna make him an offer he can’t refuse”

Rebuttal for each “no” Back it up with evidence

Barriers to Integration Financial Time Space Attitudes Language

Selling points Part of education MCHS mission statement Quicker referral

(Kainz, 2002)

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Infusion

Training model Phase I: Orientation & Overview Phase II: Establishing Skills, Roles, & Practice

Levels Phase III: Maintaining & Expanding Clinical

Skills Phase IV: Termination & Transfer

(McDaniel, Belar, & Schroeder, 2002)

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Using the ACGME Core Competencies

Interpersonal & Communication Skills Collaborative office visits (joint interview) Video-taping residents Consultation between disciplines (BS and MD)

Professionalism Patient Care and Medical Knowledge

Only on Behavioral/DSM content

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Creating Healthcare Partnerships Post Residency

Meeting the Inclusive Care Needs

of the Healthcare Consumer

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Key Factors for Partnerships

Build key relationships Integration experience Discuss integration

research outcomes Be a team member Persist in marketing

services

Share psychological expertise

Be available Learn the PC culture Attend to ethical issues Plan around financial

issues

Establishing

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Key Factors for Partnerships

Areas of special interest Developing consistent

plans for integrated practice

Shared community services

Professional presentations on integration & outcomes of partnerships.

Established

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Q & A Time