Patricia J. Robinson, PhD

Mountainview Consulting Group, Inc.

Zillah, WA USApatti1510@msn.com

The Primary Care Behavioral Health Model: A Platform for ACT in PC

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Workshop ObjectivesLearn about a new job for behavior therapists (as part of a primary care team)

Consider ways to deliver ACT in brief interventions that primary care colleagues can learn and support (ACT as a team approach)

Consider case examples and participate in role plays of suggested ACT approaches

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The Primary Care Behavioral Health (PCBH) ModelInitial exploration in the USA started in the 1980’s

Superior outcomes to usual care for depression (Katon, Robinson, et al., 1996)

Clinical outcomesPatient satisfactionProvider satisfaction

Better use of the limited health care dollarDecade spent refining a model delivery issues

PCBH model adopted by Community Health Care System, many HMOs, and more recently in individual PC practices

Economic reimbursement issues still being sorted out

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Behavioral Health Consultant (BHC)

Mission Methods To improve the health of the population of patients receiving care at the PC setting where the BHC works

Health: Last (1988) “a state characterized by anatomical, physiological, and psychological integrity; ability to perform personally valued family, work, and community roles; ability to deal with physical, biological, psychological and social stress; a feeling of well-being; and freedom from the risk of disease and untimely death.”

Consultation versus psychotherapy (Teach / coach / Advise, PC remains in charge)

Work looks like PC (brief, episodic)

Focus on population versus case

Interventions range from pt focus to population focus to system focus

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Sharing ACT with PC ColleaguesExpanding from mechanistic to contextualExpanding from relational to functionalBHC service models core principles of ACT

Assessment of QOL (not dx focus)Focus on referral problem / question (complete contextual interview, use functional analysis skills)

TEAMS Analysis (Thoughts, Emotions, Associations, Memories, Sensations)Tool to explore experiential avoidance

Three PillarsTool to identify patient needs regarding strengthening of ACT processes (Open, Aware, Engaged)

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Example: Chronic Disease (Patient)

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Example: Chronic Disease (Provider)

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Three Pillars Assessment

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OpeningDe-FusionAcceptance

AwarePresent MomentSelf as Context

EngagingClarifying valuesSupporting value-consistent action

Three Pillars: Chronic Disease

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Three Pillars: Chronic Disease

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Application of ACT PC Tools: TEAMS and Three Pillars (Role Play, Other Applications)

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Role playVolunteers

PtProvider BHC“TEAMS” team“Three Pillars” team

Other Applications of ACT in PCTrainingPracticeMeetingsClinical Pathways involving ACT processes (e.g., chronic pain / Pain and QOL Pathway)