PSYCHOLOGY & INTEGRATED PRIMARY CARE

Transcription

1 MODELS FOR ADDRESSING MENTAL HEALTH IN PRIMARY CARE EDUCATION & TRAINING PSYCHOLOGY & INTEGRATED PRIMARY CARE Susan H McDaniel PhD ABPP Dr Laurie Sands Distinguished Professor of Families & Health Director, Institute for the Family, Department of Psychiatry Vice Chair, Department of Family Medicine University of Rochester Medical Center Rochester NY Training the Future Child Behavioral Healthcare Workforce Using an Interprofessional Family Systems Approach to Train Psychology Postdoctoral Fellows in Pediatric Primary Care 11/29/2016

2 George Engel, MD Father of the Biopsychosocial Approach

3 Lyman Wynne, MD, PhD Schizophrenia Researcher and Pioneering Family Therapist

4 Robert Haggerty, MD Children and Communities Jack Medalie, MD The Hidden Patient Interaction between physical symptoms and stress

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6 A Biopsychosocial Approach to Health and Illness through Integrated Primary Care

7 Primary Care Family Psychology Postdoctoral Fellowship 2 YEARS OF PROFESSIONAL AND INTERPROFESSIONAL EDUCATION & TRAINING

8 Interprofessional Family Systems Medicine Seminar

9 UNIVERSITY OF ROCHESTER FAMILY MEDICINE PRIMARY CARE 200 HOURS 35 YEARS INTEGRATED PRIMARY CARE SERVICE, EDUCATION & TRAINING 5 MONTHS PSYCHOSOCIAL MEDICINE 2 YEARS PRIMARY CARE Training the Future Child Behavioral Healthcare Workforce Using an Interprofessional Family Systems Approach to Train Psychology Postdoctoral Fellows in Pediatric Primary Care WASHINGTON DC 11/29/2016

10 Discipline-specific Education & Training

11 24th ANNUAL INTERDISCIPLINARY INTEGRATED HEALTHCARE & MEDICAL FAMILY THERAPY INTENSIVE PRESENTED BY CO-DIRECTORS: Susan H. McDaniel, PhD, ABPP Tziporah Rosenberg, PhD Professor of Psychiatry and Family Medicine; Director, Institute for the Family Assistant Professor, Family Therapy Training Program Institute for the Family WHEN: June 12 TH 16 TH, 2017 WHERE: University of Rochester Medical Center CONTACT: (585)

12 Outcomes from Psychology Fellows Family Therapy Training *Excellent individual adult, couple, & family therapy skills *Apply family systems concepts and skills to facilitating primary care team effectiveness *Supervise masters level clinicians and paraprofessionals

13 Family Medicine 3 Psychologists 1 Postdoc Surgery 1 Psychologist Gen Pediatrics, Peds Rheumatology 4 Psychologists 2 Postdocs University of Rochester Institute for the Family Psychiatry Susan H. McDaniel, Director 10 Psychologists 4 postdocs Women s Health Clinic Fertility Center 1 Psychologist 1 Postdoc Geriatric Medicine 1 Psychologist 1 Postdoc Epilepsy Center, Neurology 1 Psychologist

14 Primary Care Family Psychology Pediatric Postdoctoral Fellows

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16 UNIVERSITY OF ROCHESTER PEDIATRICS PRIMARY CARE 18 HOURS 35 YEARS INTEGRATED PRIMARY CARE SERVICE, EDUCATION & TRAINING 1 MONTH + weekly clinic seminars PSYCHOSOCIAL MEDICINE 2 YEARS PRIMARY CARE Training the Future Child Behavioral Healthcare Workforce Using an Interprofessional Family Systems Approach to Train Psychology Postdoctoral Fellows in Pediatric Primary Care WASHINGTON DC 11/29/2016

17 UNIVERSITY OF ROCHESTER MEDICAL CENTER 4 elements OF PRIMARY CARE EDUCATION & TRAINING THE COLLABORATIVE HABIT (increased self-awareness, move from me to we, regularly appreciate colleagues contributions, surface and manage conflict, have exposure to team science and mindfulness training) SHARED MENTAL MODELS ACROSS DISCIPLINES INTERPROFESSIONAL TEAM TRAINING (a biopsychosocial systems approach) STRONG DISCIPLINARY IDENTITIES AND SKILL SETS (commitment and pride, not tribalism) Training the Future Child Behavioral Healthcare Workforce Using an Interprofessional Family Systems Approach to Train Psychology Postdoctoral Fellows in Pediatric Primary Care WASHINGTON DC 11/29/2016

18 Evaluation of Pediatric Residency Training in Integrated Primary Care Compares outcomes from 3-year clinical placements at either the: *University ambulatory primary care clinic with traditional psychiatric/psychological consultation and referral, or the *Large, urban, community hospital s underserved ambulatory integrated primary care clinic Surveys of 174 of 245 alumni (71%) over 15 years

19 Percent Agree Engaged in joint treatment planning with BMH professional during continuity clinic RGH pre SMH pre RGH - Integrated SMH - control p<.001 Garfunkel et al, Acad Med, 2011

20 Continuity clinic experience prepared me for collaborating with mental health professionals Percent Agree prergh presmh ibmh Typical MH p<.001 Garfunkel et al, Acad Med, 2011

21 CC preparation for collaboration vs. residency preparation for handling MH Issues p<0.001 p=0.02 Garfunkel et al, Acad Med, 2011

22 The Difficulty in Scaling Up the Primary Care Family Systems Integrated Care Model: Training Faculty!

23 MODULE 1 INTRODUCTION TO INTEGRATED PRIMARY CARE

24 World Health Organization (Patel, 2013) Integrated primary care is the only feasible way to address problems of access and stigma that result in treatment gaps for common mental, behavioral, and substance use problems globally, for children and adults.

25 Primary Care Family Psychology Postdoctoral Fellowships are one answer!

26 Thank you!

27 Pisani A, leroux P & Siegel D. (2011) Educating residents in behavioral healthcare and collaboration: Integrated clinical training of pediatric residents and psychology fellows, Academic Medicine. 86:2: Garfunkel L, Pisani A, leroux P & Siegel D. (2011) Educating residents in behavioral healthcare and collaboration: Comparison of integrated and conventional training models, Academic Medicine. 86:2: