2022 Workshops

Summary

The association between adverse childhood experiences (ACEs) and mental health conditions (i.e. depression, anxiety, PTSD) and physical health conditions (i.e. heart disease, cancer, autoimmune diseases) has been well-established. However, the association between ACEs and medication intolerance or poly-allergy is less understood. Thus, the present study examined whether depressive symptoms serve as a mediator in the association between ACEs and perceived multiple drug allergies in a primary care population. Three hundred forty-nine participants were recruited from 11 primary care clinics and hospitals located in a metropolitan area of Missouri. Structural equation modeling was used to measure ACEs, symptoms of depression and anxiety, and medication intolerance. The following variables were collected using an online survey: ACEs, patient health, patient health behavior, demographics, and drug allergies. Results indicate that participants had on average 1 allergy each (mean = 0.93) and 20% of participants reported having more than one allergy. Additionally, 46% of participants reported experiencing at least one ACE. Results indicated a dose-dependent association between ACEs and allergies to medication, establishing a pathway between ACEs, depression, and multiple drug allergy. The proposed explanation for this sequalae examines a combined effect of ACEs and depression on an individual’s inflammatory response, altering their perception of allergy. By increasing knowledge of such pathway, providers in primary care settings can be better-informed when prescribing medication and maintaining adherence from patients.

Summary

Mobile apps can provide a means to address healthcare disparities and combat common barriers to accessing psychiatric care experienced by underserved populations being cared for in Integrated Care (IC) settings. Technology use such as mobile apps may help scaffold treatment, increase patient autonomy and access, and ease provider burden as new evidence suggests patients across the socioeconomic spectrum are interested in using apps to supplement behavioral health treatment and more mental health apps are available than ever before. Yet challenges remain in understanding feasibility aspects related to the integration of technology as little guidance exists for medical and behavioral health integrated primary care providers interested in incorporating technologies such as mobile apps in treatment within these settings. Chief among these challenges is how to assist providers with navigating and helping patients trouble shoot digital health tools such as mobile operating systems, apps, and identifying quality mental health apps in a digital marketplace. Attendees, at any stage of their education or career, will learn about the process and results of a study that explored the implementation and use of online learning modules that aim to augment providers digital navigation skills, use of a shared decision-making model for mobile apps, and how to effectively evaluate mobile mental health apps in order to scaffold treatment and augment patient autonomy in treatment. The presentation will also include descriptive statistics, survey results, and future directions will be discussed.

Summary

This quality improvement (QI) project focused on improving faculty confidence in discussing ethno-racial health disparities with their learners during precepting time using the modified OMP Model for Health Equity. Methods: Population and Setting: Physician Faculty and Family Medicine Residents within the Family Medicine Residency (FMR). Implementation of this QI project used a Plan-Do-Study-Act (PDSA) framework. Faculty physicians and residents were administered the AREA survey (faculty), precepting practice survey (residents), and demographic information electronically 1 month prior to the modified OMP for Health Equity intervention (“plan” stage of PDSA). Faculty physicians were introduced to the intervention through a brief (30 minute) didactic during a faculty meeting. Faculty physicians then began use of the intervention for a two-month period. After the intervention (“do” stage of PDSA), faculty were re-administered the AREA survey to assess impact of the modified OMP for Health Equity as well as the brief didactic during the faculty meeting and to determine next steps for ongoing faculty development related to addressing health disparities with learners (“study” and “act” stage of PDSA). Results: The AREA survey was completed by 12 family medicine faculty prior to the intervention and by 8 faculty after the intervention. Prior to the intervention, the majority of faculty demonstrated engagement in the areas of awareness (mean= 4; SD= 1.32) and reflection/empowerment (mean= 4.83; SD= 0.36) while lower engagement levels were seen in action (mean=1.53, SD= 0.49). After the intervention, faculty engagement levels slightly increased in the areas of awareness (mean=4.25; SD= 0.70) and action (mean= 1.58; SD= 0.49) and slightly decreased in reflection/empowerment (mean=4.5; SD= 0.51). A total of 28 family medicine residents completed the pre-survey and a total of 32 completed the post-survey on precepting practices. Using a 1-7 Likert scale, where higher numbers indicate discussions occurring very often and residents being very satisfied, residents reported that discussions of ethno-racial disparities occurred often during precepting in the residency’s outpatient continuity clinic and in its inpatient service both before the intervention (mean=4.07; SD= 1.58) and after (mean 4.06, SD=1.58). Residents reported overall satisfaction with the clinical teaching about ethno-racial health disparities prior to the intervention (mean= 4.04; SD = 1.59) and slightly higher satisfaction after the intervention (mean= 4.66; SD= 1.59). The results show that by using the PDSA cycle framework for QI, faculty engagement in addressing ethno-racial health disparities can improve. The modified OMP for Health Equity intervention can be used as a concrete clinical teaching tool to increase awareness and to promote self-reflection and change on issues of ethno-racial health disparities for not only learners, but for primary care educator engagement as well.

Summary

Background: The COVID-19 pandemic presented a significant challenge to federally qualified health centers (FQHCs) who provide comprehensive health care services, including the delivery of integrated behavioral health (IBH). FQHCs are the primary resource of behavioral health care in many communities. Tele-behavioral health dramatically increased during the pandemic due to two factors: emergency safety orders that limited in-person clinic capacity and state and federal emergency mandates that allowed for the reimbursement of services delivered through tele-health that were not previously permissible. This study aimed to explore how FQHCs adapted IBH care delivery during the pandemic. This study assessed barriers to IBH during COVID-19, as well as tele-behavioral health uptake, use, and adaptation, and goals for future use of tele-communication at FQHCs beyond COVID-19. Study design: A mixed-method study design was utilized. A web-based survey was developed and disseminated (October to December 2020) to a convenience sample of FQHC administrators in 12 states identified through HRSA’s “find a health center” website where contact information was obtained. A semi-structured interview guide was developed and used in-depth interviews were recorded via Zoom (February to April 2021). Description of population: sampled A total of 46 administrators from 10 states participated in the online survey regarding IBH and tele-behavioral health. Most responses were recorded from California (n=12; 26.1%), Kansas (n=10; 21.7%), and Pennsylvania (n=8; 17.4%). Nine interviews with FQHC administrators from six states were collected from California (n=3), Kansas (n=2), Arizona (n=1), New York (n=1), Pennsylvania (n=1), and West Virginia (n=1). Procedures and measures: FQHC administrators were contacted by email and phone to invite them to participate in the survey. The survey was deployed via Qualtrics and collected descriptive data, including FQHC location, number of clinics, and IBH model. Respondents who completed the online survey were asked to participate in a qualitative interview and those who responded affirmatively were contacted for interviews. Key results: Prior to COVID-19, 30.4% of FQHCs (n=14) delivered IBH care using tele-communication. Since COVID-19, all but two of the FQHCs surveyed used tele-communication to deliver IBH. All respondents reported patient barriers to tele-health use impacted service delivery, along with some reporting lack of reimbursement for tele-health services and concerns on HIPPA, privacy, or compliance. The following themes were identified from the qualitative interviews: tele-behavioral health worked to sustain behavioral health service delivery during COVID-19; core components of IBH were significantly impacted during COVID-19; and patient and payment barriers were a concern for long-term use of tele-behavioral health but FQHCs are hopeful and desire to continue use.

Summary

While many organizations are increasingly receptive to and supportive of integrated behavioral health programs, the process of actual implementation can present fundamental challenges. In the aftermath of the COVID-19 pandemic, front line providers are increasingly seeking the support that integrated behavioral health programs can provide. This presentation describes the process and experience of implementing a shift from a co-located to an integrated model of behavioral health service in a large Family/Internal Medicine practice. We present the blueprint for the changes that took place, including a description of a novel Behavioral Health Medical Assistant role, barriers and facilitators of implementation, psychology trainee curriculum, and results from a provider utilization survey. We also discuss efforts and outcomes related to maintaining the integrity of our integrated behavioral health model during the COVID-19 prevention restrictions. Presenters will be available for questions and consultation for attendees interested or active in implementation of integrated behavioral health services at their own clinics.

Summary

Communication within an integrated-care team is a critical component to a successful patient-centered, access-orientated culture. With our nation struggling with a mental health crisis the Biden administration has prioritized the expansion of integrated-care. As clinicians tasked with this expansion, we need to focus on communication to develop effective and sustainable programs. Integrated-care often uses defined models. Regardless of model or population, the overarching prerequisite is flexible communication techniques, co-management and bi-directional education. Clinicians working in the Collaborative Care Model (CoCM) utilize a Registry to aid transparency around treatment plans. Our pediatric program is a complex network of sites and providers based on the Primary Care Behavioral Health Model. We adapted the CoCM approach, developing a unique communication/co-management strategy called Registry Conferences. These are weekly, zoom-enabled workgroups, bringing the multidisciplinary frontline team together, including our pediatricians, psychiatrists, therapists, care coordinators and supervisors. These Conferences are fast-paced, highly efficient opportunities to discuss shared-cases, consult, educate and support each other. We have found these Conferences to be successful in fine-tuning our co-management techniques. To our knowledge these Conferences have not been described before. We believe they can be adapted to a variety of models, across all age ranges, and scalable to a variety of program sizes. In this presentation we will highlight the goals, benefits, structure and logistics of our Conferences. We will discuss how to prioritize efficiencies and engage the team. We will provide data and case examples highlighting the successes, unanticipated benefits, and roadblocks. We will describe tools and skills needed to implement Conferences at other institutions. Registry Conferences are where we experience the true magic of our integrated-care culture.

Summary

The Oak Street Health (OSH) Care Model is different from traditional healthcare models. OSH is in the fortunate position to invest in interventions to improve patient care, in order to improve patient health outcomes. That improvement in outcomes generates a reduction in healthcare spending on avoidable ED visits and hospitalizations. These savings are then re-invested into the OSH Care Model to continuously improve our services for patients. The overarching goal has been the same since OSH started — to deliver excellent quality care to all our patients to improve their health outcomes. As a result of our value-based funding model, OSH is freed to be creative about upstream social and behavioral health interventions. One investment made to deliver excellent care was adopting elements of the Collaborative Care model as the foundation for integrating a behavioral health program. The foundations of the Oak Street Health Collaborative Care model will meaningfully improve the lives of our entire patient population. Aim of presentation This presentation aims to review the implementation of an integrated mental health program serving a high-need, largely dual-eligible Medicare population. The description will be organized around the 5 foundational elements of Collaborative Care.

Summary

A goal of integrating pediatric behavioral health into primary care is to increase access to care. Integrated behavioral health clinicians are in the unique position to complete warm hand offs (WHO), which is when the trusted medical provider introduces the patient to the behavioral health clinician during the medical appointment. WHOs allow for same-day services and/or scheduling follow-up behavioral health appointments. Some early studies found no additional benefits of completing a WHO (Pace et al., 2018), while more recent studies found improved follow-up rates (German et al., 2020; Gurney et al., 2020; Mitchell et al., 2022) and a reduction in time until behavioral health encounters (Young et al., 2020). The goal of the current study was to use a pre-post design to evaluate the differences in time-to-be-seen and patient/family engagement metrics within a family medicine clinic following the implementation of a monthly presentation regarding the impact of WHOs on patient’s behavioral health care. The presentation included feedback regarding the WHO procedures, frequency of WHOs, common presenting concerns, and outcomes of WHOs. Additionally, behavioral health clinicians presented the provider with the most collaborations for the month with an owl pendant. Prior to the intervention, the average time to be seen within the clinic was 42 days. Time-to-be seen for the three months following the intervention were 16, 8, and 5 days, respectively. Additional benefits of WHOs included same-day behavioral health services (n = 10), including crisis evaluations, safety planning, and brief behavioral management strategies, which were provided for 28% of WHOs. Primary care providers described the presentation as helpful for understanding the impact of WHOs vs. referral-based care. Overall, the preliminary data show that in a busy family medicine clinic, providers are more likely to facilitate a WHO instead of placing a referral following continuous feedback. Importantly, WHOs increase patient engagement in behavioral health services and reduce time-to-be-seen.

Summary

Community healthcare organizations are accustomed to managing staffing shortages, burnout, and overwhelm, but these challenges have been amplified since the start of the pandemic. Despite evidence of the clinical value that population health work, quality improvement, and preventative health interventions provide to achieving high quality healthcare; these activities are often put on the back burner amidst crisis. Our Population Health Research and Quality Improvement team recognizes the paradox of workforce crisis and overwhelm, and the clear benefits of prevention and quality improvement work to achieving downstream health gains that may alleviate future challenges. In this presentation we address strategies to engage in research, quality improvement, prevention, and evaluation; while honoring the real struggles both healthcare staff and consumers face during a crisis. Specifically, we will discuss modifications we made to a number of grant activities to support integrated healthcare among individuals with mental health concerns. We will share our challenges and success around implementing a new tobacco cessation project; transitioning an in-person diabetes self-management group into a new virtual group; development and implementation of a new skills training service to help individuals with severe and persistent mental illness and diabetes engage more actively in their medical care; and the development and implementation of a new chronic pain group. The audience will learn tools and strategies to help move new projects forward and to maximize innovation in a challenging implementation environment.

Summary

While significant research has highlighted the clinical value of Integrated Behavioral Health practices to patients and communities (O’Donnell et al., 2013), financial viability often remains a barrier to establishment of these models (Herbst et al., 2018; Miller et al., 2017). While CoCM billing codes established in 2017 have made it possible to bill for services and provider time in potentially more financially sustainable ways (Cross et al., 2019), adoption of these codes by health care systems has been slow and is not without its own challenges (Malâtre-Lansac et al., 2020). In this presentation, we will discuss lessons learned from the adoption and roll out of CoCM billing codes at a large academic medical center system, incorporating both quantitative and narrative perspectives. Quantitative findings include results of a prospective cost analyses comparing psychotherapy codes to Collaborative Care codes, which showed a potential 29.3% increase in revenue, as well as a Strata analysis demonstrating the organization currently makes $20 per Collaborative Care patient based on revenue and both direct and indirect costing models. We also incorporate the viewpoints of multiple individuals involved in the logistical roll out of CoCM codes, with presenters including administration/leadership, information systems, coding, and frontline behavioral health clinicians each speaking to the benefits and challenges of the process from their unique perspectives. We will also discuss the importance of considering value metrics of integrated care in addition to finances, including health care utilization, community well-being, and provision of care to traditionally under-served populations.

Summary

The integration of behavioral health providers (BHPs) into primary care (PC) continues to proliferate and is fast becoming the expectation in healthcare versus being an exception (NASEM, 2021). One such popular philosophy of integration is the Primary Care Behavioral Health (PCBH, Reiter et al, 2017) model that focuses on matching PC’s value of population-based health and productivity (Martin et al., 2021). However, with this increased focus on the fast-paced, productive PC environment, questions regarding burnout and engagement for these BHPs have been raised. Will BHCs be put at an increased risk of burnout in their attempts to help their PC counterparts? There has been a dearth of research regarding levels of employee engagement throughout PCBH systems and while there is support that team-based care may buffer burnout (Zubatsky, 2018), research has been established regarding the deleterious effects that high productivity, a staple of PCBH, can have on health care providers (Dillion et al., 2020). This presentation will be one of the first that demonstrates two concepts that may be seen as either/or and opposites (i.e., PCBH and employee engagement), can very well happen simultaneously when done with intentionality. Specifically, the presentation will detail Community Health of Central Washington’s four-year journey of achieving high fidelity to the PCBH model, including high productivity amongst its BHPs, as well as the highest employee engagement scores out of any department within the health center. The presenters will describe evidenced-informed initiatives and interventions (Deao, 2017; Studer, 2013) taken to increase employee engagement from the BHP team. Additionally, quantitative and qualitative data will be presented that details employee engagement metrics and the relationship to PCBH fidelity data.

Summary

The last two years our frontline workers have endured burnout, moral injury, and compassion fatigue due to the pandemic, which leads to an increased risk in suicide, safety issues, and an overall breakdown in our community safety net. We designed the leadership of the University of Utah Integrated Behavioral Health Team based on a collaborative-feminist model prioritizing the psychological safety of the clinicians doing the work. This presentation will include a critical examination of the model, highlighting specific team-based interventions to address micro-aggressions, moral injury and stress traumas, and engagement and retention of the workforce. We will include measurable outcomes including patient and provider experience, sustainability, and clinical excellence.

Summary

It is no secret that frontline healthcare workers across disciplines are experiencing unprecedented levels of compassion fatigue and burnout. Similarly, the US population at large is struggling with significant levels of stress on multiple fronts. Technology is being utilized in new and creative ways over the past few years to increase access to healthcare resources and otherwise address these problems. In this session, we will present a project HealthSource of Ohio’s BHC team developed to promote wellness across our organization electronically. HealthSource is a large FQHC, serving 60k+ unique patients per year across 8 primarily rural counties, with a small BH workforce. This, together with increased demand for behavioral health services among our patient population, has made our BHCs’ attempts to provide in-person, site-by-site education and support to our co-workers challenging at best. In addition, it occurred to our BHC team that such efforts excluded our non-clinical staff (e.g., call center staff) who we knew also to be experiencing significantly increased stress. Furthermore, we have heard consistently from our medical colleagues and support staff that it is important that any wellness resources or activities not feel like “one more thing” they must do in their already-overloaded lives. HealthSource makes frequent use of various technological platforms for organization-wide communication, so we decided to leverage these existing pathways to broadly disseminate wellness content in small doses. Thus, HSO’s weekly “Wellness Nugget” – a brief, informal self-help video – began. Early into this project, HealthSource began to make a concerted effort to build our online presence across multiple social media platforms. In an effort to maximize the value of both our online presence and the wellness content we were already producing, we began to post Wellness Nuggets online for community access as well. We will describe this project in detail, showcase a Wellness Nugget, and present descriptive data regarding views and other analytics as well as both spontaneous and formally-requested feedback from HSO providers, staff, and patients.

Summary

(a) The recent pandemic created a significant shift in the process and workflow of healthcare services including primary care behavioral health services. There was a rapid unplanned shift to telemedicine with a lot of challenges along the way. Adaptability and adjustments to workflow became a crucial part of the work for BHCs. This is a retrospective study looking at patient satisfaction and clinical effectiveness of BHC telehealth services versus in-person services. Yakima Valley Farm Workers Clinic is a large FQHC in the Pacific Northwest, and it has over 40 clinics across Washington and Oregon with integrated behavioral health services at most of these clinics. Adapting to telehealth across the clinics became a vital part of the job for many of the providers and staff members. YVFWC serves the underserved communities. The population sample for this study includes men, women, and children of all ages. The study looks at patient satisfaction scores from BHC telehealth visits and in-person visits as well as PHQ-9 scores and GAD-7 scores across the two type of visits. Data for PHQ-9 and GAD-7 scores are collected during clinical visits. Patient satisfaction scores are usually randomly selected patients and scores are collected internally. Descriptive statistics will be used to present the results.

Summary

The national demand for Psychiatry is at an all-time high. Despite the increasing need, access is limited. The national scarcity of psychiatric resources is experienced individually by patients and by the greater community of Southern Oregon where rates of depression, anxiety, substance use disorders and suicide are higher than compared to statewide figures. La Clinica, a Federally Qualified Health Center (FQHC), in Southern Oregon has an innovative approach to addressing this need. The Psychiatric Health, Life skills and Opportunities for Wellness (PHLOW) Program began as a 1 Full Time Employee (FTE) pilot project with the goal to provide psychiatric support services to primary care providers, behavioral health consultants and patients; and has grown into a sustainable and expandable integrated psychiatric program. The PHLOW Program developed strategically out of community and organizational need and the model of care is designed with the organizational strengths and limitations in mind. Session attendees will learn firsthand how an FQHC leveraged a 1 FTE pilot program into a sustainable and growing Integrated Psychiatric Program. Attendees will learn functional specifics about the PHLOW Program model that they can uniquely structure to their professional and organizational needs. Additionally, the presenters will share relevant details, the good, the bad and the ugly, of the program development process and outline future program expansion goals.

Summary

Participants will get information on our our same day clinic, with 3 medication providers and one behavioral health consultant, helps see patients on a walk in basis to ensure comprehensive care. This model is intended to decrease Emergency Room usage and use appropriate levels of care. We will showcase 2 case studies to showcase how this help decrease emergency room usage, help patients get necessary medications and provide resources to decrease homelessness and increase access to care.

Summary

During the COVID-19 pandemic, Jefferson Health recognized a critical need to develop mental health and coping support for employees, specifically frontline health care workers. Throughout the pandemic, employees were navigating a variety of challenges unique to their roles in an academic medical center setting. From the experiences of clinicians facing daily trauma, moral injury and burnout; to the experiences of faculty, staff and corporate employees facing blurred work/life routines, childcare and remote work challenges, supporting employees during this unprecedented time required an innovative approach to mental health and coping support. An interdisciplinary team of behavioral health professionals, HR professionals, university administrators and change management leaders came together to create resources that would help alleviate anxiety, promote connection, foster resilience, prioritize self-care, and provide mental health intervention to those most vulnerable. Additionally, few COVID-19 employee wellness initiatives have been evaluated and have primarily focused on frontline health care workers. This session will highlight the four-tiered `Pyramid of Care’ approach that Jefferson developed to meet the emotional and mental health needs of employees during the pandemic and describe the feasibility and utilization of, and participant satisfaction for virtual COVID-19 employee wellness sessions conducted at this large university and health system. Method: Thomas Jefferson University behavioral health consultants (BHCs) and behavioral health leaders developed and offered JeffBeWell (JBW) wellness sessions over 17 weeks during March 2020 through July 2020. Sessions were advertised via mass emails and an employee intranet. Multiple live thirty-minute sessions were offered weekly; facilitators provided psychoeducation and offered coping tools. Topics included working remotely, parenting, sleep, nutrition, grief, anxiety, and yoga and relaxation. Attendance was tracked and participants were asked to complete satisfaction surveys; survey data was analyzed using descriptive statistics. Results: A total of 388 sessions were offered with 1,324 participants. Attendance rose in weeks 1- 5, followed by a decline and then a second increase in Weeks 15 through 17, 213 participants (16%) responded to the survey. The largest portion of respondents were in academic administrative roles (46%), followed by clinical providers and staff (34%) and faculty and students (9%). Of respondents, 91% of respondents felt that the sessions met their expectations, 92% felt the session helped them, and 92% planned to attend future sessions. Discussion: JBW sessions were feasible to implement, attended by diverse participants and well received by survey respondents, although attendance has fluctuated during the pandemic. BHCs have refined sessions based on participant feedback and are tailoring more sessions to specific audiences.

Summary

Although family-centered care has been emphasized in behavioral health (BH) practice, few family-based interventions and care models have been validated for older adults with cognitive impairment. Dementia care presents need for increased levels of family engagement due to complex care needs that can be systemically addressed within the context of primary care. Much of the literature on family-centered interventions for persons with dementia (PWD) often separate caregiver data from PWD data. Healthcare warrants more systemic tracking of outcomes to demonstrate that family engagement makes a significant impact in older adult health (e.g., primary caregiver involvement leads to improved ADLs). With increasing numbers of geriatric issues in primary care and integrated BH care, the coordination of community resources and development of more non-pharmacological approaches to dementia and older adult issues (e.g., validation therapy, reminiscence therapy, Cognitive Stimulation Therapy) are imperative. This presentation will provide a brief report on current trends related to care for older adults with dementia including evidence-based approaches and opportunities for future growth and improved family engagement. While traditional “pull” interventions such as traditional office visits have demonstrated usefulness, the pandemic has made delivery of these interventions increasingly challenging, requiring greater accessibility for underserved patients and families outside of the clinical setting. Therefore, development of “push” interventions to implement within geriatric care (e.g., group home visits, community-level activities for families and caregivers) is greatly needed in both peri- and post-pandemic landscapes. Using case examples and pilot data from group interventions, we will demonstrate how team-based care and new “push” interventions can overcome common obstacles and promote collaborative, beneficial care for both PWD and their family caregivers.

Summary

Rates of chronic conditions among adults are high in the United States, and patient engagement and effective self-management are key to chronic condition prevention and treatment. Against this backdrop, the Veterans Health Administration (VA) is implementing a Whole Health System of care intended to engage and empower Veterans to pursue goals aligned with their values. The Personal Health Inventory (PHI) is a brief values assessment tool intended to inform patient care that prompts patient ratings on various domains of health (e.g., Recharge, Moving the Body), reflection on what matters most, and possible steps to pursue improved self-care or goals aligned with what matters most. Two key barriers to PHI use include limited provider time and the potential need for orienting patients to personal, reflective questions. The purpose of this study was to gather patient perspectives on independently completing the PHI based on an acceptability framework. We conducted a pilot mixed methods study of 25 post-9/11 Veterans (16% female, 52% identified as a racial and/or ethnic minority) new to VA healthcare who completed semi-structured phone interviews. Data collection is complete. Results will include quantitative ratings of Sekhon and colleagues’ acceptability framework and qualitative themes related to experiences completing the PHI. Preliminary results suggest positive results given high means (0-10 scale, higher is better) on most domains of acceptability, for example affective attitude = 8.1 (2.0), self-efficacy for completing PHI independently = 9.8 (0.8), and effectiveness for thinking about what matters most = 8.2 (2.3). Qualitatively, Veterans typically reported that the PHI was easy to complete and prompted reflection of various domains of health. The findings will help to understand and address potential barriers to patient-centered care aligned with what matters most to each patient, informing implementation and clinical use of the PHI by the primary care team.

Summary

Being on the frontlines of a pandemic has forced us to stare straight at mortality – our patients and our own. We have been single-mindedly focused on the task at hand, doing what needs to be done while instinctually suppressing and containing our emotional response, at great cost to any semblance of work-life balance. In healthcare, medical providers and behavioral health staff are conditioned to consider their own needs and emotions last, and the ability to sustain emotional and physical stamina for the sake of patient care has been significantly challenged. It has never been more necessary or timely to create space to address the warning signs of COVID sequela in our workforce and engage with the arts to allow for reflection, meaning-making, and honoring each other’s experiences, thoughts, emotions, and reactions. This presentation will highlight two hospital-based art exhibits, one in a suburban New England hospital and one in an urban Chicago hospital. The multi-disciplinary engagement, the range of art forms utilized, and outcomes based on qualitative analysis of participant and audience feedback will be included. A selection of these creative works will be used to guide participants through a narrative experience of processing memories and physical or emotional reactions that emerge. Participants will have the opportunity to explore the challenges to creating a space for art in a fast-paced, profit-driven, reactionary culture, as well as the benefits and opportunities inherent in the process of artistically expressing what seems inaccessible and difficult to put words to. Participants will ultimately be able to draw from this experience to brainstorm strategies to integrate the arts into their own lives and healthcare community.

Summary

Substance misuse persists and is under-treated across the United States (SAMHSA, 2021). Further enhancing the skill sets and capacity of diverse members of primary care interprofessional teams to include proficiency in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model, could help to alleviate the `treatment gap’ (those requiring treatment, but not receiving it) by enhancing interprofessional teams at the pre-graduate level (e.g., health educators, health coaches) to expand capacity and meet the volume of patients with substance use-related needs. In this study, SBIRT knowledge, training satisfaction, and self-efficacy were evaluated among undergraduate and graduate health and behavioral health students following exposure to a series of online training modules. Upon completion of the training, graduate level students, regardless of discipline, reported higher satisfaction and greater knowledge than undergraduate students; there were no differences in efficacy between the groups. Additional analysis at the graduate level evaluated differences between behavioral health and medical trainees. Behavioral health students reported greater satisfaction with the training than medical providers; they additionally reported higher levels of efficacy in delivering brief interventions than their medical counterparts. The findings of this study reinforce the need and potential to infuse SBIRT training into higher education curricula for diverse healthcare professions in an effort to expand the integrated care team in the provision of substance use services.

Summary

Psychologically-informed physical therapy (PIPT) is a growing treatment approach that recognizes psychosocial factors and their influence on patient outcomes. However, the psychosocial skills needed to improve PIPT is unclear. The Patient Centered Observation Form (PCOF) defines provider behaviors that demonstrate psychosocial skills. Training and application of these behaviors is expected to improve person-centered communication, engagement, adherence, satisfaction, and health outcomes. Healthcare practitioner beliefs centered on biomedical causes of disease may be a barrier to adoption of psychosocial behaviors. This study was a collaboration between psychology and physical therapy to examine the relationship between psychosocial behaviors and practitioner beliefs in physical therapy care. This study acknowledges physical therapists as frontline workers attending to restorative and rehabilitative needs of the human body. Doctoral psychology interns observed licensed physical therapists in five different outpatient settings during physical therapy encounters (n=41 encounters). Outpatient settings also included rural and urban areas. Psychology interns tracked psychosocial behaviors on the PCOF. Therapists were also administered the Physician Belief Scale (PBS), a self-report measure that captures provider beliefs regarding psychosocial factors. Physical therapists in outpatient settings demonstrated the most psychosocial skill in the following PCOF categories: 1) Establishing Rapport; 2) Gathering Information in the form of open-ended questions; and 3) Maintaining relationship throughout visit. The same therapist sample also demonstrated a strong association between practitioner beliefs and PCOF scores. This is the first study to directly observe PIPT behaviors in physical therapy clinics. The findings indicate specific psychosocial behaviors that physical therapists utilize, as well as behaviors to adopt. This study also has implications for future conversations, trainings and studies, to strengthen and complement the ongoing innovation of integrated care.

Summary

Residents of rural areas experience mental health conditions at the same rate as their urban and suburban counterparts but experience significant disparities in access to mental health treatment and quality of care. While the overall suicide rate increased 41% from 1999 to 2016, rural areas experienced the most rapid growth. Primary care is the most common mental health delivery setting in all areas but that is especially true for rural areas. Rural areas have the greatest shortage of mental health providers, making it especially important that these providers are leveraged for the largest population effect. Research evidence shows that Collaborative Care can eliminate disparities in treatment outcomes for rural residents. Providers from 3 rural primary care clinics participating in an initiative focused on implementing Collaborative Care in rural areas will share their experiences, including implementation challenges they faced and the strategies they used to address these. Sarah Acosta-Smith is a naturopathic physician who works as a primary care provider and PCP champion at Family Health Centers in Brewster, WA. Chelsea Matz is a behavioral health care manager practicing at NEW Health in Colville, WA. Auren O’Connell is a psychiatric nurse practitioner who works as a psychiatric consultant at Kittitas Valley Health Care in Cle Elum, WA. They will each share their perspectives as rural healthcare professionals working in a Collaborative Care team that serves a large proportion of patients with significant social determinants of health.

Summary

Suicide continues to be a major public health concern. It is well known that many individuals at risk for suicide present in primary care, multiple times, during their month of death. Integrated care settings can play a critical role in prevention by understanding best practices for suicide safer care and adopting a systemic approach to suicide prevention. This workshop will provide basic best practices for identifying and caring ofr patients at risk for suicide by all members of the care team in an integrated care setting.

Summary

Evidence-based modalities developed to treat trauma are commonplace in outpatient behavioral health practices, but we often struggle to adapt these therapies to the integrated setting where brief intervention is common. In this session, we will present Accelerated Resolution Therapy (ART) as a useful tool for treating trauma in an integrated setting. Accelerated Resolution Therapy has been shown to achieve benefits rapidly, usually within 1-5 sessions, and is effective in treating PTSD and complex trauma as well as other mental health problems such as anxiety, depression, phobias, grief, chronic pain, and relationship issues. We will explore the basics of Accelerated Resolution Therapy, highlight examples of how it has been used effectively in the primary care setting, and discuss both benefits and barriers to implementing this modality. We will focus on the compatibility of this therapy as a brief intervention within the PCBH model and the particular benefit of sustainability as Accelerated Resolution Therapy reduces exposure to vicarious trauma – critical to clinician self-care and preservation in these trying times.

Summary

The use of written narratives has been shown to increase resiliency, prevent the loss of empathy, increase cultural sensitivity, and highlight cultural diversity. As humans, we relate to stories more than facts or numbers. Using stories, we can strive to achieve Narrative Competence and increase our ability to absorb stories to understand human expression and experience. Using different narrative skills, including close reading, deep listening, spontaneous micro-writing, and sharing, we will help attendees achieve a greater understanding of humanness. Exercises will be conducted in pairs; participants will do some writing in real time and sharing as they feel comfortable. All writing exercises will be short pieces – 6 word stories, 55 word stories, Haiku, and poetry. This presentation emphasizes the importance of reflective narratives in obtaining and evolving perspectives. Our stories of our past experiences will allow us to look towards the future with a greater confidence and empathy. We will also aim to show attendees the benefit of narrative medicine for their own maintenance of wellness. Self-reported stories or stories about a shared experience can act as gratitude meditations and pathways to a deeper understanding and reconciliation of a happening.

Summary

Mindfulness has been defined as “remembering” who you are and what is important, every moment of every day (Epstein, 2017). This is no easy task given the river of demands, distractions, and pressures we face at work and at home. This session invites participants to reflect on the educator-learner relationships through a lens of gratitude using narrative writing. This engaging and experiential session invites conversations within oneself and outwardly with other participants with compassion, tenderness and playfulness. Background/Rationale: Even before the pandemic, healthcare practitioners expressed experiences of isolation and loneliness, despite working with patients and teams. Perhaps this has to do with missed opportunities to talk about what is important in our work, the underlying values, and the appreciation of meaningful work with a lens of gratitude for self and colleagues. Narrative medicine approaches have been shown to open a window to deepened reflection through the close reading of texts and the invitation to write from carefully chosen prompts. The practice of sharing written narratives with colleagues can deepen relationships and encourage curiosity across teams in an often fragmented workplace. The session will begin with an overview of narrative approaches to team-based healthcare education, followed by the sharing of two stories of mentor relationships. Participants will be invited to mine the stories for key themes, meaningful inspiration, and emotional resonance. This will be followed by an invitation to write and additional reflection time for the participants to share their own creations. Finally, the presenters will underscore the value of narrative writing approaches to healthcare education, team cohesion, and the enhancement of vitality, meaning and resilience in healthcare practitioners and teams.

Summary

Background: The Legal Clinic for the Disabled, a civil legal aid agency, has four Medical-Legal Partnerships (MLP) across seven diverse sites in low-income communities and developed best practices to implement and sustain MLPs. LCD’s partnership with St. Christopher’s Hospital for Children (SCHC) is a case example of MLP’s effectiveness. SCHC is in an epicenter of poverty where 66% of the children in the surrounding zip code live in poverty. SCHC and LCD established an MLP in 2011. The MLP embeds an attorney in SCHC’s primary care practice to address social determinants of health (SDoH) including housing and habitability, food insecurity, immigration, public benefits, domestic violence, and family law. Attorneys and healthcare personnel combine law and medicine to mitigate negative SDoH. Objective: Systematize screening in an outpatient practice to proactively identify legal issues and connect families with resources or immediate legal intervention to mitigate negative SDoH. Methods: Families received a 14-item SDoH screener during the visit. Providers reviewed the screeners, gave resources and/or referred to an onsite attorney. The attorney regularly trains healthcare staff on screening and substantive legal issues. Screening tools were collected and results compiled. Results: 39833 families were screened for unmet legal needs from August 2011 through December 2019. The number of screens increased each year (year 1=895, year 9=7591). Overall, 40% (10480) self-identified at least one unmet need. From 2011 to 2019, the rate of self-reported unmet need decreased (year 1= 74%, year 9 = 19%) while the service rate (legal assistance and/or resources) increased (year 1 = 27%, year 9 = 63%). Conclusions: The MLP successfully implemented SDoH screening in a busy outpatient practice. With this holistic approach, each team member’s role best utilizes time and capabilities. With efficient screening, triage, and referrals, many families have their issues addressed during the visit.

Summary

“It is extremely vital to care for women’s mental health during pregnancy and after childbirth during these unprecedented times (Usmani et al., 2021, p.1).” Perinatal mental health concerns for pregnant persons were already common and have only become more prevalent during the Covid-19 global pandemic (Farrell et al., 2020). Usmani et al. (2021) concluded that it is imperative to continue to think of ways for the healthcare system to address maternal health services during the pandemic. Spurred by an obstetrics (OB) physician who noticed Yakima County was particularly struggling with its maternal health with regards to substance use disorders, obesity related complications, interpersonal violence and high rates of smoking, Community Health of Central Washington (CHCW) created a pathway to help support pregnant persons. CHCW’s already established and robust PCBH service was fertile grounds for this innovation (Reiter, Dobmeyer & Hunter, 2018) and supported the focus of high productivity for the BHCs (Martin, Bridges & Cos, 2021). In 2018, CHCW launched this “initial OB” visit pathway for BHCs to increase their involvement with perinatal patients. This pathway proved to be enormously helpful for what would hit just two years later – the pandemic. CHCW saw this as an opportunity to continue to strive for support for this vulnerable population, and more currently attempts to answer Usmani et al.’s call for addressing maternal mental health. As Usmani et al. further explained and relevant for providers working in family medicine, “the mental health impacts of the pandemic are of great concern in postpartum women as it affects the wellness of not just the woman herself but the family and her children,” (p.9). This presentation addresses this year’s theme across many fronts including highlighting the work of the frontline workers who are taking care of OB patients. Additionally, and in light of the pandemic worsening the already pervasive experience of burnout amongst medical providers and taking into account there is some research that supports team-based care can help to mitigate burnout (Dillon et al., 2020; Zubatsky, Pettinelli, Salas, & Davis, 2018), we describe a team-based approach to caring for perinatal patients. This presentation is salient for anyone working in healthcare settings that provides OB services as well as family medicine and pediatrics. Specifically, in this presentation we present a program evaluation of this pathway. Metrics will be provided on number of OB initial visits we have conducted over the past four years as well as the number of unique patients served. We will also provide qualitative depictions and accounts from CHCW’s physicians, OB staff, patients and BHCs alike.

Summary

Approximately 17 Veterans a day die by from suicide, and rural-residing Veterans are 20% more likely to die by suicide than Veterans living in urban locations. As primary care settings are more likely to see patients prior to suicide and are the only places rural residents typically can access, primary care team members, including behavioral health consultants, need to have greater awareness and skills in suicide prevention. Prior research has shown that rural providers face several barriers in terms of suicide assessment and prevention including inadequate training, stigma, and lack of resources. This workshop is designed to provide attendees with knowledge and skills to increase confidence in providing care to rural primary care patients with suicidal ideation, with an emphasis on those who are Veterans. Participants will learn about unique suicide risk factors that prior research has found relevant to both Veteran and rural populations, such geographic isolation, and socioeconomic factors. They will also learn innovative practical strategies (e.g., useful metaphors, ways to structure questions) to talk about suicide and access to lethal means in a patient-centered way. Then, participants will be given the opportunity to practice these skills with peers while experts provide consultation and feedback to assist the learning process and ensure that they walk away with new skills for their next day in clinical practice.

Summary

Integrated care has been barraged with a wholistic health triad of disparities, encompassing physical, behavioral, and psychosocial health. Populations are reeling from mental health’s epidemic within the pandemic. Fresh iterations of trauma yield a complex interweave of comorbid chronic illness manifestation. Substance use, including opioids is at alarming levels. Value versus volume remains a reimbursement reboot run amuck! Engage in an innovative session that revisions the clinical, quality, and fiscal focus of population-health. Learn why wholistic health equity is a required fifth, or Quintile Aim, and integrated care’s next opportunity.

Summary

The environment created by the pandemic has caused strained and created inexplicable hardship. The rise of mental health concerns has created a second pandemic. Kids Count Data in Maine for 2021 indicates 20.2% of Maine children ages 0-17 reported >2 ACEs, teen depression rates are hovering around 16.1% and 16.5% of children ages 3-17 are experiencing anxiety. Child and teen suicide rate is at 8.5 per 100,000 deaths, putting us above the national average of 6.6. Demand for psychiatry has never been higher and, despite the tremendous need, shortages continue to exist, especially for rural and medically underserved populations. MaineHealth is working to address these gaps in psychiatric care by building an infrastructure of consultative support for primary care providers. Our goal is to enhance care, reduce burnout of primary care by providing timely support, and improve the health and wellbeing of our patients. One strategy was creating the Psychiatry and Primary Care Partnership (PPCP) for our system. The partnerships break down walls to allow primary care providers access to psychiatry when treatment regimens are proving uncertain. PCPs can message the psychiatry partner via the electronic health record (Epic) to ask questions and receive answers quickly. This also includes lunch and learns to further the PCPs knowledge and skill set around managing psychiatric conditions. When the pandemic hit, additional access to psychiatric support was vital in order to meet the rising demand of mental health in our pediatric population. The Child Health Access HRSA grant has provided funding for staffing to implement and coordinate synchronous consultations between a PCP and psychiatric provider. These consultations occur via Zoom and average thirty minutes. The grant allows dedicated time for training primary care teams in recognizing and treating an array of psychiatric conditions. A twelve week educational series on various topics was developed and made available to all providers in the state. E-Consults were the next option to be developed. These consultations include a review of the medical record, documentation in the medical record, patient consent, and patient co-pay. This approach allows for reimbursement and ultimately sustainability, documented recommendations, and increased psychiatry access for patients. Implementing the Collaborative Care Model is our next goal. We have several projects underway to move us towards this. We are currently funding consultative services from the AIMS Center to learn from their expertise as we develop our next option in psychiatric support to our colleagues in primary care. These consultative options for psychiatry, both synchronous and asynchronous, are beginning to provide the much needed respite and care necessary to assist our primary care colleagues in rendering the best care. While there remains a long road ahead, together we can make a difference in caring for patients.

Summary

The newly formed CFHA Collaborative Care Model (CoCM) workgroup identified a growing need and desire to learn practical ways to build robust behavioral health integration programs. Some programs desire to provide services on a continuum that includes both the primary care behavioral health (PCBH) and Collaborative Care (CoCM) models or that incorporates components of each. While both models are supported as effective ways to integrate, there is little guidance for how to create a program that incorporates both models, especially in systems that are not publicly funded (such as the Veterans Administration).

This talk will include a short didactic that will briefly outline the history of these models and ways that they differ and complement one another. The discussants will briefly provide examples of programs that provide services that span the continuum. This brief didactic will be accompanied by group discussion centered around 1) What tools or information does the field need to know to advance in this area? 2) What are the best practices in the field? 3) What are the biggest challenges in this field?

Participants will have the opportunity to discuss these important questions in the session AND will be able to hear the results of the discussion. The session will end with a summary of the discussion and will also inform the future work of the CFHA CoCM workgroup.

Summary

Mixed payment has been key to the success of behavioral health clinicians in primary care. Mixed payment methods ensure that BHCs receive payment for services above and beyond fee-for-service. Learn more about non fee-for-service payment methods that are supporting primary care behavioral health.

Summary

Covid-19 and the accompanying isolation and social unrest has strained even the strongest of relationships, both those in the personal and intimate realm and those in the interprofessional team-based realm. The wave of mental health distress tops any covid infection curve and does not dissipate after a ten-day quarantine. The need for integrated behavioral health in primary care has never been greater, to meet patient needs and to alleviate the stress burden and burn out of health care team members. This presentation is given by a physician and a behavioral health clinician with 15 years of experience partnering to provide integrated behavioral health in primary care in a community health center, and who also happen to be married. The parallels between actual marriage and the figurative marriage between the behavioral health and medical worlds will be elucidated. There has been extensive literature on principles of strong unions, as well as more recent data on the tenants of strong interprofessional work. Using the metaphor of secure interpersonal relationships, we will explore what pieces apply to successful professional partnerships, explore some of the common pitfalls of relationships in integrated care, and practice communication tools geared towards working through conflict, embracing interdependence, and strengthening connection.

Summary

Background: Implementation of behavioral health integration (BHI) in a practice varies depending on needs of the patient population, practice resources, and local workforce availability. Given this variation, there is no single model that will be the right fit for all practices in how they approach integrating care. Furthermore, practices often implement integration in a hybrid approach that blends elements of different models. Payers have expressed a need to understand what additional resources for BHI are used for and to have demonstrated accountability from practices. Objective: To develop a framework for BHI in primary care to inform the design of alternative payment models supporting BHI, align payer expectations, decrease administrative burden on practices, and achieve a level of standardization of BHI care delivery requirements that enhance patient care while still allowing for flexibility. Study design and procedures: (1) Milestones used for the Colorado State Innovation Model were examined to select items specific to BHI, (2) BHI milestones were refined and categorized into components of implementation approaches, (3) Other frameworks were reviewed to identify any gaps, (4) Key informants were interviewed using a semi-structured format and the framework was further refined based on feedback. Population sampled: 15 key informants were interviewed, including payers, patient advocates, policy experts, behavioral health providers, and primary care providers. Results: A framework was developed outlining foundational care delivery expectations for BHI as well as for additional components: integrated behavioral health professional, advanced coordination and care management, psychiatry, and advanced care of substance use disorders. Conclusion: This framework can be used by payers and policymakers in developing aligned alternative payment model strategies for BHI.

Summary

Health equity and health disparities are buzz words these days, and you may have a good understanding that BIPOC patients and providers struggle with less-than-adequate care and support in their work. You might have even learned in school about a couple particularly egregious experiments in history that resulted from racist beliefs, such as the Tuskegee experiment where African American men with syphilis were actively withheld proper care. However, there is more to racism in the medical and behavioral health fields. While an hour will just scratch the surface, we invite you to learn your own history and gain a better understanding of how racism has warped the views of medical and behavioral health providers in the U.S. in the past and how it continues to have an influence today.

Summary

An essential function of the primary care behavioral health (PCBH) model is to integrate services so that patients may access and utilize healthcare resources more easily and effectively. Integrating behavioral health within all aspects of healthcare delivery provides opportunities for patients to become more engaged in their care and contribute to shared decision-making and treatment planning. The goal attainment scale (GAS) is an excellent vehicle for promoting more active patient participation. The GAS is a measure that can be co-constructed with the patient to operationalize and quantify key health behaviors related to their goals. Using this instrument, the patient’s goals can be both individualized and standardized. Facilitating individualized goals provides personalized, patient-centered care. Creating a standardized methodology for self-monitoring and reporting progress provides a well-validated process for measurement base care. Thus, the GAS enables the patient to monitor progress toward their health goals using clearly defined, behavioral metrics. Further, these operationalized behaviors can be shared across behavioral and medical members of the care team to enable greater consistency and continuity of support for the patient’s treatment plan. This presentation will provide guidance for providers across disciplines to incorporate the GAS into their patient encounters in primary care. Common primary care patient concerns will be presented, and participants will be challenged to develop working GAS measures to address them. The presentation will conclude by discussing broader applications of GAS, including applications for improving team-based care and integration, promoting structured training experiences for learners, and the incorporation of technology when using the GAS for measurement-based care.

Summary

In Spring of 2020, we entered an unprecedented era for Healthcare providers that continues to persist and challenge the roles of caregivers. The COVID-19 pandemic, coupled with heightened pressure due to workforce shortages saw employees (referred to as caregivers) at Providence Health System face ever increasing feelings of burnout, stress, and anxiety, including suicidal ideation. We knew that we could not wait, nor could we rely on a short-term fix. Caregiver wellbeing and mental health is core to who we are as an organization, and foundational to our ability to live into our promise of “know me, care for me, ease my way” that guides how we engage with one another, with patients and with our communities. As a result, No One Cares Alone was established, serving as an umbrella for a suite of pro-active and reactive caregiver mental wellness programs aimed at increasing access to wellbeing resources for 120,000 healthcare professionals and supporting our commitment to zero suicides. Caregiver engagement in employee assistance program services subsequently increased by 100% and over 240,000 digital engagements. This workshop tells the story of how cross-functional departments and geographic regions came together in a time of need to establish a nationally recognized ecosystem of research-informed and innovative programs.

Summary

Chronic pain is common in primary care. Twenty percent of adults report chronic pain and seven percent report high-impact chronic pain that “frequently [limits] life or work activities” (National Center for Health Statistics Data Brief, 2020). Furthermore, a bidirectional relationship exists between chronic pain and medical and mental health and well-being, so chronic pain has far-reaching consequences for millions of people. Clinicians need to provide high-quality, compassionate care for patients suffering from chronic pain while minimizing the risk of harmful treatments, particularly inappropriate use of long-term opioids. Multimodal treatment of chronic pain is essential for maximum treatment outcomes, and behavioral health interventions, such as cognitive behavioral therapy, mindfulness therapy, or relaxation training, are essential (Department of Health and Human Services Interagency Task Force Report, 2019). Therefore, improving the capacity of primary care to provide meaningful treatment of chronic pain lies at the intersection of increasing the primary care behavioral health workforce and creating scaffolding for primary care teams to implement effective behavioral interventions for chronic pain. Our presentation addresses how we can improve the capacity and preparedness of primary care behavioral health to achieve meaningful results in the treatment of chronic pain. First, we review the challenges faced by clinicians and patients with regard to the scope of chronic pain and access to effective, safe, and sustainable treatment. Second, we describe our efforts to improve the primary care behavioral health provider pipeline through use of a pre-professional training program. Third, we highlight the creation of a team-based clinical care pathway for the treatment of chronic pain intended to improve utilization of evidence-based multimodal interventions for the treatment of chronic pain.

Summary

Forte Wellbeing, a Phoenix-based multidisciplinary and holistic medical home, has designed lifestyle group programs and standard workflows to be grounded in community and individuals’ capacity for behavioral change. According to learning theories, participating in a new, complex behavior, such as moving from a sedentary to active lifestyle, typically requires learning small components of a complex behavior due to physical, mental, emotional, social and environmental barriers that complicate lifestyle change. Forte’s care model is designed to break down barriers to health behavior change by aligning patients with the appropriate services and providers while considering patients’ readiness to change, the context of their life and the complexity of their health needs. Forte is based upon world class improvement methodologies (Lean) with data-based decision making and utilization of analytics to create an operationally sound, innovative and scalable care model which puts the patient at the center of a reimagined medical home.

Summary

The United States continues to face a behavioral health crisis that has worsened due to the COVID-19 pandemic. In 2021, nearly 40% of adults reported symptoms of depression or anxiety, an increase from 10% in 2019. The behavioral health crisis is also acutely impacting children and teens, with suicide the second-leading cause of death among those ages 10 to 24. A national 2020 survey also found that 71% of parents felt the pandemic had affected their child’s mental health. Despite the clear need for increased access to behavioral health services for both adults and children/adolescents, there is a persistent and severe shortage of behavioral health providers.

Behavioral health integration (BHI) is essential to resolving the nation’s behavioral health crisis. Furthermore, the current shift in the U.S. health care system toward digitally enabled care presents a unique opportunity to enhance BHI and engage more people in behavioral health treatment.

This interactive presentation from the American Medical Association examines the opportunities and challenges of accelerating BHI through digitally enabled care, expanding on their recent report with Manatt Health. You’ll also hear about the practical solutions stakeholders across the health care ecosystem can pursue to advance digitally-enabled BHI.

Summary

As COVID-19 is entering an endemic chronic phase, we are facing growing poor mental health and emerging prolonged health issues across the lifespan. These consequences will increasingly present themselves in healthcare settings. How can we best help patients and their families/key networks with both relational and longer-term health and mental health sequelae and ongoing uncertainties of the evolution of the pandemic/post-pandemic? Using a multisystemic family-oriented lens, this presentation highlights strategies to foster resilience, family relationships repair and healing, and meaning-making of the COVID-19 experience. We address such issues as (a) family depletion, residual distancing, intolerance, cutoffs; (b) communication amongst family members and with healthcare providers that hinder or promote optimal COVID-related health behaviors; (c) long-term COVID-19 health and cognitive complications (“long-haulers”); d) divergent family member perspectives and beliefs about ongoing COVID-19 precautions based on different historical, cultural, political, and ideological filters; (e) complicated loss and bereavement, racial injustice, and socioeconomic disparities Through the intervention of family-centered consultation, this presentation will offer strategies to address the nuanced and lingering biopsychosocial-spiritual impacts the COVID-19 pandemic has had on individuals and families. In a post pandemic world, consideration needs to be given to all relational systems that come into contact with the public health, and healthcare sectors.

Summary

Every day, patients may possibly be started on one or more psychotropics for their depression, anxiety, ADHD, and/or insomnia. There is negative stigma towards taking these types of medications or they may not take them at all for fear of adverse effects. After medication initiation, they may discontinue it shortly afterwards without giving it the chance to be effective. However, there may be words of advice that may be given to prevent this and increase the chance for success. This presentation will go over those frequently asked questions in these common psychiatric disorders. Hopefully the psychiatrist perspective and subsequent responses to those questions may be beneficial to our work in integrated primary care. The target audience is for any clinician with an interest in learning more about what to say or not say to patients’ medication questions or at least know where to direct them so that they are not misinformed. When left to their own devices, who knows what patients will find on the internet? All disciplines are welcome. Handouts will be provided. 5 minutes: Introduction 10 minutes: FAQs for depression 10 minutes: FAQs for anxiety 10 minutes: FAQs for adhd 10 minutes: FAQs for sleep 5 minutes: Websites/resources for psychotropic medications 10 minutes: Q & A

Summary

Participants will learn about value-based payment (VBP) models, including the opportunities, challenges, incentives, and disincentives of each approach. We will review the steps necessary to determine readiness for VBP, including the role of Integrated Care providers during this cultural shift. Further, participants will learn strategies for developing a business case for VBP to ensure the sustainability of Integrated Care programs.

Summary

This workshop will introduce learners to three essential skills needed for brief primary care behavioral health encounters. The skills include rapid engagement, a focused assessment, and brief intervention. The session will begin with an overview of the relative importance of each skill to primary care encounters. We will introduce clinical scenarios in which a clinician might need to place more, or less emphasis on one skill or another depending on the context and the patient’s presenting concerns. Learners will be challenged to consider their own practice preferences and behaviors and to consider the relative importance they place on each of the core skills discussed in this training. Next the workshop will include approximately 20 minutes of small group work applying this framework to case vignettes. Participants will be asked to discuss how they would balance the emphasis on engaging, assessing, and intervening. The vignettes will represent patients with diverse medical and behavioral needs. Finally, we will introduce participants to a self-assessment tool that BH clinicians can use to reflect on their use of these skills after a clinical encounter. This tool will be discussed, and learners will be asked to reflect on how this tool can support their own practice as well to help train others. Draft Agenda 0 – 5 minutes. Introductions and agenda 5 – 25 minutes. Lecture with examples that illustrate balance between engagement, assessment, and intervention. 25 – 45 minutes. Small group discussion of 2-3 vignettes. 45 – 55 minutes. Review a tool for monitoring your own use of engagement, assessment, and intervention. Discuss use of tool for onboarding new providers as well as supporting new providers. 55- 60 minutes. Wrap up and final questions

Summary

Introduction: Primary Care Behavioral Health (PCBH) workforce development is of great need due to the growth of behavioral health (BH) integration into primary care, specifically at a time when behavioral health needs are increasing because of the COVID-19 pandemic. BH supervisors are often asked to supervise pre-licensure level masters and doctoral behavioral health trainees with little to no support from their organization or the host institution of the trainees as clinical supervision is provided in addition to their full-time clinical and administrative duties. Additionally, it is imperative to provide current and future behavioral health clinical supervisors in primary care settings support and guidance when engaging in clinical supervision in primary care, given there is no formal training to become a BH clinical supervisor in primary care. Methods: Fourteen clinical supervisors participated in 13 communities of practice (CoP)-focused workshops focused on clinical supervision within the Primary Care Behavioral Health (PCBH) model over a 4-year prior. These workshops occurred twice a semester (in person and virtually) for supervisors hosting students participating in a Health Resources and Services Administration (HRSA) Behavioral Health Workforce Education Training (BHWET) grant focused on preparing masters-level clinical mental health counseling students to function as Behavioral Health Consultants (BHCs) in primary care settings in rural and urban areas. Clinical supervisors completed a post-workshop survey after each workshop, providing their feedback not only on their satisfaction with the content but the impact of the workshop content on building their skills providing clinical supervision within the PCBH model. Results and Discussion: Clinical supervisors were satisfied with the content presented during the CoP workshops as well as indicated improvements in their confidence with providing clinical supervision within the PCBH model. From 58 feedback surveys over 13 supervisor workshops, supervisors reported anywhere from “Proficient – Complete and up-to-date information” to “Expert – Complete and up-to-the minute information (presenter is clearly a subject matter expert)” on material presented and on their understanding of the material. Areas of improved confidence and competence included supervision in integrated health care settings, topics discussed in primary care, and telehealth visits. Overall, this demonstrates an approach to building clinical supervisor confidence in working with pre-licensure trainees within the PCBH model. CoP workshops show promise as an approach that institutions of higher education and health care organization can adopt to improve clinical teaching and clinical supervision in primary care as well as support clinical supervisors in the community who work with trainees in primary care.

Summary

As we all know, the covid pandemic has created an unprecedented need for integrated behavioral healthcare providers. At the same time, students in master’s level clinical training programs are facing additional challenges in obtaining the field-based training that will support their readiness and confidence in entering the workforce after graduation. Today, we will explore three distinct versions of training partnerships between our FQHC and local masters-level trainees that are mutually beneficial in meeting the training needs of the student clinicians, while also serving to build a behavioral health workforce and increase our clinics’ capacity to meet the needs of our communities. We will review the educational and/or licensure requirements for masters-level psychiatric nurse practitioners, mental health counselors, and clinical social workers. We will then discuss the ways in which our FQHC partnered with students from these disciplines to meet the needs of the individual trainees, while simultaneously supporting the goals and values of our healthcare organization. Considerations related to billing, financial sustainability, and organizational ethics will also be briefly discussed. By the end of this presentation, participants will have learned about how to identify potential training partnership opportunities in their specific geographic areas, as well as initial steps to begin creating these training programs. Lastly, and consistent with this year’s conference theme of celebrating frontline integrated healthcare workers, throughout this presentation we hope to highlight the meaningful contributions to healthcare made by students, trainees, and early career masters-level clinicians.

Summary

Background/rationale: The use of integrative models of care represent best practice for the treatment of anxiety and depression among primary care patients of all ages and with minority populations. Integrated models of care improve coping strategies and adherence to medications, which may in turn improve a variety of outcomes associated with the burden of chronic disease. Patients report improved satisfaction with access to integrated care in the primary care settings with which they are already familiar. Providers also report significant improvements in satisfaction related to access, quality, and continuity of care. The purpose of this evaluation was to assess provider satisfaction with an integrated behavioral health clinic (BHC) situated within a rural primary healthcare clinic. This abstract represents a work in progress; outcomes related to patient satisfaction and the management of Type II Diabetes will be included in Oct. Description of population sampled: Over a six-year period, responses to an annual provider satisfaction survey (n=244) were included in a dataset. Descriptive analysis confirms that respondents were representative of the clinic’s provider population. All provider types (including part-time) were included. Study design: A retrospective, observational study design was utilized to examine pre-existing, de-identified data using the RE-AIM framework. Procedures and measures used: Data were complied by clinic staff and shared with independent researchers for analysis. A variety of objectively measured outcomes were assessed according to the RE-AIM framework (Reach: baseline characteristics of cohorts, Effectiveness: satisfaction, Adoption: program utilization, Implementation: qualitative report of adaptations over time, Maintenance: trending scores, staffing plan) and will be presented. Provider satisfaction was assessed with a clinic-authored scale that met criteria for face validity and has been used consistently over a five-year period. Key Results: Between 2016 and 2021, 244 surveys were included in the initial analysis of provider satisfaction. Sixty four percent of respondents were female. Respondents represented all provider types: 52% MD, 30% DO, 9% NP, 9% PA. The vast majority of providers (98%, n=235) were highly satisfied with the integrated services, and 74% (n=177) thought the services were extremely helpful to their patients. 85% (n=202) thought that patients were better able to manage medication regimens after seeing BHC. 96% (n=231) thought that having the BHC made their job easier. Recommendations for improvement included back-to-back scheduling to facilitate co-visits, hiring more staff for faster access, and offering Spanish-speaking counsellors. Respondent explained that the benefit of having a BHC was being able to “off load interventions I am not very good at to someone who is.” Conclusions: The integration of a BHC within a rural family practice was highly satisfying to primary care providers.

Summary

Background: Essential components of the Primary Care Behavioral Health Model (PCBH; Reiter, Dobmeyer & Hunter, 2018) have been summarized using the GATHER acronym: Generalist, Accessible, Team Based, High productivity, Educator, and Routine pathways (Robinson & Reiter, 2016). Despite a growing evidence base for PCBH, the “E” in GATHER remains an understudied, yet potentially impactful component of the model. The first aim of this presentation is to present results from a pilot project highlighting how Behavioral Health Consultants (BHCs) can use microteaching (brief, targeted teachings) during warm handoffs and other clinic-based interactions to teach clinical and team-based care skills to members of the primary care team in a way that is feasible and acceptable. Our second aim is to introduce participants to 5 microteaching skills that are components of the One Minute Preceptor (Neher, et al, 1992), so they can begin to conduct microteachings themselves. If given the opportunity for a 60-minute presentation, we will expand on this second aim and provide introductory training in how to conduct microteachings via experiential teaching methods, consistent with adult learning theory. Study design and population: Twelve BHCs participated in a 1-hour training on microteaching and then tracked their teachings in a shared Excel file. After three months, BHCs and physicians rated how feasible and acceptable the microteachings were via the Acceptability of Intervention Measure and Feasibility of Intervention Measure (Weiner et al., 2017). Results: Data over the first year of implementation will be presented. As an example, in the first three months BHCs provided 269 instances of microteaching with 66 residents (66.7%) across five clinics. These microteachings occurred across warm handoffs (n = 138, 51.3%), curbside consultations (n = 78, 29.0%), debriefs (n = 46, 17.1%), and team huddles (n = 7, 2.6%). BHCs and residents rated the microteaching interactions as acceptable and feasible. Since this is an ongoing study, our team should have updated data to present by October.

Summary

Patient satisfaction has long been used as a method of measuring the quality of care patients receive from their mental health services (Fortin et al., 2018). It also plays an increasingly important role as the healthcare industry moves toward value-based care models (Hirpa et al., 2020). However, creating and implementing satisfaction survey processes can be time-consuming and challenging to integrate into everyday workflows. In this presentation the speakers will demonstrate how to plan, implement, and evaluate a patient satisfaction survey process in an organized and cost-effective manner based on clinic or program needs. A panel of speakers will provide an overview of how a patient and parent satisfaction survey process was planned and implemented within a newly established pediatric integrated primary care program with multiple clinic locations. The speakers will outline each step of the process of planning, such as goal setting and identifying stakeholders. The process of preparing materials, communicating with appropriate staff, and anticipating possible challenges to implementation will be discussed. The speakers will also discuss how to collect the survey data and evaluate the results with consideration to the size of the program and frequency of survey distribution. Therapists on the panel will also share their experience with the patient satisfaction survey process and how the feedback from patients has impacted their work. Attendees will be given worksheets that they will use to guide them in outlining plans for implementing their own patient satisfaction process. A portion of the time will be spent working in small groups to allow attendees to discuss their own survey process and work through potential barriers and questions within a group format. Additional handouts with recommendations for goal setting, question topics, and specific data points to consider when constructing the survey will be provided.

Summary

Over 46.6 million Americans suffer from mental illnesses, yet a majority are treated solely with medication, despite consistent documentation that over 50% prefer having psychosocial treatments as part of their care. Ethnic minorities, older adults, and people living in rural areas are at greatest risk of not receiving psychosocial treatment, despite their preference for this treatment. The U.S. has a shortage of mental healthcare specialists, with nearly 120 million Americans living in federally designated mental health provider shortage areas. There is strong evidence that training bachelor level (BA) people in evidence-based strategies results in far better access to this care and greater clinical and societal outcomes. Other countries around the world have used this model to overcome these shortages of professionals. Training BA level practitioners to deliver evidence-based psychosocial interventions will overcome racial, ethnic, age, SES, and rural disparities in access to mental health care, resulting in high societal impact. The Biden administration as of March 2022 encouraged piloting new approaches in the preparation and education of bachelor level paraprofessionals as part of a comprehensive plan to address the national mental health crisis. Based on the initiative in the United Kingdom to train BA behavioral health support specialists in structured, low intensity, evidenced based interventions, the University of Washington Department of Psychiatry and Behavioral Sciences, with support from the Ballmer Foundation, is developing a curriculum that will be available to higher educational institutions to incorporate into existing behavioral health programs. The curriculum will include use of an intelligent tutoring system to advance self-paced skill development outside of the classroom; training in structured, low intensity, evidenced based patient activation and cognitive behavioral strategies; and measurement-based care. As the result of completing the curriculum and subsequent supervised practicum, graduates will be prepared to deliver interventions under supervision. This new paraprofessional role will be defined by a state certification process. This presentation will engage the audience to explore the opportunity to train and deploy this new BHSS workforce to support care delivery within integrated care settings. We will also review potential opportunities for this new BHSS workforce to engage qualified individuals in seeking graduate level training.

Summary

Stress overload is the new pandemic and a root cause of a broad range of problems, from mood disorders to addictive behaviors in patients to burnout among healthcare workers. Research has shown that traditional cognitive methods may fall short of switching off stress at today’s unprecedented levels, so new skills for stress overload resilience are urgently needed. Emotional Brain Training (EBT) is a structured method based on the latest neuroplasticity and neurophysiology research, which treats stress by switching off reactive stress circuits and activating resilient circuits. The self-directed activation of circuits that promote homeostasis and healing chemicals and deactivation of the chronic activation of the cortisol cascade is an emerging approach in healthcare. It targets the neural root cause of stress-induced epidemics of mental and physical health problems. EBT was initially designed as part of a federally funded Leadership Training Program in Adolescent Health at UCSF with the tools used by children and adolescents. Later, the method was adapted to treat stress-induced emotional and behavioral health problems in adults as a neuroscientific psychotherapy. The resilience tools process emotions in a novel way that is rapid, with patients often experiencing relief in two to three minutes. More than 500,000 people of diverse backgrounds and ages have used these techniques. EBT focuses on the mastery of five core skills of optimal resilience that are designed to combat activations of trauma circuits, wires encoded during adverse childhood experiences, and exposure to the ubiquitous stress overload in modern life. The goal of disseminating the tools is to equip the US population with skills that enable them to protect themselves against the stress overload of our times and support the efficiency and effectiveness of healthcare. There is one skill for each of these causes of stress: 1) situational stress overload, 2) stress reactivity that triggers mood, behavioral, and relational problems, 3) core ineffective beliefs associated with an insecure attachment style, 4) trauma and fear memories, and 5) grieving. Participants will experience the fundamental mechanism of EBT, which is to use a simple, structured emotional process to deactivate the stress-induced “emotional blockade” (e.g., anxiety, depression, panic) of stress overload that thwarts resilience followed by expressing positive feelings. This process was designed to deactivate the HPA axis and quiet the cortisol cascade. A behavior change technique completes the process. Participants will view demonstrations of using the most impactful skill (situational stress overload) and access a free, downloadable mobile app to facilitate applying the skill in clinical practice. EBT can be added to any treatment modality and used across the spectrum of preventive and therapeutic services to apply the latest neuroscience to deactivating stress reactivity and promoting resilience and flourishing.

Summary

During the COVID 19 pandemic, there has been an unforeseen tension in the beliefs around the legitimacy of the virus and its mitigation and treatment methods in both the U.S. and the UK. Medical providers have been thrust at the forefront of what can feel like a battle between science and personal/family/cultural/political beliefs. As a result, an `us versus them’ mentality has arisen, making it challenging to maintain trust and faith in the doctor/patient relationship. At best, this challenge has been dealt with in mutually respectful `agree to disagree’ ways. At worst, it has caused significant rupture in these relationships, contributing to provider feelings of moral injury, burn-out, and anger. There is not yet much research data on this phenomenon, but it has been observed through both news outlets and anecdotally across healthcare systems. In the U.S., there is preliminary data indicating physicians and other frontline healthcare workers have experienced a significant increase in burnout, and as of Nov 2021, about 20% in the United States have quit healthcare. Similarly in the UK, although healthcare providers were clapped in the street and hailed as heroes early in the pandemic, political dynamics within the healthcare system as well as burnout due to overwork has resulted in 24% attrition of General Practitioners (PCPs) by middle of 2021. There are numerous reasons for this exodus, and challenges with patients and families who disagree on masking, vaccinations, and treatments are among them. The purpose of this presentation is to highlight and provide context of how disagreements over illness beliefs have impacted provider/patient-family relationships through personal accounts from frontline healthcare workers, explore how concepts related to power, control, and outside influence in these relationships have intensified during COVID 19, further contributing to relationship fracture, and discuss evidence-based emotional-regulation strategies that can help reduce conflict in relationships and promote resilience.

Summary

Healthcare professionals are facing a historic volume of patients – leading to increased workloads and complex patient journeys that are challenging to manage. Partnerships that encourage communication and data-sharing across interdisciplinary healthcare professionals delivers improved patient outcomes by reducing clinical burden for providers, among other benefits. In a session designed to effectively illustrate the power of partnerships, you will hear from evolvedMD, a leading behavioral health services integration company, and NeuroFlow, a best-in-class technology and care services company for integration of behavioral health, leadership on how healthcare services and technology can come together to provide meaningful and effective solutions to both patients and behavioral health providers. Through this innovative collaboration, evolvedMD behavioral health providers utilize NeuroFlow’s cloud-based registry to enable real-time collaboration and management of patient panels with straightforward time-tracking and documentation, helping to scale psychiatric collaborative care (CoCM) at 24-primary care clinics throughout the southwest. Bridging and continuing care between appointments, patients have access to NeuroFlow, a behavioral application offering evidence-based resources and tools to support overall health. This partnership brings together high-tech and high-touch care, providing patients with proactive, personalized support while simplifying clinical workflows. Moreover, evolvedMD also offers NeuroFlow to their employees to support mental and behavioral health, and to provide behavioral health providers the opportunity to personally experience the positive impact of technology-enabled integrated care. In this session, we will provide an overview of evolvedMD and NeuroFlow and detail how this partnership has overcome specific challenges of integrated behavioral health (10 min). Next, we will highlight behavioral health providers’ experiences of utilizing NeuroFlow as a tool in the care they give to patients, and as a personal wellness tool (5 min). Lastly, we will identify how other integrated care settings can form a similar partnership (5 min). The remaining time will be Q&A (5 min).

Summary

Peer specialists are individuals in recovery who have training and professional roles offering support to others facing similar situations. Fitting with the conference theme, peer specialists are members of the integrated primary care (IPC) workforce who contribute to delivery of patient-centered care. This study explored implementation considerations associated with various roles for peer specialists in IPC settings. We will present qualitative data from an exploratory descriptive mixed methods study of key stakeholder feedback on integrating peer support into primary care. We conducted semi-structured interviews with 19 providers (7 Veteran peer specialists, 6 primary care providers, 6 integrated behavioral health providers) and 15 primary care patients recruited from the Syracuse VA Medical Center to examine perceived strengths and challenges with a variety of roles for peer specialists in IPC (e.g., patient navigation, leading groups). We used conventional content analysis to inductively develop codes from the data. Commonly perceived strengths of peers included their lived experience with recovery, their ability (vs. other providers) to share more personal experiences with patients, patients being more honest or receptive with peers (vs. other providers), and the innate comradery that exists among Veterans. Commonly perceived potential challenges included peers needing additional support, supervision, or training to fulfill certain roles; lack of clarity on peers’ role or scope; and possible difficulties establishing rapport if peers and patients are demographically dissimilar. Overall, patients and IPC staff perceive a variety of benefits related to improving patient comfort and trust from having peer specialists serve in various roles, alongside potential implementation challenges. Our findings can help inform clinical practice, implementation of peer support, and future research on peer support in IPC.

Summary

Given the complex demands of integrated behavioral health care, initiating quality improvement and program evaluation projects can be challenging. However, by leveraging evidence-based practices and planful clinical documentation, the barriers to engaging in program evaluation can be lowered. For example, routine outcomes monitoring is an important part of evidence-based practice, and providing feedback to patients can result in improved functional outcomes. However, research suggests that despite recognizing their benefit, many clinicians do not use outcome measures regularly. This presentation will review how behavioral health consultants (BHCs) working in integrated primary care settings can implement ongoing clinical data collection into standard practice and convert existing data into the foundation for program evaluation. We will also discuss how BHCs can apply principles of routine outcome monitoring (i.e., data collection and feedback) to drive interdisciplinary collaboration and warm handoffs. First, this presentation will discuss how outcomes monitoring and basic clinical data collection can be integrated into routine clinical practice. Attendees will be provided with examples of brief measures of functioning and quality of life that can be built into clinical service. Next, attendees will participate in a focused training on how these data can be used to improve their service and drive increased collaboration through case examples and facilitated discussion. Using the theoretical framework of routine outcomes monitoring, attendees will have the opportunity to engage in targeted exercises to develop a working plan they can bring to their own practice, focused on identifying specific team-based behaviors they would wish to monitor and encourage. We will also review specific strategies and tools for converting clinical charting and outcomes data into visually engaging and practical diagrams to improve team-based collaboration through feedback. Attendees will be engaged through brief focused didactic content, handout-led discussion, and small group workshop exercises to apply concepts, led by and designed for BHC’s to bring to their own clinical settings. Attendees will leave this presentation with increased knowledge, practical skills, and specific tools to increase and streamline the connection of their clinical workflow with quality improvement and program evaluation aims.

Summary

Managing stress, burnout, and vicarious trauma are longstanding issues for the health and behavioral health workforce (HBW). The Novel Corona-virus pandemic has amplified routine burnout to record levels. Practitioners and patients are amid a new dynamic of Collective Occupational Trauma (COT).. This reality has put the Quadruple Aim in peril with increased workforce turnover, staff shortages, costs, and quality challenges. A tidal wave of issues has hit every practice setting: the incidence of workforce mental health, burnout, and staff attrition at record levels. Servant and transformational leadership models are assets, but challenging times mandate a fresh approach. Transitioning to Trauma- informed leadership (TIL) has become the latest industry, “shift and pivot” moment. Engage in an empowering presentation that details how to infuse the elements of trauma-informed care into effective leadership operations. Experience why TIL is your answer to workforce sustainability!

Summary

Electronic health records (EHRs) have been touted as a key facilitator of improved patient care and outcomes. EHRs can help patients receive optimal care by improving communication among health care team members, promoting timely access to information at the point of care, standardizing care processes, and providing clinical decision support. The creation of learning health systems–in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation of the EHR–are dependent on our ability to modify EHRs to meet emerging care delivery and quality improvement needs. Despite this, many EHRs are not optimized to support delivery of quality improvement initiatives or interdisciplinary team workflow optimization. Moreover, although many EHRs contain large volumes of patient-level data, poor organization of data fields across multiple windows, duplication, and other issues create information overload for clinicians and hinder the usability and application of data to interdisciplinary team clinical decision making and care delivery, which can result in suboptimal care or patient harm. This presentation a) describes how one integrated health care delivery system modified its EHR to accelerate the implementation and evaluation of an interdisciplinary, integrated care EHR workflow for behavioral health concerns; b) outlines a specific process other health care systems may employ to bring their EHR workflows in alignment with interdisciplinary team goals in support of improved patient care and outcomes generally, or around specific presenting concerns or processes. Topics will include, but are not limited to: a) understanding the varying workflows of the interdisciplinary care team members and how to involve them in the EHR front-end redesign; b) strategies to improve documentation and uptake of the workflow from clinical staff via increasing buy-in and streamlining documentation workflow processes; c) approaches to training and retraining on new EHR processes.

Summary

People living with Serious Mental Illness (SMI) are at significantly increased risk of chronic health conditions and negative health consequences than those without SMI. Integrated Care is not a novel concept; it is becoming increasingly common to embed behavioral health providers and services into various medical care practices (primary care, hospital units, emergency departments, pharmacies, even some big box stores. Less common, however, is “Reverse Integration”, and thinking of the behavioral health provider as the “health home”, embedding medical services and resources into behavioral health clinics. This presentation will review base rate data at a large community mental health center. We will examine the following relationships utilizing data from a depression screener (PHQ-9), Health Information Exchange (HSX), and 5 Physical Health Questions asked of all our clients: 1. Does self-report of chronic medical illness and Emergency Department (ED) usage correlate with HIE and claims data?; 2. Do clients with higher behavioral health needs (i.e., more severe depression) experience higher rates of chronic physical health conditions and/or ED utilization?; 3. Do rates of chronic physical health conditions differ by severity of depression and/or mental health diagnosis? The target population for this program is program leaders and clinicians who work with people who live with SMI, and particularly clinics interested in Reverse Integration. Too often, when we discuss integrated care, we fail to focus on the medical needs of those in Behavioral health clinics, and instead focus resources on medical clinics serving those with co-occurring SMI. It is vital that we approach integrated care from a truly holistic and bidirectional point of view, recognizing that health homes may have different points of origin.

Summary

In this presentation, I will lead a discussion around the decision and build up to hire more than 20 Behavioral Health Clinicians at our organization less than a year during the pandemic. I will discuss strategies that were used to recruit and train all of the providers in a timely manner in addition to lessons learned during the process. Onboarding process will be discussed, including the use of mentors. I will have data on turnover, makeup of the team and feedback on from training.

Summary

Children spend the majority of their time in school where academic and many behavioral health needs are addressed. For example, many schools utilize multi-tiered systems of support to deliver behavioral health prevention and intervention programs to students in need. The school system and special education supports can be difficult to navigate. When children are having difficulty in school, families often first seek support from their primary care providers (PCPs). With the impact of the COVID-19 pandemic, direct interaction with teachers and school staff were limited (Liu, Bao, Huang, Shi, & Lu, L. (2020). Now as schools reopen and work towards the promised “return to normal”, the need to address students’ social, emotional, and academic needs has only grown. Given these challenges, medical providers are receiving even more requests for school and behavioral health supports (Armitage & Nellums, 2020). These needs have been even greater for underserved and minority populations due to the growing needs for behavioral health supports and the often-limited access to high quality care. Thus, primary care offices are often where families initially seek support. Integrated behavioral health consultants (BHCs) who have expertise in special education and training in schools can support pediatricians and families in navigating the nuances and complexities of the school system (Sheridan et al., 2009). Additionally, BHCs can facilitate multi-disciplinary collaboration across systems to best support the child (Sheridan & Kratochwill, 2007). Front line health care workers and teachers have been two professions challenged most through the pandemic. The presenters will discuss the even greater need for cross system collaboration since the pandemic and explore case examples of successful BHC, PCP, and teacher collaboration. Examples will be introduced on ways to successfully collaborate across multiple settings using data-based decisions to support children’s academic and behavioral health needs. Attendees will then be presented a case and given a worksheet to complete on how specific pediatric concerns (e.g., anxiety, disruptive behaviors) may look at school, the PCP’s office, and in therapy. They will then work to generate recommendations for each setting with understanding of potential barriers. A handout with guidelines for case conceptualization and coordination of care will be provided for future use.

Summary

Kaiser Permanente Northwest Region (KPNW) is a fully integrated delivery system located in Oregon and Southwest Washington. The organization has adopted the Primary Care Behavioral Health model (PCBH) within it 16 primary care clinics and currently employs 45 Behavioral Health Consultants (BHC) serving over 630,000 members. PCBH has evolved at KPNW over the past five years; creating greater opportunities for operational changes to support patient care and sustainability of the workforce. BHC are among the frontline staff carrying the burden, alongside medical clinicians and staff, of providing care for individuals and communities impacted by the pandemic. Unlike most presenting issues seen in primary care, BHCs are living with the losses, stressors and fears that effect their patients. In the ever-changing climate of the pandemic, there were continual changes to respond to. The accumulation of increased stress, patient demand and rapid changes contributed to higher volume of burnout and decreased moral. There was a strong need for leadership to support the BHC workforce particularly from an operational approach. The templates for BHCs scheduling were a reasonable place to start operational change. Not only was sustainable support needed for the frontline behavioral health staff, but there was an identified need to move more toward fidelity of the PCBH model. This shifted allowed for an increase “in the moment’ warm hand-offs, enhanced BHC flexibility for the various demands within primary care, and a facilitated an increase in BHC’s sense of control of their schedule. The previous template was frequently filled in advance, reducing opportunities for true warm hand-offs, less flexibility for patient needs and contributing to the BHC’s burnout experience. In a partnership between management and BHC staff, a new template and new workflows were created and piloted at two clinics. The new template developed what is called “BHC Directed” time. This new slot type designated 15-minute windows of time for BHC utilization. This flexible utilization includes warm hand-offs, care coordination/case management and supports the many additional tasks of BHC work. After several months of testing the model, the pilot rolled out to the rest of the region, allowing for increased communication with doctors and in-the moment warm hand-off both in-person and virtually. The template formula continues to be perfected but KP has demonstrated success in balancing the number of schedulable visits (same-day and future) and “BHC Directed” slots in order to align with the GATHER acronym and spirit of PCBH. We would also like to share how this template is utilized throughout the day by BHC and primary care staff, share examples of our template library, and the formulary used of same days visits to future schedulable appointments to maintain access, flexibility and meet productivity expectations.

Summary

We know the pandemic has been particularly hard on frontline clinicians and BHCs (and their respective leaders) are no exception. When organizational leaders and clinicians alike are facing obstacles such as the ones surfacing in these unprecedented pandemic times, it is common to go into preservation mode and to let quality control and other “requirements,” such as the peer chart review process, suddenly “go by the wayside” or to be moved to the bottom of the “to do list.” However, implementing (and maintaining) peer chart reviews in primary care and in other healthcare settings are often mandatory and they can also be instrumental in the pursuit of delivering high quality healthcare (Staton, Kraemer & Patel, 2007). Additionally, with regards to Primary Care Behavioral Health (PCBH), the peer chart review process can help support novice (as well as seasoned) BHCs as they strive to maintain habits that contribute to fidelity (Beehler et al., 2017; Funderburk, Polaha & Beehler, 2021). Many leaders and clinicians might start to cringe at the prospect of restarting or implementing peer chart review obligations at this time; however, this presentation addresses this year’s conference theme, “Celebrating frontline integrated healthcare workers,” by demonstrating how one can create a BHC peer chart review form that clinicians working in PCBH can find both clinically (and operationally) meaningful (Funderburk et al., 2021; Robinson et al., 2018; Robinson & Reiter, 2016) while simultaneously striving to reduce their burden. The presenters will provide a road map to help individuals and organizations develop a form that is meaningful and aligned with the core messaging of BHCs’ training (e.g., GATHER; Reiter, Dobmeyer & Hunter, 2018) albeit straightforward and deliberately focused on reducing the burden on the BHCs who will be completing these peer chart reviews. Keeping our BHCs upskilled, engaged and supported has never been more important in light of what many are deeming the “Great Resignation,” which has hit healthcare particularly hard.

Summary

This presentation will share findings on the creation and implementation of a risk stratification method to identify primary care patients at greatest risk for negative health outcomes and how that data can be leveraged to make clinically actionable decisions.

Summary

Health care systems and behavioral health providers often have to balance competing demands making it difficult to keep up with changes in the evidence-base surrounding integrated primary care and specifically behavioral interventions. In addition, it is not easy to encourage, monitor, and improve evidence-based practices within one’s own and others’ work as it often requires time and behavior changes. Drs. Funderburk, Barron, and Mitzel, with Ms. Brockmann, will lead this presentation sharing evidence as well as clinical experiences from within the VA Center for Integrated Healthcare, a national center supporting embedded behavioral health providers in the VA. Initially, we will begin with a specific case example that exemplifies the problem. This example will incorporate and highlight data collected from a national survey of non-VA and VA embedded behavioral health providers (n=204) and supervisors of full-time non-trainee providers (n=49). We will highlight the top three barriers (e.g., time, knowledge, comfort) and facilitators (e.g., trainings, confidence, referrals) to incorporating evidence-based interventions into clinical practice as well as other contextual factors that can impact this process. Then, we will share existing resources within CFHA (e.g., evidence-briefs) and others that can help clinicians and administrators find evidence as well as eliminate the tendency to re-invent interventions. Finally, we will share practical strategies based on the literature and our own experiences on how to avoid common pitfalls and improve the translation of evidence into practice. For instance, we will share program evaluation data and lessons learned from the VA that suggests virtual competency-based training strategies are an effective alternative to in-person strategies. In addition, we will briefly share a current innovative approach designed to reduce drift following the initial development of a new clinical practice within the VA that we are piloting.

Summary

As integrated care moves towards becoming the standard of care, it is more important than ever to maintain awareness of what level of integration your program is currently practicing. Integrated care involves the primary collaboration between medical and behavioral health providers, but also includes other essential team members such as community health workers, peer support specialists, personal health coaches, promatores and more. There can be a developmental curve describing the level of integration for programs. It is normal to move back and forth in degree of integration as new challenges and opportunities arise. Programs can find themselves moving from ready to not ready and back again with different concerns impacting integration. This presentation will discuss and review common boulders of integration. Boulders are the common, normal, and expected experiences that are a part of interprofessional team collaboration, growth, and adaptation to contextual factors. Boulders include increasing medical provider buy-in, creating BHC templates that allow for balance between pre-scheduled follow ups and warm handoffs, incorporating telemedicine, and increasing buy-in from administration. Strategies to help climb and conquer boulders will be presented for consideration. In addition, there will be opportunities to discuss challenges and growth opportunities in small groups, engaging in problem solving with multidisciplinary peers in the field.

Summary

Background: This study focused on identifying specific interventions health systems implemented during the first year of COVID-19 across the micro (individual), mezzo (organization), and macro (community) continuum to address burnout among the health workforce. Unrelenting conditions have placed the frontline health workforce at high risk for burnout- the emotional, physical, and mental exhaustion caused by excessive and prolonged stress. Study design: This study involved a two-pronged approach: (1) Conducting expert interviews with administrators involved in COVID-19 burnout prevention efforts within health systems, and (2) A scoping review (SR) of the published literature on burnout interventions implemented for healthcare workers during the pandemic. Description of the population sampled: Interviews (N=5) were conducted with health care experts in hospital administrative work directly involved in the COVID-19 burnout prevention efforts. The databases used in the SR include PubMed, PsycInfo, CINAHL and Business Source Premier. Procedures and measures: The SR utilized a search protocol that included a priori inclusion criteria, search terms, database selection, and data abstraction. All steps of the scoping review were conducted by at least two investigators. Strategies identified were organized into micro, mezzo, and macro-level interventions. Key results: The SR resulted in 20 articles after title and abstract screening were conducted. Nearly 86% of the articles described interventions in academic medical centers. Micro-level interventions included increasing behavioral health support. Mezzo-level interventions included virtual town-hall meetings or wellness initiatives. Macro-level interventions included coordinating supports such as working with external state agencies to assist with childcare. Most articles described burnout-interventions that were new efforts in response to COVID-19 and reflect how little was formalized in preventing burnout prior to the pandemic.

Summary

Introduction: Primary Care Behavioral Health (PCBH) workforce development is of great urgency due to growing behavioral health (BH) integration into primary care, specifically at a time when behavioral health needs are increasing because of the COVID-19 pandemic (Kanzler & Ogbeide, 2020). It is imperative, therefore, to support BH clinical supervisors in primary care to build up the BH workforce to meet the BH needs that often present to primary care, which is also known as the “de facto mental health system” in the United States (Ede et al., 2015). There is currently no formal training to become a BH clinical supervisor in primary care nor are there current competencies specific to clinical supervision within the PCBH model. Thus, it is also imperative to provide current and future behavioral health clinical supervisors in primary care settings with specific, measurable competencies based on expert consensus. Methods: Using a modified Delphi process, the authors aim to identify and reach expert consensus on core competencies for BH clinical supervisors in primary care. A diverse, purposive sample (Patton, 1990) of fifteen experts in PCBH Training and Education as well as faculty development were chosen precisely because they are among the most qualified experts in clinical supervision within the PCBH Consultation Model of Care (Reiter, Dobmeyer, & Hunter, 2018). The experts (N=15) have been requested to evaluate quantitative and qualitative behavioral anchors associated with core competencies of PCBH supervision gathered during initial in-depth interviews, as well as 3 subsequent rounds of Delphi feedback surveys to reach consensus. Expected Results and Discussion: Because education and workforce development depend on having clearly defined target performance expectations, the final product will be a listing of the desired behavioral anchors within specific competencies for BH providers providing clinical supervision to pre-licensure BH trainees in the primary care setting. Unlike existing guidance, this list of competencies will represent a consensus statement arrived at through both qualitative and quantitative iterative means with a broad base of experts in the field. The development of competencies will further support BH clinical supervisor needs, professional development, and provide a concrete way to evaluate progress towards teaching and training excellence – which will also have a great impact on the development of the future BH workforce within primary care.

Summary

An August 2020 report revealed that nearly 21% of essential health care workers had seriously considered suicide in the past 30 days. Certainly, the social, biological, societal and economic impact of the COVID-19 pandemic has been significant on our health care workforce. A 2021 study of front line health care workers indicated that nearly 2/3 of respondents felt that worry or stress about the pandemic had led to a negative impact on their overall mental health. Even prior to COVID, burnout reports among physicians, nurses, and other members of the health care team approached, and sometimes exceeded, 50%. In a 2021 survey of national nurse leaders, those self- reporting as “not emotionally healthy” rose 56% in a six month span from February to August 2021. Health care workers share many traits and qualities that simultaneously make them wonderful at taking care of others such as devotion, compassion, selflessness, and empathy. These traits, however, when not closely monitored and balanced with self-care, can also become the “Achilles heel” of the health care professional, rendering them vulnerable to burnout, compassion fatigue, excessive grief, hopelessness, and self-destructive behaviors such as addiction and even suicide. A November 2021 study in the American Journal of Nursing concluded that nurses are at a 38% higher risk for suicide than other workers, in large part due to burnout. Physicians, similarly, are 40% more likely to die by suicide than the general population. Experts point to burnout, compassion fatigue, unaddressed grief, addiction, despair, and loss of hope as contributing factors to these alarming statistics. This 60 minute presentation will provide a broad overview of well-being and distress through the lens of burnout and self-care, multifactorial dimensions of wellness, dealing with adversity, post-traumatic growth, compassion fatigue, grief, and maintaining hope and meaning as means of building resilience personally and within the health care team.

Summary

Value based contracts are the future of how the healthcare system manages cost and risk. Providers from a variety of care systems including rural primary care, FQHCs, RHCs, CAHs and hospital systems are all facing challenges related to EMR systems and data. We will discuss both the challenges and opportunities that make the future both uncertain and promising.

Summary

Background: Family-centered primary care requires interdisciplinary teamwork to effectively respond to patients and families complex needs. Collaboration among team members is crucial in delivering systemic biopsychosocial intervention. The integration of behavioral health clinicians (BHCs) as team members is an effective approach to fostering collaboration. Additionally, BHCs play a key role in improving clinical outcomes, decreasing medical costs, improving patient and provider satisfaction, and enhancing expertise among primary care providers (PCPs) and other team members. Rational: This presentation will highlight how BHCs can facilitate interdisciplinary collaboration within primary care settings while simultaneously enhancing a family-centered approach to care. Four seasoned behavioral health experts, representing diverse integrated primary care settings throughout the US, will identify the relevant steps in initiating and maintaining team member engagement. To highlight each step of engagement, the behavioral health experts will share video segments of interdisciplinary professionals and patients sharing their experiences, lessons learned, and suggestions for interdisciplinary engagement and collaboration in providing family-centered primary care. Presentation: We will first provide an overview of the tenets of interdisciplinary collaboration and approaches to family-centered primary care (13 min). Then, we will identify skills and techniques for BHCs to utilize in fostering engagement in collaboration. An accompanying video will highlight a physician assistant’s perspective on this initial stage (10 min). Next, we will define approaches to maintaining team-based engagement. A video will garner a physician’s insight into maintaining communication and shared care of patients (10 min). Lastly, we will illustrate specific ways in which BHCs enhance the family experience of team-based care via a videoed family interview (15 min). Q&A will conclude (12 min).

Summary

Background/rationale: Across the U.S., 20% of cardiothoracic surgery patients discharged to home experience unplanned readmission within 30 days of discharge. Readmissions are often avoidable, associated with higher rates of mortality, increase healthcare costs, and lead to poor patient outcomes. Providing high quality, patient-centered education (regarding medications, follow-up appointments, coping strategies, wound and symptom management) by an interprofessional team is hypothesized to improve patient outcomes by facilitating patient and family engagement with post-surgical care plans, including appropriate follow-up with primary and mental health care. Description of population sampled: The dataset included 9,454 adult patients who underwent a cardiothoracic surgery between 2014 and 2020 at a large urban hospital in the Inland Northwest. The majority were male (63%, n= 5,953) and White (92%, n=8722), which accurately represents the lack of diversity within the general population where this study occurred. Study design: A retrospective, observational study design was utilized to evaluate the impact of patient education on 30-day readmission rates. Time series analysis produces the highest level of evidence in observational designs. Procedures and measures used: Data were first explored descriptively to assess variability and normalcy before performing a time series analysis to evaluate trends in readmission. The quarterly percent of cases were evaluated by time series analysis for trends. The total patient cases were also grouped by year, annual readmission rates were divided by the total annual cases to calculate the absolute annual percentage of readmissions for cardiothoracic surgery cases. Key Results: There was a 6% decrease (p<0.001) between average readmissions prior to and post program implementation. Patients with comorbidities were twice as likely to experience readmission than those with a low co-morbidity index [1.9 (1, .074), p =<.001]. Conclusions: A comprehensive program designed to improve patient and family engagement with post cardiothoracic surgical care plans was associated with a significant decrease in 30-day readmissions, emphasizing the importance of interprofessional and community based care.

Summary

Depression is a significant public health concern in the United States. Symptoms of depression have increased over the course of the COVID-19 pandemic. Depressive symptoms, measured by the Patient Health Questionnaire – 9 (PHQ-9), were observed to increase in a national sample of U.S. adults between pre-COVID-19 and during the COVID-19 pandemic; overall, the rate increased from 8.5% to 27.8% according to Ettman et al. (2020), who noted specific risk factors for depression as earning a lower income, having less than $5,000 in savings, and greater exposure to stressors of the pandemic. Center for Disease Control and Prevention estimates suggest rates of depressive symptoms as high as 41.5% across the US population in February 2021 (Vahratian et al., 2021). To address these concerns a variety of integration models have been developed and implemented to place behavioral health professional in primary care clinics. The Primary Care Behavioral Health (PCBH) model focuses on population health metrics and places Behavioral Health Consultants into clinics to address a wide range of primary care concerns. Often PCBH models will prioritize metrics focused on the population reach and its ability to see many times more patients than other integration models due to brief intervention, team based care, and parallels to primary care workflows. PCBH metrics highlight the strengths of this model and reinforce the fidelity to the PCBH model. Despite significant data around PCBH, few programs gather data outside of their own integration model’s designed metrics. This focus on measuring only within a specific model creates “bind spots” in quality and patient care evaluation. To alleviate this potential barrier, this project reviewed outcome data regarding PHQ-9 scores within a target population of adults with diagnosed depressive conditions. In measuring changes in PHQ-9 scores over 12 months, data was collected to determine how depression symptoms changed over time. Additionally multiple patient factors were reviewed to determine possible correlations between changes in Depression symptoms over this time frame. This review provided insightful data about the specific program, interventions, and the patient population, but more importantly identified a sub-population within the adults with depression which did not respond to PCBH and primary care interventions. Statistical review of this data creates opportunities to think beyond the PCBH model and allows for a hypothesis of additional strategies which may provide further benefits to future integration models. Ultimately a data driven strategy utilizing several integrated approaches and variety of behavioral health team members could provide added benefits to any one model. This enhancement would lead to improvement across patient outcomes, satisfaction and also lead to better efficiency in primary care reducing stress on providers and lowers the cost of care to the healthcare system.

Summary

Want to stay up to date with the most current evidence regarding brief interventions that can be utilized by Behavioral Health Consultant (BHC) to assist primary care patients? This presentation will share evidence from three completed randomized controlled trials (RCTs) conducted on brief interventions designed for primary care patients in the DoD/VHA in the past three years. Each presenter will briefly share the results of their published research and then translate it into specific suggestions based on the research to improve your clinical practice. First, Dr. Funderburk will present the results of a RCT that examined brief behavioral activation (2 30-minute appointments, 2 boosters) compared to usual care provided by BHCs in 140 Veterans experiencing depressive symptoms. The results suggest that brief behavioral activation has promise as an intervention for BHCs due to its impact on quality of life, functioning, and patient engagement, but more research is needed. Then, she will use the data from the trial to provide specific suggestions for BHCs in their clinical practice regarding the initial assessment of depression to the components of the intervention. Second, Dr. Cigrang and colleagues will present the results of a RCT that examined an adaptation to the Marriage Check-Up compared to a waitlist control in 244 married couples, in which one member was active duty. Significant improvements in relationship satisfaction, communication skills, and other relationship domains provide evidence that this brief intervention may be an option when patients are interested in couples interventions. Then, he will share specific suggestions for the BHCs in their clinical practice based on the evidence when working with couples. Third, Dr. Livingston will present the results of a RCT that examined a computerized relational agent, who conducted a screening for alcohol use and provided a brief intervention and 1-month follow-up if appropriate. Among the 178 Veterans assigned to the relational agent versus usual care were more likely to receive a brief alcohol intervention and report lower number of alcohol consequences, but drinking outcomes were the same. Then, he will share specific suggestions on how BHCs can utilize evidence-based practices when meeting with patients reporting at-risk alcohol use.

Summary

Stress levels and burnout rates were high among health care workers prior to the coronavirus pandemic, ranging from 30 to 50%. Now, current estimated rates range from 40% to 70%. Research suggests that psychotherapeutic interventions focused on enhancing psychological flexibility promote resilience. For example, a recent review of 14 studies evaluated the use of interventions informed by Acceptance and Commitment Therapy (ACT) to reduce burnout. Thirteen of the reviewed studies reported a positive outcome on one or more outcome measures (Towery-Swift, Lauvrud, & Whittington, 2022). A telehealth format for delivery of services may enhance access. Recent evaluation of telehealth services as a platform for an employee assistance coaching program found improved well-being and fewer work absences among stressed employees, with an average of only 2.6 contacts (Sagui-Henson, et al., 2021). This presentation describes the work of Yturriondobeitia, Jensen, and Robinson in pursuing a goal of developing a manualized treatment (Life NOW) and a training program that would prepare a professionally diverse group of health care workers to provide telehealth services for health care workers experiencing stress overload, beginning with a brief feasibility study, and progressing to beta testing. The Life NOW curriculum uses Focused ACT (a brief intervention model developed in and for primary care, Robinson, 2020) to engage healthcare workers in brief phone visits focused on improving functioning. Healthcare workers calling for service decide when and how often to use the telehealth service. All calls result in development of a specific plan to improve the caller’s quality of life and psychological flexibility. In this presentation, participants will learn about survey techniques used to inform core features of the Life NOW program. Participants will learn about key program materials, including several handouts (e.g., the Life NOW assessment questions, Roots of Resilience).

Summary

The Covid-19 pandemic illuminated how significantly psychological and physical health is impacted by social isolation and loneliness. “Alone, Together” is weekly group therapy for older women delivered via Zoom. This presentation is co-created by the two group therapists and six of the patient participants to describe the evolution of the “Alone, Together” intervention for this socially isolated health-compromised female population. Presenters will provide an overview of what group therapy is, the pros and cons of group versus individual therapy and open versus closed groups, the co-therapists’ roles, and will share Zoom rules, group norms, session format, and documentation and billing details. Evaluative data includes demographics of participants, attendance patterns, qualitative synopsis of themes that emerged, and patient feedback. An important and unique outcome of this ongoing therapeutic group is the way the patients self-describe the way they became empowered in their relationship and communication with their physicians, including the creation of a powerful poem entitled, “How to talk to your Doctor about Pain”, which was (at their request) used in a transformative narrative exercise with family medicine resident physicians. Participants in this talk will be led through a similar narrative process with this poem, and will be engaged in discussion about how the lessons learned of this telehealth group therapy approach might translate to other locations or populations and increase access to socialization and mental health support.

Summary

Community programs and healthcare systems are often at-odds with the people who lack housing among us. The systems frequently approach homeless people as vagrants who clog up our services, sap our bottom lines, and require resources that we are poorly equipped to provide. From the perspective of people living without housing, the systems of care can put up unnecessary barriers, offer services that don’t reflect their realities, and retraumatize people who are already on the margins of society. An American system that is based on for-profit motives is ill-equipped to provide levels of care that are necessary to meet homeless people where they are. Similarly, an American training system that focuses on clinics and hospitals will never produce a work-force with the skills and passion required for providing services across the levels of Maslow’s Hierarchy of Needs. During this session we will grapple with these issues by sharing stories from Grand Junction, Colorado, a community with a highly integrated network of clinics, non-profits, and training institutions with a long history of success in partnering with the local unhoused population. The first half of our seminar will consist of 5 Pecha Kucha presentations. This highly evocative format focuses on storytelling as a medium for causing discomfort, sharing ideas, and promoting growth. The topics of the Pecha Kuchas will include 1) barriers to providing care to the unhoused population, 2) partnerships between clinics and non-profits, 3) training the professional and lay work-force for serving the homeless, and 4) leadership through local government and elected officials. We will then use small group activities to reflect on the stories, extract important lessons, and support each other in providing services and training the next generation of teams serving the homeless population.

Summary

We will share learnings from three organizational and individual strategies being implemented in Oregon to support primary care teams, including integrated Behavioral Health Clinicians (BHC). 1) A monthly BHC Community of Practice was launched in October 2021 in response to significant burnout that integrated BHCs are experiencing and a marked increase in leaving primary care for specialty work. Sponsored by a regional payer, the BHC Community of Practice creates a supportive peer community while also addressing gaps in clinical knowledge related to successful implementation of the Primary Care Behavioral Health (PCBH) model during the pandemic. 2) THRIVE is a year-long community of primary care organizations working together to support staff vitality and organizational wellness. A pilot cohort of 15 diverse primary care practices launched in September 2021. THRIVE members participate in monthly learning collaboratives, leadership coaching, and an anonymous pre and post survey of all staff and providers. Baseline data of 358 respondents across all practices showed significant variation in needs based on role at the practice, which lead to tailored interventions for PCPs, BHCs, RNs, MAs, and practice administrators. Post survey data will indicate if organization-level interventions are successful at addressing staff vitality. However, early qualitative feedback indicates we are filling a critical need for primary care providers and their care teams. 3) Funded by a large regional payer, we provide individual technical assistance (TA) and clinical coaching to support effective behavioral health integration at approximately 150 primary care practices throughout Oregon. Individual TA for integrated BHCs is critical for addressing gaps in knowledge, maintaining fidelity to PCBH, value-based payment success, and for supporting clinicians on the front line of addressing behavioral health needs during the pandemic.

Summary

Intro: Mental health (MH), substance use (SU) and concurrent MHSU disorders are highly prevalent in the United States and Canada, carry significant health, social, and economic expenditures and are challenging to address. Although recent efforts have been made to integrate MH and SU care at the provincial, state, and territorial policy level, innovations at the service delivery level are often not reflected in macro policy frameworks and vice-versa. Additionally, the best available evidence and guidance on what models and interventions work best for which populations, geospatial needs, and service providers is incomplete or lacking. Objectives: We conducted a scoping review to examine the latest evidence on nature, types and benefits of MHSU integration efforts at service, system, and policy levels. We sought to identify what configurations of MHSU integrated services work best for which populations, based on psychiatric, medical co-morbidities, psychosocial needs, ethnic, geographic backgrounds, settings, and cultural factors. Methodology: Literature was identified with an expert advisory committee and librarian scientist. Searches of 5 databases including PubMed, PsycINFO, and CINAHL. After initial screening of abstracts and titles, authors independently reviewed the full text of articles. All points of discrepancy were resolved by discussion and consensus. Articles published between 2018 and 2021, which primarily addressed MH and/or SU concerns across prevention, treatment, intervention, service, system, and policy levels were included for analysis. Results: From 417 initial titles, 333 were selected for full-text review, and 217 were included for data extraction and synthesis. We will present 1) where and how the latest evidence supports the integration of MHSU care; 2) barriers and facilitators to integrated MHSU care at the service, system, and policy levels, 3) how equity and diversity can be further foregrounded to better address impacts on specific populations and 4) provide key recommendations for research and policy. Extent literature highlights the emerging role of innovative e-mental health technology, stepped care models, the increasing foregrounding of need for implementation science approaches to fill evidence to practice gaps, the advancing role of public health interventions, while elucidating mechanisms needed to support integrated health and social care interventions, culturally safe, community health workers, nurses, care managers, psychologists and persons with lived and living experience into the MHSU workforce. Conclusions: Our scoping review provides comprehensive evidence on the nature, type, and populations benefiting from MHSU integration, with special attention given to settings, groups, and contexts most actively considered as well as those requiring further research and policy support.

Summary

The Montana Healthcare Foundation (MHCF) has been supporting the adoption of integrated behavioral health (IBH) across the state since 2016, through financial support for healthcare providers to adopt IBH. Over the course of the initiative, sites have consistently struggled to effectively collect, analyze, and visualize client-level data to monitor the impact of universal screenings and identify barriers to improving clinical practices. In recognizing this challenge, MHCF partnered with JG Research & Evaluation to improve data processes among IBH grantees. JG has worked directly with 41 sites, and identified common barriers to the collection, use, and interpretation of client-level data in IBH initiatives. After identifying these barriers, JG staff developed solutions tailored to address these barriers in a manner that reflects that data capacity and infrastructure of each location. One solution was to develop a web-based data dashboard, built with R Shiny, that provides site staff with easy access to aggregated clinical outcome metrics by provider, as well as a patient registry that aids sites in identifying when screeners may need to be readministered. In addition to addressing barriers in the context of a site, JG has partnered with the Montana Health Information Exchange (HIE) to develop processes for tracking ambulatory outcomes among IBH clients, with a specific focus on emergency department utilization and acute psychiatric care. During this presentation, JG and MCHF staff will provide an overview of the initiative, discuss the challenges identified by sites about using screening data to understand clinical practices, outline the strategies used by JG to address these challenges, and present the process that is being developed to link clinical-level patient data with a statewide HIE to better monitor how the IBH initiative is lowering unneeded utilization of emergency department services for behavioral health crises in Montana.

Summary

This is a quality improvement activity to understand the compassion fatigue and burnout among clinical support staff within a primary care clinic during pandemic. This site is a medium sized urban family medicine residency program. The research indicates that there are cultural gaps within primary care teams specifically between faculty and clinical support staff which contributes to the burnout at both levels. Closing such gaps can be helpful in mitigating burnout across the teams. This quality improvement activity is focused on the burnout and compassion fatigue of the clinical support staff, and to understand the dynamic changes between faculty and clinical support staff members during pandemic. The purpose of this quality improvement activity is: 1. Assess the compassion fatigue and wellbeing among the support staff using needs assessment survey; 2. Provide a monthly support group to improve overall morale; and, 3. Assess the improvement at 3- and 6-month mark.

Summary

Mental health disorders are diagnosed at a rate of 1 in every 4 adults in the United States (Mental Health Disorder Statistics, 2020). Emerging helping professionals from a variety of backgrounds make diagnosis of mental health disorders (Types of Mental Health Professionals, 2020). The importance of accurate and appropriate mental health diagnosis by these emerging professionals is essential as erroneous diagnoses can lead to negative consequences for the patient,, the healthcare industry, and society in general (Feisthamel & Schwartz, 2009). The value in accurate mental health diagnoses along with the DSM-V assist with aiding clinical practice, help with comprehension of symptomology, validating the client’s understanding, and further treatment planning (Probst, 2013; Shah et al., 2019). Moreover, Canino and Alegría (2008) claim there is little consensus on the influence that cultural factors have on the pathology and diagnosis of psychiatric disorders or how they differ on core definitions. These differences can be connected to clinician’s implicit ethnic and racial biases based on the magnitude of specific disorders and how comparisons have been made across different ethnic groups (Blair et al., 2013; Canino & Alegría, 2008). New professionals report that they do not feel equipped to provide mental health diagnosis based on the training they received in their graduate training (Freadling & Foss-Kelly, 2014), therefore there is a need and call for training programs to address this gap. Furthermore, FitzGerald and Hurst (2017) described how higher rates of pathology for minority populations can contribute to oppression and discourage medically vulnerable communities from receiving care if they believe they are being stigmatized by their healthcare providers. The purpose of this study is to test the effectiveness of a training intervention on challenging clinician cultural biases and how that may contribute to appropriate and accurate diagnosis of mental health conditions. This interactive presentation will introduce the feasibility of a training intervention designed to prepare mental health professionals for culturally appropriate diagnosis funded through a national grant to support anti-racist practices. The content covered will include multicultural considerations related to diagnosis, explanations of multicultural activities to be used in diagnosis related courses to challenge trainee biases and future areas of research in developing culturally competent diagnosis. Attendees will be provided the activities associated with the training intervention and practice using them in the session. Lastly, in line with the conference theme, we want to provide support for healthcare workers working with individuals that have experienced trauma as a result of social unrest during the COVID-19 pandemic through tangible strategies to address biases.

Summary

This presentation examines the process of developing, implementing, and evaluating a community-based pediatric primary care behavioral health (PCBH) program. Structural limitations imposed as precautions for COVID-19 are presented in relation to the launch of this new program. In addition to discussing program development and implementation, cross-sectional study data is presented examining the process of introducing an integrated behavioral health model within a well-established community pediatric primary care organization. Participants included both clinical and administrative staff (N=91) of a pediatric primary care “supergroup,” comprised of 4 community clinic settings and central business office. A descriptive analysis of practice needs is provided, followed by multivariate analysis of clinicians’ ratings of their practice readiness for behavioral health integration. The majority of clinicians reported seeing 21-25 patients per day. The most frequent behavioral health concerns encountered were Anxiety/Mood (53%), Disruptive Behavior and ADHD (51%), Speech/Language Problems, Sleep Issues (27%), and Autism Spectrum and Developmental Disorders (23%). However, when rating the most difficult behavioral health concerns, clinicians reported Anxiety/Mood (43%), Disruptive Behavior and ADHD (34%), Suicidality (26%), and Family Problems (25%), Autism Spectrum and Developmental Disorders (25%). Collaboration Satisfaction (CS) and Integration Readiness (IR) displayed a moderate, positive correlation, r(87) = .51, p = .001. Participant ratings suggest generally positive Collaboration Satisfaction with an average raw score of 5.04 (out of 9). Integration Readiness ratings were also positive overall with an average raw score of 6.28 (out of 10). There were no significant differences in the variability of ratings Collaboration Satisfaction or Integration Readiness when controlling for clinic site or participant role (clinician or administrator). Results highlight significant interests and needs expressed by clinic staff for behavioral health services, but with a relatively limited level of practice readiness for incorporating these services into their current workflows. Areas for program development and growth are discussed, including key areas identified for improving program integration.

Summary

Background Integrated healthcare delivery with a patient-centered focus can lead to excellent patient outcomes. However, the management of such a program can be complicated by fragmentation of employees and supervisors across large geographic areas. In our program, we embedded therapists employed by our organization into general pediatric clinics across our community. Because employees are working on-site at clinics owned and managed by different organizations, direct supervision as well as tracking of performance can be complicated. We sought to develop a centralized dashboard with automatic data abstraction from the Electronic Health Record which is shared among all practices involved in our program. This allowed us to track not only specific patient outcomes such as changes in PHQ-9 scores but also track resource utilization, clinician productivity, access metrics, among others. Case example In this presentation we will discuss how a management and outcomes dashboard can be used to improve care delivery, what is required to set up a system like the one we are presenting, as well as helping participants come up with metrics that are of particular importance to their program. Hands-on exercise Participants will be guided on an exercise of metric selection and the process by which they would design their program dashboard. Presenters will foster discussion about recommended metrics and provide participants with specific feedback to tailor metrics for their programs. Resources Handouts will be given for examples of program metrics, sample dashboard pages, planning tools.

Summary

The U.S. National Strategy for Suicide Prevention calls for communities to identify supportive structures that encourage efficient and sustainable suicide prevention programming (HHS & Action Alliance, 2012). Implementing an evidence-based suicide prevention model, Zero Suicide, in a health system during the COVID-19 pandemic has led to a more sustainable approach in training clinical and non-clinical workforce. Skills will be taught around using technology in primary care to prevent suicides. By leveraging existing webhosting technologies, we removed barriers during COVID-19 to maximize opportunities to increase number of staff trained in the life-saving intervention Question, Persuade, Refer (QPR Institute, 2022). Utilizing established organizational infrastructure such as an internal online training library, new onboarding staff, residents, and trainees can quickly and efficiently complete trainings for mental health screenings and assessments on-demand. By making these trainings virtual they are now sustainable and can continue to be evaluated through electronic reporting tools. Feedback on screening, assessment, and referral data is regularly provided to primary care clinics to review and improve patient outcomes. Updated policies and procedures around suicide prevention are provided during virtual continuous quality improvement meetings. Electronic Workforce Development Surveys (Education Development Center, 2021a) are completed annually to gauge staff knowledge and skills around suicide prevention. Resulting data also informs future training needs and helps match trainings that are provided to staff. The Organizational Self-Study (EDC, 2021b) is completed by leadership to measure Zero Suicide data elements. This data illuminates areas of insufficiency and assists in planning recommended actions for change. The use of online trainings and electronic evaluations tools allows for sustainable suicide prevention efforts by large health systems for years to come.

Summary

In October, 2019, Community Health of Central Washington (CHCW) embarked on a health care journey to improve access to medical and behavioral health care to the students at Davis high school in Yakima, Washington. Yakima is a rural, medically underserved, low-income county with 85% of the 2,615 students at Davis high on Apple Health Care. The clinic was opened knowing that we needed to address the disparity of medical and behavioral health care to this adolescent community. The Davis Health Clinic is a fully functioning medical clinic located inside Davis high school that also offers integrated behavior health care to work with patients with multiple adverse childhood experiences (ACE’s) and social determinants of health (SDoH). We have had many successes and struggles and are continuing to creatively work through and around obstacles, such as lack of transportation for students, maintaining confidentiality, and outreach. While our model of care is proving successful within the school setting, we continue to search for ways to expand with limited to no external funding. In this presentation, we will discuss where we came from, and where we are now in an integrated health clinic in a rural, central Washington town.

Summary

The COVID-19 pandemic forced Cabin Creek Health Systems (CCHS) to evaluate practice delivery models, and create new models of care to serve rural communities, unhoused individuals, and POC. In this discussion, CCHS will present a model of services developed over two years of surviving, while not sacrificing primary care. First priority was to protect staff and patients within the system. Clinics worked collaboratively with administration to develop procedures and safely continue services. These strategies included simple tasks like masking, and social distancing, but also more complicated measures including small sheds to shelter staff while providing services in clinic parking lots. This process eventually allowed for the use of lifesaving antibody treatments in rural and underserved communities. Secondly, CCHS worked to increase access to prevention strategies through testing and vaccine. Local public health provided options that worked for some, but not all. They utilized centralized venues and did not muster resources for rural communities, minorities, or other underserved populations. Filling those gaps became a priority. CCHS has tested over 20,000 patients and delivered more than 33,000 vaccines without disrupting primary care. To note: CCHS earned the moniker the “56th county of WV” as they received their own allocation of vaccine to address populations missed by public health. Special efforts were made to address barriers to services, including: transportation, trust, and ease of use, by focusing on person-centered approaches. Furthermore, CCHS utilized partners, church communities, community centers, schools, and local businesses to deliver services in the areas needed most. Finally, CCHS identified a need to expand services to vulnerable populations. With social service providers, CCHS began consultation, and service delivery to help social service providers provide critical resources such as food, housing, and healthcare in the community. This initiated the CCHS Mobile Medical Team, and Unit to triage, screen, and provide intervention at shelters, service sights, and on the street. In two years (3/2020 – 3/2022), 1,061 individuals received intervention and countless more received education, connection to care, personal care items, or a new perspective of their health options. Protecting, increasing, and expanding services was an effort involving countless providers, partners, and community members. The effort was tremendous, Integrated Primary Care continued to work, pharmacy moved to drive through services, dental triaged cases, behavioral health had sessions, and school-based health providers connected with children despite school closures. Services went uninterrupted as the service delivery adapted to the changing nature of the disease. Like other providers, CCHS adapted, evolved, and overcame the additional barriers caused by COVID-19, and continued to care for their communities while doing it.

Summary

Background and Significance Utilizing simulation in health professions training has been connected to multiple training benefits. Yet, there is a dearth of information available on the potential benefits of infusing simulation as part of interprofessional training in substance use screening, brief intervention, and referral to treatment (SBIRT) specifically. The goal of this study is to examine health professions trainees’ perspectives about completing an SBIRT-focused simulation specifically within the context of interprofessional education. Understanding how trainees experience interprofessional engagement in SBIRT training may help inform strategies for SBIRT implementation across integrated care settings. Method This analysis is part of a larger program evaluation project aimed at developing an interprofessional training program on substance use and SBIRT. Graduate level students (n=23) from the disciplines of counseling, marriage and family therapy, nursing, social work, and speech-language pathology participated in one of six interdisciplinary small-group debriefing meetings after completing a didactic SBIRT training, a pre-simulation interprofessional team meeting and a series of SBIRT-focused virtual simulations. Data from the debriefing meetings were recorded, transcribed, and utilized in thematic analysis to explore trainees’ perspectives about SBIRT training within the context of interprofessional collaboration. . Results Preliminary thematic analysis indicated the following themes: 1) the benefits of developing one’s approach to SBIRT within the context of interprofessional engagement; 2) the universality of SBIRT across disciplines; and 3) the benefits of learning and practicing alongside other professions. Discussion Findings indicated trainees recognized both the universality of SBIRT in practice and the benefits of learning about perspectives from other professions, and how they would engage SBIRT in practice. Modeling the importance of honoring the uniqueness that each profession brings, while also having a universal language for substance use screening and brief intervention in integrated care, may provide trainees to be better equipped to engage in integrated health upon entering the workforce.

Summary

Training faculty from the Mid-America Mental Health Technology Transfer Center (MHTTC) will help you navigate implementation of pediatric integrated primary care (IPC). Presenters will utilize didactic instruction to introduce training and technical assistance available in pediatric IPC through MHTTC. The didactic portion will also cover both practice and business models in IPC as well as practical steps to consider when establishing an integrated care practice in rural and urban areas. Strategies to introduce IPC to an organization, practice, and/or primary care provider in rural and underserved communities. Presenters will describe successful strategies and lessons learned when establishing a pediatric integrated primary care clinics. Hands-on exercises will assist attendees to begin mapping a pathway toward implementation of a pediatric integrated primary care practice utilizing the `Steps Toward Implementation’ IPC rubric. Resources including a comprehensive integrated care manual developed through the MHTTC will be introduced, discussed and provided to attendees as an in-depth guide to IPC implementation. This session will include dissemination of information and resources for a variety of professionals with range of background and knowledge in pediatric integrated care. The presentation team will include those who have successfully implemented pediatric integrated primary care and currently practice in these settings.

Summary

With the popularity of short video clips showing the “real” ADHD, it has easily become one of the top social media crazes. The downstream effect is an influx of ADHD referrals seen within primary care. This brief presentation will go over the different ways that various organizations have approached diagnosis and management of ADHD in adults. It is curious to think about what specific aspects of each approach would provide an ideal approach to ADHD patients in an integrated behavioral health setting. Target audience is for anyone with an interest in learning and figuring out ways to solve this big dilemma of what to do with these adults that may or may not have ADHD. All disciplines are welcome. 2-3 minutes: Introduction 11 minutes: Highlight various approaches to ADHD by different organizations 6-7 minutes: One possible ideal approach to management of ADHD in integrated behavioral health care 10 minutes: Discussion/Q & A

Summary

Because individuals with dementia become increasingly dependent upon others as their illness progresses, dementia care requires the involvement and commitment of others, usually family, along with support from community resources. The quality and effectiveness of a person’s dementia care are largely shaped by the foundation of family relationships and their social and community networks. While most current dementia care models incorporate patient-centered care principles and acknowledge the critical role of family member caregivers, these approaches tend to focus narrowly on individual caregivers and their dyadic relationship with the person with dementia. They underappreciate the broader relational impact of dementia on couples and families and how family relationships affect care outcomes. Understanding of family history and processes can highlight both untapped resources and threats to effective treatment. Using a multisystemic family model, this presentation will illustrate the value of screening and assessing family processes to promote optimal dementia care; support use of periodic consultations at key junctures in the illness to capture changes in individual family members and family development that may impede adherence to the plan of care; and identify ways in which standard dementia care practices may compromise delivery of safe, ethical care. Because the incorporation of relational care into dementia practice requires interprofessional education, this session will also address professional roles and responsibilities by discipline regarding post-diagnostic care, team collaboration, and communication skills.

Summary

This session is intended for beginning behavioral health providers working in a primary care medical setting (although we would be thrilled to have interested colleagues and collaborators across all disciplines and of all experience levels to join us). The primary goal for this session is open Q&A! All sessions require pre-defined discussion points, so we will begin with a brief but hopefully relevant and helpful didactic presentation. First, we will provide a rapid overview of the Primary Care Behavioral Health (PCBH) model as defined by Reiter, Dobmeyer, and Hunter (2018). Next, taking inspiration from Neftali’s January 2022 blog post on BHC role diffusion, we will discuss pitfalls that can pull BHCs away from the bullseye regarding their primary care role, and how this can cause them and their primary care teams trouble. Finally, we will discuss strategies for overcoming these challenges. Consistent with previous feedback received on this session over the previous two years, we will have a smaller panel consisting of an experienced BHC, a trainee with approximately one year’s experience as a BHC, and a primary care provider well-versed in the PCBH model. We love the consistent feedback we’ve gotten about having even more time for Q&A! We will do our best to maximize the time available, so bring your questions and be ready to share your own wisdom as well!

Summary

Too often, completed research that has important implications for policy does not make it into the hands of the right audience or is not packaged in a way that is accessible for policy decision-makers. Researchers need tools and strategies to design policy-relevant research and to translate their results for decision-makers to advance timely, evidence-based policy at various levels. Participants will learn how to define the policy question or problem pertinent to their research; identify relevant stakeholders and decision-makers; develop strategic framing and products for their audience(s), and plan for dissemination. Tools will be introduced to help clinicians and researchers translate their work to drive timely and actionable policy change within practices and organizations and at the local, state, and federal levels.

Summary

The CFHA listserv is a robust source of clinical innovation and has great potential for diffusion of ideas across its large network of clinical practices. That potential is only realized, however, if others try to replicate what innovators share. This presentation shows how Community Health of Central Washington developed an innovation around measuring variables associated with fidelity to the Primary Care Behavioral Health (PCBH) model and shared it to the listserv. In turn, ETSU’s Institute for Integrated Behavioral Health adapted the innovation to their system of practices. First, attendees will learn how leadership in a well-established system of clinics (CHCW) developed and implemented a data-based method for evaluating clinician performance associated with the PCBH model and began sharing the outputs with their behavioral health providers. Presenters from CHCW will also discuss their rationale for measuring fidelity to PCBH, as well as the why and how of their dissemination strategy. Next, attendees will learn how leadership in a newer clinic system (ETSU) adapted the innovation to measure progress in their efforts to establish PCBH across five clinics. Presenters from ETSU will discuss how they collaborated with their clinical informatics team to collect monthly fidelity metrics using the electronic medical record, and describe their process for sharing these data with behavioral health consultants. Clinicians from ETSU’s program will follow, presenting short, narrative style presentations in which they link their experience of the data with transformation in their professional work. Finally, ETSU faculty will discuss how they leveraged fidelity data to improve performance and demonstrate the value of their work above and beyond financial returns. The session will close with brief commentary regarding the importance of these data in research and clinical settings and CFHA’s role in fostering the spread of innovation in connection with scientific literature.

Summary

Background: COVID-19 has caused substantial burnout among healthcare. The impact of burnout among the health workforce most often focuses on clinical providers. However, less lauded and recognized are lower-paid essential workers within health systems who keep patients and employees clean, fed, and moving. These workers and their needs are often “invisible” when conceptualizing who comprises the essential health workforce. Population: Twenty low-wage, frontline workers from three states were interviewed. Seven participants worked in environmental services (i.e., housekeeping), six in food services, five in patient transport, and two had front-desk roles. On average, workers had been in their jobs for 5.8 years (ranging from 3 months to 20 years), and most (80%) had their jobs prior to the pandemic. Study design: Qualitative interviews explored the main sources of stress that contributed to feelings of burnout and strategies to help buffer these stressors and provide professional and personal supports. Data collection: Interviews were conducted using a semi-structured interview guide over an e-meeting platform. All interviews were checked for accuracy and transcribed for thematic content analysis. Interviews focused on participants’ work and educational background; levels of burnout they experienced, COVID-19 resources provided by their employer; homelife and job security. Key results: Low-wage workers (N=20) from hospitals in California (n=1), Colorado (n =5), and North Carolina (n=14) were interviewed. All participants indicated that their basic needs were met yet qualitative analysis revealed more nuanced themes. Overall, seven themes were identified including: changes in duties and understaffing, fear of contracting COVID-19 for self and others, desire for recognition, lack of clarity and perceived unequal distribution of COVID-19 benefits, employer provision of paid time off, organizational efforts for mental health support, and self-coping strategies and pride in job.

Summary

Warm handoffs (WHOs) are an interaction between a behavioral health provider (BHP) and primary care provider (PCP) in which information about the patient’s presenting concern and plan for behavioral health services is discussed in collaboration with the patient (Pace et al., 2018). Effective WHOs are a critical component of integrated primary care and can promote patient engagement and facilitate the transfer of care from the PCP to the BHP (Gormley et al., 2020; Mitchell et al., 2022; Oppenheim et al., 2016; Young et al., 2020). Therefore, an essential part of workforce development includes training PCPs and BHPs in strategies they can use to complete effective WHOs and communicate information in a manner that is concise, informative, patient-centered, and empathetic. In this presentation, a framework used during WHOs called CHATS (Convene, History, Assessment, Triage, Safety/Supplementals/Schedule) will be described. Examples of how this framework can be used to engage patients, address safety concerns, and clarify the treatment plan will be shared. Strategies to train BHPs and PCPs in using this framework will also be described. Additionally, challenges to using the CHATS framework and strategies that can be used to overcome barriers to effective WHOs will be shared. Attendees will have the opportunity to apply the CHATS framework to vignettes and will be engaged in a discussion related to using this approach. Additionally, resources for supervisors and training directors regarding strategies that can be used to teach this framework to BHPs and PCPs will be provided.

Summary

Interprofessional team-based care is an organizational mandate. Outcomes highlight the benefit of collective expertise in addressing the most complex patient circumstances to date, including those living amid wholistic health inequities, of physical, behavioral and psychosocial health. Yet, quality of interprofessional team collaboration has been among COVID-19’s countless casualties. Record levels of burnout and workforce attrition are negatively impacting team dynamics and compromising patient-centered care. Increased incidences of bullying and fragmented communication are yielding poor team handoffs, unethical practices, and compromised patient outcomes. Integrated care has a new opportunity: to re-brand and lead interprofessional team-based care! Engage in a unique presentation to inform your Interprofessional Team Leadership Expertise! Learn about the Interprofessional Team Activation Cycle, an original model for practitioners to develop, implement, and leverage ethical and effective teams across practice settings.

Summary

Approximately one in five adults with Type II diabetes experiences depressive symptoms which affect self-management of overall health and well-being. Patients with multiple chronic conditions, such as diabetes and depression, have lower medication, dietary, and physical activity adherence thereby elevating risk for other comorbid conditions to develop. In effort to address diabetes and depression management, Eastern Shore Rural Health System, Inc. (ESRHS) participated in a four-month integrative health pilot initiative aimed at increasing depression screening and monitoring of diabetes management at dental hygiene recall visits. Dental hygiene patients with elevated HbA1c were identified using a registry report and were screened for depression in the waiting room prior to their visit. Hygienists were trained to address positive depression screens and elevated HbA1c values which involved initiation of in-house consultation with a behaviorist or health education services, respectively. Data were collected and the clinical pathway was gradually improved over the course of the four-month pilot program. The increase in screening of patients for depression and diabetes resulted in expansion of this initiative to other hygienists across ESRHS clinical sites in early 2022.

Summary

This session will build on the Conference Podcast to help CFHA members develop skills in policy and advocacy efforts to support integration of behavioral health. This interactive session will help you identify concrete steps you can take to advocate for patients and your work locally and within your state. You’ll learn to refine your elevator speech, identify partnership opportunities and what you need to know to be an effective advocate.