collaborative family healthcare association 19th annual … · 2018. 4. 1. · geisinger medical...

POSTER PRESENTATIONS of 31 Collaborative Family Healthcare Association 19th Annual Conference • October 19-21, 2017

The following Posters will be presented on Friday, October 20, 2017 from 6:45 am – 12:00 noon:

A DSRIP Project In Action: Integrated Primary And Behavioral Care UTMB/Brazoria County Indigent Care Clinics Author(s): Kathleen Nader RN MSN, ANP-BC, GNP Nurse Practitioner Provider Adjunct Assistant Clinical Professor, The University of Texas Medical Branch School of Nursing, Galveston, Texas, Sandra Davis, MBA, Lauren Pierce, MS LPC, Elizabeth Pouncy, LVN, Melanie Reddick, MA, LPC, LMFT, LBSW, Karen Wong, MHA

The indigent population faces many challenges including social isolation, poor access to health care and heightened levels of depression. Depression and other behavioral conditions hinder healthy outcomes. The UTMB School of Nursing DSRIP project encompasses the expansion of primary care with the integration of behavioral health care. Our project included the indigent clientele of Brazoria County, Texas. These patients were seen and managed by a nurse practitioner provider assisted by a licensed vocational nurse. By including PHQ-9 depression screening as a vital sign with every primary care visit, it alerted the provider those clients who were in dire need of behavioral health services. A licensed behavioral counselor staffed by the Family Service Center of Galveston County provided counseling sessions while the primary care provider held primary care clinic. If a client was in distress, the counselor could provide services the same day as primary care. UTMB psychiatry services were also offered for medication management and for management of complex psychiatric conditions.In addition a clientele support group held every 1-2 months were also available and encouraged. Monthly DSRIP Team meetings were held to discuss patient outcomes. With a well coordinated team, healthier outcomes were possible. All clients were considered integrated if completed one primary care and one behavioral health visit (counseling or psychiatry). All integrated patient were provided an anonymous patient satisfaction survey, In DY4,(2014-2015) 82.5% indicated satisfaction, in DY5 (2015-2016) 91% of the clients were satisfied with services. As of July 2017 (DY6), 93% of integrated clients were satisfied with services. In addition, those clients who received integrated services achieved lower PHQ-9 scores and a subset of those integrated clients also showed improvement in blood pressure readings of 120/80 or better. In summary the integration of primary care and behavior health care, addresses the whole individual leading to a more confident and motivated client.

Track: 1. Practice Poster Number: P1

The Role of Family in Medicine: A q-sort Study

Author(s): Florencia Lebensohn-Chialvo, PhD., Assistant Professor, Department of Counseling & Marital and Family Therapy, University of San Diego

A robust literature has established the important role family plays in health. In response, certain disciplines in medicine (e.g. family medicine, pediatrics) have taken up the charge of developing family-oriented care models. However, a recent nationwide study of family medicine residencies revealed that even when educators and residents see the value in family-oriented care, it does not always translate into residency training priorities. Without a training culture that values and emphasizes the role of family in medicine, future generations of physicians will likely adopt a more individual-centric approach to care. Q-methodology, an under-utilized approach, offers a useful way to capture distinct viewpoints on a particular topic and then quantify respondents’ affiliation with those viewpoints. An added benefit of this approach is the opportunity for respondents to reflect, both during the completion of the q-sort and when presented with individualized results.



Collaborative Care, with Doctoral students, as part of a Palliative Care Clinic in a Federally Qualified Health Center

Author(s): Stephen E. Lupe, M.S., Doctoral Candidate, Clinical Psychology, Florida Institute of Technology, Kristi Van Sickle, Psy.D., Program Director, Psychology Education Grant, Florida Institute of Technology, Angela Miller, M.D., Medical Director of Palliative Care Clinic, Brevard Health Alliance, Chad Breznay, Psy.D., Director of Behavioral Health, Brevard Health Alliance

In recent years, there has been an increase in the recognized value of an integrated team approach to palliative care (Kasl-Godley, King, & Quill, 2014). We set about to develop a team approach as part of a palliative care clinic in a Federally Qualified Health Center. The team consist of a physician who is board certified in palliative care, a clinical psychology doctoral student supervised by a licensed psychologist, a clinical social worker, a medical assistant, and a dedicated clinical office staff member. The physician heads the team, but all members provide treatment and treatment recommendations. This is based off the integrated primary care model, and looks at the patient in terms of not only medical illness, but psychological and social needs which has been supported in the literature and has been shown to provide more comprehensive care and lead to better patient care outcomes (Payne, & Haines, 2002; Gwyther, & Med, 2008; Berman, & Laviana, 2016; Wu et al., 2011).


Normalized injustice and the 20 year premature death of Latino men with diabetes

Author(s): Carolina Gonzalez Schlenker, MD, MPH Ricardo Madrid, CHW Raúl Treviño, CHW

1. Problem/Purpose relevant to conference theme/objectives In our primary care clinic Latino men with diabetes experience a 20 year decrease in life expectancy. Their typical trajectory starts in young adulthood followed by 2 to 3 decades of intense employment under conditions of uncertainty, low wages, and working environments that are dangerous, dirty and demanding . Additional burden is their immigration status which leaves many vulnerable to breaches of agreements and invisibility. Promotores’ persistent attempts to reach these men right after diagnosis to prevent late diabetes damage failed. If promotores, who are Latino men like them, with an authentic concern for their health, supported by a multidisciplinary team, cannot change these fatal outcomes, what could? 2. Background The Advanced Primary Care (APC) project at downtown San Antonio’s UHS Family Health Center is a wrap-around multidisciplinary support system for primary care practitioners taking care of the poorest population in the city. Our zip code, where most of our patients live, shows a 20 year gap in life expectancy compared with the richest zip code in the city’s north . This gap is historical. The “Two San Antonios” have always existed, so injustice has been normalized. The APC consists of two nurse care managers, a health educator, two medical assistants and 9 promotores/community health workers doing teamwork to reach patients in their own context and see things from their own perspective. It is this very perspective of our Latino men with diabetes that we found troublesome. 3. Discussion of issue or concepts/variables of interest Several theories explore how people rationalize inequality in wealth and the unjust hierarchies they are embedded in. System justification theory


explains how epistemic, existential and relational needs in oppressed individuals drive them to legitimize the status quo. We present our patients’ progression of bodily damage due to diabetes as evidence that system justification is a maladaptive response to their environment. 4. Population, sample, setting if research & description of community resource More than 1000 patients with uncontrolled diabetes have participated in our promotores program between 2012 and 2017. Latino men in their 40’s and 50’s tend to have the highest A1C at diagnosis and are the most difficult to engage in effective diabetes management. The main reason is that they work most of the day, often including weekends. After a fleeting presence in our program at time of diagnosis, this subpopulation reappears a few years later with high levels of disability in the form of amputations, neuropathy, and renal failure making their usual physical labor impossible, which robs them of their livelihood and life’s purpose. Promotores asked six of these (second wave) patients if they would be willing to reflect with us about this tragic trend. Interlex, a local media company, volunteered to film what we called Latino Men Diabetes Symposium. The Texas Diabetes Institute offered to host the event. 5. Methods (research) or interventions (practice/teaching). Two of our male promotores invited 3 of their patients with disabling diabetes conditions to participate. The goal of the Symposium was to produce a public message aimed at newly diagnosed Latino men with diabetes to attend to their disease in order to prevent its progression. Participants were also invited to ask questions about diabetes that remained unanswered to them. They signed a permission to being videotaped. A 3-hour session was held and fully filmed in which patients shared the trajectory of their disease, the barriers found in their care, and proposed messages for those that have just been diagnosed. An analysis of the questions asked, the responses given and their nonverbal behavior was made through a careful review of the videotape. 6. Findings, conclusions & implications As predicted by system justification theory, our patients’ retrospective assessment of their disease management attributed their failure to personal shortcomings. For the most part, they blame themselves. No critical awareness was observed about the unyielding structural barriers to their self-care. There was no sense of indignation in their nonverbal behavior towards the economic circumstances they had to endure. This left us with the moral dilemma of witnessing injustice that has been normalized but failed to be adaptive, as patients progressed to their premature death in front of our eyes. After exploring different options we have designed a workshop to respectfully help our patients build critical awareness skills to detect injustice and then “name” justice in different scenarios. Participants of the Symposium have been invited to a second meeting for this purpose. After the training, participants will test their new skills in their daily lives. A participatory evaluation will be conducted at a third meeting and a public message will be produced. We conclude that system justification is maladaptive and that health will become impossible if we allow the economic system to mute our expectations of social justice.


Trial of Computerized Screenings for Toxic Stress in Rural Primary Care Pediatrics

Author(s): Javier I. Rosado, PhD, Director of Clinical Research, FSU Center for Child Stress & Health, Elena Reyes, PhD, Director, FSU Center for Child Stress & Health, Natalia Falcon, PhD, Postdoctoral Fellow, Center for Child Stress & Health

Toxic Stress is defined as strong, frequent and/or prolonged adversity without adequate adult support. This would include adverse life experiences, such as physical or emotional abuse, neglect, caregiver substance abuse or mental illness, exposure to violence or economic hardship. Many studies have found


correlations between these experiences and specific diseases, both physical and mental. The clinical detection and treatment for toxic stress is a relatively new area. Recently the AAP called for pediatricians to recognize the physical and mental consequences of exposure to toxic stress and to participate in the “design, testing, and refinement of new models of disease prevention, health promotion, and developmental enhancement beginning in the earliest years”. This poster will present on the establishment of universal screenings for exposure to toxic stress in a primary care pediatric setting.


Understanding the Training Needs of Pediatric Residents: The Need for Programs and Partnerships to Enhance Medical Education in Behavioral Health

Author(s): Christopher Rutt, MA, Geisinger Medical Center Monica Whitehead, MS, Geisinger Medical Center Rachel Petts, MA, Geisinger Medical Center Amy Signore, PhD, MPH, Geisinger Medical Center Tyler Bogaczyk, BS, Geisinger Medical Center Paul Kettlewell, PhD, ABPP, Geisinger Medical Center Jeffrey Shahidullah, PhD, Rutgers University

Purpose/Background: An American Academy of Pediatrics (AAP) policy statement (2009) suggested increasing residency training in behavioral health (BH) for primary care physicians (PCPs). Medical education programs agree that BH training is limited and needs to be improved (Leigh et al., 2006). Some have suggested a framework for how to implement these changes (Martin et. al., 2007), but very few, if any, have examined residents’ training experiences prior to and during their medical education. Current practicing physicians report competence in identifying severe BH problems, but have more difficulty in identifying less severe problems or psychosocial problems, and while they view treating these problems favorably, they tend to refer to psychiatry/psychology (Steele et. al., 2010). The purpose of this study was to assess pediatric medical residents’ perceptions of their past, current, and future training experiences with regard to assessing and treating behavioral health problems. Methods: Focus groups were conducted with residency programs from two large health systems in the northeast. There were a total of N = 40 residents across two sites (Site 1, N = 28; Site 2, N = 12). Participants were divided by first year residents (N = 22) or second and third year residents (N = 18). The majority of first year residents were female (81%) with a mean age of 27.8 years. Among second and third year residents, 72.2% were female with a mean age of 30.3 years. No differences were found between sites on demographic variables. Focus groups were audio recorded and transcribed. The transcription was double-coded for analysis guided by a Grounded Theory framework (Glaser & Strauss, 1967). Primary research questions included: (1) Why did residents choose pediatrics as a specialty and what continues to excite them about the field? (2) What worries/concerns do residents have about practicing in pediatrics? (3) What prior training in behavioral health were residents exposed to during medical school? (4) What worries/concerns do residents have about delivering BH interventions? (5) What areas of BH training do residents identify as potentially helpful components of their residency training? Results/Conclusions: Results of the current study have yielded multiple overarching themes: (1) residents are concerned about making errors (e.g., “missing something is one of my biggest fears”), (2) a lack of training in BH and the desire for additional training (e.g., “I don’t think I have had a formal lecture on that [depression]”), (3) limited time to address BH problems (e.g., “you don’t always get enough time to actually sit down and have those in-depth conversations that are meaningful and can actually help”), and (4) concern with ability to identify and/or manage BH problems, such as prescribing psychiatric medications and referring to specialty care. Findings suggest that pediatric residents do not receive sufficient training in BH and do not feel confident in providing BH care. In addition, residents feel


that additional training in BH is both necessary and important. These results lend support for AAP’s (2009) policy initiative for more innovative residency training programs that incorporate BH and primary care to improve competencies among PCPs. The poster will discuss implications for partnerships among programs in which behavioral health providers can be explicitly involved in the training of future pediatricians.

Track: 2. Programs Poster Number: P6

Treating Chronic Pain at a Federally Qualified Health Center: Staff Perspectives

Author(s): Nathan K. Goins, PsyD, Doctoral Candidate, George Fox University Graduate Department of Clinical Psychology, Marie-Christine Goodworth, PhD, Assistant Professor, George Fox University Graduate Department of Clinical Psychology, Mary Peterson, PhD, Chairperson, George Fox University Graduate Department of Clinical Psychology, Kathleen Gathercoal, PhD, Director of Research, George Fox University Graduate Department of Clinical Psychology

Although half of all patients with chronic pain seek treatment with their primary care practitioner, many physicians report being overburdened, with limited confidence in their training in the treatment of chronic pain. Opiate monotherapy remains the most common treatment utilized, despite strong correlations with addiction issues and increased distrust between patients and providers. In response to these issues, multidisciplinary stepped-care approaches utilizing psychoeducation, cognitive therapies, movement-based therapy, pharmaceutical treatment, yoga, and acupuncture have been developed. However, treatment within Federally Qualified Health Centers (FQHC) are complicated by financial constraints and high complexity in patient populations. This study examined the perspectives of staff members at an FQHC in Portland, Oregon on barriers to chronic pain treatment as well as the perceived efficacy and feasibility of potential interventions. Surveys including Likert-type responses and a free response section were administered in staff meetings, collected by team coordinators, and at other times convenient to the respondent. After survey results were analyzed, semi-structured interviews were conducted with a selection of participants’ representative of the various roles within the clinic. Themes derived from this approach highlighted a need for training for all staff, concerns regarding utilization of resources, desirability of non-opioid treatments, increased care coordination and policy adherence, and treatment for opioid dependence, distress regarding opioid-based treatment, and concern regarding the impact of systemic, financial, and legal barriers. Recommendations are discussed, specifically as they relate to the FQHC.


The Bumpy Road to Integration in Texas: Financial Barriers and Ideas for a Smoother Journey

Author(s): Juliana Alba-Suarez. Rebecca Hammonds. Crystal Guevara. Joshua Morris, Julie Heier, MA, Sarah Gojer, Elizabeth Walsh, Ph.D., Jane Gray, Ph.D., Training Director, Texas Child Study Center

Many efforts in policy and legislation have been aimed at reducing health disparities, yet research continues to show disparities in health care access, quality, and outcomes. In the US, a majority of children and adolescents with mental health conditions that results in functional impairment are more likely to be seen in their primary care setting than in a specialty mental health setting. Integration of behavioral health services in primary care settings allows underserved youth to receive behavioral health assessment and


evidence-based treatments in the medical home. The largest barriers to the integration of care are often financial and reimbursement issues, which vary by state. The state of Texas experiences a number of barriers that make the journey toward integration more challenging. Examples include gaps between state legislation and insurance regulations with respect to allowing trainees to bill for services under their supervisors. This poster presents a case study of a Health Resources and Services Administration (HRSA) Graduate Psychology Education project in Central Texas focused on pediatric primary care, specifically exploring barriers to implementation and the financial sustainability of integrating behavioral health into primary care clinics in Texas. This GPE project trains psychology doctoral students and interns in integrated pediatric primary care (Federally Qualified Health Centers). Across clinics participating in the project, there were 362 behavioral health encounters in the first six months, and 78% of these were funded by Medicaid or other safety net plans. A review of current Texas policies and regulations and interviews with psychologists, medical providers, and practice managers of primary care sites participating in the program will be conducted to gather information about current billing and reimbursement challenges and potential solutions for sustainability beyond the grant period. Integration of care in pediatric primary care settings increases access to mental health services for underserved youth. In some states, like Texas, achieving this goal can be challenging due to financial barriers. Understanding the issues surrounding sustainability of integrated care is an important step in both shaping future statewide policies that expand the reach of coverage and helping clinics and providers find innovative ways to serve patients and promote long-term growth of integrated health clinics despite current and future fiscal constraints.

Track: 3. Policy Poster Number: P8

Primary Care Behavioral Health Consultation Model Implementation within a Family Medicine Training Program: Initial Outcomes and Observations

Author(s): Stacy Ogbeide, PsyD - Assistant Professor, UT Health San Antonio, Michelle Rogriguez, MD - PGY 1, Family Medicine Residency, UT Health San Antonio, Yen Phan, MD - PGY 2, Family Medicine Residency, UT Health San Antonio, Sherinne Jose, MD - PGY 1, Family Medicine Residency, UT Health San Antonio, Brittany Houston, BA, Doctoral Student, Our Lady of the Lake University, San Antonio, TX

The implementation of the Primary Care Behavioral Health (PCBH) model within a family medicine residency clinic will be discussed. The PCBH model has been shown to create early intervention opportunities in the primary care setting with improved patient outcomes. This quality improvement project sought to investigate the early impact of this treatment approach on patient care – not only patient outcomes but the primary care provider’s ability to improve the management of behavioral health conditions within continuity patient visits. The following patient outcomes were assessed during the first year of implementation: depression screening scores (PHQ-9), anxiety screening scores (GAD-7), and health-related quality of life scores (Q-LES-Q-SF). Additionally, barriers to using the Behavioral Health Consultant and accessing same-day behavioral health services were also examined. The total number of visits for 2016 was 955 (668 unique patient visits). The average number of behavioral health consultation visits for patients was 1.4 (SD = 0.99). The top five reasons for referral were: depression (39%), anxiety (26%), stress (16%), chronic illness management (10%), and weight management (9%). During this


presentation, change scores for patient outcome tools will be discussed which show promise with improving patient care. Additionally, the barriers for utilizing the PCBH service and PCBH service improvements for the upcoming years will also be discussed. Lastly, the impact of the PCBH service on family medicine residency education will be discussed.


The Recovery Zone: Improving Treatment Adherence through Peer Engagement within an Integrated Care Setting

Author(s): Anna Rivera, M.A., LPC, Kevin Milligan, Ph.D., LPC, Mary Tolle, Certified Peer Support Specialist, Clarissa Aguilar, Ph.D.

The Center for Health Care Services (CHCS), the local mental health authority in San Antonio, Texas, has received a four year grant funded by SAMHSA. The Primary Behavioral Health Care Integration (PBHCI) grant provides integrated behavioral health and primary care services to our adult population who receive mental health treatment for severe mental illness, substance abuse, and co-occurring disorders. One objective is to develop and implement peer-based services. Peer support services are designed and delivered by individuals who are in recovery from a mental or substance use disorder. The peer provider has formal training to deliver services in health settings to promote recovery and resiliency. The Recovery Zone is a peer led drop in program that provides increased coordination of care, social support, resources, and participation in arts, crafts and music lessons. The program’s goal is to improve positive health outcomes through improved access to care and utilization of services. North West Integrated Health Care Clinic is one of four adult behavioral outpatient clinics belonging to CHCS. It was chosen as the site for the Recovery Zone because of its adjacent proximity to the peer program, primary care, outpatient behavioral health services, and two high acuity programs, in order to increase treatment adherence, address challenges of daily functioning, and improve health outcomes of the population served; through enhanced service delivery. In effort to maintain the delivery of evidenced based practices, our peers continue to engage in yearly trainings. The trainings are offered through VIA Hope, certification entity for peers and the Center for Integrated Health Solutions (CIHS) who provide an array of trainings and technical assistance to grantees paving the way to the integration of primary care and behavioral health services. Over the last year, 85 adult consumers regularly attend The Recovery Zone. We continue to offer enhanced peer services and activities through the Recovery Zone. The program has received positive feedback from those in attendance. Participants attribute their engagement with peers within The Recovery Zone as a direct correlation to their improved overall health and increase in independent living. We also have received positive feedback on our program from our grantors during a recent site visit. In light of the high rates of co-morbid physical health conditions, electing to participate in a non-traditional integration model has proven to be advantageous in addressing many of the challenges faced by the population we serve, one being accessing primary care services. The use of our peers has bridged our healthcare services and provided our clients the support and positive relationships needed to remain adherent to treatment; resulting in reduced health disparities, lower healthcare expenditures, and improved quality for healthcare delivery.



Level of Integration and Access to Pediatric Behavioral Health in Primary Care: WHO matters

Author(s): Tawnya Meadows, PhD, Chief of Behavioral Health in Primary Care, Geisinger Health System, Jessica Sevecke, PhD, Associate, Geisinger Health System, Sean O'Dell, PhD, Associate, Geisinger Health System

There are many different models of integrated primary care; however, little is known regarding how model characteristics affect access to and utilization of pediatric behavioral health care. This poster will present program evaluation results of two behavioral health primary care hubs who receive pediatric referrals from on-site medical providers, as well as from off-site medical providers within the same health system. We investigated the effects of this model on the number of days from referral to appointment, as well as, show rates across primary and secondary clinics. Six months of data from two behavioral health primary care hubs will be collected and analyzed[OSM1] . Hub one consists of a rural family practice with two on site psychologists and three secondary sites (two pediatric and one family practice site). Hub two consists of one large urban family practice and two family practice secondary sites. Over 150 patient charts will be reviewed to collect data on number of days between referral and intake, show rate, total number of sessions, patient demographics, and presenting problem. Comparisons will be made between referrals to an on-site psychologist with potential for a warm hand-off versus a psychologist that is not on-site but has a formal collaborative agreement with planned monthly case conferences and no potential for a warm hand-off. In addition, each site will complete the Level of Integration Measure to aid in interpreting these comparisons. Varying models of integrated behavioral health services for pediatric patients are implemented across the country. For some agencies, behavioral health services may be provided on-site but for others, referral rate or total number of patients may be too low to justify having a full time behavioral health provider on-site. This results in a "hub" structure, honoring behavioral health referrals from multiple smaller, surrounding health care clinics. Results of this study suggest that this model still promotes access to care and allows for a strong collaborative relationship between an agency contracted, off-site behavioral health provider and medical providers as it is to have an on-site behavioral health provider available for same-day consultation.


Patients and Hepatitis C: A Strengths Based Assessment for Treatment Readiness

Author(s): Karla Caballero

Hepatitis c is a condition that causes inflammation and damage to the liver as a result of a virus (Center for Disease Control, 2016). This disease brings about physical and biological stresses, as well as serious implications for the mental health of those infected. If a person has a history of mental health concerns, then a diagnosis of hepatitis c could exacerbate or reignite some of these issues. Therefore, it is a question of how a diagnosis and available treatments tie into a person’s over all mental wellbeing and the likelihood of adherence to treatment should they become candidates. This presentation outlines an assessment readiness template for medication adherence to popular hepatitis treatments. Additionally, it will highlight the behavioral health consultant’s role, a general overview of hepatitis c, the risk factors for contraction of


the virus, preferred methods of treatment, patient’s mental health status prior to treatment, adherence to treatment and suggestions for effective treatment outcomes. Keywords: hepatitis c virus, mental health, psychology, interferon, substance abuse


Universal Screening for Alcohol Misuse in a College Student Health Clinic

Author(s): Misty Ramon, MS; David RM Trotter, PhD; James McDonald, MD; Tim Fox, MBA; Eileen Sprys, MD; Miguel Villarreal, MD; Arnulfo Gonzales, MD; Jeff Paxton, MD; Jennifer Mitchell, MD; Wade Crowson, RN, MSN, FNP-C; Inola Mello, RN, MSN, DNP-C; Donna Toney, RN, MSN, FNP-C; Jarred Minefree, PA-C

Introduction: Alcohol-related problems are a leading cause of morbidity in college students (NIAAA, 2002). This is unsurprising as many students begin experimenting with alcohol during college, and may end up using in risky ways. The USPSTF recommends screening all adults age 18+ for alcohol misuse to identify opportunities for brief alcohol interventions (Moyer, 2013). College student health centers (SHC) are a prime setting to address alcohol misuse among college students, as students identify SHC medical staff as a good source of health information (2007 National College Health Assessment), and they often open to discussing sensitive issues during routine medical care (Schaus et al., 2009). Additionally, high patient volume at SHCs provides the opportunity to access alcohol misuse at a public health level (Ehrlich et al., 2006). This presentation will describe efforts to begin a universal alcohol screening protocol in a university based SHC. Methods: This is an ongoing project that began in 2015 with the screening of a small subset of patients, and has been expanded to all patients. All patients are screened via the AUDIT-C, and we use a cut off of 4 or more, or a response of 1+ on item 3 (Bush et al., 1998). During this project our providers were trained in a brief intervention called SBIRT. Our providers offered more intensive interventions with higher AUDIT-C scores. Results: Between 2015 and 2017 we increased the number of students being screened from about 1-2 per day, to about 100 per day. We will present data on number of positive AUDIT-C screens, extreme AUDIT-C scores, documented brief interventions using SBIRT, proportion of patients referred to counseling, and the number of patients self-referred to our counselor. We will also present data on the effectiveness of various efforts used to effectively implement this project. This project is ongoing, and complete data will be available in the coming months. Discussion: We have developed a successful universal alcohol screening workflow for a high volume SHC. We will discuss the efforts that have made this workflow successful, as well as the lessons we have learned. Finally, we will discuss how we plan to use what we have learned from this project to create new work flows that will allow us to screen and provide brief interventions for new clinical targets (e.g. depression, anxiety, and suicidal ideation).


Building Hospital, Family, and School Partnerships: A Hospital Education Advocacy Program

Author(s): Caroline Carberry, UT Austin Annette Leija, M.A., UT Austin Marcella M. Maxwell, M.A., LMFT, Behavioral Health School Liaison, Dell Children's Medical Center of Central Texas


Children with chronic illnesses experience worse academic outcomes than healthy children (Shaw & McCabe, 2007). Problems such as increased absenteeism can lead to lower academic performance and social isolation (Emerson, 2016). Absences from school have been linked to an increased sense of learned helplessness and despair in medically ill children, which can impact the rehabilitative process (Kaffenberger, 2006). These problems have led to an increased focus on school reentry programs for chronically ill children to limit the effects of their illness on academic performance. There are a variety of conceptual models for hospital to school reentry (e.g., Harris, 2009; Power, DuPaul, Shapiro, & Kazak, 2003). These models stress the importance of school-hospital-family collaborations. However, little prior research has explored the implementation of a comprehensive hospital-wide program that successfully integrates the school, hospital, and the family. A hospital in central Texas developed an educational advocacy program that focuses on building partnerships among the school, the family, and the medical team for youth with chronic and acute medical conditions. The overarching goals of the program are to provide comprehensive and coordinated care, facilitate communication and collaborative treatment among providers (e.g., school nurses, teachers, medical personnel), improve family and patient education, and increase satisfaction of services. Outcome data collected will include school attendance, patient quality of life (PedsQL), patient social and emotional functioning (Achenbach System of Empirically Based Assessment), parent-school communication, and patient satisfaction of services. A second aspect of the program involves the development of a training component for school nurses and school staff that focuses on increasing the knowledge and skills related to working with youth who are transitioning from the hospital to school. Research suggests the need for ongoing communication and coordinated care across settings (American Hospital Association, 2014). The educational advocacy program was developed to address this need and to help parents navigate stressors related to their child’s transition from hospital to school. Strategies for improving collaborations and challenges when applying an integration framework in a hospital setting will be discussed.

Track: 4. Partnerships Poster Number: P14

Differences in Conceptualizing Factors Affecting Traumatic Stress after PICU Stay: Risk, Or Potential For Resilience?

Author(s): Jordan Dell, BA, Doctoral Student, The University of Texas at Austin, Ashlee M. von Buttlar MA, Doctoral Student, The University of Texas at Austin, Amanda A. Bowling, BA, Doctoral Student, The University of Texas at Austin, Alexandra L. Fisher, Ph.D., Director of Psychology Services for the Pediatric Intensive Care Unit, Dell Children' Medical Center

Background/Rationale: Children and their caregivers are at an increased risk for traumatic stress following admission to the PICU (Colville & Pierce, 2012; Nelson & Gold, 2012). Research conducted in nursing and medical journals has focused on risk factors (Carlson et al., 2016), and the protective role that informed care practices can have on patient and family traumatic stress after a PICU admission (Davidson, Jones, & Bienvenu, 2012; Sottile, Lynch, Mealer, & Moss, 2016). The purpose of this review was to determine whether the absence of a given risk factor is conceptualized as a protective factor in the literature, and vice versa. Specifically, the researchers wanted to determine whether the literature tends to evaluate protective variables in terms of representing lower risk, or more resiliency. Understanding how practitioners in medical settings


conceptualize the variables protecting against post-PICU traumatic stress would help further inform the development of integrated behavioral health services. Methods/Results: A literature search was conducted using psychological and medical databases, including PsycINFO, MEDLINE, and CINAHL, and using keywords such as PICU, traumatic stress, protective, risk, coping, and resiliency. Studies were limited to those published in peer-reviewed journals from 1997 to 2017 that examined protective factors for traumatic stress in children or caregivers after PICU admission, or modifiable risk factors whose inverse was acknowledged by the authors as a potential protective factor. Of the resulting 227 articles, 11 met the inclusion criteria. Of those 11, 10 focused on risk factors that could be modified into protective factors through ameliorative care practices, two focused on non-modifiable risk factors, and no studies focused on non-modifiable protective factors. Informed care practices included increasing parent coping and practitioner communication skills, decreasing medical practices predictive of traumatic stress, and increasing child and parent agency in care. Conclusions: Articles showed a pattern of studying protective factors for traumatic stress that could be strengthened by ameliorating the effects of modifiable risk factors through informed practices, thus emphasizing the importance of integrating behavioral health teams in the PICU. Evaluating how researchers conceptualize whether a lack of risk affords protection has important implications for whether practitioners in medical settings should, or do, attend more to patients with identified non-modifiable risk factors, or to those whose risk factors they can ameliorate. More research on the identification and strengthening of protective factors is needed, and these findings warrant further research on PICU providers’ assessments of both risk and resiliency in their patients. Interdisciplinary collaboration and integrating behavioral health care teams into the PICU is vital to translate this research into improved patient outcomes.


Pediatric Residency Training and Behavioral Health: Models and Outcomes from a Multi-site Study

Author(s): Jeffrey D. Shahidullah, PhD, Rutgers University, Paul W. Kettlewell, PhD, Geisinger Health System, Mohamed H. Palejwala, PhD, Michigan State University, Kathryn A. DeHart, MD, Geisinger Health System, Joann Carlson, MD, Rutgers Robert Wood Johnson Medical School, Laura Diaz, MD, Rutgers Robert Wood Johnson Medical School, Kris Rooney, MD, Lehigh Valley Health Network, Tyler L. Bogaczyk, BA, Geisinger Health System, Ilene G. Ladd, MS, Geisinger Health System, Sharon L. Larson, PhD, Geisinger Health System

The purpose of this study was to evaluate the effectiveness of innovative behavioral health training curricula on pediatric residents' attitudes, knowledge, and skills in primary care behavioral health service delivery. 65 residents across 3 training programs in the northeastern U.S. completed an survey at the beginning (July) and end (June) of a training year. Residents at each site received 1 of 3 different behavioral health training curricula: Site 1) control group ("training as usual" consisting of mandated 1-month DBP rotation); Site 2) didactic exposure only; Site 3) integrated service delivery plus didactic exposure.



Experiencing the Impact of Integrated Healthcare

Author(s): Sherri A. Ruggiero, PhD John B. Martin, PhD

The philosophical underpinnings of integrated healthcare are based in the understanding that health results from a balance of physical, emotional, behavioral, cognitive, social, and spiritual factors. Use of the integrated healthcare model in the primary care setting provides an opportunity to manage the physiological and psychological concerns of patients through collaboration and implementation of evidence-based treatments. Screeners such as the Physical Health Questionnaire-9 Item (PHQ-9), General Anxiety Disorder – 7 Item (GAD-7), and Cohen’s Perceived Stress Scale-10 item (PSS-10) for depression, anxiety, and stress allow for early detection symptoms, monitoring of treatment effectiveness, and the discharge of patients from behaviorist treatment when scores are consistently low. Assessments from 602 primary care patients were collected at the onset of behaviorist interventions and at the final session. Large effect sizes were determined for all three assessments: PHQ-9 (d=0.95), GAD-7 (d=0.97), and PSS-10 (d=0.84). The average number of behaviorist sessions was 3.08. Brief, evidence-based interventions provided to patients in this primary care setting have revealed a significant positive response on health indicators such as the PHQ-9, GAD-7, and PSS-10. Results indicate the efficacy of integrated healthcare in the primary care setting, and support future expansions toward this goal.



The following Posters will be presented on Friday, October 20, 2017 from 12:15 pm – 5:30 pm:

Flexing your Hex in Primary Care: Pilot Evaluation of an ACT Adolescent Group

Author(s): Carrie E. Massura, Ph.D., Postdoctoral Fellow, Geisinger Health System, Shelley J. Hosterman, Ph.D., Pediatric Psychologist, Geisinger Health System, Sean M. O'Dell, Ph.D., Pediatric Psychologist, Geisinger Health System, Monica R. Whitehead, Ph.D., Rachel A. Petts, Ph.D.

Background/Rationale: Acceptance and Commitment Therapy (ACT) has been shown to be an effective intervention for individual adolescents experiencing psychological difficulties (Hayes, Boyd, & Sewell, 2011). However, despite promising research examining the adaptation of ACT treatments for adult psychotherapy groups (Kocovski, Fleming, & Rector, 2009), few investigations have explored how to modify ACT interventions for adolescent groups. Similarly, ACT components have been successfully disseminated in adult primary care settings (Demarzo et al., 2015), but the extant literature concerning ACT in pediatric primary care is limited. The current project seeks to expand research in this area by examining treatment outcomes for adolescents attending a group-based ACT intervention conducted in an integrated pediatric primary care clinic. Methods/Results: Three integrated pediatric primary care clinics associated with a rural health system are conducting transdiagnostic ACT group treatments for adolescent patients. Participants include 40+ adolescents who completed an initial psychological evaluation and agreed to attend a 9-10 session ACT group program. Data regarding participant demographic characteristics (e.g., age, gender, etc.), number of group sessions attended, and measures of weekly homework completion will be collected. Furthermore, analyses will explore changes in adolescents’ weekly top problem severity ratings and their pre- and post-treatment responses to the Acceptance and Fusion Questionnaire for Youth (Greco, Murrell, & Coyne, 2005) and the Revised Children’s Anxiety and Depression Scale (Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000). Initial findings suggest that the group-based treatment is well-attended and accepted by adolescent participants. Conclusions: Considering the existing evidence illustrating the effectiveness of ACT for adolescent populations, in group formats, and in primary care settings, it is likely that the current project’s novel ACT adolescent group treatment will improve psychological flexibility and reduce psychological symptoms across attendees. Discussion will include suggestions for how to adapt ACT curricula for groups of adolescents and successfully conduct such treatments within active integrated pediatric primary care settings.


Does Behavioral Health Integration Improve Perceptions of Training in Mental Health for Residents? A National Survey of Pediatric Residency Program Training Directors

Author(s): Jeffrey D. Shahidullah, PhD, Rutgers University, Paul W. Kettlewell, PhD, Geisinger Health System, Mohammed H. Palejwala, PhD, Michigan State University, Andrew Billups, BA, Rutgers University, Benjamin Madsen, BA, Rutgers University, Stephanie Anismatta, BA, Rutgers, University, Susan G. Forman, PhD, Rutgers University


The rationale of this study was to survey all pediatric residency program training directors in the United States to ascertain: (1) their attitudes towards the quality of training in behavioral health that their program offers, and (2) whether the involvement of behavioral health providers in that training (integrated service delivery – warm hand-offs/curbside consults in primary care continuity training clinic) predicts the level of quality that directors perceive. An evidence-based data-elicitation approach was used (Dillman’s Tailored Design Methodology, 2009) whereby a mail-based survey was sent to all pediatric residency training directors in the U.S. (N = 214). A response rate of over 60% was received. Behavioral health providers’ involvement in training was associated with a greater perception of overall training in mental health by residency training directors. Other results presented in this poster include training director’s perceptions of the quality of a variety of methods of training in behavioral health (standardized patients, feedback via EMR review, observations and performance feedback) that behavioral health providers may be positioned to provide. Perceived barriers to these behavioral health training innovations are also discussed.


Crisis Evaluations in Primary Care: The Possible Benefits of On-Site Behavioral Health Providers

Author(s): Monika Parikh, PhD, Pediatric Psychologist, Geisinger Medical Center, Laura A. Cook, PhD, Pediatric Psychologist, Geisinger Medical Center, Micaela Thordarson, PhD, Post-Doctoral Fellow, Geisinger Medical Center

There is a paucity of research related to crisis evaluations, particularly in integrated primary care (PC) settings. Suicide is a leading cause of death for children and adolescents in the US (Baraff, Janowicz, & Asarnow, 2008) and adolescents in the world (Patton et al., 2009). PC settings have been identified as an effective location for targeting suicide prevention, as a recent study indicated that 75% of adolescents who completed suicide were in contact with their PCP during the year prior to completing suicide and 50% of adolescents were in contact with their PCP within 30 days of completing suicide (Luoma, Martin, & Pearson, 2002). When faced with patients who present with depression and/or suicidality, having a BH provider available to see the patient can hopefully increase the likelihood that a patient can be provided with crisis intervention services in a PC setting. This poster will complement Concurrent Education Session number D2.


Understanding Primary Care Healthcare Professionals’ Beliefs on Traumatic Stress Disorder

Author(s): Amanda A. Bowling, BA, Doctoral Student, UT Austin, Alexandra L. Fisher, Ph.D., Director of Psychology Services for the Pediatric Intensive Care Unit, Dell Children's Medical Center and UT Austin, Ashlee M. von Buttlar, MA, Doctoral Student, UT Austin, Jordan Dell, BA, Doctoral Student, UT Austin, Renee Higgerson, MD, Attending Physician, Pediatric Intensive Care Unit, Dell Children's Medical Center, LeeAnn M. Christie, MSN, RN, Critical Care Research Scientist, Dell Children's Medical Center

Background/Rationale Following PICU admission, children and their caregivers are at risk for developing mental health problems, such as PTSD (Colville & Pierce, 2012; Nelson & Gold, 2012). Research has shown the preventive utility of screening for traumatic stress following PICU admission (Dow, Kenardy, Le Brocque,


& Long, 2012; Dow, Kenardy, Le Brocque, & Long, 2013). In a study of PICU staff, providers’ awareness of child and family interventions was associated with frequency of assessment for traumatic stress risk factors (Bowling et al., 2017). Less is known about community pediatricians’ awareness of PICU admission as a risk factor for PTSD. This study will examine the relationship between primary care providers’ knowledge of interventions for traumatic stress, frequency of assessment for traumatic stress risk factors, and comfort in approaching families about traumatic stress. This study will clarify how traumatic stress symptoms are addressed and treated in primary care after hospital discharge. Methods/Results A survey was sent to primary care providers through the local Pediatric Alliance. Data on providers’ knowledge of proven child and family interventions for traumatic stress, their frequency of assessment for risk factors, and their level of comfort approaching families, are reported on a Likert scale. The survey also asks about their practice’s current level of integrated mental health services and their referral practices for mental health concerns. The survey closes by assessing participants’ willingness to participate in future training programs, and records whether participants choose to seek information provided at the end of the survey regarding traumatic stress symptoms, risk factors, and interventions. Conclusion The study seeks to explore the relationships between the aforementioned variables and providers’ current understandings of interventions for traumatic stress and how comfortable they are in approaching families. Results will highlight the importance of including psychologists and other mental health providers in interdisciplinary alliances with community pediatricians and other primary care providers, with the goal of promoting the further integration of follow-up mental health care for PICU-exposed children and families in primary care settings.


A Successful Implementation Strategy to Support Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Pediatric Care

Author(s): Abigail Schlesinger, MD, Medical Director, Children's TiPS, UPMC Children's Hospital of Pittsburgh, UPMC Western Psychiatric Institute and Clinic, Shannon Meyers, RN, Outpatient Nurse Coordinator, UPMC Children's Hospital of Pittsburgh, Meredith Kursmark, MD, Pediatrics/Adolescent Medicine, Children's Community Pediatrics, Shari Hutchison, MS, Outcomes Manager, Community Care Behavioral Health, Suzanne Daub, LCSW, Sr Director Integration, Community Care Behavioral Health, Becky Burkley, MS, Program Manager, Community Care Behavioral Health

Background: Use of prescription drugs, alcohol, and other illegal drugs by adolescents is a growing health concern. The American Academy of Pediatrics recommends that adolescents are screened for substance use, due to the range of adverse consequences associated with use, but implementation has been limited. The following effort describes a learning collaborative approach with 3 large-volume pediatric primary care practices to support implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) for youth 11-20 years. Method: Providers were asked to implement SBIRT at their practices, complete an electronic workbook to report on process aims, and report on quality improvement cycles and strategies to improve implementation during monthly webinars. Process aims included the percent of youth screened, the percent of youth at high-risk for substance use who receive a brief intervention and/or referral to treatment, and the percent of youth with moderate-risk for substance use who receive brief advice or brief intervention. Results: At project initiation, 16 staff have been trained in SBIRT. Practices had 1842 visits; 613 youth were screened resulting in 605 completed assessments. The majority of youth, 422 (70%), had no risk for substance use, 165 (27%) low-risk, 7 (1%) moderate-risk, and 2 (<1%) high-risk. Conclusion:


Screening adolescents for substance use and substance use disorder (SUD) is critical in prevention, intervention, and treatment efforts but training alone may be insufficient to produce long-term change. With support of this initiative, community-based pediatric practices have successfully initiated SBIRT in adolescents and young adults and will continue to improve implementation as part of a 12-month learning collaborative.


Family Involvement in Collaborative Integrated Primary Adult Mental Health Care in the UK; One Leg of the Tripod

Author(s): David J. Humphreys, MSc, Systemic Family Therapist & Visiting Lecturer University of Hertfordshire.

Family involvement in collaborative integrated primary care, especially mental health care has proved a challenge. The concept of the Tri Optic articulated by Peek.C.J, 2015 building on Don Bloch's 1988 vision of the dual optic is acknowledged by Mausch. L. Fogarty,T.C. (2015) as a vital goal. In the United Kingdom adult primary mental health care development has been driven by the perceived need to provide increased access to therapists, using evidence based models. The aimbeing to treat an increasing population with mild to moderate anxiety and depression. Collaborative family involvement whilst acknowledged by the National Institute of Clinical Excellence (NICE) to be desirable, has struggled with the often-linear nature of treatment and perceived limitations of human rights and data protection law.


The Integration of Primary Care and Behavioral Health Services in a Behavioral Health Setting: a PBHCI Model in South Texas

Author(s): Clarissa Aguilar, Ph.D., Maria Loera-Quintanilla, MPAS, PA-C, Kevin Milligan, Ph.D., LPC, Ruth Morgan, M.D., FAAFP, Anna Rivera, M.A., LPC, Integrated Care Team at the Center for Health Care Services

The Center for Health Care Services, a PBHCI grantee, functions as the local mental health authority for Bexar County/ San Antonio, Texas, an urban area of over 1.81M residents. Our center serves over 13,000 adults with severe mental illness. PBHCI funds helped our program develop a unique reverse integration model offering primary care services within our behavioral health home. Our reverse integrated model is unique because of its existence in South Texas, its distinctive staffing model, the collaboration between primary care and the multifaceted behavioral health system, and the scale of which the program is being implemented. While outcome data are not yet available, the current data provides evidence to reflect the importance of recruiting a strong interprofessional team, such as a significant increase in patient enrollment (200%), a higher show and retention rate, and a qualitative shift regarding how our patients are approached and engaged to action. Our distinctive staffing model and key elements of the PBHCI reverse integration model include the integration of brief psychological intervention in primary care, incorporation of wellness programs, peer support, collaborative and interdisciplinary team planning, and cross-cutting interventions that are necessary to keep patients engaged, supported, and empowered.



Resident Exposure to Patients Based on Resident Demographics in a Suburban Family Medicine Clinic

Author(s): Sydney Deal, MD, GE Alan Dever, MD, PhD, Michele S. Smith, PhD

BACKGROUND/RATIONALE: Family Medicine residency prepares physicians to care for patients of all ages, races, genders and visit types. The ACGME states that “continuity of comprehensive care for the diverse patient population family physicians serve is foundational to the specialty” and that “the patient population must include a sufficient number of patients of both genders, with a broad range of ages, from newborns to the aged.” These guidelines are in place to provide the greatest opportunities for learning, however there are minimal studies that evaluate resident exposure. The studies that have been done have found that physician demographic characteristics influence the care provided (Levy & Merchant, 2002; Johnson, Roter, Powe & Cooper, 2004; Berger, 2008; Sahebkar & Raparelli, 2016). This study examines the frequency of residents getting balanced exposure to a diverse patient population. METHODS/RESULTS: Electronic health records were reviewed for the periods July through December 2015 and July through December 2017. All patients scheduled during this time were included in the study; the sample size was 6342. Variables included age, race, sex, and visit type. A cross-sectional design was used and data analyzed using Chi-square, Fischer Exact tests, and difference of proportions. IRB approval was obtained. White, Hispanic and Asian providers had a statistically significant difference in race of their patient population, with each group seeing a greater percentage within the same race, compared to normal clinic demographics. Black providers did not see a greater percentage of Black patients compared to their counterparts. Both Male and Female providers had a statically significant difference in gender of their patient population compared to normal demographics; Female providers were more likely to see Female patients while Male providers had an almost equal balance between Male and Female patients. CONCLUSIONS: While a patient population may be diverse, a specific physician’s panel may not represent the clinic population. Additional steps may be necessary in order to increase population diversity within each resident’s patient panel.

Track: 5. Training in Research and Evaluation Poster Number: P28

Results of a three world view meta-evaluation of integrated behavioral health care

Author(s): Amelia Muse, MS, LMFTA, Doctoral Candidate, East Carolina University, Technical Assistant, Center of Excellence for Integrated Care, Angela Lamson, PhD, LMFT, Professor, Associate Dean for Research and Graduate Studies, East Carolina University, Katharine W. Didericksen, PhD, LMFT, Assistant Professor, East Carolina University, Jennifer Hodgson, PhD, LMFT, Professor, MedFT Program Director, East Carolina University, Alexander Schoemann, PhD, Assistant Professor, East Carolina University

A significant amount of the research on integrated behavioral health care (IBHC) has focused on specific clinical protocols, diseases, or populations, with less research focused on the transformation of healthcare systems and processes by which programs develop into successful and sustainable integrated models. To show that IBHC is effective (clinically), feasible (operationally), and sustainable (financially), evidence incorporating outcomes from all three worlds (Peek, 2008) is needed. This evidence can only be generated


by conducting research and program evaluation on the clinical, operational, and financial aspects of integrated behavioral health care, across a variety of sites and programs. Attention must be given to the ways in which clinical, operational, and financial outcomes are measured and processes are evaluated to successfully transform IBHC programs. Therefore, a meta-evaluation, a study of how programs conduct evaluation, is needed. This project employed a survey to explore and define the clinical, operational, and financial metrics used in IBHC evaluation. Researchers recruited 145 IBHC professionals (BHCs, PCPs, and administrators) representing 93 separate health systems across the United States. Results showed that over 60% of IBHC programs are involved in some level of evaluation, however only 21% of programs evaluated aspects from all three worlds of the Three World view (Peek, 2008). A few of the major findings were that there were significant differences in knowledge about evaluation across different professional roles (BHCs, PCPs, and administrators), the degree of integration and level of evaluation were not related, grant funded programs were most likely to evaluate clinical characteristics, and programs with single-source funding from billing and reimbursement for services were more likely to evaluate operational and financial characteristics of their programs. This study is the first meta-evaluation of IBHC using the Three World view (Peek, 2008. This study showed that there is significant variation in evaluation practices and understanding of evaluation among professionals working in integrated behavioral health care. Implications for this study are relevant to researchers, behavioral health clinicians, medical providers, and administrators who are working to evaluate their integrated behavioral health programs to demonstrate utility and sustainability, as well as make improvements to providing higher quality care. This study demonstrated that real world implementers are struggling to measure the outcomes from all three worlds of the Three World view (Peek, 2008), and there are many barriers to conducting evaluation. It is time for professionals working in integrated behavioral health care to collaborate and come together to use their unique skills and knowledge to better evaluate the clinical, operational, and financial worlds.


Rethinking Parental Coping with Child Health: A Proposed Theoretical Model

Author(s): Rola Aamar, PhD, MedFT Postdoctoral Fellow, East Carolina University, Katharine W. Didericksen, PhD, Assistant Professor, East Carolina University, Amelia Muse, PhD, Technical Assistant, Center of Excellence for Integrated Care

For parents of children with special healthcare needs (CSHCN), managing the chronic illness becomes a core aspect of day-to-day parental functioning, which often presents as a stressor. A well-regarded model for exploring stress is Hill's ABCX model (1949), which Boss (1987) expanded on by framing in the context of coping. To continue to expand on the understanding of parental coping with CSHCN, this presentation will move the ABCX model from the heavily linear narrative to a more systemic perspective aimed at examining the relationships between environments, resources, needs, and coping. The purpose of this presentation is to share the findings of a systematic review of the literature on stress and coping when parenting a child with CSHCN. This presentation will also introduce a new theoretical model to explain how biopsychosocial-spiritual needs and resources and the family's systems play a role.



Starting Anew- Substance Use Treatment for Pregnant Women

Author(s): Rebecca Aycock, PhD, Psychologist, VCU, Sebastian Tong, MD, Family Medician Physician, VCU, Kathryn Polak, MS, Psych Student, VCU, Sydney Keplin, MS, Psych Student, VCU, Janet Abraham, MSW, Social Worker, VCU, Dace Svikis, PhD, Psychologist, VCU

Opioid misuse has grown exponentially among women over the past decade and is now the leading cause of accidental death. Effects of the opioid misuse epidemic extend beyond health with negative consequences on families, communities, law enforcement and economic productivity, and these consequences are intensified in pregnant women. The prevalence of opiate use among pregnant women can range from 1% to 2% to as high as 21%. Opiate-dependent women experience a six-fold increase in maternal obstetric complications such as low birth weight, toxaemia, third trimester bleeding, malpresentation, puerperal morbidity, fetal distress and meconium aspiration. Neonatal complications include narcotic withdrawal, postnatal growth deficiency, microcephaly, neuro-behavioral problems, increased neonatal mortality and a 74- fold increase in sudden infant death syndrome. At an academic medical center, an interdisciplinary team worked together to develop a treatment program for addressing opiate misuse in prenatal care. The team collaboratively identified essential clinical components for the program based on the expertise of the various team members to institute best practices. The program consists of medication assisted treatment (Subutex), health education, psychological assessment (ASI), psychological treatment (group and individual therapy), social work interventions and care coordination. Furthermore, we continually engage patients to ensure that the program’s content adequately addresses their concerns. Examples of patient derived content include, education about pain medications during and after labor, breast feeding while on Subutex or methadone, addressing trauma and intimate partner violence, and identification of community resources to help with social needs. This poster will complement Concurrent Education Session number C5.


To Integrated Training and Beyond: Case Example of Integration within a Pediatric Residency and Doctoral Psychology Program

Author(s): Rebecca M. Hammonds, BA, Doctoral Student, University of Texas at Austin; Julie E. Heier, MA, Doctoral Candidate, University of Texas at Austin; Joshua A. Morris, BA, Doctoral Student, University of Texas at Austin; Juliana Alba-Suarez, BA, Doctoral Student, University of Texas at Austin; Crystal Guevara, BA, Doctoral Student, University of Texas at Austin; Sarah R. Gojer, MA, Doctoral Student, University of Texas at Austin; Jane S. Gray, PhD, Training Director, Texas Child Study Center

Background/Rationale Integrated behavioral health can only propel forward by training a knowledgeable workforce prepared for interdisciplinary collaboration. This approach is imperative since mental health needs are often first discovered in primary care clinics, yet there are nationwide shortages of mental health providers and pediatricians with advanced knowledge of youth mental health needs. Preparing future health professionals for team-based care is a priority endorsed by medical and mental health associations. Still, siloed programs and rigorous schedules and requirements limit opportunities for integrated training. Pediatricians cite lack of training, brief clinic visits, and inadequate reimbursement models as barriers to


addressing mental health needs. The Interprofessional Educational Collaborative recommends early integrated training; medical providers and BHPs report collaboration during training prepares them to continue consultations and deliver effective BH interventions in future practice. Methods/Results This poster presentation will describe an interprofessional training program funded by an HRSA Graduate Psychology Education grant that provides three cohorts of psychology students and interns with yearlong integrated training and clinical practice with trainees from pediatrics, psychiatry, and social work. Co-training within this program, including coursework, didactics, experiential learning, and onsite consultation and collaboration opportunities will be illustrated. Attitudes and values about interprofessional work and attitudes and skills in integrated care, as well as perceived benefits of specific program components and likelihood to engage in integrated care in the future will be evaluated using self-report measures and brief interviews with medical and behavioral health trainees. Information will be presented as a case example with a brief literature review about interprofessional training, a program description, results of self-report measures, and trainees’ direct quotes. Conclusion Emerging providers must learn to effectively collaborate with each other and treat patients using a biopsychosocial model. Program structures where pediatric and psychology trainees share didactics, primary care clinic space, and patient visits are a promising educational and clinical strategy to overcome the hurdles of lack of training and clinic time, and reimbursement. In this program example, regular joint didactic training lays the groundwork for fostering interprofessional relationships and communication, develops a greater understanding of one another's professional competencies, and encourages frequent supervised collaboration for complex patients. Integrated care models cannot sustain without novel integration of behavioral health and medical providers in their training and approach to patient care. This case will illustrate strategies, benefits, and challenges of interprofessional training with the goal of furthering the dialogue of ways to enhance interprofessional training.


Training Clinicians in the Field of Medical Family Therapy: A Guide to Implementing a Comprehensive Master's Level Internship Program

Author(s): Ruth Nutting, PhD, LCMFT

This poster will provide a guide of how to implement a master’s level medical family therapy internship within an integrated primary care setting. Specific explanation will highlight: recruitment process, training details, therapy modalities utilized, evaluations completed, and educational opportunities provided. Professionals with interest in establishing a master’s level medical family therapy internship, within a primary care setting, will benefit from attending this presentation.


Reflecting on the Mental Wellness Quality Improvement Project at PACE of the Triad: The First Year with a HRSA Graduate Psychology Trainee


Author(s): Anahita Z. Kalianivala, MA, LPA, Clinical Psychology Doctoral Student, UNC Greensboro Janet D. Pennell, LCSW, Social Worker, PACE of the Triad Holly Gerber, LCSW, Social Worker, PACE of the Triad Misty Paladino, LCSWA, Social Worker, PACE of the Triad Adria Smith, Quality Coordinator, PACE of the Triad Joe Stanley, MA, Center Manager, PACE of the Triad Elaine Nosal, OTR/L, Occupational Therapist, PACE of the Triad Julie Williams, MD, MS, Geriatrician, PACE of the Triad Rosemery O. Nelson-Gray, PhD, Department of Psychology Faculty, UNC Greensboro Susan P. Keane, PhD, Director of Clinical Training and Department of Psychology Faculty, UNC Greensboro

The Program of All-¬Inclusive Care for the Elderly (PACE) provides comprehensive medical services to nursing¬ home eligible adults over 55. A primary aim is to help individuals remain in their homes and communities. However, addressing medical needs alone is insufficient to maintain the overall wellness of our aging. It is critical to address mental health needs, too, because depression is not a 'normal' part of aging. In 2016, PACE of the Triad developed a quality improvement project (QuIP) to address behavioral and mental health needs among its population. During that year, a HRSA grant allowed for a partnership with the UNCG Clinical Psychology program in which a doctoral student trainee was placed at PACE to obtain training in an integrated health setting. With the addition of the trainee to PACE staff, the Mental Wellness QuIP accelerated implementation of behavioral health (BH) programming, using the trainee as the BH consultant for the site's 175+ participants. QuIP goals included developing a role for the BH trainee, including a referral process and integration into the existing interdisciplinary team, and implementing an age¬ appropriate BH screening. Because an open and accepting culture among PACE staff was essential to the success of a BH program, we hosted Mental Wellness Month in May 2017, including staff education and a mindful coloring presentation for participants and staff. At the end of May, the staff was surveyed for their perceptions as a result of these activities, and 32 (50%) responded: 93.8% reported improvement in their perception of mental health and wellness, 90.6% reported improvement in patience and compassion for participants, 84.4% reported increased consideration of participants’ mental wellness when addressing care needs, and 90.7% reported improved ability to adapt their behavior and caregiving style to participants’ mental wellness needs. Staff surveys indicated effectiveness of the Mental Wellness Month initiative and quantified progress on QuIP goals. Additionally, staff behavior across the year (e.g., increased curbside consultations and referral sources) indicated increasing ability to consider participants’ BH needs. Future program development goals for the QuIP include continued evaluation of our BH service needs and integration; evaluating psychometrics of the screening measure being piloted; continuing staff/participant education to increase awareness and reduce the stigma of mental health, and examining utilization outcomes. Recognizing that BH in our setting is in high demand due to the aging nature of our population and their multimorbidities, we also intend to develop skills¬ based staff training so BH service delivery can occur across disciplines and providers.


Suboxone: A team approach

Author(s): Ryan Dix, PsyD, Behavioral Medicine Faculty/Integrated Psychologist, Providence Health System, Mari Kai, MD, Internal Medicine Residency Director, Providence Health System, Brinton Clark, MD, Internal Medicine Clinic Medical Director, Providence Health System, Jonathan White, PharmD, Clinical Pharmacist, Providence Health System, Kathleen Engstrom, Project Manager, Providence Health System

Addiction and overdose from opioids are epidemic both locally in Oregon and across the nation. Our intervention aimed to increase awareness and treatment providers in primary care for opiate use disorder.


Providence Medical Group is a large primary care network within a large multi-state integrated healthcare system. Our focus targeted providers within the Portland Service Area, which includes clinics in southwest Washington, as far west as Hood River, OR, and as far south as Newberg, OR. Team members included two physician clinical champions, a clinical pharmacist, a behavioral specialist, and a project manager. The first part of the project focused on an educational initiative aimed at PMG primary care physicians. A baseline survey to assess knowledge and interest about medication-assisted treatment with buprenorphine was sent to all primary care providers in Providence Medical Group. The educational intervention consisted of several methods. A 12 minute educational video was produced, highlighting our physician champions’ experience in treating opioid use disorders in the primary care setting. The team created a buprenorphine toolkit that included useful information such as training resources, office visit templates, office workflows, and frequently asked questions. The team made presentations at large regional medical director meetings, then subsequently visited primary care clinics during their designated provider meetings for further education and dialogue. A monthly conference call was developed for any providers that had questions about training or to discuss current cases. A larger audience was also targeted with a Grand Rounds presentation at Providence Portland Medical Center. The provider survey before the educational intervention began had a response rate of 34%. The survey identified that 77% of responding physicians think that buprenorphine treatment should be provided in primary care settings but only 24% were somewhat to very likely to prescribe buprenorphine. The intensive outreach was successful in increasing the interest of primary care physicians to adopt this treatment into their practice. At the start of our project, we had identified 5 physicians in 3 different PMG clinics who had their buprenorphine DATA waiver and were treating patients in primary care, 2 of those being our physician champions. At the conclusion of our intervention, we had 35 physicians in 16 clinics who had undergone the training and had applied or received their waivers. This poster will complement Concurrent Education Session number B3a.


Rates and Predictors of Psychotherapy Utilization after Psychosocial Evaluation for Stem Cell Transplant in Cancer Patients

Author(s): Valentina Penalba, MS, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine

Although standard of care prior to hematopoietic stem cell transplantation (HSCT) includes a psychosocial evaluation, little is known about the rate and predictors of psychotherapy utilization among patients presenting for pre-HSCT evaluations. This study aimed to examine the proportion of patients undergoing pre-HSCT evaluations who utilize psychotherapy services and to explore predictive factors, including distress, anxiety, depression and quality of life (QoL). Results indicate that only a small subset of patients presenting for pre-HSCT psychosocial evaluation utilize psychotherapy services - not most patients who report psychosocial concerns and who could potentially benefit from intervention. Further research is necessary to help clarify barriers to psychotherapy service utilization among HSCT patients and to help improve uptake among high-need patients.



The following Posters will be presented on Saturday, October 21, 2017 from 9:00 am – 2:30 pm:

Team-Based HIV Care: An Integrated Family Medicine Training Program

Author(s): Danielle King, PsyD, Behavioral Medicine Faculty, Resurrection Health, Peter Blatz, MD Consulting Infectious Disease Specialist, Resurrection Health, Chad Thompson, MD Family Medicine Resident, Resurrection Health

HIV care has transitioned from management of a terminal illness to management of a chronic disease and therefore must also address multiple other healthcare issues usually managed in primary care. In addition to patient need, the literature suggests that patients desire integration of HIV care and primary care services. Primary care providers need training in evidence-based HIV care to meet patient need. Data suggests that evidence-based care incorporates a multidisciplinary team. Resurrection Health has developed an HIV-care curriculum for family medicine residents designed to equip them to work in integrated, multidisciplinary teams including a consulting infectious disease physician, a behavioral health consultant, and medical case managers. This presentation will outline this training curriculum and care model with an emphasis on resident and patient experience.


Crohn's Disease and the Young Couple: An Interpretative Phenomenological Analysis

Author(s): Ruth Nutting, PhD, LCMFT

This presentation will explore how an individual's diagnosis of Crohn's disease is perceived to affect the couple relationship and young adult life-cycle transitions. By attending this presentation, researchers and healthcare providers will better understand how the numerous physical symptoms of Crohn's disease cause psychological and social implications for the diagnosed individual and partner. A systemic, biopsychosocial understanding of Crohn's disease will encourage couple level clinical assessment and increase systemic interventions, promoting greater resilience among young adult couples.


To go or not to go? Likelihood of specialty mental health treatment for patients receiving care within the Primary Care Behavioral Health consultation model.

Author(s): Stacy Ogbeide, PsyD, Bethany Gutierrez, Karlos Garza, Ankita Mizra, Kripa Shrestha

Patients with chronic medical conditions are more likely to suffer from behavioral health conditions such as depression, anxiety and substance use disorders than those without chronic medical conditions. The majority of behavioral health care takes place within primary care settings rather than in specialty mental health settings. Access to specialty mental health care can be difficult due to limited access to mental health providers and wait times to receive mental health care (Ede et al., 2015). Many studies show that integrating behavioral health services into primary care settings can reduce medical costs, improve treatment adherence, improve clinical outcomes and improve patient and provider satisfaction (Robinson


& Reiter, 2016). One benchmark of quality improvement is measuring patient satisfaction with integrated behavioral health care (Deavers, DePesa, Mitchell, Mazza, & Cassisi, 2015). The purpose of this study is to determine patient satisfaction with behavioral health consultation visits that take place within the context of primary care as well as determine patient likelihood to seek out specialty mental health care services if behavioral health consultation services were not provided within the context of primary care.


Emergency Room Management of Suicidal Behavior in Teens: Implications for Practice, Programs, and Partnerships in Inter-Professional Education

Author(s): Monica Whitehead, MS, Psychology Intern, Geisinger Medical Center, Paul Kettlewell, PhD, Attending Psychologist, Geisinger Medical Center, Nicole Quinlan, PhD, Chief of Pediatric Consultation Liaison, Geisinger Medical Center, Robert Strony, MD, Emergency Medicine Residency Training Director, Geisinger Medical Center, Jeffrey D. Shahidullah, PhD, Assistant Professor, Rutgers University-New Brunswick

Background/Rationale Suicide accounts for the third leading cause of death in 10-14 year-old youth and the second cause of death in 15-24 years olds (Centers for Disease Control and Prevention, 2013). One avenue to assess safety related to suicide and other mental health crisis behaviors includes patients presenting to the emergency department (ED). However, in more than 50% of cases, crisis evaluations are completed without a mental health professional such as a psychiatrist, psychologist, or county mental health worker (Baraff, Janowicz, & Asarnow, 2006). In most circumstances, medical providers are not only uncomfortable assessing depression and/or suicide, they are often inadequately trained in how to properly make related treatment recommendations. Therefore, there is a call to better understand medical providers’ ability to manage mental health crises, particularly in the ED setting. This study examined confidence and competence of suicide assessment and treatment with emergency medicine residents. Method/Results First (R1; n = 13), second, and third year (R2/R3; n = 9) residents (18.2% female; Mage = 30.68 years) completed a survey assessing confidence and competence in assessment and treatment related to suicidal behaviors. Scoring was based on the American Academy of Child and Adolescent Psychiatry Practice Parameters for suicidal behavior. R2/R3s rated higher confidence relative to R1s in risk assessment and follow up recommendations (p = .01 and .04). R2/R3s were better able to differentiate voluntary and involuntary hospitalizations and to correctly identify who consents for hospitalization (p < .001 and .04). Residents had difficulty identifying appropriate consent procedures for adolescent patients. Residents were on average able to identify five risk factors for suicide, the majority listing “previous attempts” and “means.” For safety planning, 59% of residents listed “increased supervision” and “removing means,” and 82% included follow up care. Conclusion This study found that emergency medicine residents have some confidence in their ability to assess and treat for suicidality. Additionally, residents were able to identify some key risk factors to consider when assessing suicidality. However, there is still apparent room for training, particularly related to safety


planning and including follow-up care in discharge planning. Additionally, residents struggled with case vignettes related to adolescents and consenting for services. Therefore, an important area for growth is expanding residents’ knowledge of how adolescents’ autonomy plays into treatment decisions. Given these areas of growth, this study also justifies the utility of including mental health professionals within the ED not only to train emergency medicine residents, but also to assist and/or complete crisis evaluations to ensure that patients are being adequately assessed and appropriate recommendations are made. This poster will complement Concurrent Education Session number D2.


Taking time: Creation of a Resiliency elective to help address burnout and improve resident wellbeing

Author(s): Ryan Dix, PsyD, Behavioral Medicine Faculty/Integrated Psychologist, Providence Health System, Tricia James, MD, Internal Medicine Faculty, Providence Health System, Elizabeth Stephens, MD, Endocrinology Faculty, Providence Health System, Richard Cohen, MD, Behavioral Medicine Psychiatry, Providence Health System, Kyler Shumway, MA, George Fox University

The prevalence of physician depression and burnout is significant, with rates up to 47% of medical education faculty and 67% of private practice physicians. Burnout then leads to decreased empathy towards patients, reduced job satisfaction, as well as increased medical error and unnecessary spending. A recent assessment of our system indicated that 87.5% of residents demonstrated moderate to severe emotional exhaustion. Additionally, 79.2% demonstrated moderate to severe depersonalization, while 20.9% to 43.2% reported depressive symptoms. To address this growing concern, the researchers created a resiliency-based intervention that provides residents with the tools necessary to sustain engagement in medicine, reduce the risk of burnout and depression, and ultimately help to create a more fulfilling personal and professional life. The curriculum includes monthly group sessions, a focused week on resilience as well as a possible weeklong elective, Introductory session at the beginning of their outpatient rotation, access to confidential mental health services and medication, and a residency retreat. Each part of the curriculum is designed to implement resiliency through mindfulness, cognitive-behavioral change, relationships, and communication. This process was designed to follow residents over a three-year period of their training, thereby fortifying their personal and professional core during a critical phase of development. We intend to present on the structure and development of this curriculum, as well as the efficacy data. Outcome of the intervention will be assessed via burnout (Maslach Burnout Inventory) and physician empathy (Jefferson Scale of Physician Empathy). These measures are administered to current residents as well as 7 control sites at the beginning and end of the academic year. Residency is a time of dramatic personal and professional development. Unfortunately, rates of burnout and depression are extraordinarily high during these years. The prevalence of this issue has a ripple effect on the medical system, leading to dysfunction, inefficiency, high turnover rates and at worst; physician suicide. Although residents are not always taught the tools to foster resilience and interpersonal engagement, this curriculum has been developed to address these deficits. We believe that this curriculum will foster long-term professional drive, deepen capacity for empathy and connection, and bolster the


leaders of our medical community. Additionally, insight into these skills will allow them to more efficiency work within a multidisciplinary team.


EHR: A Quality Improvement Tool for Enhancing Primary Care Behavioral Health Model Fidelity

Author(s): Dawn Ready, DBH, LCP Behavioral Health Integration Specialist, Indian Health Services; Faculty Associate, Doctor of Behavioral Health Program, Arizona State University

The Primary Care Behavioral Health Model (PCBH) of integration has become the leading model for primary care settings looking to meet triple and quadruple aim goals (Bodenheimer & Sinsky, 2014). Yet most who enter this brave new world have no formalized training on ensuring model fidelity through a focus on the clinical, operational and financial correlates of the primary care setting. Enhancing clinical outcomes and attending to quality improvement efforts can seem to be a daunting task for the novice trailblazer (In Grol, In Wensing, In Eccles, & In Davis, 2013). This poster presentation wil focus on the critical role of leveraging an integrated healthcare clinic's electronic health record (EHR) to enhance PCBH model fidelity. Leveraging an EHR across the continuum of care allows for better integration among providers, standardization of data and care plans using evidence-based protocols that meet quadruple-aim goals. This poster will complement Concurrent Education Session number E8.


Linking Families to Resources: Assessing Social Determinants of Health in Pediatric Primary Care via the TEAM Care Screener

Author(s): Matthew Tolliver, PhD, Behavioral Health Consultant, ETSU Pediatrics Deborah Thibeault, LCSW, Clinical Assistant Professor, ETSU Social Work Gayatri Jaishankar, MD, Associate Professor & Medical Director, ETSU Pediatrics Jodi Polaha, PhD, Associate Professor, ETSU Family Medicine Karen Schetzina, MD, MPH, CLC, FAAP, Professor, ETSU Pediatrics

Background/Rationale: The American Academy of Pediatrics recommends universal surveillance of social determinants of health in primary care. Addressing these determinants is likely crucial to reducing extant health disparities. Such screening in urban pediatric primary care has been shown to increase access to relevant resources for families when combined with provider training in using a community resource binder (Garg et al., 2007). However, resources in more rural areas are often scarce and helping families navigate a complex resource system often requires a more individualized approach. Additionally, in an increasingly screener heavy pediatric environment, social determinant screeners that are comprehensive but brief are needed to reduce the burden on both patients and providers. Methods/Results: A brief TEAM Care social determinants screener protocol was developed to meet the needs of families presenting to ETSU Pediatrics. Our clinic serves primarily low income families, many of which live in rural


areas. During the first eight months of data collection, 2043 TEAM Care screeners were administered at annual well child checks. The prevalence of caregiver endorsed concerns was as follows: financial concerns impacting ability to pay for food, housing, or utilities (7%), transportation problems (4%), caregiver depression (4%), concerns about caregiver drug/alcohol use (2%), domestic violence (1%), and literacy problems (1%). 13.4% of caregivers endorsed at least one concern on the screener. Caregivers who endorsed a concern were provided individualized resources via a warm handoff or phone call by integrated social work interns. Interns were available on an ongoing basis to check in with families, adjust resource recommendations as needed, and coordinate care with the child’s primary care physician. Our poster will report on an anticipated 3000 TEAM Care screeners collected during the first year of administration. Conclusion: Last year at CFHA, we reported the initiation of the TEAM Care Screener, modeled after the WE CARE Screener (Garg et al., 2007) and designed to screen for social determinants of health in pediatric primary care via six items. Previous preliminary reports of this study included data from approximately 1000 screeners. A one year report of the TEAM Care screener will be completed in September 2017, making it ideal timing to present at CFHA in October 2017. We anticipate reporting prevalence data from 3000 screeners and incorporating results from a provider satisfaction survey of the screener process. The TEAM Care screener process was designed to maximize efficiency for families and providers, and the addition of social work interns ensures that families who endorse needs receive individualized help. A future goal is to more systematically follow up with families to determine how many were connected to recommended resources.


Training Future Generations of Health Care Providers in Medication Assisted Treatment Options for Substance Use Disorders

Author(s): Esther N Schwartz, PhD, Post-Doctoral Fellow, Department of Family and Community Medicine, Texas Tech University Health Sciences Center David RM Trotter, PhD, Assistant Professor and Director of Behavioral Science, Department of Family and Community Medicine, Texas Tech University Health Sciences Center

Background: Only 1 in 10 individuals who meet criteria for a substance use disorder (SUD) receive any kind of treatment. Secondary and tertiary care systems cannot adequately respond to the demands for SUD treatment services, given the prevalence of SUDs in the general population. Therefore, SUD treatment and mental health services, with an emphasis on harm reduction, must be integrated into the primary care health systems. Mediation Assisted Treatments (MAT) are an evidenced for the treatment of SUDs. This poster will describe a successful educational initiative in the use of MATs for preclinical medical students (MS2), Family Medicine Residents, and Family Medicine Faculty/Attending Physicians. Methods: A series of MAT training modules were developed for our various learners. The training modules were customized by learner category to meet learner’s needs. The medical student and residency MAT modules were presented in the context of a broader SBIRT training. The attending physician module was presented in the context of a Grand Rounds presentation, and SBIRT was referenced during this presentation. Results: We collected program satisfaction data from learners. Preliminary results suggest that the MAT program met its objectives and that learners found the trainings valuable to their future practice.


This poster will complement Concurrent Education Session number B3a.


Post Diagnosis of Chronic Illness: The Utilization of Illness Perceptions and Systemic Supports to enhance Resiliency.

Author(s): Alexander Young, MA, Our Lady of the Lake University

Resiliency is a significant attribute in the prevention of psychological distress (Bonanno, 2005). However, a scarcity of qualitative research exists on how resilience interplays with patients that suffer from chronic illness (Cal, Sa, Glustak, & Santiago, 2015). This is troublesome as individuals that test HIV positive often report high levels of anxiety, depression, and suicidal ideation post-test (Paul et al., 2011; Smith, et al., 2012). Criterion and Intensity sampling were used to identify a case that met criteria for this pilot study. The individual was then asked seven open-ended questions in a therapeutic interview to assess resiliency features (Creswell, 2013; Nelson, Onwuegbuzie, Wines, & Frels, 2013). Results indicate that systemic supports are crucial and mindful actions allow an individual to remain supported throughout their illness journey. Interestingly illness perceptions changed over time to a benign less threatening form, which may be unique to HIV. This finding of resilience is in line with de Terte, Stephens, & Huddleston, (2014) construction of a systemic resiliency vs. internal resilience. This study found that while resiliency processes do exist in individuals with HIV; it appears that resiliency processes are delayed and exist in an external capacity and may appear in the form of active action to catalyze and maintain resilience.


Integrated Health Care for Pediatric Anxiety

Author(s): Katherine Kainer, MA, Counseling Psychology Doctoral Student, Our Lady of the Lake University, Alexander Young, MA, Counseling Psychology Doctoral Student, Our Lady of the Lake University

Anxiety disorders are the most common type of mental health disorder affecting children and adolescents, with 20% of pediatric patients scoring above clinical cut-offs on screening measures for one or more anxiety disorders (American Academy of Pediatrics, 2017). Unfortunately, challenges exist in detecting pediatric anxiety, such as unawareness or inability to articulate worries, presentation as somatic symptoms, and comorbidities with other psychological and medical conditions (Sawyer & Nunez, 2014). Thus, the majority of children and adolescents experiencing anxiety are undetected and less than half actually receive treatment (Ginsburg, Drake, Winegrad, Fothergill, & Wissow, 2016). Due to limited access to specialty mental health care, families of children and adolescents with anxiety often seek support from their primary care physician (PCP), which has led to increasing efforts to enhance access to mental health interventions in primary care settings (Rozenman & Pacentini, 2016). Therefore, the purpose of this poster is to review interventions for pediatric anxiety in primary care and apply the 5A’s Model to a pediatric anxiety case composite, highlighting the collaborative nature of integrated care. This poster will complement Concurrent Education Session number F6.



Integrated Care & Collaborative Suicide Prevention

Author(s): Lauren Wilson, MSW, LCSW, Doctoral Candidate, Family Medicine, Saint Louis University

Suicide rates are increasing and integrated care health teams have an important role in prevention. When family physicians and behavioral health consultants work collaboratively with at-risk patients, outcomes may include better health, better care, lower costs and greater provider satisfaction. The clinical vignette illustrates the impact of suicide prevention strategies implemented by a diverse team of health care providers. This poster will complement Concurrent Education Session number D2.


Brief CBT for Medically Ill Primary Care Patients: How Much Does it Cost?

Author(s): Chelsea G. Ratcliff, PhD, Assistant Professor, Sam Houston State University, Christine W. Pao, MA, Graduate Research Assistant, University of Houston, Shubhada Sansgiry, PhD, Assistant Professor, Baylor College of Medicine/Michael E. DeBakey VAMC, Nancy J. Petersen, PhD, Associate Professor, Baylor College of Medicine/Michael E. DeBakey VAMC, Jeffrey A. Cully, PhD, Professor, Baylor College of Medicine/Michael E. DeBakey VAMC

Background/rationale: Evidence indicates that integrating behavioral health into primary care (PC) improves health outcomes, increases satisfaction with care, and reduces healthcare costs.[1] Despite this, evidence-based psychotherapies (EBP), including brief cognitive behavioral therapy (bCBT), are infrequently used in PC settings.[2] This is partially due to the frequent mismatch of EBP duration/intensity with the time constraints of PC as well as inadequate EBP implementation support for PC clinicians.[3] Estimations of the cost of implementing PC-appropriate EBPs (such as bCBT) are essential for hospital administrators deciding where to invest limited resources. This study examines the cost of implementation of bCBT by VA Primary Care Mental Health Integration (PC-MHI) clinicians (staff psychologists (SP), social workers (SW), and physician assistants (PA)). Data for this study were collected in the context of a RCT of bCBT for medically ill Veterans with elevated symptoms of anxiety and/or depression.[4] Methods/results: Ten clinicians (SP=6; SW=2; PA=2) were recruited from 2 large VA PC-MHI programs and trained in a structured bCBT approach for medically ill Veterans via a modular online program. Mentors (CBT experts) listened to 23% of bCBT sessions and provided one-on-one feedback (audit and feedback (A&F). Clinicians provided an average of 4 bCBT sessions to 81 patients. Clinicians and mentors reported time spent on program, hourly wages were estimated using the VA General Schedule, and the number of patients seen by SPs (n=56), SWs (n=7), and PAs (n=18) were used to determine the per capita cost of training, A&F, and delivery. Total intervention costs were estimated at $433/patient for SPs (per capita $46 for training, $135 for A&F, $252 for delivery), $347/patient for SWs (per capita $103 for training, $89 for A&F, $154 for delivery), and $325/patient for PAs (per capita $56 for training, $102 for A&F, $167 for delivery).


Conclusions: The cost per patient of implementing brief CBT is modest, regardless of PC-MHI provider discipline. Supporting implementation of brief CBT by physician assistants and social workers may be lower in cost compared to staff psychologists. This preliminary cost analysis does not consider effectiveness outcomes. However, the intervention improved depression and anxiety symptoms (Cohen’s d = .33 to .37) posttreatment compared to enhanced usual care, and these effects were maintained at 8 and 12 months.[5] Future work will compare intervention implementation cost, medical expenditures, and quality-adjusted life years between patients in the bCBT and control groups to determine bCBT cost-effectiveness.


Improving Safe Opiate prescribing: Integrating a Certified Alcohol and Substance Abuse Counselor into a Family Medicine Training Practice

Author(s): Colleen Fogarty, MD, MSc, Associate Chair of Family Medicine, University of Rochester – Department of Family Medicine, Rochester, NY, B. Wade Turnipseed, LMFT Nabila Ahmed-Sarwar, PharmD, BCPS, CDE, BC-ADM Kelly Lame, CASAC Holly Russell, MD, MS Mathew Devine, MD Tziporah Rosenberg, PhD

At our Family Medicine Center, a training site for Family Medicine residents, family nurse practitioner residents, post-doctoral psychology fellows, pharmacy interns, and marriage and family therapy interns, we have developed policies and procedures to improve patient safety among those patients who are prescribed opioid medications for chronic pain. This includes initiating naloxone training for patients at risk, integrating a Certified Alcohol and Substance Abuse Counselor (CASAC) into a Family Medicine Training Practice, and working with patients to decrease their opiate prescriptions as appropriate to the clinical situation. This poster will complement Concurrent Education Session number B3a.


collaborative family healthcare association 19th annual … · 2018. 4. 1. · geisinger medical...

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