Session # D7a Behavioral Health Screening in Primary Care: Is There an Alternative Measure? Brian DeSantis, PsyD, ABPP VP, Behavioral Health Peak Vista Community Health Centers Please insert the assigned session number (track letter, period number), i.e., A2a Please insert the TITLE of your presentation. List EACH PRESENTER who will ATTEND the CFHA Conference to make this presentation. You may acknowledge other authors who are not attending the Conference in subsequent slides. CFHA 18th Annual Conference October 13-15, 2016  Charlotte, NC U.S.A. Collaborative Family Healthcare Association 12th Annual Conference

Faculty Disclosure The presenter of this session has NOT had any relevant financial relationships during the past 12 months. You must include ONE of the statements above for this session. CFHA requires that your presentation be FREE FROM COMMERCIAL BIAS. Educational materials that are a part of a continuing education activity such as slides, abstracts and handouts CANNOT contain any advertising or product‐group message. The content or format of a continuing education activity or its related materials must promote improvements or quality in health care and not a specific propriety business interest of a commercial interest. Presentations must give a balanced view of therapeutic options. Use of generic names will contribute to this impartiality. If the educational material or content includes trade names, where available trade names for products of multiple commercial entities should be used, not just trade names from a single commercial entity. Faculty must be responsible for the scientific integrity of their presentations. Any information regarding commercial products/services must be based on scientific (evidence‐based) methods generally accepted by the medical community. Collaborative Family Healthcare Association 12th Annual Conference

Learning Objectives At the conclusion of this session, the participant will be able to: Discuss two advantages that traditional primary care BH screening measures provide to integrated care practitioners Identify three significant shortcomings of traditional primary care BH screenings. Describe two possible advantages that an ultra- brief, alternative measure may provide to primary care BH screening Include the behavioral learning objectives you identified for this session Collaborative Family Healthcare Association 12th Annual Conference

Bibliography / Reference DeSantis, B., Jackson, M., Duncan, B., & Reese, R. (in press). Casting a wider net in behavioral health screening in primary care: A preliminary study of the Outcome Rating Scale. Primary Health Care Research and Development Duncan, B., & Reese, R. (2015) The partners for change outcome management system (PCOMS): Revisiting the client’s frame of reference. Psychotherapy 52(4), 391-401. Arroll, B., Goodyear-Smith, F., Crengle, S., et al. (2010). Validation of PHQ12-2 and PHQ-9 to screen for major depression in the primary care population. Annals of Family Medicine 8(4), 348-353. Fuchs, C.H., Haradhvala, N., Hubley, S., et al. (2015). Physician actions following a positive PH-Q-2: Implications for the implementation of depression screening in family medicine practice. Family Systems & Health, 33(10), 18-27. Siu, A.L. (2016). U.S. Preventive Service Task Force: Screening for depression in adults: U.S. preventative services task force recommendations statement. Journal of American Medical Association, 315(4), 380-387. Continuing education approval now requires that each presentation include five references within the last 5 years. Please list at least FIVE (5) references for this presentation that are no older than 5 years. Without these references, your session may NOT be approved for CE credit. Collaborative Family Healthcare Association 12th Annual Conference

Learning Assessment A learning assessment is required for CE credit. A question and answer period will be conducted at the end of this presentation. Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation. This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements. Collaborative Family Healthcare Association 12th Annual Conference

Primary Care: The Defacto MH Care System Majority of patients with MH conditions assessed and treated in primary care (Hunter et al., 2009; Petterson et al., 2014) Integrated care has led to the development of brief screening measures Identify and diagnose MH problems Assist in interdisciplinary clinical decisions to improve care Collaborative Family Healthcare Association 12th Annual Conference

Depression in Primary Care Most prevalent MH diagnosis with majority of depressed adults receiving treatment by PCPs (Bland, 2004; Edlund et al., 2004) U.S. Preventive Services Task Force recommends routine adult depression screenings (USPSTF, 2002, 2004, 2016) U.S. Department of Health and Human Services (HRSA) requires depression screenings in FQHCs Collaborative Family Healthcare Association 12th Annual Conference

PHQ-9 and PHQ-2 (Kroenke et al., 2001; 2003) “Gold standard” primary care adult depression screeners; often used in a two-step approach (Arroll et al., 2010) University hospital based family medicine clinic with integrated BH; only 5% of 200 positive PHQ-2 patients given a PHQ-9 (Fuchs et al., 2015) Competing demands, time constraints and knowledge of patients cited by PCPs Despite validity of PHQ-9 and its wide use in research trails, real world work flow demands challenge routine use in PC (Blasinsky et al., 2006) Collaborative Family Healthcare Association 12th Annual Conference

Further Limitations of Traditional BH Screeners (PHQ-9, GAD-7, PC-PTSD, AUDIT) Narrow symptom-based, diagnosis focused Limits identification of a broad array of MH distress affecting medical outcomes (i.e. relational, social) Common MH co-morbidities brings feasibility challenges to a multi-measurement approach Developmental age range restrictions Collaborative Family Healthcare Association 12th Annual Conference

A Possible Ultra-Brief Alternative Outcome Rating Scale (ORS; Miller & Duncan, 2000) 4-item, self-report measure of global distress and functioning across major life domains One of two measures comprising the Partners for Change Outcome Management System (PCOMS; Duncan, 2012; Duncan & Reese, 2015) PCOMS is a SAMHSA EBP Never been investigated as BH screener in PC http://heartandsoulofchange.com INDIVIDUALLY: (Personal well-being) |------------------------| INTERPERSONALLY: (Family, close relationships) |------------------------| SOCIALLY: (Work, school, friendships) |------------------------| OVERALL (General sense of well-being) |------------------------| Collaborative Family Healthcare Association 12th Annual Conference

A Preliminary Study Compared ORS with PHQ-9 (and PHQ-2) at three small, rural Peak Vista FP Health Centers N=426 adult patients (14.8%) Evaluated correlations, reliability coefficients, and numbers of patients screening positive (DeSantis et al., in press)

Results Bivariate Correlations ORS vs. PHQ-9: r = .72 Internal Reliabilities ORS: a = .92 PHQ-9: a = .89 PHQ-2: a = .81 ORS categorized significantly more patients in the clinical range ORS: 167 PHQ-9: 126 PHQ-2: 99 (DeSantis et al., in press) Collaborative Family Healthcare Association 12th Annual Conference

Key Limitations ORS ‘s sensitivity, specificity Number of triggered BH consults and their follow-up outcomes Generalization of results (DeSantis et al., in press)

Implications of Exploratory Study ORS may cast a wider net, offering a viable alternative that addresses limitations of traditional measures In addition to universal or targeted screening, may be used by BHPs in warm-hand offs ORS, as part of a SAMHSA EBP for psychotherapy (PCOMS), may offer brief integrated BH treatment a feasible quality improvement outcome system www.pcoms.com

Session Evaluation Please complete and return the evaluation form before leaving this session. Thank you! This should be the last slide of your presentation Collaborative Family Healthcare Association 12th Annual Conference