Family Medicine and Medical Family Therapy: A Model of Integrated Care and Training William T. Manard, MD, FAAFP Max Zubatsky, PhD, LMFT Craig Smith, PhD, LMFT F. David Schneider, MD, MSPH Dixie Meyer, PhD, LMFT Saint Louis University School of Medicine Department of Family and Community Medicine

Disclosures All participants: No relevant disclosures

3 Bill Objectives Describe the benefits and challenges of combining behavioral health with medical training and practice. Outline methods to merge potentially competing models of care. Describe how to improve person-centered care available through a co-located collaborative care model.

4 Bill Overview In 2013, the Department of Marriage and Family Therapy at Saint Louis University became the Division of Medical Family Therapy in the Department of Family and Community Medicine at Saint Louis University School of Medicine A new model of care was required to provide proper training to both our medical and therapy trainees This new partnership has had challenges There are many benefits to such collaboration Although much has been done, much remains to be developed

Why a single department? 5 Dave/Craig Why a single department? In 2013, due to University realignment, Saint Louis University restructured the Marriage and Family Therapy program The Department of Family and Community Medicine noted this: Was an ideal collaboration opportunity fitting well with family medicine’s model of care Would strengthen the division of behavioral medicine within the department

Why a single department? 6 Dave/Craig Why a single department? Beginning with the 2013-2014 academic year, the Marriage and Family Therapy training program became the Division of Medical Family Therapy within the Department of Family and Community Medicine This provided an opportunity for an important program to continue, while affording needed behavioral health collaboration for the medical training programs

7 Max Curriculum changes The Medical Family Therapy program restructured several courses and training opportunities to meet department needs: MedFT courses on theories, health, and clinical topics in medicine Integrating residents in supervision and practicum courses at on-campus clinic Primary care experience for students on their clinical rotations Offering two clinical/research scholarships for students to work with other faculty in the department

Curriculum changes Residency training changes 8 Bill Curriculum changes Residency training changes MedFT students at residency FMCs Providing consultation services Providing counseling services Collaboration in integrated care teams MedFT students on residency inpatient services Provide consultation services as part of rounds Some direct patient care Limited by necessity

Curriculum changes Predoctoral education for medical students 9 Bill Curriculum changes Predoctoral education for medical students Opportunities for students and faculty to work with medical students on inpatient training MedFT faculty who are facilitating trauma informed care workshops with interprofessional education MedFT students training and mentoring medical students at the Health Resource Center

Challenges of integration 1010 Bill Challenges of integration What does integration mean? How to integrate care? How to integrate training? How do we blend differing practice cultures?

Integration Multiple facets to integrate Funding streams to merge 1111 Bill Integration Multiple facets to integrate Funding streams to merge Single clinical practice? Collaboration and integration vs. co-location

Integrating care Bill Where to put more “bodies”? 1212 Bill Integrating care Where to put more “bodies”? Multiple practice sites with varying facilities MFT’s “home” practice Faculty practices Residency practices Finding the best environment for collaboration Meeting as a group “Curbside consultations” Finding the best environment for direct patient care

Integrating training PhD and MA training programs 1313 Max Integrating training PhD and MA training programs Where do differing levels of learners fit in? Do these training programs serve different goals? Involvement in residency training Teaching team-based care How best to integrate How best to integrate different training programs? MD model is different than MFT model Supervision Expectations Patient care perspectives Gaining understanding of the impact of these differences

Integrating cultures Similar goals for care, but different approaches 1414 Max Integrating cultures Similar goals for care, but different approaches Do we speak the same language? How do we prioritize what needs are most important for patients? When do we have time to consult about cases?

Benefits to integration 1515 Max Benefits to integration Improved quality of training Improved quality of patient care Greater research and scholarly opportunities

Improved quality of training 1616 Max Improved quality of training MD training has aspects to offer to MFT training Biochemical understanding of behavioral changes Navigation of health care systems MFT training has aspects to offer MD training Family systems theories Therapeutic techniques (MI, ACT, CBT, medical genograms) Interpersonal communication Faculty of both programs complement one another

Improved quality of care 1717 Max Improved quality of care Behavioral health consultation Discussion of complex cases in office Introduction of behavioral therapy for potentially resistant patients Behavioral health referral Ongoing therapy services in medical office Referrals to the MedFT on-campus clinic Reduction of stigma Complex care management Participation on interdisciplinary team for complex patient care planning Offer further insights into care of one another’s patients

Research as an added benefit 1818 Max Research as an added benefit Supporting each others’ research efforts Collaboration for topic development Collaboration for actual studies Differing approaches to scholarly activity complement one another

Research as an added benefit 1919 Max? Dixie? Research as an added benefit Initial question: What are the health concerns predominately treated? Pain Disorders Muscle Pain Headaches Back pain Arthritis Neuropathy Obesity All of the above comorbid with depression and/or anxiety

Research as an added benefit How do our physicians, staff and MedFT students view integrated care in our clinics? What are some of the common barriers and challenges that we see in practice? What roles can MedFTs serve in this capacity?

Future directions Continuous presence of consultative services 2121 Bill Future directions Continuous presence of consultative services Increased counseling presence in practices Greater integration of MedFT in MD predoctoral education Greater cross-department collaboration with willing partners Developing a MedFT Fellowship position in the department

2222 Bill Conclusion Transitioning to a medical family therapy model can be challenging Integrating into an existing faculty practices offers exciting opportunities, but barriers continue to exist Co-location is a start, but integration remains a goal Many scholarly opportunities that remain to be uncovered

Contact information Bill Manard – manardwt@slu.edu Max Zubatsky – zubatskyjm@slu.edu Dave Schneider – dschnie13@slu.edu Craig Smith – csmith112@slu.edu Dixie Meyer – dmeyer40@slu.edu Doug Pettinelli – pettinj3@slu.edu Jeff Scherrer – scherrjf@slu.edu Carissa van den Berk-Clark – cvanden1@slu.edu

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