Integrated Behavioral Health Care with Underserved Pts: The VCU PC Psychology Program Benjamin Lord, M.S. Virginia Commonwealth University

Our Program Virginia Commonwealth University includes PhDs in both Clinical and Counseling psychology The Clinical Psychology Program includes specialty tracks in Child Psychology and in Behavioral Medicine All PhD students do practicum training in the community after their first year in the program –Community Mental Health Clinics –University Counseling Services –Primary Care Psychology at VCU Medical Center

VCU Primary Care Psych: A Hx Clinic was started in 2008 Place psychology PhD students in the Primary Care clinic at VCU Medical Center –Work with MD residents –Work with underserved, indigent patients “Coping with Chronic Disease Clinic” Began with 3-4 students performing consultations and advertising services several days per week CURRENTLY: –16 PC Psych students at any given time –Expansion to Pediatric Primary Care –3 PhD LCP Supervisors –Psychiatry Liason –3 Official clinic days with scheduled visits –Consultation services 5 days per week –Monthly didactic training for MD residents –Team-Based Learning –Provided approximately 950 sessions to 190 individual patients Dr. Bruce Rybarczyk Director of Clinical Training Founder of VCU PC Psychology

The Four Needs Training PhD students in psychology to develop or work in future integrated care settings Improving access to mental and behavioral health services for the underserved Train medical residents to use mental and behavioral health services Research the integrated care model to show when and how it works

Our Training Model: Learn one, See one, Do one, Teach one Developing Competency in Integrated Care

When and Where Does Training Happen? Training Opportunities –Counseling Skills Course –Behavioral Health and Health Psych Courses –PC Psychology Course –Group Supervision –On-site peer and faculty supervision –Shadowing –“On the Job” Training –Workshops/Team- Based Learning Trajectory of a PC Psych Student 1 st year –Counseling skills course –Attend “Group Sup” –Shadow 2 nd semester 2 nd year –Begin seeing patients solo 3 rd year+ –Consultation and leadership

Mental and Behavioral Health Services Assessment, Treatment, and Referral

Who are we serving? Over 50% minority Over 20% rural, low income 80+ %ile on SRRS-R Behavioral Health Problem areas: Insomnia, Chronic Pain, Smoking Cessation, managing diabetes Mental Health Problem Areas: Depression, Anxiety Avg: 4-5 sessions VCU Medical Center, where PC Psychology operates Referral Methods: Traditional: Pt. is scheduled for an initial session by PCP Same-Day Consultation: PC Psychologist is requested to participate in pt’s PCP appointment

Services We Provide Mental Health –Depression –Anxiety –Panic Disorder –Somatization –Adjustment –Risk Assessment –Brief Cognitive Evaluations Behavioral Health –Pain management –Behavioral Treatment of Insomnia –Smoking Cessation –Medication adherence –Diabetes management –Diet/Weight loss –Coping with chronic disease Interventions are brief, problem- focused, and generally based on cognitive-behavioral principles

Assessment Tools SRRS-R –Life Stressors PHQ-9 –Depression GAD-7 –Anxiety ISI –Insomnia MPQ-SF –Pain Behavioral Measures –Cigarettes smokes per week –Weight –A1C

The QPD Quick Psychodiagnostic assessment tool for primary care Self-administered on portable tablet Screens for: QPD Tablet: An easy screening tool for use by both PC Psychology and medical residents

Training with Medical Providers Enhancing Integration with Residents and Staff

Three Major Projects Team-Based Learning –Large training activities –Focus on one topic (adherence, pain, depression) –Troubleshoot in teams (MDs, Pharmacists, psychologists, pastoral counselors) The “Clinic Minute” –5min didactic presentations –Developed based on requests by attendings and medical residents –Interpersonal skills; Adult ADHD; Chronic Pain Mandatory Shadowing –2 nd year residents do rotations where they sit in on PC Psychology sessions and participate in brief didactic presentations

Researching our model Some Preliminary Data

Current Research Projects Success with Team-Based Learning –Evaluate outcomes of our TBLs in terms of the educational goals and attitudes toward working in a team Success with Residents –Surveyed residents attitudes toward PC Psychology, the amount of contact with PC Psych, and their attitudes toward integration Success with Patients –Currently analyzing data on outcomes from our screening and assessment measures –Also conducted patient satisfaction research w/ sample of 20 patients

Figure 1. Mean percentage of maximum possible subscale score by profession for TBL 1: Adherence TBL DATA

Figure 2. Mean percentage of maximum possible subscale score by profession for TBL 2: Depression TBL DATA

Figure 3. Mean percentage of maximum possible subscale score by TBL session (excluding chaplain participants who did not attend both sessions) **Difference in Value was significant p<.01 TBL DATA

Resident Survey N = 58 medical residents Referral rates: 58% referred btw 1 and 7 patients in 30 days 75% satisfied or very satisfied with PC Psychol

Satisfaction Question Mean rating Q1My clinician seemed warm supportive and concerned3.8 Q2My clinicain seemed trustworthy3.8 Q3My clinician treated me with respect3.7 Q4My clinician did a good job of listening3.7 Q5I was able to express my feelings during the visit3.7 Q6I talked about the problems that are bothering me3.7 Q7The approach my provider used made sense3.7 Q8I learned some new ways to deal with my problems3.7 Q9I believe the visit was helpful to me3.8 Q10Overall, I was satisfied with today's visit3.7 Q11 I plan to do what I told the clinician I would do before I come to the clinic for my next visit3.7 Q12I intend to use what I learned in today's visit3.7 Q13At times, my provider didn't seem to understand how I felt3.8 Q14At times, I felt uncomfortable during the visit0.8 Q15I didn't always agree with my clinician0.5 Q16Number of visits with PC Psychology5.2 Patient Satisfaction Questionnaire Results

PHQ-9 Scores

GAD Scores