INTEGRATED CLINICS: Threat or Enhancement to Training? Cindy M. Bruns, PhD Association of Counseling Center Training Agencies – Baltimore, MD 2112

DISCLAIMER Oops! Please don’t mistake me for an expert. I just proposed this presentation in the spirit of ACCTA volunteerism. I do, however, work in an integrated clinic and am fairly competent at literature searches.

LEARNING OBJECTIVES  1) Participants will be able to describe at least 3 potentially problematic issues related to integrated medical and counseling clinics.  2) Participants will be able to describe at least 3 potentially beneficial outcomes of integrated medical and counseling clinics.  3) Participants will be able to describe at least 2 methods of facilitating collaboration in a multidisciplinary setting.

INTEGRATED CARE OUTSIDE THE UNIVERSITY SETTING  Have been discussions in the literature for the last 2.5 decades  Definitions vary widely: Biopsychosocial treatment Professionals from different disciplines working closely to provide continuity of care Behavioral or mental health consultants working with physicians Direct (assess to answer a specific question, chart answer) Informal (sit in on staffings and provide expertise) Collaborative (combines direct, informal, and often psychotherapy)

WHY INTEGRATIVE CARE IN THE “REAL” WORLD?  Mental health concerns constitute a significant percentage of presenting issues in primary care settings  Increased focus on biopsychosocial aspects of disease  Increased focus on wellness and prevention  Recognition of the psychological aspects of compliance with treatments and interaction of mental and physical health concerns  Lack of training for health care providers with respect of psychological functioning

WHY INTEGRATED SERVICES AT UNIVERSITIES?  Reduction of barriers (i.e., less stigma about going to the health center vs the counseling center)  Mental health concerns are large percent of presenting complaints at health centers  Ease of cross-referrals  Elimination of duplicate resource expenditure  Students may be less confused about where to go for what  Many of same reasons for integrating care in the “real” world

AMERICAN COLLEGE HEALTH ASSOCIATION

WHAT ARE WE REALLY DOING OUT THERE? AUCCCD Data on Collaboration and Integration

AUCCCD DATA My counseling center collaborates with Student Health Services Not at all 3.90% A little 15.12% A fair amount 46.34% Extensively 34.63%

AUCCCD DATA Is your center located adjacent or near a student health service? Yes 57.11% No 42.89% Is your center located in a student health service building? Yes 35.15% (up from 15% in 2009) No 64.85% Is your center administratively integrated within a health service? Yes 25.36% (up from 15.6% in 2009) No 74.64%

AUCCCD DATA Do you and you Student Health Services share an electronic medical records system? Yes 16.01% No 83.99% Do you and you Student Health Services share access to your counseling records without needing additional informed consent? Yes 12.20% Yes but only with Psychiatry 6.34% No 81.46%

AUCCCD DATA Are you (the Counseling Center Director) the chief administrator over the health service? Yes 11.35% No 88.16%

CONCERNS ABOUT INTEGRATION  Being over-taken by medical/disease model  Records/confidentiality  Loss of autonomy  Budget/resource allotment  Having a director who doesn’t understand counseling  Loss of counseling center identity  Basic philosophical differences…clients versus patients, etc.  Others?

POTENTIAL TRAINING DRAWBACKS  Training program seen as “extra” or “expendable” item in the budget when times are tight  Subtle or not so subtle pressure to change training or treatment philosophy toward medical model/problem-solving approaches  Interns exposed to “turf” wars or triangulation  Others?

POTENTIAL BENEFITS TO TRAINING  Exposure/introduction to behavioral health issues and practice  Development of cross-discipline consultation skills  Develop broader conceptualization skills using multiple perspectives  Education regarding interaction of medical diagnoses with psychological effects  Greater education about medication uses and side effects

POTENTIAL BENEFITS CONTINUED  Experience with truly coordinated care of a client/patient  Learning how to navigate medical system in order to advocate for clients in a supported and supervised setting  Develop appreciation for the difficult job of medical providers, nurses, etc.  Others?

IMPORTANT CONSIDERATIONS PRE-INTEGRATION  Talk, talk, talk, talk Goals of integration Roles Training Philosophy Legalities (e.g., records, confidentiality)  Respect, respect, respect  Clarity of structure  Common goal: Student Service

IMPORTANT CONSIDERATIONS POST-INTEGRATION  Talk, talk, talk, talk  Respect, respect, respect  Regular Multidisciplinary Team Meetings  Shared vision statement  Individual department mission statements related to vision  Continued clarification of roles, laws, ethics, boundaries, etc.