1. 2006 STFM Families & Health1 Teaching Mental Health Promotion Skills Sandra Burge, Ph.D. Manuel Oscos-Sanchez, M.D. Sally Dunlap, Ph.D. Cynthia Alford, Ph.D. Lewis Rose, M.D. University of Texas Health Science Center – San Antonio Acknowledging support from HRSA Residency Training Grant

2. 2006 STFM Families & Health 2 Today’s Objectives Participants will:  Learn a 4-level framework for Mental Health Promotion  Learn about one program’s curriculum for mental health promotion skills training.  Develop a plan for a 2-hour workshop to teach one mental health promotion skill (BATHE)  Share and develop 4 active learning strategies that can be applied to mental health skills training.

3. 2006 STFM Families & Health 3 Introductions

4. 2006 STFM Families & Health 4 Our Story Begins With… A grant proposal to HRSA With a focus on mental health promotion And clinical skills In a cultural context

5. 2006 STFM Families & Health 5 Rationale Mental health care is the everyday stuff of family medicine.  25% patients meet criteria for a mental disorder  Most do not follow through on referrals to mental health professionals  Most prefer to get mental health care from their personal physician

6. 2006 STFM Families & Health 6 Rationale 75% patients do NOT have mental disorders, but fall on a continuum…  Mentally healthy  At-risk for psychological distress  Psychologically distressed (subclinical) Subclinical symptoms impede life functioning Simple interventions can ease suffering and prevent progression to full-blown disorders.

7. 2006 STFM Families & Health 7 Rationale Can family doctors do these interventions? They already DO…  Provide anticipatory guidance  Use encouraging words  Deliver bad news  Inquire about life stressors  Counsel distressed people  Advise health behaviors

8. 2006 STFM Families & Health 8 Overview of Curriculum  broaden family physicians’ clinical repertoire for mental health promotion  broaden family medicine faculty repertoire for teaching clinical skills With funding from HRSA, We developed a curriculum to:

9. 2006 STFM Families & Health 9 Overview of Curriculum Faculty  4 family physicians, with interests in… Adolescent care Procedures Geriatrics Maternity care  4 Ph.D. faculty Clinical psychologist Social scientist Medical anthropologist Medical educator

10. 2006 STFM Families & Health 10 Overview of Curriculum 4 levels of intervention skills  Mental health promotion for healthy people  Mental illness prevention for at-risk people  Mental health intervention for people with symptoms  Mental health diagnosis & treatment for people with a mental illness. 18 skill workshops  Delivered bimonthly over 3 years.

11. 2006 STFM Families & Health 11 Overview of Curriculum Level 1: Mental health promotion skills for mentally healthy people  Anticipatory guidance  Health behavior change counseling  Planning enjoyable activities  Building support networks  Reflective listening  Parenting skills

12. 2006 STFM Families & Health 12 Overview of Curriculum Level 2: Mental illness prevention skills for at-risk people  Exploring spirituality as a personal resource  Developing affirmation & coping statements  Coping with loss, sadness, anger, guilt  Reframing & solving problems  Relaxation techniques  Solution-focused techniques

13. 2006 STFM Families & Health 13 Overview of Curriculum Level 3: Mental health interventions for distressed people  Office counseling – BATHE  Conflict resolution  Assertiveness skills

14. 2006 STFM Families & Health 14 Overview of Curriculum Level 4: Mental health diagnosis & treatment  Patient-centered interviewing  Patient-centered negotiation  Coping with fear, worry, anxiety, panic

15. 2006 STFM Families & Health 15 Workshops Completed Anticipatory guidance Health behavior change counseling Planning enjoyable activities Building support networks Parenting skills Developing affirmation & coping statements Coping with loss, sadness, anger guilt Assertiveness skills Patient-centered interviewing

16. 2006 STFM Families & Health 16 Development Process Weekly meetings Peer instruction re: content Development of teaching strategies  Active learning  Limited lecturing  Use of personal or clinical experience  Translating from psychology to family medicine  Focus on skill-building  Variation in teaching strategies

17. 2006 STFM Families & Health 17 Innovations Focus on health promotion & disease prevention Workshops are skill-based Teaching methods emphasize active learning Protected (paid) time for 8 M.D. & Ph.D. faculty

18. 2006 STFM Families & Health 18

19. 2006 STFM Families & Health 19 A Few Words about Active Learning “…strategies promoting active learning [are] defined as instructional activities involving students in doing things and thinking about what they are doing.” Bonwell CC, Eison JA. Active Learning: Creating Excitement in the Classroom. National Teaching and Learning Forum, http://www.ntlf.com/html/lib/bib/91-9dig.htm

20. 2006 STFM Families & Health 20 A Few Words about Active Learning Passive learners listen to lectures Active students are engaged in learning  reading, writing, discussing, solving problems, practicing new skills Active learners engage in higher-order thinking  analysis, synthesis, application, evaluation Bonwell CC, Eison JA. Active Learning: Creating Excitement in the Classroom. National Teaching and Learning Forum, http://www.ntlf.com/html/lib/bib/91-9dig.htm

21. 2006 STFM Families & Health 21 Stop. Think. Write. Get a pen and paper (handout) Think about the teaching strategies you or others use…  To engage the learner in learning  To promote higher-order thinking Write down 4 strategies

22. 2006 STFM Families & Health 22 Hold on. We’ll use these ideas in a few minutes.

23. 2006 STFM Families & Health 23 Let’s Pretend… YOU are the curriculum development committee. Your task will be to develop a two-hour workshop to teach the BATHE technique to 24 residents, all levels.

24. 2006 STFM Families & Health 24 Your Turn: Develop a Two-Hour Workshop Form small groups Familiarize yourselves with the BATHE content. Make a plan for a 2-hour workshop to teach BATHE.

25. 2006 STFM Families & Health 25 Show and Tell Random Selection Winners, Share Your Workshop Plan!

26. 2006 STFM Families & Health 26 Show and Tell Other groups  Name one way that your workshop differs.  What additional teaching strategies have you proposed?

27. 2006 STFM Families & Health 27

28. 2006 STFM Families & Health 28 Teaching Strategies Move to a new group Referring to your notes and workshop plans, Come to consensus about the 4 most effective active learning strategies for teaching mental health skills

29. 2006 STFM Families & Health 29 Teaching Strategies Consider for each strategy:  What type of learning can this address? Knowledge, attitudes, skills  How are learners engaged?  What higher-order thinking is addressed?  How and where could this learning strategy be implemented?

30. 2006 STFM Families & Health 30 Share Your Results

31. 2006 STFM Families & Health 31 Reflections Participating in active learning activities Working in groups Our experiences in group-work

32. 2006 STFM Families & Health 32 Gracias, Amigos y Amigas! We wish you safe travel back to the Great White North. The end…