1. Ray Hornyak, Jeanne Spencer, Jenna Stephens, Narissa Whitelaw Conemaugh Family Medicine Residency Program Johnstown, Pa.

2. The Problems… Many primary care patients would benefit from behavioral health care services Family physicians often do not have the time or training to address many of the chronic health behaviors and mental health needs of their patients Patients referred to mental health specialists outside the office frequently do not go

3. Other Problems… Psychologists are trained to treat patients with both health and mental health needs: There are few behavioral health internship sites available for graduating doctoral psychologists There are even fewer internship sites available to learn and practice primary care behavioral health

4. One Solution… Develop a primary care psychology internship in a family medicine residency program

5. So We Did… Conemaugh Psychology Internship Program - 2 Pre-Doctoral Psychology Interns - Practicum Students

6. Family Medicine Program Conemaugh Family Medicine Residency Program - 18 Residents, 6 per year - 12 Faculty, including 1 Psychologist - Multi-disciplinary staff, including Pharm.D’s; Social Worker, HIV Specialist, Nursing, Clerical Staff

7. Advantages to medical residents Psychological services available on site for triage and treatment, allowing more time to manage patients Able to assist those “difficult” patients with multiple health/psychosocial needs who are unlikely to seek help elsewhere Can provide additional assessment/diagnostic services, education (e.g. group visits, lectures)

8. Advantages to psychology interns Develop skills through multiple learning opportunities with residents and faculty Implement short-term assessment and treatment models, as distinct from traditional psychotherapy Navigate throughout the medical center to provide psychological services as an adjunct to their primary care role (e.g. cardiac rehabilitation, neuroscience)

9. Advantages to patients “One-stop-shopping” to obtain integrative care and seamless health/mental health treatment Cost-effective to patients, and to the health care system Patients more likely to accept treatment with a warm hand-off and communication between professionals

10. Program a dvantages… Psychology interns and family medicine interns begin training together, starting at orientation, and develop mutual trust and appreciation for one another’s roles Psychology interns are available to all residents for on-the-spot consults, patient assessments, and referrals for behavioral and/or mental health treatment

11. Challenges…. Time – always a challenge for residents and interns to be available for referrals or consults Space – crunch for exam rooms becomes a major obstacle when the clinic is fully-staffed Money – interns cannot bill for direct services, and must rely on indirect sources for program support

12. The future…… As medicine continues to move toward systems care (e.g. the Affordable Care Act; Medical Home), the integrative care model of health care is seen as a positive step in improving care and lowering costs through addressing co-existing mental and physical health conditions

13. Future (cont’d) Co-training of family physicians and psychologists in a primary care residency can be a rich source of education and practice, which will benefit students, provide improved patient outcomes, and further the mission of providing cost-effective, high-quality, integrative care to all.

14. THANK YOU!