1. Cross-Disciplinary Training of a Family Medicine Resident and a Family Therapy Intern Alison G. Wong, MA Doctoral Family Therapy Intern Hugh Blumenfeld, MD PhD Assistant Professor of Family Medicine Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Track I3 October 28, 2011 3:30 PM

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Rationale The experience described today started with the goal of increasing competency in co-treatment, but grew into a model of collaboration that improved patient care by interweaving the complementary strengths and gaps in the approaches of the medical and mental healthcare disciplines. Within the holistic environment of the Patient-Centered Medical Home, medical and mental health professionals can and should be trained in collaborative care, not only in practice but in theory.

4. Objectives Identify the clinical and educational benefits of co-training across medical and mental healthcare professions. Describe the individual and relational challenges of cross- disciplinary training in primary care behavioral health. Identify strategies to respond to the theoretical and logistical challenges Propose ways in which the changes in our professions open doors to new ways of working together

5. Expected Outcome Knowing the potential benefits of cross-training, participants will create opportunities for medical residents and family therapy interns to work together to achieve true collaborative care in the context of a comprehensive medical home.

6. The Setting Alison Wong, Family Therapy Intern – Master’s internship in Family Therapy – Interest in Medical Family Therapy Hugh Blumenfeld, Family Medicine Resident – Longitudinal Medical Family Therapy elective – Co-therapy 2-3 hours weekly for 1 year – Long-time interest in psychiatry & counseling

7. Facilitating Factors Co-location – Multiple “warm hand-offs” – Shared EMR, communication – Shared mentors, supervision Residency program - culture of training Long tradition of integrating behavioral therapy into primary care Longitudinal time frame allowing continuity

8. Therapist Experience Therapist’s role in co-managing psychiatric care Understanding the constraints of the physician Recognition of patterns in medical care and their relation to mental health symptoms Increased medical knowledge Educating patients to co-manage their own care

9. Physician Experience Learning the variety of psychotherapeutic techniques Appreciating the dynamic nature of the therapeutic process vs. the categorization of psychiatric diagnoses Increased interaction with therapists to blend medical and counseling modalities Rethinking the roles of medications and counseling in mental illness Creation of a med-psych clinic to address the needs of patients with complex medical and social issues Extending the Aegis of Healing

10. Case Presentation Clinical History – History of heroin abuse; now “appropriately managed” by long term methadone maintenance – Pain: polyneuropathy, chronic back pain with multiple MRI’s and medications – Weight gain, fatigue, uncontrolled type 2 diabetes. – Diagnosis of depression and anxiety with panic attacks; multiple psychiatric & therapy referrals, on SSRI – No documentation of associated symptoms, changes in depression severity, or dosing changes

11. SA Drugs SA Drugs Incarceration Rosa Maria Rafael Carmen Maria Drugs Incarceration The Perez Family 58 Nina SA @ 16 5652 Ricky 52 Mentally Retarded 57 m. 2010d. 1980s

12. Case Presentation Phase I: Assessment – Joining and social history – First revelation of command hallucinations – Basic stress management and coping Phase II: Collaborative care treatment – Medication evaluation and initiation of changes – Expand social and resource network – Weight loss, pain reduction, disease self-management Phase III: Progress – CBT and Aversion Therapy reduced anxiety and compulsive behaviors – Change from victim to advocate – Change from managed to self-managed care

13. Rosa Speaks

14. Learning Assessment Identify the primary benefit(s) of co-training opportunities among family therapists and physicians: a.Instill a model of collaborative and coordinated care among trainees via training culture b.Encourage trainees to become familiar with other settings of care via co-location c.Improved care management of psychiatric illness d.All of the above

15. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!