1. There Are Elephants In This Room! The Marriage Between Primary Care and Behavioral Health: Some Elephants in the Room Brian DeSantis, PsyD, ABPP Director, Behavioral Health Peak Vista Community Heath Centers Inc. Frank V. deGruy, MD MSFM Professor and Chair, Department of Family Medicine University of Colorado Collaborative Family Healthcare Association 17 th Annual Conference October 15-17, 2015 Portland, Oregon U.S.A. Session # 5686472 ( G6 in Period 6) October 17, 2015 B,F

2. Faculty Disclosure The presenters of this session have not had any relevant financial relationships during the past 12 months. B

3. Learning Objectives At the conclusion of this session, the participant will be able to: Identify common challenges to making the (arranged) marriage of integrating behavioral health into primary care work. Discuss two covert marital stressors (elephants in the room) that should be addressed between the marital partners. List two proposed solutions to these “elephants” to help achieve a collaborative and mutually supportive marriage. F

4. Learning Assessment A learning assessment is required for CE credit. Evaluate this session at the end. We will leave time for questions and answers at the end of this presentation (and in the middle of it, too). F

5. Overview 1.Our Premise: Team-based care is desirable. 2.Marriage and elephants as metaphors: differences that don’t at first show but matter. 3.We’ll surface two and process them. B

6. Differences Between Health and Mental Health Professionals Differences in emphasis within the biopsychosocial model (medical vs relational). Language for problem appraisal, diagnosis, management, and treatment. Treatment preferences: what do you reach for first? Red is yummy! B

7. Exercise Descriptors—adjectives—that reveal perceptions about medical and behavioral health professionals F

8. Medical Professionals Cold, insensitive Rigid, controlling Egotistical, arrogant Obsessive compulsive Pressed for time Technician Somatically fixated F

9. Behavioral Health Professionals Impractical Flaky Touchy-feely Wishy-washy Not real docs Right-brained and left- winged Psychosocially fixated F

10. I’m OK, You’re Not. Just eat both. B

11. First Elephant George, a 65yo WM, w/ DM, RA. Wife died 6wks ago, now living alone. Can’t sleep, can’t think straight. PHQ-9 = 14. HbA1c = 9.5 Joints hurt. 15 minute visit.

12. F,B (Warm Handoff) F,B

13. First Elephant Discussion Understanding of problem Intervention Roles Points of conflict Possible resolution B

14. Second Elephant Lushawn, a 32yo BF “can’t breathe.” Husband left her without warning 1mo ago. Very distressed: can’t sleep, can’t eat, can’t think, no motivation. Best friend suggested antidepressant. She’s here asking for Prozac.

15. (Warm Handoff) F,B

16. Second Elephant Discussion Understanding of problem Preferred treatment Antidepressants vs psychotherapy vs both Differences between clinicians F,B

17. General Discussion Dealing with hidden differences Patients are part of the team: ask & listen Strengthening the partnership Leadership Other preconditions for integrated care All equally delicious! F,B

18. References 1.Kathol, R.G., deGruy, F., & Rollman, B.L. (2014). Value-based financially sustainable behavioral health components in patient-centered medical homes. Annals of Family Medicine, 12(2), 172-175. 2.Duncan, B.L. & Reece, R.J. (2012). Empirically supported treatments, evidence-based treatments, and evidence-based practice. In G. Stricker & T. Widiger (Eds.), Handbook of psychology: Clinical Psychology (2nd ed., pp. 997-1028). Hoboken, NJ: Wiley. 3.Sparks, J.A., Duncan, B.L. Cohen, D., & Antonuccio, D.O. (2010). Psychiatric drugs and common factors: An evaluation of risks and benefits for clinical practice. In B.L. Duncan, S.D. Miller, B.E. Wampold. & M.A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (2nd ed., pp. 199-235). Washington, DC: American Psychological Association. 4. Special issue on integrating behavioral and primary care: http://www.jabfm.org/content/28/Supplement_1 http://www.jabfm.org/content/28/Supplement_1 5. Kelly JM, Kraft-Todd G, et al. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta- analysis of randomized controlled trials. PLoS ONE 9(4): e94297. doi:10.1371/journal.pone.0094207

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