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Session # F2b October 28, 2011 1:30 PM. A Day in the Life of a Behavioral Health Consultant. Jeffrey T. Reiter, PhD, ABPP Co-Director, Primary Care Behavioral Health Service, HealthPoint Community Health Centers Seattle, WA.

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a day in the life of a behavioral health consultant

Session # F2b

October 28, 20111:30 PM

A Day in the Life of a Behavioral Health Consultant

Jeffrey T. Reiter, PhD, ABPP

Co-Director, Primary Care Behavioral Health Service,

HealthPoint Community Health Centers

Seattle, WA

Collaborative Family Healthcare Association 13th Annual Conference

October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

faculty disclosure
Faculty Disclosure

I have not had any relevant financial relationships during the past 12 months.

need practice gap supporting resources
Need/Practice Gap & Supporting Resources
  • Integration of primary care and behavioral health is increasing, with use of various models
  • A consultant model (aka PCBH) is utilized in many organizations, but is not widely understood
  • This talk will delineate the consultant model from other models using real world examples and clinical tools
  • Strosahl, K. (2005). In O’Donohue et al. (Eds.) Behavioral Integrative Care: Treatments that Work in the Primary Care Setting. Routledge (Chapter 1)
  • Robinson, P. & Reiter, J. (2006). Behavioral Consultation and Primary Care: A Guide to Integrating Services. Springer: New York
objectives
Objectives
  • Identify the basic components of a consultant model
  • Explain how a consultant model differs from a therapy model
  • Outline strategies for conducting consultative visits of varying lengths
  • List the most important components of consultative feedback for a PCP
why a consultant model
Why a Consultant Model?
  • Overwhelming number of behavioral issues in PC
    • The specialty (case-focused) model will be insufficient
  • PCPs poorly trained in behavioral interventions
  • PCPs will use more behavioral interventions if exposed to them regularly (Robinson, 1996)
context of a consultative visit
Context of a Consultative Visit
  • Timing can vary
    • Before PCP visit: prep for PCP visit
    • During PCP visit: for support; help with assessment or intervention; or due to time constraints
    • After PCP: answer specific question or augment care
  • Purpose can vary
    • Medication-focused (Meds indicated? Which class?)
    • Functionally-focused (“Please help with____”)
    • Other specific question (suicide risk?, meds risk?, etc.)
goals of a consultative visit
Goalsof a Consultative Visit
  • Goal is to optimize PCP care, efficiency
    • For specific questions
      • Primarily answer the referral question
    • For medication-focused referral
      • Provide a diagnostic category
      • Obtain medication history (response, SE) and current preferences
    • For functionally-focused referral
      • Listen for important history the PCP did not have
      • Provide behavioral recommendations for pt, PCP
content of a consultative visit
Content of a Consultative Visit
  • General content
    • Role introduction
    • History of the presenting problem
      • Including psych tx history, if applicable
    • Overview of functioning
      • Work/School, Family, Social, Physical, Recreational
      • Look for relationships b/w problem and function
        • Often forms the basis for the intervention
      • Substance use (etoh, tob, caffeine, drugs)
        • If indicated
        • Past history, current use
    • Recommendations for pt and PCP (including f/u plan)
sample clinic day
Sample Clinic Day
  • 9:00 PCP wants meds rec
    • 52 y/o homeless, ? ADHD vs bipolar
  • 9:30 Question re disability expiring
    • 64 y/o Russian-speaker, depression
  • 10:00 PCP says “I don’t know her problem”
    • 62 y/o, psychiatrist d/c’d, on 3 meds from 3 Drs
  • 10:30 Open→WH w/ PCP in exam room
    • 12 y/o autism, ADHD, recently showing tics, hall’s
sample clinic day cont d
Sample Clinic Day (cont’d)
  • 11:00 N/S→WH in exam room, PCP- prep
    • 6 y/o ADHD, insomnia, enuresis
  • 11:30 Planned f/u from 1 week earlier
    • 20 y/o Spanish-speaker, depressed w/ SI
  • 1:00 Team mtg (15-min talk on pain, 5-min on tobacco cessation)
  • 2:00 Cx→same-day appt for NRT refill
sample clinic day cont d1
Sample Clinic Day (cont’d)
  • 2:30 Open→WH for CSA
    • 60 y/o severe etoh, chronic arm pain
  • 3:00 Planned f/u after 2 weeks
    • 47 y/o homeless, MDD w/ psychosis, acute SI due to meds
  • 3:30 Planned f/u after 1 month
    • 45 y/o homeless, MDD, trying to get disability
  • 4:00 Cx→WH for PCP prep on new pt
    • 16 y/o expelled from school, needs risk assessmt
  • 4:30 Open→Same-day f/u after 4 mos
    • 20 y/o seeking disability for PTSD, dep
keys for flexibility
Keys for Flexibility
  • Be open toshorter than usual visit (e.g., 10 mins)
  • Be mindful of your schedule
    • Does the next pt need a full 30 minutes?
    • Can the WH pt wait?
    • Do you have an opening later to catch up?
  • Perspective
    • Primary goal is to improve PCP’s care and efficiency
    • “A bird in the hand is worth two in the bush.”
    • Positive interaction and f/u plan may reduce no-show
questions and session evaluation
Questions and Session Evaluation

Questions?

Please complete and return theevaluation form to the classroom monitor before leaving this session.

Thank you!

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