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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


  • 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


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

Thank you!