Integrated Behavioral Health Care with Underserved Pts: The VCU PC Psychology Program

1. Integrated Behavioral Health Care with Underserved Pts: The VCU PC Psychology Program Benjamin Lord, M.S. Virginia Commonwealth University

2. Our Program • Virginia Commonwealth University includes PhDs in both Clinical and Counseling psychology • The Clinical Psychology Program includes specialty tracks in Child Psychology and in Behavioral Medicine • All PhD students do practicum training in the community after their first year in the program • Community Mental Health Clinics • University Counseling Services • Primary Care Psychology at VCU Medical Center

3. Clinic was started in 2008 Place psychology PhD students in the Primary Care clinic at VCU Medical Center Work with MD residents Work with underserved, indigent patients “Coping with Chronic Disease Clinic” Began with 3-4 students performing consultations and advertising services several days per week CURRENTLY: 16 PC Psych students at any given time Expansion to Pediatric Primary Care 3 PhD LCP Supervisors Psychiatry Liason 3 Official clinic days with scheduled visits Consultation services 5 days per week Monthly didactic training for MD residents Team-Based Learning Provided approximately 950 sessions to 190 individual patients Dr. Bruce Rybarczyk Director of Clinical Training Founder of VCU PC Psychology VCU Primary Care Psych: A Hx

4. The Four Needs • Training PhD students in psychology to develop or work in future integrated care settings • Improving access to mental and behavioral health services for the underserved • Train medical residents to use mental and behavioral health services • Research the integrated care model to show when and how it works

5. Our Training Model: Learn one, See one, Do one, Teach one Developing Competency in Integrated Care

6. Training Opportunities Counseling Skills Course Behavioral Health and Health Psych Courses PC Psychology Course Group Supervision On-site peer and faculty supervision Shadowing “On the Job” Training Workshops/Team-Based Learning Trajectory of a PC Psych Student 1st year Counseling skills course Attend “Group Sup” Shadow 2nd semester 2nd year Begin seeing patients solo 3rd year+ Consultation and leadership When and Where Does Training Happen?

7. Mental and Behavioral Health Services Assessment, Treatment, and Referral

8. Who are we serving? Referral Methods: Traditional: Pt. is scheduled for an initial session by PCP Same-Day Consultation: PC Psychologist is requested to participate in pt’s PCP appointment • Over 50% minority • Over 20% rural, low income • 80+ %ile on SRRS-R • Behavioral Health Problem areas: Insomnia, Chronic Pain, Smoking Cessation, managing diabetes • Mental Health Problem Areas: Depression, Anxiety • Avg: 4-5 sessions VCU Medical Center, where PC Psychology operates

9. Mental Health Depression Anxiety Panic Disorder Somatization Adjustment Risk Assessment Brief Cognitive Evaluations Behavioral Health Pain management Behavioral Treatment of Insomnia Smoking Cessation Medication adherence Diabetes management Diet/Weight loss Coping with chronic disease Services We Provide Interventions are brief, problem-focused, and generally based on cognitive-behavioral principles

10. Assessment Tools • SRRS-R • Life Stressors • PHQ-9 • Depression • GAD-7 • Anxiety • ISI • Insomnia • MPQ-SF • Pain • Behavioral Measures • Cigarettes smokes per week • Weight • A1C

11. The QPD • Quick Psychodiagnostic assessment tool for primary care • Self-administered on portable tablet • Screens for: QPD Tablet: An easy screening tool for use by both PC Psychology and medical residents

13. Training with Medical Providers Enhancing Integration with Residents and Staff

14. Three Major Projects • Team-Based Learning • Large training activities • Focus on one topic (adherence, pain, depression) • Troubleshoot in teams (MDs, Pharmacists, psychologists, pastoral counselors) • The “Clinic Minute” • 5min didactic presentations • Developed based on requests by attendings and medical residents • Interpersonal skills; Adult ADHD; Chronic Pain • Mandatory Shadowing • 2nd year residents do rotations where they sit in on PC Psychology sessions and participate in brief didactic presentations

15. Researching our model Some Preliminary Data

16. Current Research Projects • Success with Team-Based Learning • Evaluate outcomes of our TBLs in terms of the educational goals and attitudes toward working in a team • Success with Residents • Surveyed residents attitudes toward PC Psychology, the amount of contact with PC Psych, and their attitudes toward integration • Success with Patients • Currently analyzing data on outcomes from our screening and assessment measures • Also conducted patient satisfaction research w/ sample of 20 patients

17. TBL DATA Figure 1. Mean percentage of maximum possible subscale score by profession for TBL 1: Adherence

18. TBL DATA Figure 2. Mean percentage of maximum possible subscale score by profession for TBL 2: Depression

19. TBL DATA Figure 3. Mean percentage of maximum possible subscale score by TBL session (excluding chaplain participants who did not attend both sessions) **Difference in Value was significant p<.01

20. Resident Survey • N = 58 medical residents • Referral rates: 58% referred btw 1 and 7 patients in 30 days • 75% satisfied or very satisfied with PC Psychol

23. Patient Satisfaction Questionnaire Results

24. PHQ-9 Scores

25. GAD Scores