Objectives

1. HRSA Funded ProgramsEve AdamsNew Mexico State UniversityJohanna NilssonUniversity of Missouri-Kansas City

2. Objectives 1. Participants will be able to differentiate between interprofessionaland interdisciplinary training. 2. Participants will be able to describe several different training curricula that teach integrated behavioral health skills to counseling psychology doctoral students. 3. Participants will be able to articulate how the Counseling Psychology values of multicultural competencies, social justice and prevention are enacted when Co Psych training programs offer integrated healthcare in community settings.

3. Overview • HRSA and GPE • Our two programs • Psi-CARE - Psychologists Collaborating and Advocating to Restore Equity: An Integrated Training Program in Behavioral Health Care for Underserved Urban Communities, University of Missouri-Kansas City • Integrated Primary Care Behavioral Health Training on the U.S.- Mexico Border: New Mexico State University’s GPE Program

4. Background • What is HRSA (Health Resources & Services Administration) • & the Bureau of Health Workforce • ACA and PCBH • Integrated & Comprehensive Care • Includes smooth transition to Behavioral Health (A 2020 Vision of Patient-Centered Primary Care, Davis, Schoenbaum, Audet, J Gen Intern Med, 2005)

5. Behavioral Health Care Models • Specialty Mental Health (MH) vs Primary Care Behavioral Health (PCBH) ------------------------------------------------------------------ • Coordinated Care- separate systems, separate facilities • Co-located Care- specialty MH focus, on site, separate charting/EHR • Integrated Care- PCBH, behavioral health consultants Gatchel & Oordt (2003) Hunter et al., (2012)

6. Interdisciplinary vs. Interprofessional • Interdisciplinary- the act of working collaboratively towards a common goal or purpose • Interprofessional (also referred to as integrated health care) • an approach to work that requires the incorporation and collaboration of more than one profession to achieve a goal or purpose • Involves the sharing of information among team members regarding patient/client care and the development of a comprehensive treatment plan to address the biological, psychological and social needs of the patient. • The interprofessional health care team includes a diverse group of members (e.g., physicians, nurses, psychologists and other health professionals), depending on the needs of the patient. • Requires moving beyond “independent practice” as the end goal of training

7. A strong integrated health care system and approach to public health in both urban and rural areas are the central (and missing) pieces of the health care puzzle…. …an integrated primary health care system will reduce the burden of illness and injury for all Americans but particularly for those minority, poor, young and elderly Americans who are currently underserved by the health care system” (The Health Care for the Whole Person Collaborative; Ronald Levant)

8. Graduate Psychology Education (GPE) • Call for proposals in mid December and due early February • Focus on preparing psychologists to address the behavioral health needs of vulnerable and underserved populations • Programs • Predoc internship training

9. Psi-CAREPsychologists Collaborating and Advocating to Restore Equity: An Integrated Training Program in Behavioral Health Care for Underserved Urban Communities • Started in July 2014 • The purpose of Psi CARE is to train 14 counseling psychology students to provide competent care to vulnerable and underserved populations as members of behavioral health care teams to individuals and families living in the urban Kansas City metropolitan area. • A three year plan • Curricula development & training of faculty • Theoretical training of students • Practicum sequence

10. Psi-CARE Pieces that fell into place • Kansas City “issues” • Focus of UMKC, School of Education, and CP program • Timing • Colleagues/partnership • Related grants and programs

11. UMKC TEAM Core Group • Counseling psychology, education, nursing and medical school Curriculum Advisory Committee • Core group plus: • Educational psychologist, staff from different treatment centers, specialists in integrated care. Community Advisory group • Core group plus • Staff from 4 different local community mental health/health centers

12. Where we are now: • Developing competencies • Developing courses and practicum • Developing training for faculty • Conducting some focus group on urban, vulnerable populations • Courses • Cultural Immersion and Social Determinants of Health • Understanding the Behavioral Health Needs of Underserved Populations: Role of Psychologists in Primary Care • Interdisciplinary Course on Primary Care • Practicum 1 and 2 Other impacts

13. Overview of NMSU Program • Graduate Psychology Education (GPE) grant for 11 yrs • Supports students with specialized training as they serve low-income and linguistically diverse populations • Primary Care/Healthcare sites: • Family Medicine Center (Residency Training Clinic) • La Clinica de Familia (FQHC) • Las Cruces Public Schools-School Based Health Centers

14. Interdisciplinary Training • Primary Care Psychology Psychology, Counseling, Nursing, MPH, MSW • Behavioral Health Practicum Psychology, Counseling, Medical Residents • Mindfulness Course • Psychology, Counseling, MSW, MPH, & MFT Interprofessional Training • Geriatric Immersion Psychology, Nursing, Pharmacy, Medical Residents ***All of these courses can lead to a minor in Integrated Behavioral Healthcare

15. Who we’ve trained: • 66 Counseling Psychology PhD students • 66 Family Medicine residents • 13 Nursing (DNP) • 33 Social Work (MSW) • 10 Public Health (MPH) • 5 Pharmacy (PharmD residents)

16. Primary Care Psychology & Behavioral Health Practicum • Training objectives • Apply Biopsychosocial model of health and illness to case conceptualization, treatment plan, and intervention at individual, group, and systemic levels • Understand and apply knowledge regarding the mind-body connection (i.e., mindfulness, stress management, emotion regulation, sleep medicine) • Learn/apply interpersonal skills that support culturally responsive behavioral assessment/interventions • Describe/demonstrate behavioral health consultation skills • Demonstrate understanding of health disparities and social justice issues relevant to health care setting, patient population, and service delivery models • Review Ethical Considerations pertinent to PCBH

17. Primary Care Psychology Class • Participating in Interdisciplinary Didactics • Shadowing with Family Medical Residents in Primary Care Setting • Outreach Presentations focused on Health Promotion such as Diabetes Management, Chronic Pain Management, Smoking Cessation, etc. • Class Presentation on Behavioral Health Topic • Cover topics such as Behavioral Approaches to Diabetes, Cardiovascular Disease, Asthma, Pain Management treatment & practice with Case Vignettes

18. Primary Care Psychology Class Sample Case Vignette for Diabetes Management • Case: Melinda is a 39 year old Mexican female living in Chaparral, NM. She has uncontrolled DM2. She eats two meals a day: breakfast and a late dinner. She cooks “traditional Mexican” meals that are heavy in carbohydrates and high in fat. She reported at the end of the day she overeats to manage stress. She has 4 children and struggles financially. She does not get exercise, but her job is physically taxing: she works cleaning houses 6 days a week. Melinda does not understand what Diabetes is or how to take her medication. • Identify • Stage of Change • Barriers for Treatment • Target Current & Desired Behaviors

19. Behavioral Health Practicum Training • Practicum includes on-site training in Primary Care clinics, rural health clinics, and student health centers. • Practicum students, known as Behavioral Health Consultants (BHCs), provide integrated behavioral health interventions to English and Spanish speaking patients in clinic. • This training opportunity fills a great need in our community, allowing all patients access to needed services including patients who are mono and bilingual Spanish speakers who have Medicaid/Medicare, and Indigent Care or are Uninsured. • Bilingual (English/Spanish-speaking) students work with predominately Spanish-speaking patients and receive same-language supervision

20. Family Medicine Center & La Clinica de Familia • Clinical and outreach services provided include • English and Spanish-language triage, intakes, and assessment • English and Spanish-language short and long-term behavioral health therapy • Group Interventions: Diabetes & Chronic Disease Management (MyCD Stanford Program) • Behavioral health consultation with interdisciplinary staff (i.e., physicians, nurses, social worker, administrators, & promotoras) • Behavioral Health screening: PhQ9, GAD7, AUDIT-C, MOCA, etc. • Advocacy and resource allocation • Psychoeducational groups

21. Mindfulness Training Components • Offering an MBSR-related course (as an elective 1-credit course) for self-care • Offering an extended mindfulness course (as an elective 3-credit course) that is interdisciplinary & teaches them skills for guiding others • Researching a mindfulness topic/intervention so they develop some expertise • Practicing brief guided meditations in group formats (e.g., Round-robin) • One assignment is a recorded meditation • Co-facilitating the class the next year • Advanced Practicum - Every student leaves the program capable of guiding a 5-10 min meditation with focus on the breath and brief body scan

22. How BHCs utilize mindfulness • Manage anxiety as a BHC in new setting; • Increase empathy/compassion toward difficult/complex patients/clients; • Increased awareness and containment of countertransference reactions toward clients and setting; • Utilized as a self-care tool by the trainees in a high stress environment; • Utilized frequently with patients as intervention for wide-range of conditions

23. Interprofessional Training • Working towards integration means: • Understanding Roles of other Professionals • Valuing differences • Learning how to Communicate Effectively • Practicing Service Delivery as a Team • Requires trainees to • Recognize Culture Clash & learn how to value the other cultures • Normalize Anxiety • Clarify Roles • Practice working within a team • Using good Communication skills www.aacn.nche.edu/education-resources/ipecreport.pdf

24. Geriatric Immersion • Examples of Training Exercises: for Team-based Learning • Pre/Post Assessments on IP attitudes & skills • Team ice-breakers • Role Plays • Case studies • Role Modeling Communication • Team-based approach to Hospital, Hospice, and Nursing Home Rounds • Community Walk

25. Cultural Competence • Psychology of Multiculturalism (introductory course) • Psychology of Social Identities (focuses on counseling & advocacy skills) • MC Research Symposium • MC issues infused throughout curriculum • Experience using translation services • Spanish Counseling minor/specialization • Spanish Consultation and Support Group/Bilingual Training • Understanding needs along the U.S./Mexico Border