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A Day in the Life of a Behavioral Health Consultant

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

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  1. 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.

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

  3. 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

  4. 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

  5. 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)

  6. Consultants and Therapists

  7. 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.)

  8. 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

  9. 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)

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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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