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Building the Workforce for Integrated Care through Large Scale Distance Learning

Posted By Sandy Blount, Wednesday, January 20, 2010
Updated: Friday, June 10, 2011

First let me tell you a little about our program and how it got started and then I will talk about the role of technology. Actually, technology was there from the beginning.

I work in a Department of Family Medicine and Community Health at the University of Massachusetts Medical School and health system. For a couple of years I taught a seminar in primary care behavioral health to our Fellows in Primary Care psychology and other interested folks from around the UMass network. The course went well when we had 5-10 folks, but in the second year, we had 2. It was too boring to teach two people. We decided to take a weekly 90 min course and make it into a few longer workshops and teach it to people who would come to Worcester to take it. We ended up with a program that is six workshops, each with six hours of material, given once a month for six months. When we put it on a listserve to reach folks in New England, several folks from far away wanted to take it too. We had three distant sites on video conference the first time. I expected to get much poorer feedback from the distant folks than from the people in Worcester, but there was no difference. They all liked it. That was the Spring of 2007.

Now by the Spring of 2010 we will have trained over 600 people in the course. For more info on the course see It is designed to provide the specific skills a person needs to provide a broad range of mental health, substance abuse and behavioral medicine services in a primary care setting. We have people taking the course either in groups by video conference, in group sites using pc/internet based conference, or individually at their own computers using internet based conference and conference calls for group interaction. We use the web for registering, for giving out handouts, for storing recordings of sessions so people can make up workshops they miss and for evaluations of each workshop and of the course as a whole.

Here are some of the things we have learned:

It is never as simple as you would think.

Communicating with 150 people at a time means if you are 90% successful, 15 people will be confused about what to do, will be calling and will take extra hand-holding to get caught up with the process. On workshop days, we have a staff of 4 in addition to teachers actively supporting the process.

S**t happens.

There was the day when we had the record ice storm in New England. So many trees were down on so many communication lines that the bandwidth of the entire web was compromised. People kept losing their connections or watching a person speaking with several second delay in the arrival of the sound. A few got very frustrated, but most folks were remarkably understanding.

Many organizations are under-organized when it comes to the technology they have.

A lot of folks have access to pretty sophisticated video conference equipment in organizations that don't know how to maximize its use. Often there are poor systems for reserving or assigning the equipment and its room. People assign the room to other people who don't use the equipment and it is not available to folks who want to use it. Most people cannot use even simple video conference equipment without support on duty because they can't solve problems, and there are always problems. For all these reasons, we have to insist on having the name and number of a person responsible for the organization of the room and a technical support person so that we can solve problems that come up.

The difference in culture and language between clinical people and technical people is as large as the difference between mental health clinicians and physicians, perhaps larger.

What is obvious to one is unfathomable to the other often. This can cause extreme stress when technical people have to work with a lot of non-technical folks. It is hard for techies to understand how non-technical folks can fail to follow simple instructions. The instructions are not simple for the non-techies, and they often think doing it differently would be just as good. This whole area takes active planning and management to avoid burnout of technical staff.

What is good in person is good at a distance and what is boring in person is boring at a distance.

There is always a temptation to put in more material and to keep lecturing so the people "get their money's worth." It turns out that for most people, it is important to work with each other and with the ideas and skills being presented to feel that the experience was optimal. We try to have at least 10 min out of every hour given to interaction between participants.

People have to be able to ask questions any time.

We solve this by having a chat function going all the time. During the entire workshop there is one of our Fellows sitting by the folks who are talking. S/he is reading questions, answering some of them, and passing on other to the folks teaching.

People like to have optionsabout how they take the course, but want to be part of a community.

I was surprised to hear a testimonial from someone who takes the course at home on her computer. She said she likes being able to be in own space, but also loves seeing all of the exchange on the chat line. She said she missed the chat line the one day she came to Worcester and took the course in person. And I thought I was so compelling in person.

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CFHA is a member-based, 501(c)(3) non-profit organization dedicated to making integrated behavioral and physical health the standard of care nationally. CFHA achieves this by organizing the integrated care community, providing expert technical assistance and producing educational content.