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Concurrent Sessions, Period 4

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Saturday, October 18, 2014 - 10:30 AM to 12:00 PM

Sessions vary in length from 20-90 minutes.

Click here for PDF of Period 4 Concurrent Sessions with objectives.

Period 4 Sessions - grid version

A4a: What's Next? Advancing Healthcare from Provider-Centered to Patient-Centered to Family-Centered

Equal parts real-life application and hopeful idealism, this session presents the recent history and near future of healthcare's evolution.  We outline the strengths and limitations of the paradigm shift toward patient-centeredness and make the case that the full vision of "moving from fragmentation to integration" will only be achieved in a model that places family at its core.  Direct application to care planning, care coordination, and health information technology provide take-home value.

Kaitlin Leckie, MS, Medical Family Therapy Fellow, St. Mary's Family Medicine Residency; Randall Reitz, PhD, Director of Behavioral Sciences, St. Mary's Family Medicine Residency; Peter Fifield, MA, Behavioral Health Services Manager, Families First Health and Support Center; Keith Dickerson, MD, Faculty Physician, St. Mary's Family Medicine Residency;

Key Track: 1.  Content Level: All audiences  (40 minutes)

A4b: Putting Family at the Heart of the Collaborative Healthcare Team

Family caregivers play essential roles as hands-on care providers, care coordinators, and treatment effect observers for America's burgeoning numbers of chronically ill patients. Yet few collaborative care models embrace patients' family members as full-fledged team members. In this workshop, we will outline 5 ways from gaining recognition in the patient chart to granting access to professionals' treatment notes to practicing shared decision-making--for family members to be effectively integrated into healthcare and social service interventions.

Barry J. Jacobs, PsyD, Director of Behavioral Sciences Crozer-Keystone Family Medicine Residency Program

Key Track: 1.  Content Level: All audiences  (40 minutes)

B4a: Improving Primary Care Access and Coordination through SBIRT and Mental Health Screening in the Emergency Department

Fragmentation of care occurs when patients enter the healthcare system through multiple and uncoordinated doors, including the emergency department (ED) which serves as de facto primary care for many. Meeting the Triple Aim will require primary care redesign and integration across the entire healthcare system. This presentation will present findings from a project that implemented substance misuse and mental health screening and referral in the ED, using an SBIRT model. The notable innovation was developing a process to establish the high proportion of patients who did not have a PCP with a new PCP, in settings with embedded behavioral health, as well as to communicate the screening results. Findings on screening processes, results, and the impact of PCP linakges will be presented.

Tina Runyan, PhD, ABPP  Clinical Associate Professor  University of Massachusetts Medical School  Dept of Family Medicine and Community Health;

Key Track: 5.  Content Level: All audiences  (40 minutes)

B4b: Expanding Behavioral Health Integration: Consultative Psychiatry and Immediate Access Behavioral Health Consultants (BHCs)

In response to a continued need to redefine how customer-owners access behavioral health services, Southcentral Foundation has expanded on their model of behavioral health integration. Following the success of integrating BHCs into their medical clinics, a similar model was adapted in an immediate access BHC position allowing for brief intervention services in both medical and behavioral health clinics. The addition of co-located and consultative psychiatry has also allowed for more comprehensive primary care behavioral health services.

Melissa Merrick, LCSW, CDC I - Administrator, Southcentral Foundation; Brian McCutcheon, Administrator, Southcentral Foundation

Key Track: 2.  Content Level: Advanced  (40 minutes)

C4a: Why primary care needs integrated behavioral health to achieve the Triple Aim: IHI's approach

In this session we will present data showing that, controlling for socio-demographic, contextual, and other factors, behavioral health/primary care integration can achieve the Triple Aim for patients with comorbid behavioral health and medical needs. We will describe data analyses showing that patients receiving behavioral health care in primary care experience better outcomes for their physical and behavioral health issues, an improved experience of care, and lower per capita costs. Participants will learn how to make the case for integration at their organization. Finally, we will describe some of the Institute for Healthcare Improvement (IHI)'s approach to and ongoing work on integration.

Mara Laderman, MSPH, Research Associate, Institute for Healthcare Improvement; Benjamin Miller, PsyD, Assistant Professor, University of Colorado - Denver;

Key Track: 7.  Content Level: All audiences  (40 minutes)

C4b: Suicide Prevention: A New Focus, and New Solutions for Integrated Primary Care

We now know that half of all individuals who complete suicide saw a primary care provider in the month before ending their lives. With 38,000 lives lost to suicide in 2011, more must be done. Thankfully, tools and resources are now available for Integrated Primary Care settings to address this major healthcare problem. The session will include an overview of the emerging Zero Suicide in Healthcare initiative, with particular attention to its implementation in an Integrated Primary Care system (Institute for Family Health). We will also share the resources that are now available to help other settings and systems to do this work.

Michael F. Hogan, Ph.D. Co-Chair, Zero Suicide Advisory Committee, National Action Alliance on Suicide Prevention; Virna Little, Sci.D., Vice President, The Institute for Family Health;

Key Track: 3.  Content Level: All audiences  (40 minutes)

D4a: Claiming a Seat at the Table: Strategies to Promote Behavioral Health Integration in Healthcare Reform

This time of dramatic healthcare system change presents an opportunity to include behavioral health in redesigned financial and structural frameworks. This presentation draws from concrete examples in Maine and Texas to examine means to ensure behavioral health is effectively integrated into a healthcare system increasingly focused on managed care and accountable care organizations.

Dr. Lynda E. Frost Director of Planning and Programs Hogg Foundation for Mental Health The University of Texas at Austin; Dr. Becky Hayes Boober Senior Program Officer Maine Health Access Foundation;

Key Track: 4.  Content Level: All audiences  (25 minutes)

D4b: Promoting Integrated Care through the Redesign of a State Healthcare System

This session will outline the process by which North Carolina policy makers and a wide variety of stakeholders from consumers to providers to payers, used Medicaid Reform as platform to transform the entire healthcare system and promote Integrated Care. These efforts used the goals of the Triple Aim to drive the plan for primary care medical homes that Integrate behavioral health and I/DD expertise in addition to other healthcare systems across the state.

Courtney M. Cantrell, Ph.D. Acting Director, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services Policy Advisor for Integrated Care NC Department of Health and Human Services; Cathy M. Hudgins, Ph.D. Director, Center of Excellence for Integrated Care;

Key Track: 4.  Content Level: All audiences  (25 minutes)

D4c: Time to Transform: Oregon Unites to Develop Expert Consensus Regarding Collaborative Practice Standards

As a part of the Person-Centered Primary Care Home, Behavioral Health  is the missing link in healthcare that will drive improved outcomes. While the ingredients for successful integration are known, behavioral health in primary care must formally define itself in the healthcare landscape to ensure that patients and the system reap maximal benefit.  Primary care medical practice is defined and understood, traditional mental health practice is defined and understood, as such primary care behavioral health practice must become defined and understood in order to impact patient and system outcomes. Oregon integrated behavioral health leaders have developed an advisory group for the state': transformation aims. The group is developing statewide expert consensus regarding essential ingredients of integration to ensure that state efforts to integrate these professionals results in improved patient outcomes and effective system transformation, especially in the Coordinated Care Organizations.

Julie Oyemaja, PhD, Multnomah County Health Services; Robin Henderson, PsyD, Chief Behavioral Health Officer, St Charles Health System; Brian Sandoval, PsyD, Director, Behavioral Health, Yakama Valley Farm Workers Clinics; Mary Peterson, Phd, Dean, George Fox University;

Key Track: 5.  Content Level: All audiences  (25 minutes)

E4: From Wingspread 1994 to CFHA 2014: What's the same or different for collaborative care: a historical review of records and reflection on what this means going forward.

The "Wingspread Conference" of collaborative family healthcare pioneers 1994 led to creation of CHFA and its first meeting in 1995—at the Omni Shoreham. It also set perhaps the first national agenda for the field. Ten years later a set of "next developmental steps for the field" was generated at the CFHA meeting that reflected reality in 2004. Now we are in 2014 with timely "next developmental steps for the field" to formulate and take. This session reviews these three "data points" on the issues and agenda for the field and leads participants to reflect on what has changed or not, where there has been progress or not—and what that means for us going forward.

C.J. Peek, PhD Associate Professor, Dept of Family Medicine and Community Health University of Minnesota Medical School; Macaran A. Baird, MD, MS Professor and Head, Dept of Family Medicine and Community Health University of Minnesota Medical School; (Discussant): Lauren DeCaporale, PhD Post-doctoral fellow, Institute for the Family University of Rochester, Rochester NY And "New Professional Member", CFHA Board of Directors;

Key Track: 2.  Content Level: All audiences  (90 minutes)

F4a: Massachusetts Primary Care Payment Reform: Progress Report on a Transformation

Massachusetts Medicaid is in the process of transforming the payment mechanism for primary care.  The new bundled payment approach is based on a model of integrated behavioral health along with quality metrics and shared cost savings.   The program is starting with 30 organizations representing 50 practices across the state.  The transformation to bundled payments gives a Per Member Per Month payment based on the level of behavioral health in the practice:  basic PCMH, PCMH plus primary care behavioral health, or these services plus specialty behavioral health services including psychiatry.  This is a fast and dramatic change for most practices.

Alexander Blount, EdD Director, Center for Integrated Primary Care University of Massachusetts Medical School; Christine Johnson, PhD Practice Transformation Expert Center for Health Policy and Research, University of Mass. Medical School;

Key Track: 4.  Content Level: Advanced  (40 minutes)

F4b: Cost Assessment of Collaborative Healthcare

This presentation will discuss the creation of a tool to assess the cost of integrating mental health, behavioral health, and substance use services into primary care. This tool was developed with a multidisciplinary team to better understand how much integration costs. This tool will be valuable for practices at the beginning stages of assessing whether or not to integrated care as well as other quality improvement initiatives for more established integrated practices. The policy implications of assessing the cost of integration with this tool will also be discussed.

Shandra M. Brown Levey, PhD, Instructor, University of Colorado; Emma C. Gilchrist, MPH, Professional Research Assistant, University of Colorado; Warren Pettine, Medical Student, University of Colorado; Benjamin F. Miller, PsyD, Assistant Professor, University of Colorado;

Key Track: 4.  Content Level: All audiences  (40 minutes)

G4a: Adapting Evidence-Based Interventions for Anxiety for Use in Integrated Primary Care Settings

Symptoms of anxiety are prevalent and burdensome among primary care patients. Although evidence-based, high-dose interventions exist for specialty care, few anxiety interventions have empirical support specifically for use in the brief, time-limited format (e.g., 1-4 15-30 minute sessions) typical of primary care settings. Using illustrative case studies, this presentation will review the rationale for and techniques involved in a variety of evidence-based interventions for anxiety that can be adapted for  use in primary care, including psycho-education, relaxation training, cognitive restructuring, exposure, and behavioral activation. This presentation is geared toward clinicians and will provide tools to enhance everyday clinical practice (e.g., handouts, apps and internet resources).

Robyn L. Fielder, Ph.D., Postdoctoral Fellow, Center for Integrated Healthcare, Syracuse VA Medical Center; Jennifer S. Funderburk, Ph.D., Clinical Research Psychologist, Center for Integrated Healthcare, Syracuse VA Medical Center;

Key Track: 2.  Content Level: Basic  (40 minutes)

G4b: Patients with Anxiety Symptoms Seen by VA and USAF Integrated Behavioral Health Providers: Comorbid Symptoms and Brief Interventions

This presentation will provide a glimpse into the real-world presentation and treatment of anxiety in primary care. Using survey data from 56 VA and US Air Force integrated behavioral health providers (BHPs) reporting on 209 patients, we will examine the (a) most common comorbid symptoms among patients presenting with anxiety and (b) types of brief interventions used. We will discuss the implications for clinical practice (e.g., selecting interventions to target anxiety and comorbid symptoms) and future research (e.g., developing evidence-based brief interventions). This presentation is relevant to BHPs, supervisors, and administrators pursuing the Triple Aim because treating anxiety symptoms can help improve patient experience and population health while reducing health care costs.

Robyn L. Fielder, Ph.D., Postdoctoral Fellow, Center for Integrated Healthcare, Syracuse VA Medical Center; Jennifer S. Funderburk, Ph.D., Clinical Research Psychologist, Center for Integrated Healthcare, Syracuse VA Medical Center; Christopher L. Hunter, Ph.D., ABPP, CDR, United States Public Health Service DoD Program Manager for Behavioral Health in Primary Care Patient-Centered Medical Home Branch, Clinical Support Division Defense Health Agency;

Key Track: 7.  Content Level: Basic  (40 minutes)

H4a: Primary Care Clinician Stress and Psychological Flexibility

This presentation attempts to help Primary Care Clinicians (PCPs and Nurses) and their Behavioral Health Consultant (BHC) colleagues better address the problem of stress and burnout among providers of primary care. Participants will learn about tools and methods to enhance their ability to talk about resiliency with PCMH team members. Participants will also have an opportunity to develop a personal strategy for building resiliency based on the cognitive-behavioral therapy model called Acceptance and Commitment Therapy (ACT). The presentation will include data on relationships between primary care provider stress level and psychological flexibility.

Debra A. Gould, MD, MPH Clinical Assistant Professor, University of Washington School of Medicine Faculty, Central Washington Family Medicine Residency Program; Michael Aquilino, LMPC Behavioral Health Consultant Central Washington Family Medicine; Patricia J. Robinson, PhD Director of Training and Program Evaluation Mountainview Consulting Group;

Key Track: 6.  Content Level: All audiences  (40 minutes)

H4b: Stress, Psychological Flexibility, and Behavioral Health Satisfaction- An assessment and intervention study with primary care providers

This presentation will review and discuss a two-part study conducted with primary care providers within Federally Qualified Health Centers. Phase one was an online 8 minute survey provided to primary care providers to assess stress, psychological flexibility, and satisifcation with behavioral health program. Phase two included an intervention week where selected providers and his/her panels were followed by a behavioral health consultant for one full-week to increase collaboration and impact provider stress level. The intervention providers were assessed by the same initial survey both pre and post-intervention as well as additional data and qualitative measures were collected that will be presented.

Melissa Baker, PhD Behavioral Health Consultant HealthPoint; Bridget Beachy, MA Behavioral Health Consultant Columbia Valley Medicine; David Bauman, MA Behavioral Health Consultant Columbia Valley Medicine; Ann Wilson, PsyD Behavioral Health Consultant HealthPoint; Kirsten Tiernan, MA Behavioral Health Consultant HealthPoint

Key Track: 6.  Content Level: All audiences  (40 minutes)


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