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How to Establish a Great Music Festival (and PCBH Group)

Posted By Corey Smith, Friday, October 28, 2016



PCBH groups and music festivals couldn’t be more different experiences, right? Well, sure, most groups don’t suggest earplugs, don’t have food trucks and usually don’t include intoxicated "20-somethings,” but there are a few lessons music festival promoters have learned that are pertinent to PCBH groups. Namely, setting the date, getting useful feedback and clear practical information for attendees.


The biggest limitation to setting a good lineup for a music festival: the date. Once the date is set, 95% of bands have been eliminated thanks to the world’s consistent refusal to revolve around me. ("But I really want to see Coldplay at Coachella!”) The task of coordinating the schedules of multiple groups of people is too much work, better to set your date and send out as many invites as possible. For behavioral providers in primary care, the challenge is similar, starting a group can be a long process and success is not guaranteed.


My typical strategy includes posting information about the group to medical providers and compiling a list of as many patients as possible. Once the date is set, I send out letters with the expectation the date will whittle the list down considerably. If 20-25 patients express interest, I’m doing pretty well. The process of securing "commitments,” scheduling and reminder calls may further dwindle the list. Once we get to the date of the opening visit, we may arrive to find 4-5 people waiting to begin (one of whom needs to leave after 15 minutes).


Thing is, this is pretty successful. Coordinating the schedules of more than two adults can be extremely challenging, especially without any momentum off of which we can feed to inject energy into the process. It’s much easier to get someone to attend a meeting that has been taking place for months or years; the risk it will not be what they are looking for is lower with a known entity. Selling tickets to Bonnaroo is easy, try selling tickets to the Maha Music Festival….


Any music festival worth its’ salt has a twitter handle and at least one hashtag (@govballnyc, @ACLfestival, #youredoinggreat, #smile) to promote the experience via social media. Often, promoters project tweets and Instagram posts onto screens near the stages. The audience, those on the fence about paying for a last minute ticket, and promoters get real time feedback on what is going well ("Gogol Bordello is melting faces in That Tent #Bonnaroo2009”) or not so well, ("The Port-a-lets look like a war crime #ACL2012”) and respond accordingly. While PCBH groups may not rate high enough for a hashtag, feedback measuring outcomes is important and can inform our practice going forward. Determinations of effects will depend upon the type of group and the information the practice believes to be most important.


For example, outcomes for a group focused upon Acceptance and Commitment Therapy for chronic pain may include patients’ subjective reports of their pain levels, changes in narcotic medication dosages or number of visits to the Emergency Department for treatment of out of control pain. Providers working on a mood management group may simply choose the PHQ-9 and/or GAD-7 to determine efficacy; this is certainly acceptable and may yield significant and actionable results. The word actionable is used intentionally in this context.


Rather than simply serving as formative and summative evaluation of the intervention, measurement may be used to inform changes to the process, intervention or make up of the group. Outcome measures are easiest to track and disseminate within the electronic health record (If you find yourself in a setting where this is possible, practice gratitude and enjoy! #youredoinggreat). Without such tracking capability my strategy has been to record data via my own excel file and, although more time consuming, this works just fine.


Festival goers like to know what to expect, as most humans do, and a festival’s smartphone application can facilitate or limit the flow and organization of the event. People need to know where to eat, how to find the bathrooms and on which stage their bands are playing. PCBH groups, similar to warm hand offs and initial visits with a BHC, should be described effectively at the outset. For some clinics, group therapy can be an effective adjunct for patients that would normally be considered for referral to specialty mental health but lack the insurance coverage for a successful referral. However, the expectation of many patients, as we often see in the PCBH setting, may be reflective of their understanding of traditional mental health. This misunderstanding can be corrected with clear conversations regarding the nature and duration of treatment prior to starting.


Over-all, the business case for group visits is clear and the increased efficiency in primary care makes group visits a wonderful addition to your practice. Behavioral providers are well trained in running groups and can take the lead with the recruitment, planning and execution of a traditional group, shared medical appointment (SMA) or other innovative group process to meet the specific needs of the practice. You won’t always get Desert Trip but you can certainly have fun, make a difference and demonstrate again the value of behavioral health providers in primary care. #smile

Corey joined the faculty at the Maine Dartmouth FMR in 2015 after serving as the director of behavioral health at MidValley Family Practice in Basalt, CO and the Lincoln Family Medicine Residency in Lincoln, NE. He completed his doctoral training at Spalding University in Louisville, KY and internship at the Wyoming State Hospital. Corey is enthusiastic about integrated behavioral health care, primary care and education. In his spare time he practices martial arts and enjoys cycling, reading, hiking, and spending time with friends.  Corey and his wife Karen are anxiously awaiting the arrival of their first child in January of 2017.

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Comments on this post...

Randall Reitz says...
Posted Sunday, October 30, 2016
You're creating connections I never envisioned. Who wouldn't want to see Coldplay at Coachella? The hardest part of starting and sustaining a group is the need for constant recruitment. You provide a lot of good ideas here. Thanks for sharing.

Not to be overly picky, but I do wonder if it is accurate to use the word "PCBH" to describe group medical appointments. I've always considered groups as pre-dating the PCBH model (indeed even the integrated care model). I think about PCBH as being a vital, but purposefully narrow, strand of integrated care that is mostly practiced on-the-fly in exam rooms.

On the other hand, II suppose a case could be made that a properly structured group medical appointment could expand the PCBH model to serve several people at the same time. Is that the vision you have for your groups?
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Corey D. Smith says...
Posted Monday, October 31, 2016
That's a good observation. I think that you are correct that group medical appointments pre-date the PCBH model and integrated care, not "overly picky" at all!

My advocacy reflects the setting of Mid-Maine where we have many patients without any type of insurance and little to no resources for traditional behavioral health intervention outside of our clinic. The limitation in Maine is the difficulty for folks in need to qualify for Medicaid. Our flavor of PCBH reflects your description of focused, efficient interventions and our reality that the model isn't a perfect fit for our population’s need. Our group appointment experiments are an effort to provide a more effective bridge for those patients in need. Group medical appointments enable us to expand our reach to serve more of our population but yes, this is definitely not strictly adherent to the PCBH model.

That said, Kanye at Governor’s Ball, amiright??
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