Post on 11-Jun-2018
CFHA Annual Conference
Saturday, October 17, 2015
G6: The Marriage Between Primary Care and Behavioral Health:
Elephants in the Room
Agenda
Brian DeSantis & Frank deGruy
3:30-3:35 Introductions DeSantis, deGruy
3:35-3:40 Overview DeSantis
3:40-3:45 First Exercise deGruy
3:45-4:00 First Elephant DeSantis
4:00-4:15 Second Elephant deGruy
4:15-4:30 General Discussion DeSantis, deGruy
October 2015
Collaborative Family Healthcare Association
12th Annual Conference 1
There Are Elephants In This Room!The Marriage Between Primary Care and Behavioral Health: Some Elephants in
the Room
Brian DeSantis, PsyD, ABPP
Director, Behavioral Health
Peak Vista Community Heath Centers Inc.
Frank V. deGruy, MD MSFM
Professor and Chair, Department of Family Medicine
University of Colorado
Collaborative Family Healthcare Association 17th Annual ConferenceOctober 15-17, 2015 Portland, Oregon U.S.A.
Session # 5686472 (G6 in Period 6)
October 17, 2015
B,F
Faculty Disclosure
The presenters of this session have nothad any relevant financial relationships
during the past 12 months.
B
Learning Objectives
At the conclusion of this session, the participant will be able to:
• Identify common challenges to
making the (arranged) marriage of
integrating behavioral health into
primary care work.
• Discuss two covert marital
stressors (elephants in the room)
that should be addressed between
the marital partners.
• List two proposed solutions to
these “elephants” to help achieve
a collaborative and mutually
supportive marriage.
F
October 2015
Collaborative Family Healthcare Association
12th Annual Conference 2
Learning Assessment
• A learning assessment is required for CE credit. Evaluate this session at the end.
• We will leave time for questions and answers at the end of this presentation (and in the middle of it, too).
F
Overview
1. Our Premise: Team-based care is desirable.
2. Marriage and elephants as metaphors: differences
that don’t at first show but matter.
3. We’ll surface two and process them.B
Differences Between Health and
Mental Health Professionals
• Differences in emphasis within the
biopsychosocial model (medical vs relational).
• Language for problem appraisal, diagnosis,
management, and treatment.
• Treatment preferences:
what do you reach for first?
Red is
yummy!
B
October 2015
Collaborative Family Healthcare Association
12th Annual Conference 3
Exercise
Descriptors—adjectives—that reveal
perceptions about medical and behavioral
health professionals
F
Medical Professionals• Cold, insensitive
• Rigid, controlling
• Egotistical, arrogant
• Obsessive compulsive
• Pressed for time
• Technician
• Somatically fixated
F
Behavioral Health Professionals
• Impractical
• Flaky
• Touchy-feely
• Wishy-washy
• Not real docs
• Right-brained
and left-
winged
• Psychosocially
fixated
F
October 2015
Collaborative Family Healthcare Association
12th Annual Conference 4
I’m OK,
You’re Not.
Just eat both.
B
First Elephant
• George, a 65yo WM, w/ DM, RA.
• Wife died 6wks ago, now living alone.
• Can’t sleep, can’t think straight.
• PHQ-9 = 14.
• HbA1c = 9.5
• Joints hurt.
• 15 minute visit.
F,B
(Warm Handoff)F,B
October 2015
Collaborative Family Healthcare Association
12th Annual Conference 5
First Elephant Discussion
• Understanding of problem
• Intervention
• Roles
• Points of conflict
• Possible resolution
B
Second Elephant
• Lushawn, a 32yo BF “can’t
breathe.”
• Husband left her without
warning 1mo ago.
• Very distressed: can’t sleep,
can’t eat, can’t think, no
motivation.
• Best friend suggested
antidepressant.
• She’s here asking for Prozac.
(Warm Handoff)F,B
October 2015
Collaborative Family Healthcare Association
12th Annual Conference 6
Second Elephant Discussion
• Understanding of problem
• Preferred treatment
• Antidepressants vs
psychotherapy vs both
• Differences between clinicians
F,B
General Discussion
• Dealing with hidden
differences
• Patients are part of
the team: ask &
listen
• Strengthening the
partnership
• Leadership
• Other preconditions
for integrated careF,B
References1. Kathol, R.G., deGruy, F., & Rollman, B.L. (2014). Value-based financially
sustainable behavioral health components in patient-centered medical
homes. Annals of Family Medicine, 12(2), 172-175.
2. Duncan, B.L. & Reece, R.J. (2012). Empirically supported treatments, evidence-based treatments, and evidence-based practice. In G. Stricker & T.
Widiger (Eds.), Handbook of psychology: Clinical Psychology (2nd ed., pp. 997-1028). Hoboken, NJ: Wiley.
3. Sparks, J.A., Duncan, B.L. Cohen, D., & Antonuccio, D.O. (2010).
Psychiatric drugs and common factors: An evaluation of risks and benefits for clinical practice. In B.L. Duncan, S.D. Miller, B.E. Wampold. & M.A.
Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (2nd ed., pp. 199-235). Washington, DC: American Psychological
Association.
4. Special issue on integrating behavioral and primary care:http://www.jabfm.org/content/28/Supplement_1
5. Kelly JM, Kraft-Todd G, et al. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials.PLoS ONE 9(4): e94297. doi:10.1371/journal.pone.0094207