Session H7 Unlocking radical behavioral change with PCBH ... · Brief Interventions for Radical...
Transcript of Session H7 Unlocking radical behavioral change with PCBH ... · Brief Interventions for Radical...
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Unlocking radical behavioral change with PCBH and ACT: Applying contextualism within the PCBH framework and primary care system
• David Bauman, PsyD, Behavioral Health Education Director, CWFM
• Bridget Beachy, PsyD, Director of Behavioral Health, CHCW
Session H7
CFHA 19th Annual ConferenceOctober 19-21, 2017 • Houston, Texas
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Faculty DisclosureThe presenters of this session currently have or have had the
following relevant financial relationships (in any amount)
during the past 12 months.
Mountainview Consulting Group, LLC – Associate
Consultants
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Conference Resources
Slides and handouts shared in advance by our Conference Presenters are available on the CFHA website at http://www.cfha.net/?page=Resources_2017
Slides and handouts are also available on the mobile app.
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Learning Objectives
At the conclusion of this session, the participant will be able to:
• Describe the basic philosophy of contextualismand how it fits harmoniously within the PCBH model
• Identify contextual interventions and techniques within the PCBH framework for a variety of common medical and behavioral health conditions
• Identify ways of inundating their medical clinics with contextualism
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1. Strosahl, K. D., Robinson, P. J., & Gustavsson, T. (2012). Brief Interventions for Radical Change: Principles and Practice of Focused Acceptance and Commitment Therapy. Oakland, CA: New Harbinger..
2. Robinson, P., & Reiter, J. (2016). Behavioral consultation and primary care: A guide to integrating services (2nd ed.). Springer: New York.
3. Hacker, T., Stone, P., & MacBeth, A. (2016). Acceptance and commitment therapy - Do we know enough? Cumulative and sequential meta-analyses of randomized controlled trials. Journal of Affective Disorders, 190, 551-565. DOI: 10.1016/j.jad.2015.10.053
4. Hunter, H. L., Funderburk, J. S., Polaha, J., Bauman, D., Goodie, J. L., & Hunter, C. M. (in review). Primary care behavioral health (PCBH) research: Current state of the science and a call to action. Journal of Clinical Psychology in Medical Settings
5. Hayes, S. C., Barnes-Holmes, D., & Wilson, K. G. (2012). Contextual Behavioral Science: Creating a science more adequate to the challenge of the human condition. Journal of Contextual Behavioral Science, 1, 1-16.
Bibliography / Reference
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Learning Assessment
A learning assessment is required for CE credit.
A question and answer period will be conducted
at the end of this presentation.
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Welcome!Our journey today:◦ Introductions
◦ What is this contextualism all about?
◦ Why context and PCBH?
◦ How can apply contextual approaches (e.g., ACT, FACT) in PCBH?
◦ How can I make my clinic more contextually aware?
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Bridget Beachy, PsyD◦ Director of Behavioral Health for Community Health of Central Washington
◦ Roles include: PCBH clinical, admin, and faculty for FM residency residents and psych interns
David Bauman, PsyD◦ Behavioral Health Education Director for Central Washington Family
Medicine
◦ Roles include: PCBH clinical, core faculty for FM residency, RTD of PCBH psychology internship
We both live and breathe PCBH and contextual approaches (e.g., Acceptance and Commitment Therapy)
Who we are
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Who you are?What is your professional background?◦ Clinician
◦ Administrator
◦ Research or academia?
Are you familiar with contextual approaches?◦ Yes
◦ Kinda
◦ What the hell is contextualism, I wanted to learn about ACT!!!
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Before we begin…Surreal moments in life…
After this presentation you will know Contextualism and how to complete and make up metaphors on the spot… ◦ Maybe instead you will want to learn more, we can help with that!
…Our why of contextualism and PCBH
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Contextualism in a nutshell
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It’s a matter of context…Behaviors do not happen in vacuums◦ Symptoms arise due to one’s context, thus, for us to intervene appropriately we must
understand the context
◦ What if instead of focusing on what shows up at 5 PM (symptoms), we focus on what show’s up at 8 AM (the person’s context)
What happens when we start to do this?◦ Disorders and pathologies go away… It makes sense why this is here!
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Why contextualism and PCBHWhat are the goals of PCBH?◦ Population based
◦ See anything and everything
◦ Need to intervene quickly
◦ Needs to be transdiagnositc
◦ …the question almost becomes, why NOT contextualism and PCBH
Everything is a response to context…◦ Depression, anxiety, diabetes, obesity, high blood pressure
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How does ACT/FACT relate to contextualism?ACT and FACT are rooted in the philosophy of functional contextualism
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Okay, I am with you, context is importantBut, bro, I got 20 – 30 minutes with a patient… what you are asking takes at least an hour◦ Yeah, we had the same thought…
What if there was a way to gather the context intentionally, systematically, and sequentially…◦ I give you the Contextual Interview
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Contextual interviewLove, Work, Play & Health Behaviors; 3 T’s
LOVE◦ Living Situation
◦ Relationship
◦ Family
◦ Friends
◦ Spiritual, community life?
Work/School◦ Work/school situation
Play ◦ Fun/Hobbies
◦ Relaxation
Health Behaviors◦ Exercise
◦ Sleep
◦ Substance use (alcohol, drugs, cigarettes, caffeine)
◦ Sex
◦ Diet, supplements, medications?
3 T’s◦ Time, Trigger, Trajectory
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Initial visit: Contextual InterviewOur story…
Every.Single.Time◦ Depression – Yep, Anxiety – Yep, Treatment Adherence – Yep, DM – Yep… you get the point
◦ Need to practice
Most radical shift in our clinical practice… interventions are great but the CI is paramount
Same sequence and in the same order every time◦ Why?
Not a checklist, but a story builder◦ Symptoms/behaviors do not happen in vacuums, they happen in a context
◦ We cannot intervene without knowing the context
Teach both our psychology interns/fellows and our residents to do this
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Hold on…What if I only have 5 minutes???
What if the patient does not want these questions asked?
How does learning about the individual’s relationship impact their DM?
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Alright… I’m intrigued I can maybe consider doing the CI… but what about interventions?
Why I love PCBH◦ It makes you use all of your skills
◦ The ninjas of the BH providers
◦ Have to be quick, intentional, radical, outside the box
How do I implement an intervention that encompasses all of the ACT hexaflex or FACT pillars?◦ … you guessed it… metaphors
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Metaphors to utilize We have some for you!◦ The Movie of Self-Compassion
◦ The Program
◦ Three Little Pigs
◦ The Baseball Pitcher or Boxer
◦ Sunburn
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How can I make ones up myself?Let’s practice…
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How can I get my clinic to be more contextual?Contextual Interview trainings
When completing feedback loop, talk about the context
Have CIs in nursing/provider stations, precepting rooms
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Session Evaluation
Use the CFHA mobile app to complete the
evaluation for this session.
Thank you!