Training the 21st Century Psychiatrist for the Patient Centered Medical Home

1. Session # FB5 October 6, 2012 Training the 21st Century Psychiatrist for the Patient Centered Medical Home Jeralyn Jones, MD Alex J. Reed, PsyD, MPH Collaborative Family Healthcare Association 14th Annual Conference October 4-6, 2012 Austin, Texas U.S.A.

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. How are people integrating family medicine and psychiatry? How are people integrating family medicine and psychiatry training?

4. Objectives • Participants will understand the rationale and forces driving integrated health care. • Participants will be able to describe different models of psychiatric collaboration with primary care providers. • Participants will explore the challenges and benefits of educating today’s trainees for the integrated care practice of tomorrow.

6. Boun Bonner Idaho Mental Health Professional Shortage AreaService Areas Kootenai Benewah Benewah Shoshone Latah Latah Clearwater Clearwater Nez Perce Geographic HPSA Lewis Facility Idaho Lemhi Adams Valley Valley Washington Custer Clark Fremont Payette Boise Gem Jefferson Madison Teton Canyon Butte Ada Blaine Bonneville Camas Elmore Bingham Lincoln Gooding Caribou Jerome Minidoka Power Bannock Owyhee Twin Falls Cassia Bear Lake Oneida Franklin State Office of Rural Health and Primary Care, Division of Health, Department of Health and Welfare, 4/07 – please contact (208) 334-5993 for updates

7. Boundary Bonner Idaho Primary Care Health Professional Shortage AreaService Areas Kootenai Benewah Benewah Shoshone Latah Clearwater Nez Perce Geographic HPSA Lewis Population Group HPSA Idaho Lemhi Adams Valley Washington Custer Clark Fremont Payette Boise Gem Jefferson Madison Teton Butte Canyon Blaine Ada Bonneville Camas Elmore Bingham Lincoln Gooding Caribou Minidoka Jerome Power Bannock Owyhee Twin Falls Cassia Oneida Bear Lake Franklin State Office of Rural Health and Primary Care, Division of Health, Department of Health and Welfare, 5/12 – please contact (208) 334-5993 for updates

8. Patient Centered Medical Home AAFPAAPACPAOA ?APA

9. Elements of PCMH Psychiatry • Personal Physician • Physician directed medical practice • Whole Person Orientation • Integrated/Coordinated Care • Enhanced Access to care • Quality and Safety • Payment Reform

10. Accountable Care Organization (ACO) An ACO is an entity that will be “held accountable” for providing comprehensive health services to a defined population Cost HMO in Drag? Accountability Primary Care focus

11. University of Washington Idaho Advanced Clinician Track/ Primary Care Psychiatry Training or…

12. EXTREME INTEGRATED PRIMARY CARE!!!! Somewhat Censored !!!

13. Mental Illness in Primary Care • Most patients with mental health disorders initially present to their PCP. • Primary care is the “de facto” mental health system for 70% of the population. • 80% of all psychotropic medications are prescribed by nonpsychiatric medical providers* *Katon, W., Reis, R.K., Kleinman, A. (1984). The prevalence of somatization in primary care. Compr Psychiatry, 25 (2)., 208-215

14. Chronic Conditions and MH Agency for Healthcare Research and Quality (2003). Medical Expenditure Panel Survey, Rockville, MD.

15. Depression in Patients with Comorbid Medical Illness Evans et al. (2005). Mood Disorders in the Medically Ill: Scientific Review and Recommendations. Biol Psychiatry, 58, 175-189

16. Traditional Mental Health

17. Primary Care

18. Typical Morning in FM Practice 56 y.o. diabetic w/ poor control 19 y.o. smoker for annual exam 33 y.o. w/ multiple somatic issues 7 y.o. with otitis media 67 y.o. with insomnia 70 y.o. with sinusitis 52 y.o. with HTN 28 y.o with chest pain & SOB Anxious Smoking Cessation Depression Enuresis Alcohol Abuse Family Violence PTSD Panic Disorder Gunn, W. B. & Blount, A. (2009). Primary care mental health: A new frontier for psychology. Journal of Clinical Psycholog, 65 (3), 235-252.

19. Tell me and I forget, Show me, and I may rememberInvolve me, and I will understand Confuscius

20. Patient Centered Medical Home Sawtooth Model FQHC—Federally qualified health center Safety Net Clinic Patients with complex medical/psychiatric illness, few resources

21. Evolution of the 21st Century Psychiatrist

22. Sawtooth Model

23. Determinants of Health Schroeder, Steven A., We Can Do Better -- Improving the Health of the American People, N Engl J Med 2007 357: 1221-1228

24. Wellness Behavior Clinic • Opportunity to see patients for behavioral health visits using specific assessment and intervention techniques • Can use these techniques to provide behavioral health interventions on the fly • Residents rotate into the clinic and learn these techniques while being observed by the “team” in another room

25. Let’s Play… Program: Support top down UW Psych FM Funders interested Faculty comfortable FM Evolving model

26. Session Evaluation Please complete and return theevaluation form to the classroom monitor before leaving this session. Thank you!