2021 Workshops

Summary

Summary

Clinicians and payers alike have historically struggled to extend beyond patient-centered care to engage family members in ways that are meaningful, cost-effective, and efficient with use of time and staffing resources. As the healthcare system works towards the Quadruple Aim of healthcare reform, multigenerational and intergenerational healthcare models continue to show promise as key pathways to improve health outcomes, reduce total cost of care, improve the patient experience of care, and enhance the experience of providers and staff members delivering care. In this unique session, representatives from a regional health plan in Colorado, an independent practice association (IPA) in New York, and a pediatric healthcare program in San Francisco, come together to discuss current and cutting-edge methods of funding family interventions in both primary and behavioral healthcare. The presenters will first define intergenerational and multigenerational healthcare and provide key pieces of evidence that support family-based interventions’ effectiveness in meeting key outcomes such as reducing avoidable emergency department utilization (ED) and hospitalizations and improving condition-specific health markers, as well as sustaining long term positive outcomes. Presenters will showcase specific examples of how clinicians can connect family interventions delivered in their setting to high-priority goals within health plans, align family-based intervention outcome measures with high-value metrics, negotiate payer contract enhancements, and demonstrate a return on investment. The presenters will contrast how financial support for family-based interventions can be strengthened in both fee-for-service and alternative payment models. This presentation will include Q&A time, and participants will be invited to share lessons learned from their own experiences with measurement of and payment for family-based interventions. The session will close with a small amount of time allocated for large group discussion on next steps for measuring and financially supporting family interventions within attendees’ current practice contexts.

Summary

Research indicates that adolescents tend to have the lowest rate of primary care service utilization compared to younger children (AAP, 2008). Potential factors leading to lower utilization may include negative provider perceptions, confidentiality concerns, and decreased knowledge of available services. However, despite lower service utilization, adolescents often report interest in discussing behavioral health and other sensitive concerns with their primary care clinician, and these discussions have been associated with greater satisfaction and better outcomes (Tylee et al., 2007; Byczkowski et al., 2010). Primary care visits present a unique opportunity for clinicians to introduce behavioral health services to adolescents and families, potentially reducing gaps in access to care. Behavioral health concerns may arise if an adolescent endorses mood or behavioral problems on screening questionnaires used in pediatric primary care to identify youth at-risk for anxiety or depression. When available, referrals to integrated behavioral health services can be beneficial, however, pediatricians are often at the forefront of managing behavioral health concerns. Clinicians may feel ill-equipped to manage behavioral health concerns during primary care visits, as these concerns may raise questions about adolescent confidentiality and disclosures, family-clinician communication, ethics, and in some cases patient safety and legal considerations. Additionally, clinicians’ approach to discussing behavioral health issues during primary care visits has many implications for adolescent and family engagement with subsequent behavioral healthcare. Especially given the nationwide shortage of behavioral health services and increasing psychological concerns for youth during the COVID-19 pandemic, clinicians are likely to benefit from increased knowledge of adolescent engagement in behavioral health discussions in primary care. This presentation will describe barriers affecting adolescent engagement in behavioral healthcare discussions in primary care, as well as ethical, legal, and safety considerations in the context of these discussions. We will also identify strategies to enhance these patient, family, and primary care clinician discussions.

Summary

Background: First responders (firefighters, paramedics, and police officers) typically involve repeated, often chronic, exposures to potentially psychologically traumatic events. When combined with insufficient social support and reduced help-seeking behaviours, such exposures may increase the risk of mental health challenges, particularly among paramedics who report the highest rates of mental disorders. Objective: The current study used the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR) to identify critical barriers and facilitators to help-seeking and accessing mental health care, and the feasibility and long-term sustainability of a First Responder Operational Stress Injury Clinic in Ottawa Canada. Methods: Semi-structured qualitative interviews included 11 paramedics (frontline, mid-and-senior management, and union), recruited using purposive and snowball sampling. Interviews were analyzed using content and thematic analyses. The TDF and CFIR guided study design, interview content, data collection and analysis, and the interpretation and reporting of results. Results: The findings underscore the pervasive and troubling nature of several barriers, including the complexities of stigma, confidentiality, cultural competency and humility, and trust. The results also highlight the influence of environmental context and availability of resources on help-seeking and accessing mental health care. Data saturation was reached when there were no new barriers or facilitators produced on help-seeking and accessing mental health care. Conclusion: The findings on cultural competency and humility are an important contribution to the literature given the scant research within first responder mental health. Further, this research will be instrumental in informing evidence-based approaches to mental health care for paramedics, particularly during and after COVID-19. This study can also serve as a helpful approach to replicate in order to determine how best to provide mental health services specific to other populations.

Summary

The COVID-19 pandemic has impacted and transformed the global population. Healthcare providers remain a particularly vulnerable group within the prolonged health crisis, susceptible not only to infection but increased professional burnout. Professional burnout is a “long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of a sense of personal accountability” (AHRQ, as cited in Mollica et al., 2021, p. 1). Prior to the COVID-19 pandemic, up to 50% of U.S physicians were experiencing professional burnout (Shanafelt et al., 2015). In Canada, 86% of surveyed Emergency Physicians met at least one criterion for burnout prior to the pandemic (Lim et al., 2020). Emerging research examining unique challenges of healthcare providers coping with the pandemic include, but not limited to, infection, death, fear of infecting family, moral injury, witnessing suffering, the enormity of the problem, and racial trauma (Mollica et al., 2021). The COVID-19 pandemic reflects a collective trauma for medicine, as well as a self-care turning point. “The physical and mental exhaustion associated with the pandemic cannot be meaningfully captured by the term ‘burnout’ ((Mollica et al., 2021, p. 20).” This presentation summarizes the “Self-Care Protocol: Practice Guide for Healthcare Practitioners and Staff” developed in the wake of the COVID-19 pandemic (Mollica et al., 2021). Grounded in the One Health holistic system of healthcare, the self-protocol aims to integrate all aspects of human life: body, mind, spirit, and environment. Further, the model includes simple to follow, easy to apply, and scientifically backed, trauma-informed, principles to promote resilient healthcare teams. These principles include (1) mission statements (2) clinical excellence, (3) peer supervision, (4) empathy, (5) reflection, (6) mindfulness, mediation, and prayer, (7) personal self-care practices, (8) natural environment, (9) evaluation, and (10) restoring human dignity. Following a summary of the model, the presenter will share practical, brief strategies and other ideas to enact the outline protocol principles. Focus will be on strategies that are brief, low cost, team-focused, and effective. The presentation format also provides participants opportunities to practice self-care. Consideration will be given to how strategies may be applied to diverse individuals and practice environments.

Summary

While the advent of the Electronic Health Record prompted hope and excitement for the possibility of data collection, seamless communication and sharing of information, and standardizing workflows, the actual result has been much frustration from providers and health systems due to the often cumbersome process of documenting and lack of true data reporting and collection. Behavioral health providers (BHPs) working in integrated care systems (e.g., Primary Care Behavioral Health [PCBH]) are not immune to this reality. Specifically, the challenges of concordant charting in a template that not only meets billing and coding requirements, collecting and reporting outcome and fidelity data, as well as is useable and functional documentation for other team members, are prevalent throughout the PCBH world. It can easily be assumed that one of the contributing factors to a lack of fidelity metrics being reported for PCBH within research projects is the lack of ability of health systems to pull data easily to show fidelity. Lastly, there also appears to be a dearth of guidance for PCBH programs in regards to EHR template development, further compounding an often frustrating reality for BHPs and administrators. This presentation will detail the development of a PCBH template at Community Health of Central Washington. Specifically, presenters will describe the iterations that have occurred to arrive at an EHR template that not only allows BHPs to concordant chart and meeting billing/coding requirements, but also produce useable information to the primary care team and fidelity data metrics. The presentation will also detail how a contextual influence has shaped the documentation to prompt BHPs and other medical providers to be intentional and compassionate through their documentation. Lastly, the presentation will provide an overview on how the documentation has evolved to easily adapt to telehealth billing requirements. Target audience members would be any BHPs working in a PCBH clinical setting, as well as administrators wanting to learn how to build templates from the ground up to meet billing/coding demands, as well as is able to report data and outcomes while not being cumbersome for providers to complete. Further, individuals who are wanting to learn how to make their documentation meaningful, contextual, and compassionate based would benefit from this presentation. This presentation helps address social inequalities through sharing information on how to make documentation compassionate/contextually focused, ensuring individuals served in the community have their context shared with the entire team. Further, developing an EHR template that produces minable data allows health inequities to be identified and actively addressed.

Summary

Undoubtedly, the global Covid- 19 pandemic has had a significant impact on the mental health of our transitional youth and young adult population including our post-secondary international and national students who are often living in isolation, frequently away from their family supports, studying virtually, and navigating their disability in this context. The impact of digitalization on academic performance in students with disabilities and the social, economic, and environmental factors and disparities potentially add additional challenges. I will address these factors of health equity in the post-secondary student with ADHD population and how to seek justice and fair mental health treatment, in this vulnerable population. The university student population is an important developmental era in the field of ADHD, as many students receive a first-time diagnosis of ADHD in their early university years. They may leave home for the first time. They begin adulting and have much to manage- making meals, cleaning their living quarters, doing laundry, and managing a much larger academic workload, often with few supports, and now, due to the pandemic, may be in isolation. These students are bright, often went through their academic years without or with little academic difficulty, and may have had wrap around support at home, hence having never experienced significant functional difficulty and thus never assessed or diagnosed. University students often present with a comorbid condition- for example depression, anxiety, eating disorder, cannabis use disorder or OCD, and if not assessing for ADHD, it will get missed in many cases. Untreated ADHD increases the risk of academic failure and drop out, accidents, STI’s, substance use disorders, to name just a few of the functional impacts of ADHD. Treating ADHD makes a BIG difference in the wellness of these emerging youth and young adults- from mental health and wellness, to academic and social success. Treating ADHD will lead to improvements in their concurrent symptoms of mental distress. To successfully treat ADHD, it is best done in a collaborative care approach within an integrated, interdisciplinary team. This session will review the challenges and ways to assess and diagnose ADHD in the university population, and how our team has transitioned to virtual care. Within the context of collaborative team care, I will review biopsychosocial treatment recommendations from pharmacological treatment, to therapy and academic support strategies to enhance the recovery of a university students with ADHD and concurrent symptoms.

Summary

Workshop Overview: Leaders in Integrated Behavioral Health can benefit from a tool that allows them to compare one primary care practice to another. These same leaders can also benefit from a tool that allows them to monitor changes in practice’s integration activities over time. The Practice Integration Profile 2.0 (PIP2) is a free, online questionnaire that provides valid and reliable feedback regarding a practice’s level of integration. Unlike a fidelity checklist, the PIP2 is model agnostic, meaning it can be used to assess all of a practice’s BH activities. Before attending this workshop we suggest (but do not require) attendees complete the PIP2 and bring their results to the workshop. The survey can be accessed at www.practiceintegrationprofile.com. Completing the survey is not required to participate in this workshop. Workshop Details: Operationalizing and implementing integrated behavioral health in primary care varies greatly and differs in the description, definition, conceptualization and ideals of integrated care. A valid and reliable measure of practice integration is needed. In 2013 the Agency for Health Care Research & Quality published the Lexicon for Behavioral Health and Primary Care Integration. Although the Lexicon provided a theoretical description of integration, it did not provide a method to measure integration activities. Starting in 2013, a group of clinicians and researchers began development of such an instrument, the Practice Integration Profile (PIP). To date more than 1,000 unique integrated care practices have completed the PIP. In 2021, the PIP authors released an updated version, PIP 2.0. This revision relied on psychometric reviews of the PIP version 1.0, cognitive interviews with PIP users, and recent evolutions in the landscape of integrated care such as the widespread adoption of telehealth. This workshop will introduce participants to the PIP2 and its value to leaders in integrated care. Attendees will be encouraged to evaluate their own practice using the PIP2 before this workshop and will have an opportunity to review and discuss their results during the workshop. Below is a proposed timeline for a 60 minute workshop: 0-10 Introduction to the PIP and its development beginning with the AHRQ Lexicon in 2013 through its most recent update in 2021. 10-20 Detailed review of the domains of integration assessed by the PIP2, such as EHR integration, BH screening practices, population health strategies, etc. 20-30 A case example of using the PIP2 to inform practice improvement 30-45 Small Group review and discussion of PIP2 results. Attendees can discuss their own practice or use sample results to learn more about their practice and the PIP 45-55 Large group debrief of small group discussions 55-60 Final questions and discussion of next steps for PIP development

Summary

For patients with medical and behavioral health comorbidities, a standard primary care visit may not be sufficient to address the multifaceted nature of their concerns. Conjoint appointments are a brief (e.g., 5-10 minute) type of appointment wherein at least two providers of diverse areas of training/expertise (e.g., a BHP and a PCP) meet with a patient jointly to address these more complex issues. While conjoint appointments are shown to be helpful, sometimes providers are hesitant to agree to try conjoint appointments. This presentation, which has an applied clinical focus, will provide attendees the opportunity to not only hear about what a conjoint appointment is and when it can be useful, but also how to go about conducting one and how to recruit other providers to engage in conjoint appointments. In this talk, we will discuss (1) briefly review and define conjoint appointments, discuss the evidence for their use, and describe other research demonstrating how they can improve patient satisfaction and BHP follow-up (~15 minutes), (2) our efforts to increase the number of conjoint appointments occurring at a VA Integrated Primary Care clinic, including strategies used to discuss this with different providers (~15 minutes), and (3) the basic mechanics of a conjoint appointment, the most beneficial components of conjoint appointments and how attendees can adapt our information to fit their own clinics (~20 minutes), followed by a question and answer period. Participants of this session will receive a handout detailing our “Lessons Learned” regarding how providers can discuss conjoint appointments with each other, common pitfalls in the process, and how a move to virtual care during the pandemic led to a shift in how conjoint appointments operate. Participants will also get to see a simulated example of a conjoint appointment.

Summary

This session is intended for beginning behavioral health providers working in a primary care medical setting (although we would be thrilled to have interested colleagues and collaborators across all disciplines join us). We appreciated the helpful feedback on our session with the same title last year, which included the suggestion that a Q & A-only session would be preferred. Although all sessions are required to include pre-defined discussion points, we have tried to incorporate this feedback by limiting our teaching points to a more specific topic that can be covered quickly. We will begin with a brief overview of the Primary Care Behavioral Health (PCBH) model as defined by Reiter, Dobmeyer, and Hunter (2018). Next, we will identify common reasons that BHCs struggle to fill their schedules, especially via warm hand-offs. Finally, we will discuss strategies for overcoming this challenge, consistent with the accessibility and high volume that are hallmarks of the PCBH model. These discussion points will provide some structure to the session, but our primary aim is to allow as much time for Q & A as is possible. Consistent with feedback received last year, we have reduced our panel to three BHCs with experience across primary care settings and populations.

Summary

From the death of Dr. Susan Moore to the firing of Drs. Aysha Khoury and Princess Dennar to the departure of Drs. Uchi Blackstock and Ben Danelson from medicine, evidence abounds that healthcare institutions, both as part of the larger racist culture and with features unique to healthcare, can create toxic and inhospitable cultures for Black, Indigenous, Latinx, and other providers of color. Whether it be facing daily microaggressions from patients and staff alike being tokenized through service as the racial/ethnic ambassador, or the never ending attempts at finding balance between professionalism and “othering,” these experiences inevitably place additional burdens on BIPOC providers (Osseo-Asare et al., 2018). Further, BIPOC healthcare providers have been historically underrepresented in healthcare and, thus, they face an undue burden. Additional research suggests that nearly half of healthcare organizations’ staff and clinicians are impacted by interpersonal racism, and even though healthcare organizations invest in training to address racism and equity, they are deemed “moderately effective” at best (Cooper, 2021). The irony in these reflections is that racism has been declared a public health emergency by many healthcare organizations, states, and municipalities alike. Yet healthcare workers of color, who are charged not only with rendering ethical and effective care but also with doing so while experiencing multi-layered, multidirectional, and multisystemic racism themselves. This presentation will address the myriad contexts in which racism shows up in healthcare organizations while firmly asserting that racism does indeed show up in healthcare settings. the negative impact of racism on BIPOC healthcare workers and, critically, will conclude with recommendations for strategies to move healthcare organizations from anti-racist in word to anti-racist in action and policy.

Summary

The UC San Diego student-run free clinics (SRFCs) are interdisciplinary partnerships that offer medical and behavioral health services at no cost to predominantly Latinx immigrant families while educating medical trainees and interpreters. The unique circumstances and pressures of the COVID-19 pandemic have disproportionately impacted the primarily underserved population cared for at the SRFCs. This has prompted a shift in both the delivery and interdisciplinary coordination of care. The shift in care delivery is reflected in the transition to telehealth as the primary vehicle for medical and behavioral healthcare at the SRFCs. Spearheaded by medical students and interpreters, this transition has increased access to care by opening up new, more flexible avenues for patients to meet with providers. However, the broader circumstances of the pandemic and the shift to telehealth, which required connecting patients with technology, equipment, and instruction they often do not have, caused their own pressures. These include heightened stress of both patients and providers, a consequent increase in the volume of mental health referrals, and difficulties intrinsic to telehealth. To address these new needs, an interdisciplinary team consisting of interpreters, medical students, and mental health professionals has come together for regular Fireside Chats. These monthly meetings represent an innovative approach to mental health education and self-care that spans disciplines. By providing a space to discuss nuances of providing care to a predominantly Spanish-speaking, immigrant population in Southern California with different members of the care team, the Fireside Chats have strengthened trainees’ competency in addressing mental health with patients, as well as offered a valuable network of support to buffer against the deleterious effects of vicarious trauma. These sessions have also strengthened the relationship between medical students and interpreters to promote partnerships that more effectively elevate the perspectives and concerns of their patients. In this presentation, a transdisciplinary team from the SRFC will describe their experiences adapting the provision of care at the clinic to the demands of the COVID-19 pandemic, especially in relation to the use of telehealth. This will include a discussion of the challenges faced during this transition, the strategies developed to face these challenges, and the new opportunities that emerged by providing services remotely. In addition, the presenters will introduce the Fireside Chats as a place of learning, coordination, cross-pollination, and mutual support that translates to better provision of services for the SRFCs’ clients. This commitment to putting patients first ultimately brings together the diverse voices of the SRFCs to provide culturally-sensitive mental healthcare amidst a period of great adversity.

Summary

A focus on ACES in healthcare requires a multi-faceted approach that includes: awareness and education, training, screening, support, treatment, and coordination. In 2014, MaineHealth embarked on an innovative interdisciplinary journey to prevent, identify and treat ACEs and trauma exposure in our pediatric patient population using a multi-tiered, data-driven, and behavioral health-integrated approach. Research and experience tells us that young children are especially vulnerable to the impact of adverse experiences. Events that threaten their sense of safety and that of their caregiver has the potential of negative consequences for years to come. It is because of this impact that we have focused on recognizing and responding to the effects of trauma in the 0-3 age group and their family system. A two generational approach focuses on enhancing the resiliency of the entire family unit. By fully supporting social determinants, medical health and behavioral health, we aim to design a care model that truly supports the needs of families. We have organized multiple layers of support for the 0-3 population. First, we offer a virtual support group to new moms of babies up to 4 months old that focuses on strengthening attachment, promoting safety, and supporting development. Secondly, we have set up system wide screening using the Edinburg Postnatal Depression Screening in pediatrics. We aim to identify women experiencing postpartum depression symptoms and related items that put both the mother and baby at risk. Elevated scores result in a warm hand off to the integrated clinician or referral back to their PCP. And lastly, through funding from the John T. Gorman foundation, we have developed an enhanced focus on the 0-3 age group within a pediatric practice. An Early Childhood Support Specialist (ECSS) interacts with all families during their well-baby visit. Using a trauma-informed, resilience-building approach, this program is designed to promote responsive, nurturing parenting that will strengthen attachment, home safety, and cognitive, language, social and emotional development during infancy. Interventions are categorized into three levels of support ranging from preventive to intensive, with a telehealth component woven in to increase access. Participants will learn about our universal approach to recognizing and responding to ACEs and social determinants of health in the postnatal and 0-3 populations. We will share how we rolled out system wide screening for maternal depression in pediatrics and lessons learned. We will describe our process for developing the ECSS role in pediatrics, including incorporating the Early Childhood Support Specialist into all well-baby visits, the functions of this role, and the proposed benefits to families. Participants will hear about our plans to spread this role and ultimately sustain it beyond the funding of the grant, by way of advocating for policy change and tapping into existing programs.

Summary

It is more the norm than the exception that practitioners and mid-level managers have to retrospectively identify, collect, and report on data to justify a program’s continuation internally or to external funders. This presentation focuses on retrospective evaluation, including both dilemmas and solutions that can be used when a prospective design is not available and/or data on additional areas of inquiry are needed. We will offer a basic framework to help attendees identify potential sources of data, questions that can be answered with available data, and other factors (i.e.: feasibility and person power) that should be considered when developing a program evaluation process. This presentation will apply this framework to two recent experiences from the presenters. Additionally, the presentation will incorporate interactive elements (e.g., use of Chat, online tools such as Mentimeter, and worksheets) to promote attendee participation. We will briefly and quickly introduce key concepts, apply concepts to the presenter’s examples, and then shift to practice with attendees.

Summary

Endometriosis is often misdiagnosed, mistreated, or missed entirely by providers. Delayed diagnosis leads to poor treatment outcomes and increased healthcare costs. We aim to give a voice to women suffering from endometriosis. We hypothesize that current insufficient practices for women’s healthcare are the result of stigma, a lack of medical training, and providers not listening to women or taking their pain seriously. Participants will be given handouts on the cardinal symptoms of endometriosis, key questions to ask during assessment, and common misdiagnoses. Interactive vignettes will illustrate both the severity and debilitating nature of endometriosis and the improved quality of life that providers can offer their patients when their complaints are taken seriously, as well as the suffering that is caused when they aren’t. Techs, nurses, primary care physicians, gynecologists and general surgeons will have a better understanding of what to look for in these patients. Mental healthcare providers will have a deeper understanding of how to facilitate medical rule outs and advocate for their patients. Participants will walk away with an increased knowledge of the disparities in women’s health, the ability to assess for and recognize endometriosis and resources and referrals to share with their staff and patients. Orientation to Workshop, 5 minutes: Introductions, review objectives, root conversation in historical context. Case Study Presentation, 20 minutes: Participants will be given vignettes based on case studies and invited to assess, diagnose and treatment plan for their patients. Didactic Lecture, 15 minutes: Overview of cardinal signs/symptoms of endometriosis, important questions for assessment, proper diagnosis and treatment options. Address Participant Questions, 15 minutes: Participants will get to address their concerns and ask clarifying questions of the presenters. Conclusion, 5: Provide speaker contact information, handouts and patient resources.

Summary

This presentation will go over the basics of ADHD presentation in adults. It will also focus on education of ADHD assessment as it pertains to integrated care. Earlier detection in whichever model, Primary Care Behavioral Health or Collaborative Care model, as with its use of associated measurement-based strategies will only provide better patient care in the outpatient primary care setting.

Target audience is for any clinician with an interest in increasing their knowledge base and confidence level with regards to ADHD in Adults. All disciplines are welcome.
Handouts and resources will be provided.

Summary

Burnout is a normal response to abnormal amounts of stress. 70% of Canadian physicians reported burnout in the 2019 according to the CFPC. The rates of ASD and PTSD are rising exponentially during the pandemic in both Canada and the US. The CMA 2018 survey described the problem as “beyond any individual’s ability to cope” and yet measures to combat it are largely directed at individual physicians with a prescription for more “self-care”. Burnout is a symptom of the systems we work in. It is epidemic and well established in physicians by mid residency. Burnout knows no boundaries, no one is immune. Systemic factors contribute more to burnout than individual ones. Doctor ” heal thyself ” and “self-care better” have become added responsibilities that are systemically unsupported and yet fueled by institutional expectations, limited resources and the culture of training. The effects of burnout are pervasive and lasting. Burnout is bad for patient health, provider health, for professional satisfaction and sustainability. It is bad for our institutions, system and society. The number one cause of medical disability and long term sick leave amongst health care providers are mental health diagnoses and this is more pronounced in those providing mental health care. Socio cultural processes around power, privilege, Inclusion, exclusion and racism are strong and implicitly part of the system we work in. Health care providers are not exempt from the effects of these processes. Research during the pandemic has demonstrated increased susceptability to ASD and PTSD among some racial and minority health care providers. How do we reduce unconscious bias so that we create an explicit understanding and share the responsibility to address these issues and solicit support at every level. This is how we heal, we create a culture of compassion, one that acknowledges the harm done while creating solutions rooted in safe, fair, equitable practices and policies. What has historically been implemented has not worked and is only worsening the rate of burnout as the pandemic demands more of health care providers, with fewer resources under higher levels of stress and threat. Mental health providers treating those with burnout are themselves burnt out while denial and avoidance of an ever expanding crisis in care grows to what one could argue it is a parallel epidemic for which there is no vaccine. We need immediate action that aids self-help, treatment, increases patient engagement in their own care, fosters stronger integrative and collaborative models of care that are supported by systemic cultural change.

Summary

Chronic pain is a highly common yet debilitating condition that significantly impacts daily functioning and quality of life of primary care patients. Primary Care Behavioral Health (PCBH) providers are in an ideal position to supplement standard biomedical pain management approaches by offering patient-centered psychosocial care. Brief Cognitive Behavioral Therapy for Chronic Pain (Brief CBT-CP; Beehler, et al., 2021) was adapted from a full-length evidence-based protocol for chronic pain developed in the Veterans Health Administration (VHA). Brief CBT-CP addresses core psychoeducation about chronic pain, behavioral activation and pacing, cognitive skills, and relapse prevention strategies and is designed specifically by PCBH providers in up to six, 30-minute appointments. Brief CBT-CP effectiveness and patient satisfaction are supported by prior evaluation findings (Beehler, et al., 2019; Beehler, et al., in press). This presentation will provide practical guidance for frontline behavioral health providers working in the PCBH model to adopt Brief CBT-CP at their clinical sites. Guided by the Evidence-based System for Implementation Support (EBSIS; Wandersman, et al., 2012) model, we will review the tools, training, technical assistance strategies, and quality improvement processes for successful Brief CBT-CP implementation. Informed by real-world experiences of implementation among a national sample of VA PCBH providers, attendees will learn how to identify patients likely to benefit from treatment and how to use measurement-based care strategies for outcome monitoring and shared decision making. Strategies for adapting the Brief CBT-CP protocol for group medical visit format will also be reviewed. Through focused didactics, panel discussion, and audience questions, participants will leave this session with the necessary groundwork to guide their clinical team in adopting a feasible and empirically supported nonpharmacologic approach to chronic pain management.

Summary

Many racial and ethnically diverse communities have higher mortality rates from chronic diseases such as cancer, diabetes, and cardiovascular disease than non-Hispanic Whites. According to the Kaiser Family Foundation, 32% of Hispanic/Latinos, 22% of African Americans, 19% of Asian Americans and 30% of American Indians are uninsured compared to 14% of non-Hispanic Whites. The impact of these statistics has been documented in the primary care setting, with African Americans, Asian Americans, and Hispanic/Latinos less likely than non-Hispanic Whites to have a personal primary care provider. Racial and ethnically diverse populations are also more likely than non-Hispanic Whites to report experiencing poorer quality patient-provider interactions as well as perceived discrimination from the health care team. More than one approach will be needed to address health disparities and systemic racism in health care in order to achieve health equity consistently. One approach is through alterations in primary care workforce development. This presentation will focus on how to create and alter curricula for trainees that encourages the examination of implicit and explicit biases regarding racial health disparities as well as the use of sociocultural, constructivist, and transformational learning approaches to encourage reflection with trainee-generated content (TGC) through creative podcasting. Doctoral-level health service psychology trainees in an integrated primary care course engaged in creative podcasting to promote deep learning related to racial and ethnic health disparities during the spring 2021 semester. This presentation will also discuss trainee experiences with creative podcasting, how this impacted their learning and reflective practices, and the importance of how TGC can promote reflection on issues of racial health equity, trainee engagement, and allow trainees, especially trainees from racially marginalized groups, a more equitable learning experience between the trainee and primary care educator.

Summary

There are few areas where health disparities are more pronounced than the uniquely burdensome impact of diabetes on Latinx families. Though greater social support is associated with improved disease outcomes for Latinx patients with diabetes, research has yet to identify the specific pathways through which social support influences self-management. This study will utilize a cross-sectional survey design to test a theoretical model highlighting the mechanisms and pathways linking social support and physical health. Specifically, self-efficacy and depression will be tested as psychological pathways connecting family support to diabetes self-management behaviors and health outcomes. This study was selected for the REC Fellowship and data collection is ongoing. The results of this study will inform continued exploration of the links between psychosocial factors and health, and specifically guide family-centered integrated care interventions supporting patients who are struggling to manage their diabetes.

Summary

The Waco Family Medicine Residency Program, in consultation with faculty of the Massachusetts General Hospital Psychiatry Academy, has created The Waco Guide to Psychopharmacology in Primary Care (wacoguide.org). This collection of psychopharmacology decision support tools combines top level evidence and expert opinion with real world primary care practice. The Waco Guide to Psychopharmacology in Primary Care is a free resource intended for use in communities where the mental health need has outpaced psychiatric specialty resources. These decision support tools succinctly reflect standard and advanced primary care mental health practices in adult, pediatric, perinatal, and substance use disorder psychopharmacology in order to maximize in office usability. The Waco Guide brings cutting edge psychopharmacology guidance in to every exam room, especially to our communities operating on the fridge of our behavioral health system.

Summary

Anxiety is prevalent, but undertreated, among primary care patients. We developed Modular Anxiety Skills Training (MAST), an evidence-based, transdiagnostic intervention for use in Primary Care Behavioral Health (PCBH) settings, to help address this treatment gap. MAST includes 9 modules that provide psychoeducation and teach cognitive-behavioral coping skills to improve self-management. We conducted a pilot hybrid I randomized controlled trial within the Veterans Health Administration (using MAST for Veterans or MAST-V) to (1) assess feasibility and acceptability, (2) preliminarily evaluate effectiveness compared to PCBH usual care, and (3) identify potential barriers and facilitators to future implementation of the intervention. Participants (N=36, 17% women, 28% non-White or Latinx, age M=47 [16] years, range: 23-77) reporting current anxiety symptoms (GAD7≥8) were recruited from primary care at a VA medical center and completed assessments every 4 weeks for 16 weeks. 35 patients were randomized to MAST-V (n=17), which was delivered by 5 study therapists (39% of sessions via telehealth), or PCBH usual care (n=18), which was delivered by 6 clinic providers. The COVID-19 pandemic began approximately two-thirds through the trial thus necessitating a switch to telehealth modalities. We will report data on feasibility (engagement, retention, number and duration of sessions), acceptability (treatment satisfaction and credibility, therapeutic alliance, qualitative patient perceptions), effectiveness (functional impairment and anxiety, depression, and stress symptoms), and implementation (validated scales, MAST-V fidelity, qualitative provider perceptions). The primary effectiveness outcome is a validated measure of anxiety symptom severity and impairment that will be at evaluated using multi-level modeling. This study illustrates how data related to effectiveness and implementation can be collected within hybrid trials. We will examine the impact of the switch to telehealth on trial outcomes. Promising data from this pilot trial would demonstrate the utility of continued research and evaluation of brief transdiagnostic modular interventions, which can be delivered feasibly in-person and via telehealth, to improve engagement and effectiveness of anxiety treatment in primary care.

Summary

The audience will learn how to apply standard integrated care practices to the precariously housed population. This will include how to adapt the integrated care model utilized by HH to patients who have precarious housing of many forms. Case Studies will be utilized to ensure participation and solution focused options to provide care. This topic will focus on socioeconomic inequities and how Hunter Health (an FQHC/IHS Clinic) works to address these with individuals patients and the community. The target audience is those familiar with integrated care looking to apply the model to individuals experiencing homelessness and how to provide best care.

Summary

The road to advancing tobacco treatment in healthcare settings is to partner with integrated behavioral health, offer virtual training and support, and link to digital resources to help patients reach their goals. Integrated care settings provide a unique opportunity to address tobacco use disorder; the leading cause of preventable death worldwide. Specialized training for providers & digital touchpoints for patients are means to impact the burden and significant disparities related to smoking. Targeted training is essential to ensuring tobacco use is addressed and treatment offered at every visit. Time and cost can be challenges when considering integrating training and treatment into every day workflow, so we have found that adding virtual training and referrals to digital touchpoints and state quitlines that utilize them is most effective. These innovations offer opportunities to reduce disparities and barriers to tobacco treatment while increasing flexibility and ease of access for both provider and patient. Moreover, this allows providers to cast a broader net to reach and support tobacco users with evidence-based treatment. Participants in this session will learn how to utilize brief interventions to address tobacco use disorder in their practices, connect patients to digital treatment interventions and connect providers to available resources available to increase skill and comfort in addressing tobacco use disorder. Additionally, ways to develop practical skills, opportunities to further inter-professional training, and new ways to use technology to support tobacco treatment will be shared and practiced.

Summary

The COVID-19 pandemic has had a disproportionate impact on individuals who use substances (IWUS). Increased risk of infection and overdose, combined with the strain on mental health and addiction services has highlighted issues surrounding access to quality addictions care. Project Extension for Community Healthcare Outcomes-Ontario Addiction Medicine and Psychosocial Interventions (ECHO-AMPI) is a virtual continuing professional development (CPD) program, making it uniquely positioned to provide support to healthcare professionals (HCPs) working with IWUS during the pandemic. ECHO-AMPI connects an inter-disciplinary team of subject matter experts with Ontario HCPs weekly to discuss client cases and best practices in supporting IWUS. ECHO-AMPI Cycle 3’s (Modules 1-3) impact on building addictions care capacity was evaluated using Moore’s evaluation framework for CPD. Satisfaction was assessed after each session using a five-point Likert scale. Participants also rated their confidence in core competency areas pre- and post-participation using a 0-100 confidence scale. Competencies reflected assessment, treatment and management of addictions. Post-ECHO, participants were asked to rate their overall satisfaction with the program and self-report whether ECHO-AMPI participation resulted in a change in their practice. Across the three modules there were 219 unique HCPs from 155 different organizations across Ontario. Average session attendance was 67 participants. Mean satisfaction scores were high (>4.35/5), and there was a 13% improvement in participants’ confidence in addictions care (p<.001). 69% of participants reported changing their practice following participation. Our findings suggest ECHO-AMPI is an effective educational intervention that builds HCP confidence and capacity to support IWUS during COVID-19. High participant engagement and satisfaction scores demonstrate that addictions care-focused CPD can be successfully delivered virtually during COVID-19.

Summary

Background: In 2020, an estimated 42% of physicians reported burnout. Burnout is associated with impaired clinical care, attrition and turnover of professional staff, and increased healthcare costs. It also has multiple negative impacts on individuals including damage to relationships, increased rates of substance abuse, depression, and even suicide. Organizational interventions targeting excessive workload and stressful clinical environments have successfully reduced burnout scores. Benefits have also been demonstrated from programs that enhance individual coping skills. One such program being mindfulness-based stress reduction (MBSR). MBSR was first utilized as an intervention within healthcare in the 1970s. Since that time, it has consistently been reported to be helpful in reducing burnout and promoting well-being and quality of patient care among health professionals. Rational: Our aim was to provide an organizational intervention of a virtual 8-week MBSR program targeted at fostering physician well-being and resilience. Method: This study utilized a single-sample, nonexperimental design comparing pre-, post-intervention scores on validated outcome measures including the Maslach Burnout Inventory (MBI-9); the Depression Anxiety Stress Scales-21 (DASS-21); the 14-item Resilience Scale (RS-14); and the Santa Clara Brief Compassion Scale (SCBC). We recruited 21 physicians within a large Midwestern Family Medicine residency program. The study utilized an 8-week, virtual, MBSR intervention led by a certified instructor. Each weekly session lasted 75-minutes. Topics included emotional intelligence, awareness, community building, communication, stress resilience, and more. Results: All 21 participants completed a baseline survey and 18 (86%) provided data in a post- intervention survey. The average age of participants was 32.9 (SD = 9.3); 52.4% were male; and 76.2% were resident physicians. Participants’ baseline scores on the MBI-9 were low, and showed no significant change. Participants reported significant improvement in anxiety (P<0.01) and stress (P<0.01) DASS-21 scores after the intervention. Participants also had a significant improvement in perceived resilience scores on the RS-14 and in compassion scores on the SCBC post-intervention (P<0.01). Presentation: We will provide an introduction to MBSR which will include an MBSR exercise (10 min). Second, methods of this study will be identified (5 min). Third, results from the study will be shared (5 min). Fourth, we will discuss limitations, next directions, and conclusions from the study (5 min). We will conclude with Q&A (5 min).

Summary

Background: Mental illness and substance use affects approximately 1 in 4 Canadian youth and young adults. Foundry centres provide services for youth (ages 12-24) and utilize a substance use integrated stepped care model (ISCM), involving a number of interdisciplinary professionals. While this model is evidence-informed, it has yet to be validated by youth. The Experience Project aims to inform this model by asking youth with lived/living experience what is important to them when accessing substance use services and asking peer support workers how they want to be integrated within the ISCM model. This information will be used to develop substance use curricula to train peer support workers and other service providers who support youth at Foundry and Youth Wellness Hubs Ontario (YWHO). Methods: The project applies community-based research methods to ensure that the voices of youth with lived/living experience are centered throughout the project. This is being achieved by a project advisory committee of 14 youth that is consulted bi-weekly, 3 youth research assistants and 2 youth peer evaluators to support with the project’s research and evaluation activities. A phenomenological qualitative study design was applied by conducting open-ended interviews with 30 youth (ages 12-24) with lived/living experience of substance use who live in British Columbia (Canada) and 30 peer support workers who support youth. The interviews are being analyzed by participant group using inductive thematic analysis and will be used to develop new substance use curricula. Results: Early findings from the thematic analysis suggests that youth do not feel worthy of substance use services and see them reserved for those in crisis and experience greater barriers such as homelessness, abuse, and harder drug use. This is exacerbated by the fact that there are not enough substance use services available, in addition to the stigma and discrimination youth may face when they finally seek help. Peer support workers describe the need for more standardized training. They emphasize the value of storytelling by youth and peer support workers, and opportunities to connect with peers and other service providers to help them feel more adept to support youth who use substances. Both youth and peer support workers stress the importance of applying a person-centred approach to care and the need for interprofessional care teams to address the social determinants of health that impact young people’s substance use. Conclusions: Youth experience many challenges engaging with substance use services as currently delivered. Peer support workers play an important role in providing person-centered services to youth and should be fully integrated into collaborative care models to be better positioned to support youth with multiple concerns. Incorporating youth perspectives in substance use curricula can also help peer support workers and other service providers meet youth where they are at.

Summary

Background: Since 2014, the University of Colorado Department of Family Medicine (CU DFM) leveraged technology and provider relationships to expand access to mental health expertise through a stepped, hybrid (virtual and in-person), team-based, integrated service. In 2020, in collaboration with the CU Department of Psychiatry, an enhanced behavioral health integration model developed, further incorporating telepsychiatry consultation (referred to as IBH+) and began scaling from 1 clinic into 7 IBH+ Family Medicine practices, specifically targeting access to our Medicaid patient population. This presentation describes the IBH+ model and reports on staffing and service delivery metrics tracked in a program dashboard. Study Design: Quality improvement Description of Population: 60,000 patients in 7 CU-affiliated family medicine practices. Procedures/ Data Collection: A Microsoft Excel dashboard serves to track project metrics and is updated monthly and quarterly through a shared electronic medical record, Epic. Key Results: As of March 2021, 3 practices adopted the full IBH+ service and e-consults expanded to 7 practices. Access to team-based care increased, adding 4.0 FTE psychology, 0.7 FTE psychiatrist, and 0.1 FTE addiction medicine. As a result, the number of patient encounters increased from 331 in July to 649 in February. During the first six months (July-December 2020), 203 unique Medicaid patients received at least one IBH+ service. Between July 2020 and February 2021, 3,388 psychology and 199 telepsychiatry visits were provided and 49 e-Consults were answered. Month-over-month increases in service delivery averages an increase in 48 patient encounters/month for telepsychiatry, in-person psychology and telepsychology. Conclusions: The IBH+ model has been successfully ramped up over 9 months and services are tracked in an ongoing dashboard. Focusing our team-based, telepsychiatry model on our Medicaid population promotes health equity for all patients.

Summary

Interpersonal Violence (IPV) is an epidemic in our country that impacts approximately a third of women and a tenth of men during their lifetime. Currently prevalence rates are increasing even more during the pandemic of COVID-19 due to a myriad of factors including isolation, financial stress, and lack of access to support and mental health resources. There is a disproportionate effect on marginalized communities, exacerbating the already detrimental adverse physical and mental health outcomes that result from IPV. Using lessons from the treatment and screening of individuals living with HIV in our own clinic, this presentation will address the vital task of adequate training of staff and screening of patients to identify and support those dealing with IPV. This presentation will address the major barriers to care that can arise from provider factors, including insufficient training, internal factors, and systemic barriers, both illuminating what may keep people from being identified as experiencing IPV and suggesting a routinized training and screening program for all medical and psychological practices.

Summary

Cognitive impairment (e.g., dementia) in older adults can be a difficult condition for patients, families, and their medical providers to address. The identification process is difficult for primary care providers (PCPs) due to time constraints, uncertainty of how to best assess for cognitive concerns, and provider discomfort with diagnosis disclosure. Therefore, formal evaluation of cognitive impairment is often omitted and it remains undetected by providers more than 40% of the time. This is especially true in populations who are underserved and have lower levels of education, which perpetuates health disparities. Family engagement in the primary care setting may help to resolve these concerns but evidence for the effectiveness of family engagement in primary care remains scant.

This presentation reports outcomes from a quantitative vignette-based study exploring the influence of family-provided information on PCP decision making and patient care. Forty-five PCPS participated in an online self-administered survey. Majority of participants were female (74%), white (76%), and practiced family medicine (78%) in urban areas (67%). Grounded in Patient- and Family-Centered Care (PFCC; Johnson & Abraham, 2012) and Intersectionality (Crenshaw, 1989), this study was designed to answer: (a) How does family engagement influence the diagnostic, management, and referral practices of PCPs with older adults exhibiting cognitive impairment, and (b) How do race and gender influence PCP diagnostic and decision-making processes when caring for white and African American patients? Utilizing PFCC with attention to the intersection of patients’ social locations provides a means for engaging and partnering with families in the care of older adults with cognitive impairment that reduces power imbalances between patients, families, and the healthcare team. The results of this study provide better understanding of how family engagement may help to reduce the influence of possible racial and gender biases and promote more equitable health care.

Summary

The time of youth and young adulthood can be particularly daunting for those with mental health problems. In one Atlantic Canadian city a community-based, drop-in, psychosocial mental health centre was designed specifically for youth and young adults aged 16 to 29 years, who self- identified as struggling with mental health problems. The purpose of this study was to explore factors that promoted and discouraged engagement with the centre. Narrative inquiry was used to gather participants’ stories. Ten participants (six males and four females), ages 19 to 29 years, who attended the program (some regularly, some intermittently) were interviewed. Thematic analysis revealed five major categories: (a) Shared Experiences: Shattered and Alone (b) Turning Point: Reasons for Coming; (c) Facilitators of Engagement and Beyond; (d) Challenges to Engagement; and (e) Benefits of Attending: Finding My Way. The common experiences of trauma and its impact were most evident and the need for an approach that helps individuals manage and move beyond the impact of the trauma is essential. Participants noted that critical factors promoting their engagement included having a safe place that facilitated their making connections and building trust to move forward. A multi-disciplinary staff, including peer mentors also played an integral role in promoting participant engagement. This program played a significant role in assisting these individuals to persevere and move forward. This study highlights the need to consider a number of factors that encourage engagement, including integrating a trauma-informed approach when developing community based programs for young adults with mental health problems.

Summary

Background: The suicide rate among Alaska Native and American Indian people in Alaska is twice the overall state rate and three times the national rate for Alaska Native and American Indian people. Recent research has shown that healthcare systems are critical sites for preventing suicide. Self-report screening methods (such as PHQ-9 or C-SSRS) are necessary but not sufficient to prevent suicide in health systems. Recently, machine learning techniques have been applied to routinely-collected EHR data to detect suicide risk. Setting and Methods: In 2019, Southcentral Foundation (SCF), an Alaska Native-owned healthcare system, validated a suicide risk prediction algorithm developed by the Mental Health Research Network (MHRN). In 2020, interviews were conducted with patients, providers, and leaders to identify stakeholder concerns and priorities for implementation of the algorithm. Transcribed data were thematically analyzed within and across participant sub-groups. Results: The MHRN algorithm accurately identified risk of suicide attempt within 90 days of a primary care visit among SCF patients with behavioral health diagnoses (AUC=0.826; 95% CI 0.809-0.843). As of March 1, 2021, 14 SCF patients and 15 providers and leaders had been interviewed. All participant groups favored the EHR-based approach to suicide risk detection. Patients expressed concern about who would have access to EHR data for this purpose and how it would be used. For some, acceptability was predicated on prior patient consent for using health records for suicide risk detection and prevention. All participants regarded the patient-provider relationship and trust as critical factors in successful implementation of the algorithm, as well as robust EHR data system and accessible, behavioral health care. Conclusions: Preliminary data analyses suggest strong but conditional stakeholder support for implementation of an EHR-based algorithm suicide risk detection in an Alaska Native owned health system.

Summary

As psychiatrists working in Northern Ontario, it has been required to be involved in developing care models to respond to the needs of communities in remote and underserviced areas. The recent pandemic has prompted new and successful models that have accelerated the growth of collaborative care models in our most isolated regions of Ontario, Canada. Historically, Indigenous peoples have resided in the most remote regions of Canada, where mental health is both limited and underfunded. The disparities across all the social determinants of health are well documented. For example, Indigenous peoples of Canada are one of the fastest growing population groups in Canada, yet many still lack access to clean water, local schools and health clinics. The toll of multiple generations of systematic cultural loss and neglect has most shown itself in the mental health effects. Sioux Lookout is a town in Northern Ontario that provides care to over33communities with a combined population of over 30,000. The majority have no road access. Any care planning requires respect for existing services, Indigenous culture, and a readiness to see both individual needs, as well as challenges in improving the system of care. Psychiatric care was provided by varied specialists previously. In February 2019, Sioux Lookout First Nation Health Authority (SLFNHA) entered into a contractual relationship with a psychiatrist who would provide a blended model of psychiatry services for which he provided 3 days of face-to-face services every two months and telepsychiatry services in between these visits. At the time of the pandemic, a request from SLFNHA to quickly move to only telehealth enhancement of services was met by all Psychiatry service providers, including a hospital from the larger centre, Thunder Bay Ontario, St. Joseph’s Care Group. These service adaptations required an integration of knowledge that respects the existing model of care developed by local providers and planners, and respect for the cultural setting, yet also required use of key components of collaborative care and the Indigenous Health Continuum. Amidst this response, there has been a sustained reduction of consult wait times from months to weeks, as well as high satisfaction reports. The author will share how the model of care mirrors that of other non-governmental organizations (NGO) providers in low income countries, such as Partners in Health. Also, an exploration of the challenges to ‘decolonialize’ mental health while bringing evidenced based care will be introduced.

Summary

Managing emotions at decision points in care is a challenge in the time-limited environment of providing patient care. This is exacerbated for patients who navigate a system that has perpetuated socioeconomic and economic disparities in care. Shared decision-making (SDM) provides a paradigm for responding to the emotional and informational needs of patients with chronic kidney disease and diabetes. However effective SDM implementation requires flexible interviewing and dialogic skills. While practiced and rehearsed scripts of care can be efficient and delivered in a caring manner, they are not responsive to the unique needs of patients from marginalized communities. This presentation presents the results from two studies. The first explored patient and physician experience in delivering bad news. The second describes delivering bad news with the use of an on-line, values based decision aid. The results of these studies are supported with recommendations of provider strategies to maintain patient and family engagement in SDM and a review of on-line patient resources.

Summary

M’iqmaq Elders Albert and Murdena Marshall of Eskasoni First Nation in Nova Scotia invented the expression “Two-Eyed Seeing” around 2003 to describe a unique collaboration at Unama’ki-Cape Breton University in Sydney, Nova Scotia) of indigenous knowledge keepers and academically trained scientists. In two-eyed seeing, one eye looks from the perspective of traditional Indigenous knowledge and epistemology, while the other gazes from academic scientific knowledge and epistemology. The goal was to reverse the privileging of academic knowledge and the dismissal of indigenous knowledge. The concept is represented by the word Eptuaptmunk in Albert’s language. Two-Eyed Seeing is spreading across Canada and is becoming more mainstream. In philosophy, the concept has been called “explanatory pluralism,” a term that suggests that more than one level of explanation exists for any phenomenon, that all levels may be equally valid, and that any given level need not make sense from the perspective of another level. This contrasts with the driving philosophy of contemporary biomedicine of positivism (one most correct answer exists and the conventional scientific paradigm will find it), reductionism (more fine-grained explanations are better), and the idea that one can control the world in order to perform experiments. Why does this matter for aiding indigenous people with addictions? Historically, the biomedical paradigm has not reached indigenous people well. Their philosophies are more holistic, implicitly aware of whole systems thinking, and aware of contextualizing behavior within communities and of interdependence and inter-relatedness. The biomedical approach has been individual, while a community-based approach can be more successful for indigenous people. We discuss the results of our interviewing traditional elders, holding talking circles in communities about substance use, creating a zoom forum in the days of coronavirus for discussions about indigenous approaches, and discussing with colleagues in indigenous contexts how to proceed. We found that a narrative approach in which we collaboratively create a story to explain the addiction that takes into account concepts of threat, power, and meaning and is grounded in an understanding of the effects of trauma (historical and contemporary) was well acceoted. Within this approach, a healing narrative is constructed which serves as a map for the person to move from being under the influence of a substance to being free from its influence. The idea of creating a community of recovery emerged as quite important for people recognized that being around substances leads to substance use. Some key concepts were important — that a substance has a spirit that must be recognized and respected, that addictions are passed to the next generation if not resolved in the current generation, and that people who use substances must be seen in the context of the suffering of the entire community.

Summary

1. Resident burnout: What is it and why should we care? An introduction to burnout amongst physician residents and how the pandemic has impacted resident wellness, including literature review. (5 mins) 2. Wellness by residents for residents: A family medicine residency program’s approach to resident wellness and how it has evolved to meet new needs in the face of the pandemic. (10 mins) 3. Next steps: Where do we go from here? Analyzing anonymous resident survey results including impact of program wellness curricula before and during the pandemic. We will describe implications for other wellness programs and future interventions (5 mins) 4. Applying lessons learned: Interactive discussion on how audience members can better adapt their wellness program to pandemic conditions (10 mins)

Summary

With the high prevalence and burden of anxiety depression and mild cognitive impairment in later life, earlier detection and treatment could both improve well being and modify the risk for Alzheimer’s disease. As most individuals with these conditions present in primary care, rarely reaching specialised services, we examined whether collaborative approaches between primary care and mental health care clinicians could support the introduction of integrated care pathways to assist with recognition and assessment, and standardize care. We introduced an integrated pathway – adapted for primary care – to diagnose and manage anxiety, depression and MCI in 5 primary care practices in Ontario. We looked at three measures – a) the detection rates for depression anxiety and MCI and primary care; b) the time to treatment for individuals identified with one of these problems, and c) outcomes for individuals in the integrated pathway methods. The main assessment tools were an PHQ9 GAD 7 MOCA and QOL. 69 participants were enrolled in the ICP arm and 76 in the Treatment as Usual (TAU) arm, in 5 different practices. The ICP included medication, patient education and social activation. Follow-up assessments were conducted at baseline and then every 6 months for up to 2 years. At the same time, we tracked changes made by the practices to incorporate the pathway, held focus groups with participating practices to learn about their experiences and conducted a chart review to identify possible changes in detection rates. Participants did not differ in age, gender, marital status, education, or employment status. Participants assigned to the ICP experienced more persistent improvement on measures of depression, anxiety and quality of life than those assigned to TAU. They were also more likely to access the right treatment and faster than those in TAU. With active screening, detection rates of anxiety, depression, or MCI increased 5-fold compared to before starting the study. However, rates of detection went back to before the study after the withdrawal of research support. Factors facilitating its introduction included an identified lead for the project in the practice, physician engagement, and limiting the demands made of physicians. The ICP was seen positively by most family physicians despite the increasing time demands. Physicians emphasised the need to keep this to a minimum when introducing a new program. A dedicated person in the practice to coordinate the initiative and screening is important and other system changes are required to accommodate an ICP. The algorithm may need to be adapted for individual practices and outcomes were positively affected by greater physician buy in and engagement. A shorter time to treatment indicated that physicians were using the algorithm. There may be benefits in providing consumer education and physician training materials electronically.

Summary

The Evolution of Play: Using Minecraft to overcome inequities in accessing behavioral healthcare during a pandemic and enhancing the tele-health experience for vulnerable populations The field of behavioral healthcare demonstrated the ability to pivot to providing services remotely or via remote healthcare with the onset of the Covid 19 pandemic. Although this allowed many to continue to access and receive services, this shift created and exacerbated inequities that have challenged vulnerable populations in receiving support. One of the vulnerable populations that was impacted by this shift is children and youth. Engaging youth in mental health treatment has often utilized various experiential approaches. As we moved towards remote healthcare many of these techniques have become difficult to access. Therapists lost the use of traditional play therapy toys, interventions, and sand trays. Drawing upon the work of Carl Rogers and the humanistic approaches, we identified Minecraft as means to “meet people where they are at”. Minecraft is a platform that is very accessible and already available. Minecraft uses flexible software that has enabled us to utilize play techniques in a safe and secure manner. We have found that even through Avatars we are able to create real connections and a sense of community. Minecraft has become a way to collaborate, learn to manage difficult emotions, and feel a sense of belonging. We, as therapists, have helped the people we serve navigate through a journey toward connectedness and growth that in turn become buffers against mental distress. Minecraft can also allow therapists struggling to reconnect to their skillset. Remote play can help increase therapeutic capacity, utilize experiential therapy modalities, and buffer from burnout brought on by the pandemic. In our proposed presentation, we will discuss how utilizing remote play tools such as Minecraft can help address mental health concerns that were exacerbated by the pandemic. We will address how we utilize already established technology to enhance the remote healthcare experience. We will discuss strategies to implement already established treatment modalities using a digital platform. We will discuss challenges and how to overcome lack of digital fluency. We will share instructions on how to start using these tools to further enhance care for vulnerable isolated populations.

Summary

Chronic diseases are costly to individuals, as they confer high risk for morbidity and mortality, and to the healthcare system, as those with chronic diseases account for 90% of the United States’ annual $3.8 trillion in healthcare expenditures. Effective self-management is key to chronic disease prevention and management; sustained behavioral changes by patients are required to reduce the significant impact of chronic disease on both an individual level and population level. Integrated behavioral health providers (BHPs) can help prevent and manage chronic disease by engaging patients in their healthcare and empowering patients to make healthy life changes. One powerful way to engage and empower patients is to center healthcare on patients’ values and goals. However, this can be difficult in the context of brief, problem-focused appointments in primary care. Therefore, this presentation seeks to increase BHPs’ knowledge and skills regarding integrating patient values and goals into Primary Care Behavioral Health (PCBH) practice, especially during the assessment and treatment planning phases of care. Didactics will orient BHPs to the empirical literature on patient engagement, including personalized care planning and shared decision making. Interactive discussions, case vignettes, and examples of tools regarding patient values and goals will be used to elicit and provide practical recommendations for BHPs to incorporate into their existing session format in PCBH practice.

Summary

Experiential or simulated teaching of patient health conditions and associated treatments is becoming an increasingly utilized method of instruction in healthcare training programs. The onset of the COVID-19 pandemic has resulted in an even greater need for experiential learning to provide a more interactive component to the virtual platform of most instruction. The pandemic also has made apparent the inequities that exist within healthcare. One key aspect of reducing these disparities is to enhance patient-centered care and the patient-physician relationship by teaching and promoting empathy in meaningful ways. Studies have shown the importance of empathy relative to favorable health outcomes, patient satisfaction, reduction of severe symptoms, and enhancement of cultural competency. Empathy also can serve to enhance students’ understanding of the inequities in healthcare. The purpose of this study, entitled the Diabetes Simulation Challenge, was to implement a unique training tool to foster empathy, a key facet of patient-centered care. Medical students participated in a 24-hour, perspective-taking activity as part of their curriculum, in which they simulated some common experiences of living with type 1 diabetes. Students’ written reflections were analyzed using an exhaustive, iterative qualitative method to determine whether this activity led to expressions of empathy or thoughts and beliefs consistent with patient-centered healthcare. Nine unique themes emerged, six of which indicated that students adopted the perspective of an individual with a chronic illness. Study findings demonstrated an understanding of the behavioral, social, and emotional challenges related to living with type 1 diabetes, as well as increased empathy towards these individuals, in most of the students’ reflections. Medical students who aim to provide patient-centered care benefitted from this perspective-taking exercise and training programs should consider using such methods to extend learning beyond traditional didactic education to help students face healthcare inequities in a more interactive, real-life context with the goal of reducing treatment disparities. Overall, this simulation offered a rich training experience for medical students as they continue to grow in their knowledge and skills related to patient-centered care. This presentation will draw connections to the ability to enhance students’ understanding of empathy, and thus expand their abilities to work towards change in inequities in healthcare.

Summary

The myriad benefits of music have been well-documented across the lifespan from birth to end of life care, encompassing positive effects on child development, mood, stress reduction, cognition, expression, pain management, sensorimotor function, social connection and quality of life in a wide variety of healthcare settings. Yet neither music, nor music therapy, an accredited healthcare profession, are currently systematically applied and integrated into multidisciplinary healthcare in Canada. With the dramatic shift to virtual care delivery in a time of isolation and global crisis, live streamed music played by professional musicians and online music therapy delivered by certified music therapists provide a spectrum of feasible, culturally inclusive, acceptable, low cost, effective treatment options to support mental health and wellbeing. Both have low potential for adverse effects, can be incorporated with other creative arts, and can be delivered across hospital and community settings for both patients and caregivers. This presentation will briefly review the neuroscience of music, clearly define music therapy vs. other forms of music and sound for health, and discuss available tools and evidence for the use of music in mental health. We will also share our Calgary virtual care experience including successes, challenges, improvement ideas, and a vision of how music could be widely integrated across the continuum to enhance societal health.

Summary

Introduction: Addressing wellbeing needs among learners, faculty, and staff during the COVID-19 pandemic is a challenge for many clinical and academic departments. Continued and systemic supports are urgently needed to ensure that departments are able to carry out their clinical, educational, and research missions. To ensure uptake, supports should be based on an accurate picture of departmental needs. Methods: Beginning in March 2020, the Plan-Do-Study-Act (PDSA) quality improvement cycle was used to inform an iterative approach to conducting a needs assessment and implementing a COVID-19-related wellness initiative in a psychiatry department. Key elements of the intervention included a Wellness Working Group, the curation of educational materials on the Department’s website, and the deployment of regular, monthly surveys (to date, N = 3) that informed the creation of further supports, such as a weekly online drop-in support group. Results: Survey response rates ranged from 22% to 32% (n = 90 to 127) throughout the intervention. Across multiple surveys, approximately 80% of respondents reported feeling supported or very supported by the Department, and 90% were satisfied or very satisfied with the quantity and quality of the information provided. The online support group and educational materials were accessed by nearly one-quarter and one-third of participants, respectively, with satisfaction rates of 81% or higher. Consistent with the Department’s mandate, ensuring equity was a key focus of the Working Group throughout its operations. Conclusion: Ensuring wellbeing during the COVID-19 pandemic is critical for ensuring the sustainability of the healthcare workforce. There is potential for this initiative to be scaled up to create a faculty-wide, institution-wide, or regional approach to addressing wellbeing. This model is adaptable to other departments seeking to address wellbeing needs during a time of crisis.

Summary

The United States department of Health and Human Services declared the opioid epidemic a public health emergency in 2017. Since that time significant medical, clinical, and financial investments have been put into ending the crisis. Nonetheless, major discrepancies in rates of overdose, access to treatment, and treatment outcomes exist among racial and ethnic minority groups, especially in the Black community. Reasons for these disparities include, poverty, racial bias, fear of legal consequences, stigma, and lack of access to culturally competent health care. Although Buprenorphine treatment is the current standard of care for medication assisted treatment for Opioid Use Disorder, Black Americans are more likely to receive Methadone treatment and at a higher rate than their White counterparts. This is both more labor intensive and more stigmatizing than Buprenorphine treatment. Studies have found Black individuals who do engage in Buprenorphine treatment are far less likely to be retained in treatment after a year, thus negatively affecting their likelihood for long term sobriety. Finally, minority opioid users experience longer wait times for care, further increasing their likelihood for drug use, overdose, and death. In 2017, non-Hispanic Black individuals had the highest rate of overdose deaths attributed to synthetic opioids when compared to the national population. This presentation seeks to highlight the history of racial inequality in opiate addiction treatment and the current impact that racial disparities have on treatment outcomes. Additional time will be spent addressing methods to mitigate the impact of sociopolitical and provider bias.

Summary

Background: Family-centered care maintains mutually beneficial partnerships between healthcare providers, patients, and patients’ families in treatment planning, delivery of services, and outcomes. Providing family-centered care requires eliciting patients’ and families’ perspectives on healthcare priorities and relevant contextual influencers, such as social determinants of health. Engaging patients and families in contextual interviews, brief systemic interventions, and shared-decision making are core tenets of comprehensive healthcare. Rational: This presentation highlights the significance of family-centered approaches in primary care. A physician and four seasoned behavioral health experts, all integrated in various primary care settings throughout the United States, will discuss and demonstrate how clinicians can utilize techniques and skills to better understand patient and family context, develop appropriate interventions, and maintain relationally focused shared-decision making. Primary care clinicians of various specialties and levels of experience will benefit from this presentation. Presentation: We will first provide an overview of family-centered assessment and intervention in primary care. This overview will discuss relevant skills and techniques (8 min). Then, a case study will be provided as a point of participant reference (5 min). Through discussion and role-play, the following will occur: 1) we will identify the tenets of a contextual interview; 2) we will then focus on relevant brief, systemic interventions; 3) we will demonstrate relationally focused patient-centered decision making (37 min). We will conclude with Q&A (10 min).

Summary

BreathingRoom™ is an online, evidence-based intervention. It is a self-directed program for adolescents and young adults to help navigate stress, depression and anxiety. An earlier version of the program (LEAP™) was validated on a clinical population and proven to enhance mental wellness through the development of deep connections to self and others. Previous research documented the value of including spiritual concepts (appreciation of beauty, mystery of life and compassion) in the healing of depression (Rickhi et al., 2015). While an increasing number of digital mental health programs are designed to serve as therapeutic tools, the evidence base for their efficacy is often unclear and ongoing analysis is required (Grist et al., 2017). To date there has been a reliance on quantitative analysis (Clarke et al., 2015). However, the qualitative, subjective improvements participants spontaneously report may be highly relevant for the path to optimal mental well-being. This study carries out an in-depth qualitative analysis of program user responses. Methodology: Data from the BreathingRoom™ program was collected from users age 13 to 24 years. They gave open-ended responses to the optional self-assessment questionnaires at the end of each of the 8 topics about how the program impacted them. Response topics included: self-acceptance, creativity, joy, gratitude, acceptance, forgiveness compassion, and celebration. An in-depth qualitative data analysis was conducted using NVIVO software for coding and thematic categorization of anticipated and emergent themes (Pung et al., 2018). Results: Preliminary analysis of 1999 user responses reflected an improvement in users’ strength of connection to self and others. Early emerging themes included happiness, goodness, confidence and feelings of love.

Summary

This lively, interactive workshop will invite participants to look “behind the curtain” to understand and participate in the editorial process of CFHA’s journal, Families, Systems, & Health. We discuss the why and how of peer reviewing manuscripts to inspire and strengthen participation in this critical scientific process. In keeping with this year’s conference theme, we incorporate discussion of ethical issues in peer review, including various forms of bias and strategies for overcoming or mitigating them. Our goals are to diversify our team of peer reviewers and equip people with a broad range of experiences and perspectives to meaningfully contribute to shaping what is disseminated as “scientific knowledge”. This workshop is designed for novice and experienced reviewers alike. Participants will reflect on their motivations for reviewing (for a particular journal and/or manuscript), and how to decide if they are ready to review and/or become more ready to review . They will consider approaches and strategies for reviewing, and develop tools for communicating in challenging scenarios, such as: a) when they didn’t review a prior version of the manuscript, b) when there are ethical concerns, and c) when some aspects of the article may be beyond their expertise. They will glimpse what happens after peer reviewers submit their reviews and gain an understanding of how editors use reviewers’ feedback. These finer points will help to comprehend qualities of an excellent peer review. Finally, we will discuss how to extrapolate these learnings to peer reviewing other forms of scientific dissemination such as conference abstracts. The presenters all have experiencing reviewing for CFHA’s annual conference, as well as other conferences.

Summary

Only a third of patients with complex psychiatric disorders, such as PTSD or bipolar disorder, engage in specialty mental health care.  Of those seen in primary care, only a tenth receive adequate treatment.  Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings. This session will report the results of a large PCORI-funded trial designed to compared two clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients with PTSD and/or bipolar disorder in primary care clinics.  Twenty-four primary care clinics without on-site psychiatrists or psychologists from 12 Federally Qualified Health Centers in three states participated in this pragmatic trial.  Adult patients (n=1,004) patients screening positive for posttraumatic stress disorder and/or bipolar disorder who were not already receiving pharmacotherapy from a mental health specialist were enrolled.  Patients were randomized to receive either: 1) Telepsychiatry/Telepsychology Enhanced Referral where telepsychiatrists and telepsychologists assumed responsibility for treatment, or 2) Telepsychiatry Collaborative Care where telepsychiatrists provided consultation to the primary care team.  Patients in both groups experienced a substantial and statistically significant increase in perceived access, decreases in symptoms and medication side-effects, and improvements in quality of life.  There were no differences in outcomes with regard to age, gender, race or ethnicity, indicating that both approaches mitigated health disparities.  While practices should adopt whichever approach is the most feasible to implement, it is important to note that the referral model used three times more scarce telepsychiatrist time than did the collaborative care model.

Summary

This presentation will take the form of a moderated panel discussion, bringing together leaders from some of the most established IBH programs across the state of WA (Community Health of Central Washington, Health Point, Swedish Medical, and Yakima Valley Farmworkers Clinic). These leaders will discuss subtle differences in how behavioral health is structured and implemented at their respective clinics, which include both small and large primary care clinics, in both urban and rural areas, as well as specialty clinics located within larger medical centers. Key discussion points will include differences in scheduling and program structure, specific type of behavioral health services provided, and best pieces of advice for IBH programs of varying sizes, types, and stages of development. Panelists will also discuss implications of program structure on the overarching goal of providing high quality, equitable behavioral healthcare to all. The final portion of the presentation will be reserved for an open Q&A session where audience members will be invited to ask the experts questions related to IBH program development and/or implementation.

Summary

“Task-shifting” or “task-sharing” is a dissemination and implementation strategy for increasing behavioral health care availability in lower-resource and underserved communities. Evidence is robust for the effectiveness of task-shifting behavioral health interventions, whereby licensed mental health professionals “shift” specific tasks to non-specialist or lay health workers, thereby increasing availability of evidence-based care (Barnett et al., 2018). In primary care settings, task-shifting can extend the care of behavioral health providers and bridge the gap between clinic and community, thereby promoting fair and just healthcare for underserved and lower-resource communities. Community health workers (CHWs) are ideally situated for task-shifting roles due to their trusted positions in the community, skills in addressing social determinants of health, and potential cost-effectiveness. However, little has been established regarding the actual steps (methods) required to adapt interventions that were initially developed for delivery by licensed clinicians so that they can be appropriately delivered by lay personnel. Therefore, we are conducting a systematic review to identify the key steps used to effectively adapt evidence-based psychological treatments for delivery by lay/non-licensed CHWs. Following a detailed pre-published protocol aligned with PRISMA-P guidelines (2015), we have searched multiple databases from 2000 – 2020 and reviewed 218 articles to date; we anticipate approximately 25 studies will meet inclusion criteria for data abstraction. We are assessing risk of bias using the Cochrane Risk of Bias (RoB 2) tool, and publication bias using the Cochrane GRADE approach. Abstracted data will be organized based on an established framework for operationalizing implementation strategies (Proctor et al., 2013).
During this presentation, we will report our final results, including best practices for task-shifting behavioral health treatments to CHWs and implications for integrated primary care teams. We will also discuss how task-shifting is an avenue for increased health equity for underserved and low-resource communities.

Summary

This presentation will provide a comprehensive picture of the first year and a half in to embedding a trauma-focused mental health specialist in to the care model in a Level 1 Trauma Center Emergency Department, as well as the addition of a Nurse Coordinator for the Sexual Assault medical forensic program. Both roles were added with the hope of bettering patient care in terms of providing more trauma informed approaches, increasing quantity and quality of specialized staff to assist with trauma patients, working to address and lessen health and social inequities in care, and establishing a robust team of support services and referrals across the lifespan. In turn, our goals are to decrease the likelihood or severity that trauma patients we work with will experience post-traumatic stress disorder, fail to connect to helpful follow-up services, and develop any number of chronic and long term health problems commonly associated with trauma. Additionally, these roles provide much needed support and training to interdisciplinary Emergency Department staff in the form of secondary trauma exposure, burnout, compassion satisfaction/compassion fatigue assessments, tailored outpatient therapy referrals, debriefs from cases, robust sexual assault program training, trauma informed care, and other continuing education. In our talk, we will try to cover all the bases that one would need to think about, questions that would likely arise, and detailed steps if others were considering adding a trauma-focused behavioral health role and/or a sexual assault program coordinator to their emergency department. We will cover the Why, When, Where, How, Benefits, Challenges, Lessons Learned, Patient Outcomes, & Success Stories of adding a Trauma-Focused Mental Health Specialist & SANE Coordinator to the Emergency Department team at UNC Chapel Hill. A physician and medical director of the Sexual Assault program at UNC will speak to the identified needs she saw for both trauma patients and those patients specifically presenting for a sexual assault related matter, and the vision she crafted for these two new roles to help improve the trauma program and put patient-centered care at the forefront. She will speak to all of the early steps that were involved in creating, developing, and hiring for these two roles, and the anticipated growth she hoped to see after a year. A sexual assault nurse examiner and emergency department nurse who went on to become the SANE program coordinator will speak to all of the many enhancements she has made to training, staffing, patient care, hospital billing, EMR management, coordinating with state and local agencies, and associated outcomes thus far. A licensed clinical social worker associate who is the trauma specialist will detail steps that went in to developing her role and program from the ground up, the helpful tools she utilized, and quantitative and qualitative outcomes, including patient voices sharing their experiences.

Summary

In this podcase style conversation, three behavioral health professionals will discuss emerging trends in value-based purchasing, specific VBP readiness milestones, and the strategies leaders can use to form fruitful relationships with payers and collaboratively invest in value. Neftali Serrano, PsyD, Chief Executive Officer of the Collaborative Family Healthcare Association will moderate a conversation with Suzanne Daub, LCSW, a principal consultant with Health Management Associates and Lori Fertall, MBA, Director of Value-Based Programs at Community Care Behavioral Health, a non-profit behavioral health managed care organization.

Summary

The rapid development of behavioral health integration around the nation in health systems with multiple primary care sites has led to the emergence of a new role: “director” (or “supervisor,” or “lead”) of behavioral health integration (DBHI). A number of people in this role feel unprepared for the leadership demands that it imposes. In January, 2021, Alexander Blount began teaching a course for clinicians in leadership roles in primary care behavioral health. Cohorts are small and highly interactive. This ELO will present some of the most meaningful experiences and concepts from the course.

Summary

The rapid development of behavioral health integration around the nation in health systems with multiple primary care sites has led to the emergence of a new role: “director” (or “supervisor,” or “lead”) of behavioral health integration (DBHI). A number of people in this role feel unprepared for the leadership demands that it imposes. In January, 2021, Alexander Blount began teaching a course for clinicians in leadership roles in primary care behavioral health. Cohorts are small and highly interactive. This ELO will present some of the most meaningful experiences and concepts from the course.

Summary

The rapid development of behavioral health integration around the nation in health systems with multiple primary care sites has led to the emergence of a new role: “director” (or “supervisor,” or “lead”) of behavioral health integration (DBHI). A number of people in this role feel unprepared for the leadership demands that it imposes. In January, 2021, Alexander Blount began teaching a course for clinicians in leadership roles in primary care behavioral health. Cohorts are small and highly interactive. This ELO will present some of the most meaningful experiences and concepts from the course.

Summary

The rapid development of behavioral health integration around the nation in health systems with multiple primary care sites has led to the emergence of a new role: “director” (or “supervisor,” or “lead”) of behavioral health integration (DBHI). A number of people in this role feel unprepared for the leadership demands that it imposes. In January, 2021, Alexander Blount began teaching a course for clinicians in leadership roles in primary care behavioral health. Cohorts are small and highly interactive. This ELO will present some of the most meaningful experiences and concepts from the course.

Summary

The rapid development of behavioral health integration around the nation in health systems with multiple primary care sites has led to the emergence of a new role: “director” (or “supervisor,” or “lead”) of behavioral health integration (DBHI). A number of people in this role feel unprepared for the leadership demands that it imposes. In January, 2021, Alexander Blount began teaching a course for clinicians in leadership roles in primary care behavioral health. Cohorts are small and highly interactive. This ELO will present some of the most meaningful experiences and concepts from the course.

Summary

This extended learning activity provides an introduction to the foundations of FACT and suggests adaptations of FACT to enhance its effectiveness with Latino patients. Latinos now comprise about 17% of the US population, and their access to service from Latino providers is limited, as about 5% of physicians are Latinos, and the percent of psychologist and social worker roles are 4% and 3% respectively. This workshop will provide guidance, video demonstrations, and skill practice exercises for all clinicians seeking to better serve Latino patients by using brief intervention techniques that enhance psychological flexibility.

Increasingly, members of the primary care team are attempting to improve their skills in brief interventions that will help them engage the diverse group of patients served in primary care. Focused Acceptance and Commitment Therapy (Focused ACT) is a brief intervention approach that is evaluated positively by patients with medical and psychological problems. Dissemination studies of Focused ACT delivered by primary care teams working in the Primary Care Behavioral Health (PCBH) model have found it to be associated with health equity, equalizing both access to care and clinical outcomes of care for all members of a community. Many clinicians can learn the basics of Focused ACT in a day of training, and this workshop will provide didactic presentations, role play demonstrations, and opportunities to practice core skills. In addition to providing an introduction to FACT foundations, this workshop will suggest adaptations of FACT to enhance its effectiveness with Latino patients, who now comprise about 17% of the US population. Ideally, they would have access to Latino providers; however, about 5% of physicians are Latinos, and the percent of Latino psychologists and social workers are 4% and 3% respectively. This is a practical training program designed for all primary care clinicians. Its intention is not only to address the need to use the language clinicians speak optimally, but also to meet the needs of the growing group of Spanish-speaking patients suffering in the context of collapsing social structures, natural disasters, hostile immigration policies, and the pandemic. By focusing on values, families and quality of life, Focused ACT is readily accepted by a diverse group of patients with many differing problems. An introduction to

Focused ACT will empower clinicians to meet the needs of the large group of patients who are failing to thrive in this difficult moment on our planet.

Summary

In large part due to the COVID-19 pandemic and subsequent racial reckoning, decision-makes and the general public are increasingly demanding more access to culturally-responsive behavioral health care. CFHA’ers are masters at creating on-demand behavioral health services where most people receive care – primary care. It is time for CFHA’ers to raise our collective voice in policy discussions to ensure decision-makers understand and appreciate what we do. Join us to learn about advocacy work and how to do it. We will explore what drives us. We will learn how to craft our integrated care stories in order to uplift our work in primary care as the powerful, lean and culturally-responsive health solution it is!

Topics Include:Getting Involved in Advocacy

Our “Why’s” for Integrated Care Policy

Influencing with Heart: Our Integrated Care Stories Power Our Advocacy

What Went Well? What More Would Help You Develop as an Influencer for Integrated Care?

Summary

The purpose of this workshop is to provide Behavioral Health Consultants (BHCs) working in primary care with the necessary skills to understand medical sequalae and comorbidities of the following chronic diseases common in primary care: Hypertension, Obesity, and Chronic Kidney Disease. BHCs will learn about psychiatric symptom “mimics”, medications for these conditions that mimic psychiatric symptoms, and how to modify behavioral interventions for improved chronic disease management.

More than 45% of Americans have at least one chronic disease, with chronic disease also being a leading cause of the death in the United States. In the primary care settings, about 75% of visits are for the management of multiple chronic diseases. Due to the increasing medical complexity of patients who present to primary care, these numbers make it more challenging for Primary Care Providers (PCPs) to manage these conditions alone. For evidence-based management, PCPs will need a team to improve the management of these conditions. Clinicians such as clinical pharmacists, registered dietitians, and health educators have an important role in primary care in order to co-manage the patient population, but often times, patients also need a clinician with expertise in behavioral medicine to understand the psychological and behavioral aspects of chronic disease management. Behavioral Health Consultants (BHCs) in primary care have a very important role in the management of chronic disease. Depending on the BHCs prior training experiences, self-efficacy with addressing chronic disease management and understanding the biological and physiological aspects of a health conditions may be low. This will in turn impact the BHC’s ability to conceptualize and design an appropriate behavioral intervention focused solely on chronic disease management. The purpose of this workshop is to provide BHCs in primary care with the necessary skills to be a successful team member in the management of the following chronic diseases common in primary care: Hypertension, Obesity, and Chronic Kidney Disease. This will be an interactive workshop utilizing approaches such as facilitated lecture and discussion, video examples, role-playing, and small group case-based learning.

Summary

The COVID-19 pandemic has caused a significant shift in providing team-based patient health care such that telehealth has become an increasing presence in providing care to children and families. Interactive strategies for introducing and applying behavioral health concepts to children and families via telehealth will be presented and how these lessons can be used to strengthen pediatric integrated care models in the future. The presenters will discuss how they have overcome the challenges of team-based care during the pandemic. Effective strategies to engage in collaboration with schools and medical teams will also be reviewed.

Summary

40% of primary care patients suffer from chronic pain or other symptoms that are not explained by demonstrable organ disease or structural abnormalities. Instead, their illness is usually linked to stress, trauma or repressed emotions. New techniques enable accurate diagnosis and successful treatment of these issues leading to relief of symptoms, lower healthcare costs and a more rewarding practice for clinicians.

A stepwise process (and the supporting published evidence) is presented for successful diagnosis and treatment of this population that includes: a) discussing stress as a possible cause of symptoms in a way that gains the patient’s confidence and cooperation, b) performing an assessment for the range of issues capable of causing pain and other physical symptoms, c) training in new psychotherapeutic techniques that can alleviate (not merely support coping with) physical symptoms and d) review of options for further development of skills managing this population. This is followed by interactive discussion of typical cases. Outcomes from learning these techniques include relief of patients’ symptoms, lower healthcare costs and a more rewarding practice for clinicians.

Summary

Systemic and institutionalized racism has historically shaped U.S. healthcare policy and the U.S. healthcare system. Racism, in conjunction with its multi-directional relationship with social determinants of health, government policies, and sociocultural climate, have created the health disparities that patients who are Black, Indigenous and/or people of color, continue to face. Health disparities can also be attributed to lesser quality of healthcare given to patients of color by healthcare organizations and providers. Conscious and unconscious bias affects how providers communicate with their patients and the medical decisions they make.1 For example, scholars have identified healthcare providers’ implicit biases and explicit discrimination as a contributing factor to the disproportionately higher mortality rates of Black mothers.2 Unfortunately, the role of healthcare providers’ own racist biases in shaping patients’ access to equitable healthcare treatment is often side-stepped and minimized in discussion. Even worse, many providers are unaware of the ways in which their own biases may be shaping the care they provide.1 Biases may also shape the policies and climates of our healthcare organizations at the administrative and managerial levels. In order to work toward an antiracist3 healthcare system in which all patients can thrive, we must address the ways in which healthcare clinics and providers inflict and perpetuate harm. For the purposes of this presentation, we will focus on three areas that impact the quality of care and access to care that our patients of color directly receive in their healthcare environments: 1) organizations’ policies and their implementation; 2) organizational climate; 3) staff and providers’ beliefs and behaviors. In this presentation, we will briefly discuss the ways in which these areas impact patient quality of and access to healthcare. We will present steps and strategies that healthcare providers can implement to disrupt and repair the ways in which we as providers, and our organizations have inflicted violence upon patients of color.

Summary

The COVID-19 pandemic has proven to have pervasive impacts on all aspects of family life. Some of these impacts are drastically increasing as reports across the world are sounding the alarm about the upcoming post-COVID mental health pandemic. In a March 11th 2021 interview, Dr. Fauci spoke of the “long-term ravages” that are ahead of us. These ravages (e.g., poor mental health across the lifespan, physical health declines due to delaying preventable services, and prolonged symptomology for those who have had COVID-19) are likely the outcomes of prolonged stress and mental anguish. These physical and mental health consequences will increasingly present themselves in healthcare settings. Using a multi-systemic and family-oriented lens, this presentation emphasizes the evolving interplay of public health pandemic challenges and mitigation strategies with individual and family processes. We highlight individual and family challenges with ongoing myriad COVID-19 uncertainties in the evolving phases of the pandemic/post-pandemic. These challenges include: (a) long-term COVID-19 health and cognitive complications (“long-haulers”); (b) communication issues amongst family members, and with healthcare providers; (c) issues that arise from divergent family member perspectives and beliefs about COVID-19 risk based on different historical, cultural, political, and ideological filters; (d) issues with loss and bereavement, racial injustice, and socioeconomic disparities; and (e) issues that arise from the prolonged exposure to stressors faced by healthcare teammates. Through the intervention of family-centered consultation, this discussion will offer strategies for addressing the nuanced and lingering biopsychosocial-spiritual impacts the COVID-19 pandemic has had on individuals and families. Special consideration will be given to the oftentimes unaddressed and invisible impacts the pandemic has had on healthcare providers and their own families. In a post-pandemic world, consideration needs to be given to all relational systems that come into contact with the public health, and healthcare sectors.

Summary

There has been growing awareness regarding the inequitable access to mental health services and negative encounters that children, youth and families who are Black, indigenous and people of colour (BIPOC) experience as a result of systemic racism (Fante-Coleman & Jackson-Best, 2020). The COVID-19 pandemic and the shift to virtual care has further revealed racial inequities (Crawford & Serhal, 2020; Martinelli et al., 2020) and the need to improve racial equity, diversity and inclusion in the child and youth mental health sector. The impacts of systemic racism however, like many complex social problems, are far-reaching and necessitate collaboration across agencies. Our two organizations, the Ontario Centre of Excellence for Child and Youth Mental Health (an intermediary organization) and Children’s Mental Health Ontario (an advocacy group with about 200 member agencies), have partnered to support this work, together with a diverse advisory committee. From a review of the literature, we identified five areas linked to effective organizational practices: organizational leadership, multi-sectoral partnerships, workforce diversity and training, client and community engagement, and continuous improvement. In this presentation, we report on our collaborative effort to identify current organizational practices that address racial equity. Using a mixed methods approach, we examined policies and practices of nearly 200 agencies in these five areas through an online survey with organizational leaders, and case studies of 8 to 12 organizations. In this presentation, we focus on multi-sectoral partnerships (e.g. with BIPOC organizations, child welfare, youth justice), including facilitators, challenges and the range and impacts of these collaborations. Data collection began in April and knowledge mobilization with key stakeholders in September 2021. The findings from the study will inform the development of a strategic plan for Ontario’s child and youth mental health sector, beginning with internal efforts in our two organizations and expanding into all agencies in our sector, for a systems approach to addressing racial equity. We will highlight lessons learned and showcase promising initiatives that can be implemented by others.

Summary

Mild Cognitive Impairment (MCI) is an issue that arises in primary care often and presents an increased risk of cognitive decline. Approximately 13% or 43.3 million of primary care patients over the age of 60 years experience MCI at any given time and only 16%-33% discuss this issue with a primary care provider (PCP), and less than half of PCPs have a standard protocol to address MCI. Not only does this impact the older adult population, but MCI is also seen across the lifespan. It is connected to many etiologies including neurodegenerative disease (e.g., Alzheimer’s), chronic health conditions (e.g., Diabetes and other endocrine disorders, Cardiovascular Disease, Chronic Kidney Disease) and can be an iatrogenic effect from medical treatments (e.g., post-anesthesia impairment) and medications commonly prescribed in the primary care setting (e.g., antiseizure medications, statins, corticosteroids). Further, many conditions (e.g., anxiety, depression, sleep apnea) can contribute to day-to-day cognition which once treated, can resolve, or improve cognitive complaints, making determination of underlying objective cognitive impairment more feasible. Behavioral health and primary care providers have varying levels of training in cognitive screening practices and because of this, MCI-related issues often go untreated which can impact treatment adherence to complicated treatment regimens, impact psychological treatments offered by behavioral health providers, and delay referrals for more precise diagnostic clarification and treatment. Additionally, primary care practices in rural and underserved areas may not have access to refer to clinical neuropsychologists. Thus, it is important to equip behavioral health providers practicing within primary care settings with evidence-based screening practices and tools to address cognitive impairment in primary care. This presentation will provide an overview of the impact of MCI in primary care across the lifespan, the importance of addressing MCI early in order to help the slow progression to dementia, review evidenced-based cognitive screening tools appropriate for the primary care settings and provide example algorithms for addressing cognitive impairment for the primary care setting. This topic is of importance due the impact of primary care offering patients and their families secondary and tertiary prevention options to address MCI which can have immense personal, familial, and broader societal benefits.

Summary

This presentation brings together clinicians of different disciplines to share lived experiences and lessons learned from serving in the military and serving military veterans. We represent widely different backgrounds: -A family physician who is a Quaker by faith who chose to accept an Officer Commission in the USAF and ended up serving on active duty in the years surrounding 9/11. (Keith Dickerson) -A Latina whose parents immigrated from Mexico, who joined the Army as a way out of poverty and who has progressed professionally within the same clinic from medical assistant to care manager to social worker to LCSW (Alicia Gutierrez). -A woman who was a pilot and captain in the Air Force at a young age but was medically discharged due to an infectious disease she contracted while in active deployment. She used GI Bill benefits to complete a masters degree in family therapy and now conducts research with the VA (Cara Pozun). -A foremost researcher in the field of integrated behavioral health whose primary research and clinical populations have been veterans (Jennifer Funderburk). -A healthcare innovator who has created and researched peer-based systems for treating suicide and building community within the VA (Blaire Ehret) -A specialist in narrative medicine who has produced several narrative-based presentations for CFHA (Randall Reitz). Over the next 6 months, this group will meet monthly in writing workshops to develop brief personal narratives. We will identify the key themes from these narratives and weave them together into a coherent and compelling experience that will incorporate music and evocative imagery. Conference attendees who attend this presentation will learn about the lives and health needs of military members and Veterans. We will highlight clinical stories and healthcare advances that are particularly relevant to these populations-”whether they’re served through the Department of Defense, the Veterans Administration, or an outpatient clinic. We will use various methods of audience engagement so that participants can augment the sharing of narratives and bring their own stories to the presentation.

Summary

Background: This project aimed to reduce opioid-related morbidity and mortality in northwest Alabama by improving opioid prevention, treatment, and recovery through efforts to construct a multisector community-wide consortium, engage in a comprehensive analysis of the impact and response to OUD/SUD, establish nonjudgmental pathways into care for SUD/OUD, implement sustainable whole-person care through the tele-ECHO model, and develop advanced data analytic predictive models of SUD/OUD in Alabama. Participants: Over 100 providers and community members in the rural counties of Fayette, Franklin, Lamar, Marion, Walker, and Winston Counties in Alabama Design: Mixed methods community-based design featuring questionnaire data and qualitative interviews and focus groups Data Collection: Consortium members helped identify individuals in project communities to complete opioid-related questionnaires and focus groups. Participants completed questionnaires online or on paper, and all interviews were conducted in person. Participants were compensated for their time. Results: Survey and focus group data indicated limited resources to address the opioid crisis in the project counties in northwest Alabama. The communities reported limited knowledge about opioids, opioid overdoses, opioid resources, and evidence-based treatments for opioids and behavioral health. Professionals also experienced isolation and limitations in knowledge and resources. Qualitatively, participant-identified prevention barriers were a lack of educational programs on opioids, of safety measures, and of access to Narcan for all community members (i.e., families, children, professional). Treatment barriers displayed the impact of rurality, highlighting limited access to services (i.e., financial, transportation) and facilities with coordinated care. Stigma from both people who use opioids and the community were described. Barriers to recovery included low resources and gaps in transition from treatment to recovery. Results led to actionable steps toward responding to the opioid crisis and related disparities.

Summary

Background: The COVID-19 pandemic has underscored the essential role of first responders, other public safety personnel (PSP), frontline healthcare professionals (FHP), and other frontline workers in protecting all Canadians. PSP and FHP are critical population defences against the COVID-19 pandemic. PSP and FHP are often tasked to work short-handed, long hours, facing the threat of contagion for themselves and their families. In serving Canadians, PSP and FHP are often tasked to provide communication, direct care, or support outside of their usual job description, expertise, experience, or level of comfort. Objective: The COVID-19 Readiness Resource Project (CRRP) was launched in March 2020 in response to the pandemic to provide PSP with the support to safeguard and protect their mental well-being, minimize the development of compassion fatigue, moral injury, and burnout, as well as preserve their ability to function in these critical roles, both during and after the emergency pandemic responses subsided. The CRRP is a national online knowledge hub serving as a vehicle for trusted information, guidance, and access to virtual self-help material. Methods: Quality improvement practices were adopted to develop a real-time iterative approach to inform the development and implementation of the CRRP. The project was supported by federal, provincial, and municipal government agents who partnered with several organizations. The CRRP content creation, development, and dissemination included patient-oriented approaches, PSP input, and knowledge translation and mobilization best-practices. Frontline PSP and FHP worked with their leaders and diverse experts from across Canada to deliver content and support PSP throughout wave one of COVID-19. Results: PSP continue to encounter evolving challenges throughout the pandemic. The CRRP provided support tools derived from the extant peer-reviewed literature on pandemics, epidemics, and disaster mental health. The available material was synthesized and tailored to the specific needs of PSP and FHP based on direct consultation with frontline members and leaders. Resources created included accessibly written content spanning 20+ categories, with videos, guided audio-recorded stress management exercises, and videos from an interactive Virtual Town Hall Series. All resources and content were made available to all PSP in Canada and internationally. Conclusion: The content developed for the CRRP will be invaluable in informing future research on rapid evidence-based resource development in the face of a crisis. In addition, the challenges experienced by the CRRP team during the development and delivery can help inform future crisis preparations and research on crisis response, disaster psychiatry, and developing actionable steps for delivering equitable mental healthcare through a culturally competent and cultural humility lens.

Summary

The Collaborative Care Model is a widely-used system of behavioral health delivery, in which behavioral health services are delivered in a team-based approach using principles of chronic disease management. Its evidence base was first developed among individuals with depression, but Collaborative Care’s reach has expanded over the past 25 years to address a variety of chronic psychiatric diagnoses across clinic settings, including rural and urban Federally Qualified Health Centers (FQHCs). Founded in 1967 in Brooklyn, the Family Health Centers at NYU Langone is one of the oldest community health centers in the US, and is now one of the largest FQHC networks in the country. In recent years, the behavioral health needs of its clients were met through a combination of specialty psychiatric services and integrated care within the primary medical clinics. In 2019, the Family Health Centers began to transition integrated behavioral health care toward the Collaborative Care Model. This presentation examines the first 20 months of Collaborative Care program implementation, a period of time that encompasses the COVID-19 pandemic and a renewed focus on racial justice. We present a timeline of implementation, paired with data from our electronic medical record, to show how use of the Collaborative Care Model via a telehealth platform during the pandemic allowed our health system to absorb increased referrals, expand patient access, and continue to meet the needs of a community greatly impacted by COVID-19 in NYC. We examine strengths of our program implementation, which include increased identification and referrals by primary care physicians, increased patient diagnoses and treatment through telemedicine, and success in delivering culturally appropriate services to patients in Spanish. We also describe challenges in bridging the digital divide and in scaling up to rapidly meet need.

Summary

Now, more than ever, we are facing the realities resultant from socioeconomic and racial disparities. Over the past 6 years, UW Health has worked in a systemic fasion to close the gaps and bring equitable healthcare to all. This symposium will discuss the actionable steps that occured on the institutional departmental (psychiatry and primary care) and provider levels to address these barriers and increase mental health access to our medically-homed patients. This workshop will also discuss how telehealth and virtual platforms were leveraged during the pandemic to ensure sustainability of our integration efforts.

Summary

The intent of the Community Crisis Planning, Prevention, Response, and Recovery First Nations Service Delivery Model is to provide a reference guide that supports contextual tailoring for planning, decision making, delivering, and monitoring performance related to this specific service. The foundation of this service delivery model is the First Nations Mental Wellness Continuum framework, which promotes a strength-based approach and recognizes: existing strengths be recognized in people, First Nations have important cultural resources at their access, people are capable of learning skills and knowledge to address concerns, community people are to be part of discovery and learning, strength-based approaches are founded on the idea that even at their weakest, clients are resilient. This model supports: community development initiatives, community health and crisis related planning, proposal development, communication across jurisdictions and sectors representing the social determinants of health, design of services, assessment of existing strengths, capacities, and services and implementation of the First Nations Mental Wellness Continuum framework. What is particularly attractive about this framework is the inclusion of the four wellness outcomes of hope, belonging, meaning and purpose which acknowledge strength-based outcomes and are defined by Indigenous knowledges.

Summary

The presentation will address the theme of the conference by helping behavioral health and other practitioners understand the various approaches to social justice advocacy (e.g. empowerment, community collaboration, patient advocacy, political advocacy). The presenters will briefly outline qualitative research results outlining the challenges and benefits of practicing in rural and other small communities and the relationship of these contextual considerations to social justice advocacy. The presentation focus will be on recommendations when considering social justice advocacy and examples of how both presenters have engaged in social justice advocacy within their own organizations and communities. The population sampled included eight mental health professionals working in rural communities. Grounded theory was utilized to analyze responses to interviews. The research was published in 2012, however the presenters believe that the conference theme and heightened awareness of the need of more practical guidance for engaging in social justice advocacy superseded recency of research expectations.

Summary

Transgender and gender non-conforming teens face numerous barriers to healthcare even in large suburban areas. These barriers only increase for teens in rural settings. Today we are going to talk about the development and implementation of gender care in a rural pediatric primary care setting. Our team works together to support adolescents who are transgender, gender non-conforming, and/or questioning their gender identities. With our interdisciplinary team of medical providers, behavioral health consultants, social workers, nurses, and medical assistants we have created a pathway that supports patients in many aspects of gender-based care from coming out, to social and medical transitions all while in the primary care setting.

Summary

What, in the 1990s, was a little understood or respected practice of integrating behavioral and physical healthcare delivery has become a mainstay of privately and publicly funded healthcare, especially for complex, vulnerable, and underserved populations. But the evolution of our field has been wobbly with many remaining conceptual, operational, and financial struggles ahead. This will be an hour-long, moderated dialogue between three CFHA founders and Don Bloch Award winners and with workshop participants. We will discuss what has been gained and lost through our evolution, untapped possibilities and resources, more explicitly addressing health disparities, the pros and cons of growing standardization and professionalization, where we fit in healthcare’s broadening definition of integrated care, and critical research questions.

Summary

VHA is a leader in developing competency-based training for integrated primary care behavioral health providers. From late 2017 through early 2020, 2,246 providers from various disciplines were trained in a multi-phase training model providing hands-on clinical skill development centered around interactive roleplay practice and multi-dimensional assessment. Program evaluation data for the in-person training indicates significant improvement in fidelity to integrated care models after training. This presentation will describe our response to the events of 2020, rapidly transitioning our 2.5 day in-person, skills-based training program to a virtual platform, including initial program evaluation data. We also implemented new and revised content in cultural competence as an essential component of integrated care practice. We conducted 14 separate 20-hour virtual trainings with over 300 integrated behavioral health providers from various disciplines from September-December 2020. Virtual training content and process was the same as in-person (except new cultural competence content). On the last half-day, participants were required to demonstrate competence via role plays using standardized patient cases. Preliminary findings indicate initial roleplay rating pass rates for virtual participants (87.7%) were comparable to those of in-person participants (89.5%). Virtual training participants were asked the same evaluation questions as in-person training participants. Both in-person and virtual trainees reported similarly high satisfaction levels, including responses specific to effectiveness of the training environment. Open-ended responses from evaluation surveys also indicated appreciation for new cultural competence content. Preliminary program evaluation data indicate that virtual competency-based training is an effective alternative for in-person training, with the added advantage of preparing clinicians to practice in virtual settings.

Summary

In this interactive workshop, we describe the teaching of behavioral sciences to family medicine residents at McMaster University. Instead of a block placement in a psychiatric unit, teaching takes place on a weekly half day, devoted to behavioral sciences, for the entire duration of the two-year residency. The training is problem based, usually within small groups, utilizing actual patients that the residents see in their practice. Multidisciplinary teaching is emphasized. The tutors for each group are usually compromised of a psychiatrist, family doctor, and social worker. The bulk of each half day involves a review of cases the residents have seen, either by direct presentation of the case to the group, or often by viewing digitalized audiovisual tapes of the encounters. We will discuss the use of the audiovisual medium as a teaching tool. We will focus specifically on giving feedback on the interview process in order to foster cohesive doctor-patient relationships, and to help develop diagnostic acumen in a time efficient manner. We will look at ways in which learners can develop comfort levels to present themselves on tape in front of a small group. A significant portion of the workshop will involve an experiential process where the group will participate in the direct viewing of an audiovisual tape depicting a patient encounter. Many of the techniques used in giving feedback will be illustrated.

Summary

Background/Rationale: Project Extension for Community Healthcare Outcomes (Project ECHO©) is an established hub-and-spoke tele-education model to bridge knowledge gaps between academic specialists and remote primary care providers (PCPs). Little is known about the mechanisms of learning in this model. This project aimed to identify how ECHO supports learning through analyzing recorded tele-video-education data from Project ECHO Ontario Mental Health (ECHO-ONMH).

 Study Design: A qualitative thematic analysis was conducted by sampling sessions across an ECHO-ONMH 34 week cycle and utilized the conceptual framework of adaptive expertise to under learning experiences. Two individuals coded participant interactions during 2-hour recorded sessions using an iterative, constant comparative methodology until thematic saturation was achieved. Results: The authors identified four key mechanisms of learning in ECHO: (i) productive struggle with cases, (ii) integrated understanding, (iii) collaborative reformulation of cases, and (iv) generation of conceptual solutions based on a new understanding. Quotes from the sessions illustrated these four key learning mechanisms during the virtual education program. Learning was observed to be bidirectional from both the hub to spoke as well as between spoke sites throughout the ECHO sessions. Conclusion: Despite the widespread implementation of Project ECHO, a paucity of research has focused on how PCP spokes learn within this capacity building model. Our study demonstrated a bidirectional exchange of knowledge between hub specialist teams and PCP spokes that aligned with the development of adaptive expertise. These findings support the role of ECHO in supporting providers in their capability to manage new and complex mental health needs in their practice. Key Words: adaptive expertise, continuing professional development, instructional methods, tele-education, capacity building, mental health

Summary

The Primary Care Behavioral Health (PCBH) model emphasizes that behavioral health consultants (BHCs) are to be generalists and address any behaviorally influenced concern (Reiter et al., 2018). Beehler et al. (2017) found in the literature that many organizations lacked this fidelity, and rather, largely addressed mental health concerns. These findings call into question the feasibility of the PCBH model and, in laymen’s terms, “do what it says it does.” Additionally, with the strong influence of stigma, especially for minority populations, many patients may present with somatic concerns. Thus, if referrals are only addressing traditional mental health conditions such as depression and anxiety, this might once again contribute to the lack of access for groups who are affected by social inequity. Research has found that the PCBH model is helpful in addressing access for indigenous populations in New Zealand (Maude, 2018) as well as low income individuals (Ogbeide et al., 2018). The BHCs at Community Health of Central Washington (CHCW) embarked on a project to establish a data tracking system that provided the framework for assessing fidelity regarding BHC involvement in the full range of concerns found in primary care. Simply using diagnoses assigned is not sufficient considering the referral problems and the diagnoses assigned are not always congruent. Initial results (2018-2019) demonstrated about 56% of visits included a referral problem related to traditional mental health concerns (e.g., depression, anxiety, trauma, etc.); whereas, 44% of concerns were related to physical health conditions, substance use, interpersonal problems, etc. Updated results (2020-2021) will be presented during the session. In this presentation, the presenters will provide an overview of this data tracking system (structured review of EHR data from BHC templates at CHCW), including the initial steps taken to develop the tracking system, the iterations of the project, and a review of the initial and subsequent findings. A discussion will ensue regarding the implications of this data as it relates to assessing fidelity in PCBH services. The target audience includes behavioral health and medical clinicians, researchers, and staff, as well as the full range of healthcare administrators. The intent is for audience members to gain an understanding of the rationale, the processes involved, and the implications of tracking referral problems data in a PCBH service. It should be noted that the basic tenets of the referral problems and warm hand-off process at CHCW were simply expanded to include telehealth visits as prompted by the COVID-19 pandemic. In other words, instead of traditionally there only being in-person warm hand-off encounters offered, once the pandemic started, telehealth visits were an additional option. In-person and telehealth warm hand-off encounters were available (and continue to be available) through the entirety of the pandemic.

Summary

Most people with opioid use disorder (OUD) do not get treatment. People who suffer from OUD and other substance use disorders (SUD) are vital in our community. They are our acquaintances, our friends, our neighbors, our family, our colleagues, and even ourselves. The need to widely adopt evidence-based models for OUD team-based care is particularly vital in community health centers (CHCs) because they serve as a safety net for medically underserved populations. Despite the increase in opioid overdose and SUD during the COVID-19 pandemic, and a preponderance of studies supporting primary care models for OUD treatment, not all primary care practices have implemented evidence-based models to meet OUD/SUD community needs and promote care team wellness. This session provides a summary of disparities and barriers to OUD/SUD treatment in primary care which provides a foundation to introduce evidence-based integrated care models for OUD treatment. The presentation will also describe how one CHC adapted and implemented the Massachusetts Collaborative Care Model for Office-Based Opioid Treatment with Buprenorphine (OBOT-B) in response to an unexpected surge in MAT/SUD patients, in a community where wait times for MAT services usually exceeded 4 months! This session will describe the actionable steps that made it possible to successfully meet a rapid increase in OUD/SUD community needs. Practical tools (workflows, protocols, registry), and organizational policy changes to support program outcomes will be shared. Through this case example, the presenters will highlight several organizational characteristics, including CHCs leadership engagement, that increase a primary care practice’s capacity to successfully respond to community OUD/SUD treatment needs. The presentation will conclude with a call to action in which participants will be asked to identify practical steps they can personally take to improve OUD/SUD services for medically underserved patients in their own communities.

Summary

Research has long since documented increased patient satisfaction when working with race-concordant providers (Laveist & Nuru-Jeter, 2002), and it’s been predicted that Black doctors may reduce the gap in Black male cardiovascular mortality by 19% (Alsan, Garrick, & Graziani, 2019); however, the diversity of our workforce is not consistent with that of the general population. In 2015, 86% of psychologists in the U.S. were white, while only 4% were Black/African American, and 5% Latinx (Lin, Stamm, & Christidis, 2018); similarly only 5% of the physician and 3.9% of the physician assistant workforce is Black (AAMC, 2019; National Commission on Certification of Physician Assistants, 2015). As we strive to create a more diverse workforce, it is imperative to identify a framework in higher education to address these disparities. Many in higher education are optimistic that the syndemics of COVID-19 and systematic racism, coupled with the momentum of the Black Lives Matter movement, may represent an inflection point for higher education systems to make policy and structural changes to better support underrepresented minority students. And yet these same systems are notoriously complex, and change is often slow. As parallel efforts unfold to diversify student bodies and promote anti-racist research agendas, critical attention must be paid to the development and dissemination of academic curricula on implicit bias, health inequity, and social justice in order to support the development of culturally responsive, anti-racist integrated behavioral health providers. While it is evident that individual initiatives are occurring independently, such as the Mayo Clinic Alix School of Medicine recently adding implemented implicit bias training in their first two weeks of year one curricula (Reddy et al., 2020), singular efforts are insufficient to impact the scale of educational programs necessary to affect widespread workforce changes. Implementation science may provide unique insights into how to address these challenges (e.g., diffusion of innovations, RE-AIM, model fidelity; Brownson, Colditz, & Proctor, 2017). Arizona State University recently completed a three year, SAMHSA-funded grant aimed at training diverse health professionals across disparate academic units (e.g., psychologists, social workers, nurse practitioners, and doctors of behavioral health). While content focused on screening, brief intervention, and referral to treatment (SBIRT), the model for rapid development, implementation, and dissemination of curricula across these programs was successful among trained faculty and curricula content was sustained in more than 90% of infused courses at the close of the grant period (Lindsey et al., 2021). We propose that this model may be adapted for the purposes of disseminating critical curricula aimed at the development of anti-racist integrated care providers.

Summary

There has been an incredible spike in virtual healthcare catalyzed by the COVID-19 pandemic. The pandemic necessitated an immediate roll-out for virtual service delivery to promote safety and access to crucial healthcare services. This presentation focuses on data collection from both the patient and provider perspective regarding telehealth as a provision of care in Wisconsin Community Health Centers. The initial survey focused on Health Center provider perceptions on: 1) Provider comfort with and use of virtual visit modalities and technology 2) Provider perception of patient comfort with virtual visits and barriers to utilization of virtual visit modalities and technology Survey Design: online survey tool to gather provider input on telehealth services. Survey Administration: Health Center CEOs emailed a link to the online survey tool to their providers who were providing telehealth services. Key findings: -The option to provide telehealth visits facilitated access to care for patients. -Providers recognized that limited or no broadband access, access to technology and patient technology knowledge, affected patient engagement through audio + video platforms. -While providers generally preferred to utilize audio + video virtual visit platforms, having the option to utilize audio only or audio + video was an important factor in meeting patient’s needs and preferences. -Providers felt comfortable using the virtual visit platforms provided by their Health Centers and would recommend the use of virtual visits to their colleagues. -Providers recognized that patients needed additional support in order to effectively participate in virtual visits. Through the information collected from this survey, along with Health Center operational data the goal is to establish baseline data on the perception and utilization of telehealth in Wisconsin Health Centers. In addition, this information will assist with gaining insight on the Health Center experience with a new technology for patients that will help inform policy decisions at the state and federal level and on operational enhancements to improve telehealth services for both providers and patients. Many states have had to provide temporary guidance related to telehealth rules and reimbursement methodology specific to Medicaid. In the state of Wisconsin, there is active collaboration with Wisconsin Department of Health Services to develop permanent telehealth policy that ensures equitable access to telehealth services. Telehealth services can enhance access to care, but how these services are defined and reimbursed will be crucial to equitable access and not inadvertently widen disparities. In addition, supporting mental health parity is also a crucial component to support whole person health. The widespread adaptation of virtual health care services will change the face of healthcare in the future and warrants intentional and collaborative approaches to ensure quality and equity.

Summary

Multiplex ADHD families, where both a parent and a child have ADHD, are a common occurrence. Up to 50% of children with ADHD have one parent who also has ADHD. Parent ADHD is associated with worse developmental and treatment outcomes for their children, emphasizing the importance of screening for and treating parent ADHD in the context of treating children with ADHD. Given that child ADHD is often identified and treated in primary care, screening for both parent and child ADHD in primary care may be an effective method of identifying multiplex families. However, it is not standard practice to screen for parent ADHD in pediatric primary care. There is little guidance on how to effectively approach parents about their own ADHD and this topic may be especially challenging among Black families due to historic and continued inequities in care, mistrust of psychology and medicine, and stigma around mental illness and medication. To overcome these obstacles in traditionally underserved populations, innovative and culturally relevant approaches are needed. In this presentation, researchers and providers involved in an ongoing effectiveness-implementation trial for multiplex ADHD families will discuss a novel treatment model implemented in pediatric primary care, clinical and implementation challenges, and lessons learned for treating multiplex ADHD. Our NIH-funded trial is a collaboration between the University of Maryland, Children’s National Hospital, and Seattle Children’s Hospital. We seek to identify multiplex ADHD families in primary care settings and link them to behavioral health care via telehealth. Families are randomized to receive one of two treatment strategies: 1) parent stimulant medication followed by behavioral parent training, and 2) behavioral parent training alone. We will present descriptive data from the Children’s National Hospital site related to recruitment, screening completion, and study enrollment. Youth served by the primary care clinics at Children’s National are predominantly Black or African-American (80%) and 85% are insured by Medicaid. We will also present qualitative findings from stakeholder meetings related to challenges of administering parent ADHD screens in clinics (M = 35% return rate), low screening completion (M = 58% across recruitment strategies), high number of no-shows to appointments (41%), as well as strategies to overcome these challenges. We will discuss strategies to sensitively address the complexities around screening for parent ADHD when working with underserved families and inform how to best treat multiplex ADHD families in primary care.

Summary

In Canada and USA, the pandemic led to the rapid launch and support for virtual care. The pandemic also made visible how the lack of recognition of the social determinants of health in the health care system at large has led to the uneven distribution of severe health outcomes in both countries. Virtual care has increased access for patients but it cannot address the inequity within populations of citizens in both countries. A family doctor and students from the Faculty of Industrial Engineers at Dalhousie University teamed up to create a novel approach to address theses problems. We have created “Geo-view” which offers three ways to make visible barriers to access, unbalanced referral patterns for health services across geography , diversity and social determinants of health within provinces/states and within a health care providers practice. Our mapping of dependency , identified as an unrecognized tsunami heading for us, is visualized for the first time in our work. This Geographical Information system based tool can be easily embedded within Electronic medical records and Hospital Information Systems to visualize at risk patients and populations. It will help recognize and respond proactively to at risk patients that have hitherto been invisible at the point care.

Summary

Interprofessional practice is core to the delivery of quality patient care. The World Health Organization (2012) states that in this climate, it is not enough for professionals of different healthcare disciplines to work within the same agency, but to actually train and practice collaboratively. Researchers and healthcare providers have found that good interprofessional collaboration can help reduce medical error, broaden the depth of services our patients and families can receive, and support our healthcare team members and even protect them against burn-out. True interprofessional work takes practice and training. Our faculty in Southern New Mexico, U.S. have created a collaborative interprofessional training that spans across several agencies: The Southern New Mexico Family Medicine Residency Program, New Mexico State University’s Counseling Psychology, Nursing, and Social Work programs, and University of New Mexico’s School of Pharmacy. We put together an annual Interprofessional Immersion, a week-long training that brings together new trainees from these five health care professions and has them train side-by-side in teams, building on the Interprofessional Education Collaborative (IPEC) Competencies. We have continued to build upon our educational strategies since the inception of the Interprofessional Immersion in 2012. Our immersion has been instrumental in building IPE skills for both our learners and faculty; it has helped set the stage for our learners to then work together in their subsequent practicum/residency programs. Last spring 2020, we were struck by challenges of remote learning due to the COVID-19 pandemic. Our team deliberated on how to effectively teach IPE in a virtual format and were able to develop an effective interprofessional training. This presentation will review educational components from the core IPEC domains, core strategies we used to offer interactive IPE training in a virtual format that still promotes team building and practice, and strategies to make the virtual format a success.

Summary

Despite the growing prevalence of mental illness, the integration of mental health services in primary care has been a persistent challenge in Canada. Successful integration leads to reduced stigma, improved treatment of comorbidities, and enhanced access to care. The objective of this project was to conduct a scoping review investigating system-level barriers and enablers to implementing collaborative care models to integrate mental health services in primary care. MEDLINE, EMBASE, and PsycINFO were systematically searched between May 4, 2020, and May 23, 2020, resulting in the inclusion of 63 articles. Sources were included if the setting was primary care, the intervention involved at least one mental health practitioner collaborating with a primary care provider, the outcome related to barriers and/or enablers to model implementation, and the article type was peer-reviewed. Sources related to pilot projects and health outcomes were excluded. Key article summary characteristics were study origin geography, study objective, care team composition, and target mental condition per model. The Consolidated Framework for Implementation Research was utilized to code and analyze implementation barriers and enablers according to its five domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. The majority of studies were conducted in North America, with models that specialized in the treatment of depression and anxiety. The main themes that emerged from the findings that related to the outer setting included: funding and reimbursement; health practitioner workforce and training; relationships with organizations and communities; and policy development and coordination. Results may inform the scaling up of existing promising local initiatives and pilot projects that integrate mental health services into primary care. Future work should focus on scaling up projects through implementation research and policy evaluations. The rationale for this presentation is to update and enrich the current knowledge base regarding the implementation factors impacting the integration of mental health services in primary care. This project addresses the conference theme particularly in regards to health equity. We believe that increased collaboration and integration between mental and physical health services in primary care results in increased access, and thus more equitable healthcare. The target audience is wide open, and we hope to disseminate our findings to clinicians, researchers, policymakers, and patients and their families. Attendees will learn about the various implementation factors related to the integration of mental health services in primary care and apply these to a variety of jurisdictions.

Summary

Land-based programming includes a wide variety of formally organized activities taking place on the land such as trapping, fishing, and hunting, maintaining a camp, or selective activities such as medicine walk or arts and crafts workshops. They may include ceremonial activities such as sweats, blanket ceremony, pipe ceremony, or smudging, but this is not always the case. Generally, land-based programs have storytelling, legends, and teachings components, and thus can be viewed as a culturally-specific therapeutic and educational experience. Unless the participant group is culturally diverse, such as in the case of youth treatment centres, most land-based programs are delivered in the local Indigenous language. Language is foundational to delivering cultural interventions on the land, especially knowledge related to place names, cultural practices, social organization and local history, to name a few. When aligned with the outcomes of the First Nations Mental Wellness Continuum and Indigenous Wellness Frameworks, land-based programs can connect participants to land and traditional activities facilitating hope, nurture belonging and give meaning and purpose in life. Conditions are created to live life as a whole and healthy person. The elements in the various delivery models assess target multiple determinants of health such as self-determination, language acquisition, cultural values, life-skills, human-nature relations, ethics, and social cohesion. These elements align with outcomes identified in the First Nations Mental Wellness Continuum framework. Each community and Nation set the scope of their own land-based programs, it is hoped the present delivery model will guide programs in a way that is culturally safe, honours local resources, and builds expertise at home. Indigenous knowledge is unique in honouring the land as life source, above and beyond a mere resource to be exploited. Indigenous worldview underlines the need to see land as the source of knowledge and healing.

Summary

The COVID-19 pandemic continues to highlight racial and socioeconomic inequities that exist in the United States and result in healthcare disparities. Integrated primary care (IPC) teams with embedded behavioral health providers and/or social workers often strive to meet the needs of patients experiencing psychological concerns as well as unmet social needs. However, IPC teams vary in terms of success in working together to effectively engage patients in care. Optimal functioning of the IPC team is necessary to provide accessible, person-centered care to help improve engagement and outcomes especially for patients facing systemic barriers to equitable care. Thus, this presentation will include three interrelated discussions relevant to team functioning and improving access to care. Drs. Jennifer Funderburk and Ellen Poleshuck will initially review a theoretical framework for access and the specific characteristics of the primary care team that can be modified to improve access to care, including the relationship between team members, willingness/ability of team members to identify and accommodate patient’s needs, and perceptions of each other’s roles. Based on a targeted narrative review on teamwork research, Dr. Luke Mitzel will share recommendations on how IPC teams can optimize working together even when some team members are virtual in order to provide high quality care. The final presentation led by Drs. Bridget Beachy and David Bauman will share lessons learned from high performing teams during the COVID-19 pandemic, including discussions of providing access to care for patients with psychological distress and comorbid unmet social needs with relevant case examples. Then, Dr. David Edelman will lead a discussion providing his perspective on this topic as an experienced medical provider working within teams.

Summary

The Covid-19 pandemic hit and soon thereafter the death of George Floyd, Breonna Taylor and Ahmaud Arbery occurred. Racism is not a new phenomenon, but the rapid succession of both pandemics, provided the unique opportunity for Americans to witness the impact of racism on people of color. Images from all three murders saturated all traditional and social media platforms for months. This material often functioned as triggers for past negative experiences of racism, interactions with police for BIPOCs in America, and ultimately causing secondary trauma (Lipscomb, et al, 2019). Additionally, African Americans experience chronic disease such as hypertension, diabetes and strokes at rates higher than white Americans (https://www.cdc.gov/vitalsigns/aahealth/index.html). Racism and secondary trauma act as complicating and compounding variables on chronic diseases within a population of individuals who are already at a societal disadvantage for accessing healthcare (Noonan, Velasco-Mondragon, Wagner, 2016). It is imperative to bridge the gap between racism and its impact on health. The education and training of providers will be stressed and modeled through practical examples and implementation tips.

Summary

Family physicians were trained by psychiatrists to deliver manualized 8-week Cognitive Behaviour Therapy-based skills groups, addressing the unmet need for an early intervention for people with depression and anxiety. This innovation was made possible by group medical visit fee codes, partnerships, and funding by the Doctors of BC and Ministry of Health that brought family physicians and psychiatrists together to develop materials, plan evaluation, and design a training system. The program served over 5100 patients with in-person groups from 2015-2019 in large urban centres in BC, Canada, with up to 34 groups running in a given month, by 19 physicians. A centralized referral centre was the key to a lean, economically sustainable administrative structure. It increased participant acceptability as they could choose between an array of group offerings. In 2018, a non-profit society was formed to administrate the program, financially sustained through physician overhead payments, no-show fees, and the Health Authority funding an administrative assistant. When the COVID19 pandemic began in 2020, the team pivoted to telehealth. Virtual groups were offered within a week, and a comparable-sized program resumed within 3 months. Quality improvement data indicated patient improvements and satisfaction ratings comparable to those obtained with in-person groups. Many patients reported that the telehealth format was preferred or made the groups accessible for the first time. Key drivers that enabled the adaptation were political will to create telehealth fee codes, brief technological skills training for facilitators and patients, and slight modification of materials. Virtual groups have vastly extended accessibility and contribute to equitability, as patients from across BC can now attend groups with an established facilitator. Physician facilitators can be trained across the province. Virtual groups will now be sustained as part of the ongoing program, post-pandemic.

Summary

The mutual existence of COVID-19 and racism has come to be best understood as a syndemic, given their synergistic interaction contributing to an excess burden of disease (Freeman, 2020). The syndemic of racism and COVID-19 illuminates the fact that Black, Indigenous, and People of Color (BIPOC) are disproportionately impacted by adverse events, such as pandemics. The effects of racism on BIPOC communities, particularly Black and Brown communities, is a long-standing and ongoing phenomenon. Despite the recent rise in awareness and attention among the wider public resulting from mass media attention to police shootings, widespread xenophobia, and anti-Asian hate crimes, racism and its insidious effects on every system in our society, including healthcare, are pervasive. Within the U.S. healthcare system, racism has undermined the health of BIPOC communities, including BIPOC healthcare practitioners, by widening the gaps of health disparities through diminished access to quality services, stigma, discrimination and a legacy of mistrust in health care institutions. As healthcare providers, it is in the interest of the communities we serve that we have an understanding of race, social determinants of health and the resulting health disparities. Understanding these issues is the first step in developing effective strategies and interventions to address the need for equitable, quality health care for all. The focus of this presentation is to a). provide an overview of the current literature on the trends and patterns of healthcare disparities, particularly as it relates to COVID, b). provide case examples of the lived experiences of these disparities, and c). provide introductory information about potential strategies and interventions. This presentation is one of a series of 3 at this conference on Race and Health Equity hosted by the Just Medicine Team. The other two presentations will cover strategies and interventions to address health inequities and the impact of racism on BIPOC providers.

Summary

Background: Medical legal partnerships (MLP) provide legal services in medical settings to address legal needs adversely impacting patients’ health. MLPs help identify unmet legal needs (e.g., housing code violations, threats to personal safety, or access to public benefits) and allow health care providers to address and act upon social determinants impacting and exacerbating health problems. MLPs are particularly beneficial to vulnerable populations for whom addressing social inequities can help achieve higher quality and more equitable health outcomes. Description: The Colorado Tele-Legal Partnership is a 2-year demonstration project to provide free legal services to patients in two urban primary care medical homes with progressive models of integrated care. This pilot is a partnership between an academic policy center, practice transformation team, primary care clinics, and a non-profit legal aid organization. Study design: Telelegal services will be implemented at two primary care practices, with services starting in January 2021 and in June 2021. A social and legal needs screener was developed, pretested among patients, and integrated into the EHR and workflow, using practice transformation techniques with the assistance of clinical champions and iterative staff engagement throughout the workflow development. Primary care providers and staff will participate in health equity and implicit bias training. Patient focus groups aim to solicit feedback and better understand patient trust and satisfaction with the legal services in the context of their personal health goals. Data collection: Partnered with IT teams for EHR adaptation to include screener and accommodate external referrals to legal team, granting EHR access. Monthly queries of patients screened, positive screening results, referrals, and declined services. Patient demographic data are being collected to determine levels of patient needs and rates of successful connection to services. Analysis will include trends among patients who have been missed for screening, and individuals who screen positive and decline services. Patient focus groups will explore these scenarios as well as patient experiences, level of trust with the medical system, improved sense of health equity, mental and physical wellbeing. Key results: The project is in its first year and preliminary findings will be available for the fall conferences. The analytic plan will provide an evaluation framework for MLPs that could be adopted broadly, measuring success in operations, improved patient equity, and demonstration of value. Conclusion: We anticipate that delivery of tele-legal services in two primary care medical homes will have a positive impact on patients and families served. This evaluation will contribute to evidence-based policy recommendations to implement expansion among primary care clinical homes and sustain MLPs, addressing social and legal needs to promote equity for individuals and families.

Summary

In the early months of the COVID-19 pandemic, child and youth mental health agencies shifted to delivering their services through virtual platforms. Our two organizations, the Ontario Centre of Excellence for Child and Youth Mental Health and Children’s Mental Health Ontario, worked together to evaluate the implementation of this shift to virtual care (Danseco et al, 2020). We define virtual care broadly, as any type of service delivered using telecommunication technology. This includes services and support provided over videoconference, phone, texting, and apps. We developed an evaluation framework informed by implementation science to obtain the perspectives of service users (clients including youth and families), service providers and agency leaders. We wanted to understand how clients and service providers experienced the transition to virtual care, the processes, facilitators and challenges in delivering virtual care. Exercises and resources are based on our evaluation which included the participation of 97 agencies and 192 youth and family members using online surveys, and interviews with 13 agency leaders and focus groups with 13 service providers. Service providers included social workers, psychologists, child and youth counselors from various types of mental health programs across Ontario. This presentation will provide participants with the steps to conducting a multi-level, mixed methods evaluation (including engaging stakeholders, developing the evaluation framework, conducting both qualitative and quantitative data analysis, developing recommendations for enhanced uptake of evaluation findings, and knowledge mobilization). Participants will learn how to use the implementation drivers (National Implementation Research Network, 2013), and the Consolidated Framework for Implementation Research (CFIR; Damschroeder et al., 2009) and the Nonadoption, Abandonment, and Challenges to the Scale-Up, Spread, and Sustainability (NAASS; Greenhalgh et al., 2017) to develop their questions and to analyze qualitative data. Resources will include a sample evaluation framework and checklist, sample interview questions and the sample CFIR codebook. We will also provide examples of evaluations from agencies, and a template for mobilizing evaluation findings. Our program evaluation toolkit will also be available as a downloadable resource, which includes various templates such as a matrix for developing process and outcome evaluations, budget templates, and stakeholder analysis.

Summary

The goals of most systems pursuing integrated health care include recruiting, training, and retaining primary care staff capable of delivering services that promote equity in access and outcomes for all members of a community. A national pilot of Primary Care Behavioral Health (PCBH) services in New Zealand in 2018-2019 determined that using the PCBH approach was associated with improved health equity. This led the Ministry of Health to pursue scale up of PCBH services throughout the country. This effort involved socializing many new clinics to PCBH and hiring several hundred “Health Improvement Practitioners” or HIPs to deliver services consistent with those offered by Behavioral Health Consultants or BHCs. A variety of healthcare providers were hired to work as HIPs, including occupational therapists, mental health nurses, psychologists, social workers, and counselors. HIP training activities included approximately 30 hours of classroom study prior to placement in a clinic, followed by in-clinic competency coaching by a HIP mentor. The next phase of training included participation in 1-hour live webinars fortnightly and peer supervision groups. The webinars involved 30 minutes of HIP mentor coaching around the “wins” and “challenges” of new HIPs, and then, 30-45 minutes of instruction and discussion on a specific clinical topic. This presentation offers lessons learned from new HIP reports of “wins” and “challenges” in the early (webinars 1-3), middle (webinars 4-6), and late (webinars 7-10) phases of starting a HIP practice. Four cohorts of 10-16 new HIPs provided information. After considering the identified themes, participants will have an opportunity to work with a learning partner to reflect on their current training approach and to plan small changes they could make to enhance their efforts to develop a workforce capable of delivering primary care services promoting health equity.

Summary

This experiential workshop will explore the role of trust as a foundation of successful practitioner–patient communication and collaboration. The poisonous legacy of racism in medicine complicates the establishment of trust with patients of color from oppressed groups. Lack of trust holds important implications for patient engagement, quality of care, and desirable health outcomes. During this engaging and participatory workshop, we will explore the role of empathy, rapport, and patient-centered communication. Participants will leave the session with tangible behavioral tools to strengthen their capacity to provide health care services that strive to reduce health inequities.

Summary

For the past decade, Canada, Ireland, and Australia have been working to address the urgent mental health needs of young people and their families. Our three countries share the challenge of low-barrier entry points for young people to access coordinated and evidence-based care, while matching the intensity of the care to the young person’s readiness and need. As the demand increases for integrated mental health services to be developed and funded, opportunity exists for Canada and their partners to develop, refine, and share lessons about integrated models of health care for young people and their families. Foundry & Youth Wellness Hubs Ontario, headspace, and Jigsaw centres have been delivering in-person and virtual integrated health services to young people aged 12 to 24 in Canada, Australia, and Ireland respectively. This presentation will discuss lessons from the four organizations, representing over 200 diverse centres/hubs and communities, for COVID-19 response, expansion, telehealth, multi-disciplinary training, service implementation (in person and virtual), partnership, government and Indigenous relations, youth- and family leadership and engagement, evaluation, and research. We will also highlight the critical role of youth, families, and communities to support the development, implementation, and scaling of centres/hubs, services, and evidence-based research. We will highlight actionable steps the organizations are taking to bring equitable health care to all young people in our countries, with outlining each organization’s careful consideration for socioeconomic inequities in health care, and paths to move forward to ensure the health and wellness for all youth. This talk will discuss the value added of organizations working together to learn how integrated youth health care can best be organized and delivered. This dialogue will highlight different perspectives, sharing insights and innovations that stand to strengthen integrative and collaborative youth health care in Canada and beyond.

Summary

Racial and ethnic minority groups experience higher prevalence rates of mental health disorders, with greater disparities in social determinants of health affecting treatment engagement and access. Over 50% of Latinxs and African Americans with diagnosed mental health conditions have unmet treatment needs (Alegria et al., 2015) and the prevalence of health inequities and disparities often found within medically underserved communities of color has contributed to workforce shortage of qualified mental health service providers (Marques et al., 2020). This gap has further increased during the COVID-19 pandemic, particularly within under-resourced communities of color disproportionately negatively affected (Kanzler & Ogbeide, 2020). Infection prevention and control guidance has presented unique challenges to providing access to care within traditional Primary Care Behavioral Health models (PCBH). Therefore, it has been imperative for primary care safety net sites to more creatively assess, engage, and adapt service delivery models to effectively address unmet community needs in culturally-responsive ways during the pandemic. This demonstration project will review the development, implementation, adaptation, and sustainability of a low-threshold mental health treatment group program delivered via audio-only telehealth in Spanish and English to address undertreated mental health needs and emotional distress exacerbated by the pandemic and civil unrest. The intervention targeted primary care patients with high utilization of primary care telehealth services within the PCBH model at a large FQHC in a multiculturally diverse urban setting by offering eleven, trauma-informed modules (adapting ACT and CBT interventions) in a weekly, open-access group format. Descriptive statistics and frequency distributions of group participants’ (n=129) demographic information, primary care service utilization, and group retention will be analyzed to examine program efficacy and the subsequent impact on patient healthcare engagement during the pandemic. Implications of the findings will be presented for population-focused interventions within patient-centered medical homes, along with next steps to flatten the curve for mental health needs utilizing a behavioral health response framework (Kaslow et al., 2020).

Summary

The COVID-19 Pandemic has significantly disrupted the delivery of traditional substance use disorder (SUD) treatment across healthcare, including the closure of residential treatment centers and disruption to community-based programs such as Alcoholics Anonymous (AA). The epidemiological implications of these changes are not yet known. However, data from the Department of Veterans Affairs (VA) suggests that engagement with SUD treatment within VA has decreased since the start of the pandemic, while overdose rates have risen. Over the past several decades, the integrated primary care (PC) setting has provided an important venue for engagement with individuals with SUDs who may otherwise not connect with traditional SUD treatment settings. There are many reasons that the PC setting provides additional access avenues for these individuals, including avoiding the stigma of traditional SUD settings and providing familiarity with the patient’s established healthcare team. During the pandemic, the need for access and treatment of SUDs has increased within PC, yet PC has faced its own challenges with service disruption from reduced face-to-face appointments and the logistical barriers with the transition to telemedicine. The utilization of technology has been instrumental to the continued delivery of effective SUD interventions within PC. In this symposium, we present three novel, PC-based interventions designed to improve access and engagement for individuals with SUDs despite these access challenges: (1) A video telehealth-based intervention for the treatment of alcohol use disorders, utilizing principles of Motivational Interviewing and Motivational Enhancement Therapy. (2) A telehealth-based group intervention for the treatment of tobacco use disorders that incorporates behavioral and pharmacological treatment delivered in tandem by a psychologist and clinical pharmacist. During the pandemic, both of these interventions transitioned from in-person encounters to a telehealth platform. Successes, challenges, and solutions to telehealth adaptation will be discussed. Additionally, to address barriers to treatment initiation and engagement, we will present: (3) A telephoned delivered, motivationally-tailored intervention to increase utilization of evidence-based treatment for tobacco use disorder. Adaptations of this intervention to promote engagement with other SUDs will be discussed and prospective outcome data collected during the pandemic will be presented. Across all interventions, best practices for team-based care that incorporates both behavioral and pharmacological interventions and integrates care from providers from multiple professions will be discussed. Additionally, approaches to implementation in non-veteran, community-based treatment settings, and adaptations to these interventions to meet the challenges of the COVID-19 pandemic will be addressed.

Summary

Developed in partnership with First Nations, the First Nations Mental Wellness Continuum Framework (the Framework) presents a shared vision for the future of First Nations mental wellness programs and services and practical steps towards achieving that vision. A response to the mental health and substance use issues that continue to be a priority concern for many First Nations communities, the Framework’s overarching goal is to improve mental wellness outcomes for First Nations. On the one hand, the Framework is designed to strengthen federal mental wellness programming and support appropriate integration between federal, provincial, and territorial programs. It describes how programs can communicate better and work more effectively together within a comprehensive mental wellness system for First Nations. The Framework establishes a continuum of care that forms the basis for this system. On the other hand, the Framework provides guidance to communities to adapt, optimize, and realign their mental wellness programs and services based on their own priorities.

Summary

Social Determinants of Health (SDOH) are estimated to account for up to 60-70% of health outcomes, but SDOH data is often not included in health records, and is often not documented in ways that are easy for providers to use. Southcentral Foundation, an Alaska Native customer-owned healthcare system responsible for providing healthcare and related services to approximately 65,000 Alaska Native and American Indian people in southern Alaska, has used community stakeholder feedback to develop a system for handling SDOH data that emphasizes value and priority to patients, providers, administrators, and other stakeholders. The system identifies pre-existing SDOH data in electronic health records to identify SDOH needs, improve the delivery of healthcare, and inform policy decisions related to population health. To create the system, SCF conducted a review of over 100 existing screeners, forms, and service applications already in use to identify existing SDOH data collection. Once SDOH data were identified, their relative value was assessed based on criteria such as completeness (how many patients have a given data point), timeliness (data update frequency), quality (perception of accuracy), usefulness (how will it be used), and acceptability (alignment with patient needs, priorities, and concerns). These SDOH variables were made accessible along with other data, allowing users to examine the role of SDOH in healthcare at multiple levels from the individual to the aggregate. Once the system was in place, SCF worked to augment action lists with SDOH data, beginning with a nurse home visiting program for families from pregnancy until the child is two years old, incorporating the SDOH variables into an actionable format. The resulting action list let nurses and case managers more easily track the provision of care including required screeners. The action list format was so successful that it has been replicated with the Child and Family Developmental Services clinic.

Summary

The aim of this presentation is to provide a basis for conceptualizing substance abuse through a family systems lens and explore treatment options that integrate family education and participation when appropriate. Participants will be invited to expand their view of the identified patient to understand how the individual’s behavior is influenced by the interconnected contexts of family relationships, genetics, adverse childhood experiences and larger systems. Various family structures where SUDs are present will be identified and the value of family education or intervention for each will be discussed. Other topics covered include the role of mutual support groups, the concept of recovery capital, a systemic view of relapsing, reconstruction of the family system, and the stages of family recovery.

Summary

The association between ACEs and physical health outcomes is well-established and evident in research and practice. However, the association between ACEs and mental health outcomes is less understood. Thus, the purpose of this presentation and systematic review is to provide an overview of the existing literature regarding ACEs and adult mental health outcomes. Additionally, the presentation will address how these negative outcomes disproportionately effect minority populations, particularly those with limited access to care. Presenters will address systemic racism as well as health and social inequities. The presenters conducted a systematic review of literature utilizing electronic databases of PubMed, PsychInfo, and Google Scholar to identify research studies that examined ACE’s and adult mental health outcomes. The selected keywords were “adverse childhood experiences” and “adult mental health outcomes”. Inclusion criteria included: 1) published between 1998 – 2020, 2) ACEs and mental health symptoms were self-report, and 3) participants were at least 18 years old. Exclusion criteria included: 1) articles published in non-English language, and 2) no new data or analyses presented. Of the 22 articles included, four themes emerged: depression and anxiety, substance use, PTSD, and general mental health. Significant associations were identified between ACEs and depressive symptoms, PTSD, and substance use. A cluster effect was identified, exhibiting an increase in negative mental health outcomes when four or more ACEs were present. A significant association between ACEs and mental health outcomes in all studies examined, suggests the importance of understanding the impact of ACEs on adult mental health. Results indicated 61% of African American children and 51% of Hispanic children experience at least one ACE compared to 40% of white children. Results identified that minority populations have less access to quality healthcare and are less likely to adhere to treatment in adulthood. Thus, the combination of experiencing more ACEs and having barriers to receiving treatment increases the risk for further comorbidities in minority populations. By collaboratively screening for ACEs and utilizing ACEs in interdisciplinary treatment teams, clinicians can treat patients from a more systemic and culturally-informed perspective.

Summary

Relational Leadership (RL) skills have been a significant enabling factor in growing behavioral health integration at Women’s Healthcare Associates (WHA) clinics, leading to increased provider comfort with addressing mental health needs, and increased quality of care for patients. Our aim in this project is to distill the specific RL skills and concepts that have relevance to furthering successful behavioral health integration into Ob/gyn care leading to increased provider proclivity toward addressing patient mental health needs and increased quality of care for patients. Project Design In order to learn about Ob/Gyn providers’ experience of engaging with integrated behavioral health care at WHA we created a standard set of questions designed to be delivered interview-style to a select group of medical providers within WHA. We received support for developing these questions from the RELATE Lab research team (https://relatelab.org/ ). Our questions had 6 overarching themes: Change over time in the medical providers’ experience of interacting with the behavioral he program Extent to which the behavioral health provider is seen as a member of the healthcare team Impact of organizational workflows including behavioral health provider visibility in the clinic Individual behavioral health provider traits influence on medical provider utilization of behavioral health services for their patients View of the impact of behavioral health utilization on patient care Discipline-specific influences on behavioral health utilization Each of our questions was aimed at eliciting information specific to the influence of providers’ individual relationships with given behavioral health providers impacted their growing utilization of and support for behavioral health integration in the organization. Of note, all providers interviewed are also company owners as WHA is an LLC owned by medical providers. We initially selected 13 medical providers who have been with the organization during the time period that behavioral health integration attempts have been occurring. Of those 13 providers we ultimately ended up interviewing 10. Analysis After completing the interviews our recordings were transcribed and we used a variation of the Framework Method to analyze the transcripts, organizing responses into 3 categories. From this categorization we were able to illustrate some themes that were consistent across the interviewees as well as draw parallels to RL skills in order to recommend specific RL skills training that may contribute to improved integration of behavioral health services into ob/gyn settings. We were also able to identify themes related to potential integration barriers including challenges in understanding between disciplines, self-identified characteristics of medical providers and workflow challenges.

Summary

Paramedics are a first point of contact for many mental health emergencies and paramedics are increasingly responding to these calls. Challenges exist in emergency mental health care in the prehospital setting, however collaboration with domains outside of paramedicine offers means of improving care and better addressing the needs of those in crisis. This presentation draws on findings from a qualitative, ethnographic case study of mental health and psychosocial calls to paramedic services in Ontario, Canada. The study conducted between September 2017-October 2018 includes interviews (n=46), observation in paramedic services (n~90hr) and document analysis. Interviewees from across Ontario included front-line paramedics, management, educators and Base Hospital physicians/directors. Challenges for mental health care in paramedicine include, limited practice guidelines, training and resources, and the emergency department (ED) as a care destination. Promising practices exist in a select number of paramedic services in Ontario. These include crisis response teams, community paramedicine follow-up programs, transportation to mental health and social services rather than ED, and continuing education. Importantly, some of these programs work beyond acute care response to address the social determinants of health (SDOH). These practices involve collaboration with nurses, social workers, police, and other social services. While beneficial, such practices exist in a limited number of paramedic services. Paramedics are in the unique position of seeing individuals in their daily living environments, providing insights into the SDOH impacting mental health. Collaborative approaches to address mental health inequities in the prehospital setting require engagement and action to address the SDOH including structures such as racism, sexism, homophobia and other forms of discrimination. Further collaborative approaches are needed to improve paramedic education, guidelines and practices this field.

Summary

For a decade, Mental Health America of Greater Houston (MHAGH) has promoted integrated health care (IHC), leading learning communities, providing training and technical assistance, and facilitating dialogue around value-based payment. Within the Integrated Health Care Initaitive (IHCI), we have conducted comprehensive reviews of programs throughout the nation, worked with subject matter experts, and reviewed research in best practices to implement integrated health care. The need is only increasing post-COVID19 due to higher exposure to trauma and trauma-related events. Now is the time to prepare providers and support and strengthen IHC to meet vulnerable populations’ growing needs. The work’s specific purpose is to advance integrated behavioral health for historically underserved communities in the Houston region. We have worked with Managed Care Organization in the Greater Houston Area that covers 90% of the Medicaid, CHIP, and dual-eligible (Medicaid and Medicare) populations. We have worked with practices that primarily serve low-income individuals and families living in urban settings. The populations served by these clinics are primarily African American and Hispanic. COLLABORATIVE GOAL: This breakthrough collaborative series aims to help participating clinics further strengthen integrated behavioral health in primary care via integration tools/training/resources and a learning community. Outcome goal: Each participating clinic will identify two IBH targets to focus within their practice from the list of predeveloped targets. By May 2022, participating clinics will further their level of integration by at least one, according to the Center for Integrated Health (CIHS) self-assessment tool. Participating organizations will: • Implement changes to improve integrated health care • Submit a monthly report that includes data as well as information on changes being tested and/or implemented

Summary

Goal: This presentation will describe a four year project to design, test, and implement a novel supported employment intervention for young people accessing integrated youth health services. Introduction: A critical mass of knowledge has accumulated to support the role of employment and education as social factors in determining the health of Canadians. This is notably true for the 1 in 4 Canadian young people aged 15 to 29 years who are diagnosed with a mental illness each year. Yet, the evidence base for effective interventions to support young people with mental illness to improve health outcomes through engagement in employment or education is to date underdeveloped. Objective: This presentation will describe a four year study to design, test, and implement a novel supported employment intervention for young people. Methods: This study was a mixed methods study comprised of four phases: (1) co-design, (2) pilot, (3) longitudinal pilot, and (4) scale. In Phase 1, a convenience sample was used to understand the supported employment needs of young people accessing integrated youth health services and co-design a prospective intervention based on an existing evidence-based model called Individual Placement Support. In Phase 2, a pilot was developed, tested and refined over a 30 month period. In Phase 3, a prospective cohort design was used in one community. Measures included employment/education >30 days, symptomology, recovery, and quality of life. Complete assessments took place at baseline, 5 weeks, 16 weeks, and at 6 and 12 months post-intervention. Focus groups with a subset of youth were conducted to generate descriptions of participant experiences in the intervention. Finally, implementation of the intervention across 11 communities and one virtual service took place. Results: A total of 18 cohorts of young people participated in the pilot phases intervention (total 155 youth, mean age 21, SD=2.2). Employment/education progress was achieved by 71% of participants, with 55% maintaining the outcome at 1 year, with 90% of participants showing improvement on recovery and mental health outcomes and overall strong satisfaction with the intervention. Results informed a pan-Canadian strategy to implement the model across 12 communities, three of which will continue rigorous research testing with like-minded community partners. The program is estimated to support 600 young people in BC each year. Conclusion: The results support a well-tested, widely applicable intervention tailored for young people with mental illness to improve health outcomes by increasing participation in employment or education. The program is estimated to support 600 young people in BC each year.

Summary

Within addictionology, narrative approaches to the addictions exist though are less recognized than conventional counseling methods. Their advantage lies in their greater acceptance by indigenous and marginalized peoples. The narrative paradigm steps aside from shame and blame by asserting that addiction is a narrative template that people adopt, often because of hopeless life circumstances with no vision for change. In the positivist paradigm, there is one and only one explanation for addiction, which is usually genetic, given its relations to the reductionist paradigm. Narrative philosophy states that we see the world using the stories that we have absorbed or constructed to explain our perceptions. This is supported by neuroscience. Story production is the default mode of the brain, what it does on idle. Human brains are organized around story, its comprehension and production. The brain evolved to manage story, especially about our social relationships. Using substances is a story that people have adopted for managing the unrelenting pain and distress of their lives. It is connected to poverty and adverse childhood events. Narrative therapies aim to provide a different story for managing adverse life events and life stressors. Typically. these new stories involve the development of agency, the sense that one’s actions can make a difference in one’s life. They make meaning of the adverse life events that contributed to the addiction. Through meaning making, shame is reduced. We present the lessons learned and the results of our using this approach with a tribal population in Maine in conjunction with a medication assisted treatment initiative. We show that a narrative approach is readily accepted due to the storied nature of much of North American indigenous cultures and that counselors working on tribal settings can readily adapt narrative approaches to their populations. Some key concepts include (1) reframing the person’s self-story about being addicted within a threat-power-meaning network in which the story of reducing or eliminating substance abuse becomes a story of opposing threatening power relationships derived from colonization and working toward recovery and rebellion becomes an act of rebelling against colonization and restoring balance from the imbalance produced by historical trauma, (2) working with stories about the spirit of the addiction and the consequences of ingesting spirit-laden substances without knowing their songs and protocols and without showing the proper respect to that substance, (3) constructing future-self-narratives that explore right relationships and meaningful conduct in the context of recovery, (4) constructing stories about the intergenerational transmission of addictions and exploring the question of “whom will be the recipient of your addiction?” We come to understand that the client sets their goals and defines what recovery means for them, which is the heart of a harm reduction approach.

Summary

Integrated care, a healthcare reform that targets on-site collaboration of medical and mental health professionals, has become increasingly prevalent in both the healthcare landscape and graduate training programs. The integrated care movement is reflected in both legislature, such as the Patient Protection and Affordability Care Act (Croft & Parish, 2013; Kuramoto, 2014; Rosenbaum, 2011), and specific accrediting bodies, such as the Council of Accreditation of Counseling and Related Education Programs training standards (CACREP, 2015). This is due in part to the estimated 49% of individuals with poor mental health receiving their treatment in the primary care setting, as opposed to a trained mental health provider (Peterson, Miller, Payne-Murphy, & Philips, 2014). With the introduction of the Heath, Wise-Romero, and Romero (2013) model of integration, agencies and facilities have reported positive consumer outcomes suggesting a reduction in both physical and mental health symptoms (Lenz, Dell’Aquila, & Baskin, 2018), increased medication adherence (Archer et al., 2012), and addressing the noted health disparities for minority populations (Kohn-Wood & Hooper, 2014). To further incentivize the training of mental health professionals in an integrated setting, the Health Resource and Service Administration (HRSA) has provided external funding opportunities through the Behavioral Health Workforce and Education Training (BHWET) Program for graduate-level counselors. Counselor educators have taken advantage of these grants with the BHWET (2018) Program reporting over 1,300 counselors receiving that their grant funding over a four-year span. Though, the future of integrated care in graduate training programs is called into question if we do not investigate this modality through both a training and sustainability lens. Unfortunately, external funding is not always guaranteed, and our research should demonstrate the impact a trained mental health provider has in integrated care. Specifically, we need to shift our focus into effective training curricula, as well as outcome studies for the healthcare industry and consumers when a mental health provider is providing care. The purpose of this interactive presentation will be to present the findings of a systematic review that specifically investigates training modalities for mental health professionals in integrated care. As such, sustainability of integrated care in graduate training will be explored to address effective training strategies for professionals-in-training. We will provide an overview of the benefits of integrated care, evidenced-based training modalities for mental health professionals, the current landscape, and future considerations for academics training graduate students.

Summary

This presentation will describe an innovative pain management program in Hawaii where there are vast health inequities, tremendous cultural diversity, and a significant number of people experiencing poverty and/or homelessness, all within a population of less than14,000 individuals. There are many unique features of this program that will be highlighted in the presentation and connected to the 3 pillars of social determination theory – competence, autonomy and relatedness. One of the unique features of the Ho’okuola Hale Pain Management Program are community partnerships. Another notable feature is the novel composition of the integrated care team that includes not only medical providers, physical therapists and behavioral health providers, but also acupuncturists, cultural educators and Hawaiian traditional practitioners who collaborate to develop and deliver comprehensive, patient-centered care plans. After an introduction to the program and a review of the evidence supporting the effectiveness of the program, the presentation will describe several benefits of incorporating cultural practitioners in integrated care plans. Key measures of success, as well as key program components that support successful outcomes, will be discussed. Finally, the presenters will also discuss why community partnerships are an essential component of program success… indeed, it takes a village!

Summary

This participatory session will create an opportunity for the audience to: • Hear a description of the infancy of the provincial YOW program, discuss the challenges it has gone through to reach its current provincial scope of practice and examine, identify and discuss recommendations in implementing a similar model in other province/jurisdictions • Understand the focus on priority populations and how these emerging priorities are fluid, resulting in a flexible, agile approach to program priorities and the requirements of associated implementation plans • Understand the importance of onboarding, educational and ongoing skill development required in maintaining a “lived experience” approach to the delivery of services. We will also explain why the inclusion of clinical youth outreach workers was prioritized in our growth strategies and planning. The Youth Outreach Worker (YOW) Program is a comprehensive multi-agency outreach initiative for marginalized youth in underserved neighborhoods and special target populations across Ontario. Started in Toronto in 2005 as a mechanism to combat the “summer of the gun”, at risk, inner city youth remain an important focus of this program yet new and emerging populations such as Indigenous, Roma, Syrian, LGBTQ etc. have allowed for emerging service approaches, focused on addressing unique needs inherent in these communities. These services are complemented by Enhanced Youth Outreach Workers (EYOW) who provide clinical intervention when required for mental health, addictions, trauma, human/sex trafficking etc. In 2018/19 the Program engaged 9,281 youth who interacted 30,220 times. YOWs hosted 3,915 group activities attended by 173,158 young people. Mental Health, employment, education and skill development are most common issues identified by youth. Ongoing use of data and an evaluation framework supports the program to confidently address programming and infrastructure opportunities as they emerge. Lived experience remains vital in building an effective YOW workforce. Through a vigorous onboarding and skills development, retention remains high within a field of work often considered vicarious and underpaid. The programs journey to this point has not been easy yet the funders, the participating agencies, YOWs, youth and families are committed to the program’s sustainability and expansion in scope and ongoing development of clinical expertise. This presentation will discuss how the programs development, history, current state and program expertise can be leveraged in designing similar youth outreach programs across the country

Summary

The perinatal period, during pregnancy and 12 months postpartum, is crucial to the health and wellbeing of women. All aspects of a woman’s life, including the biological, psychological, social, and spiritual, are impacted. Coping with these changes can have profound effects on women, children, and family’s mental, physical, and emotional health (National Perinatal Association, 2018). In utilizing a systemic and intersectional lens, behavioral health are uniquely positioned to support, treat, and advocate for women and their families during the challenging transition from pregnancy to motherhood. Perinatal mood and anxiety disorders (PMADs) are a collection of diagnosable mental health conditions that can occur during the perinatal period. According to the American College of Obstetricians and Gynecologists (Kendig et al., 2017), “perinatal mood and anxiety disorders are among the most common mental health conditions encountered by women of reproductive age” (p 422). Within the United States, PMADs are considered the most common birth complications for women, affecting approximately one in seven women in the U.S. (Luca et al., 2019) or approximately 15-20% of postpartum women (Gavin et al., 2005). As systemic thinkers, behavioral health providers must be prepared to assess and treat PMADs as the symptoms present in a variety of primary or specialized care constellations, such as routine post-natal follow-ups, stressors related to parenting, and symptoms related to depression and anxiety. The presentation will begin with an overview of the most recent literature about PMADs, including the known risk and exacerbating factors. Then a systemic and intersectional lens will be applied to the existing literature, identifying gaps in conceptualizing treatment and providing the foundations for the use of a contextual and systems-based approach. Finally, the existing evidenced-based practices in individual, couple, and parent-child approaches will be reviewed, along with suggestions for applying an intersectional lens to assessment, treatment, and advocacy at the community level.

Summary

The COVID-19 pandemic has drastically shifted how professionals have provided mental health services across various settings. The practice of telehealth has replaced in-person service delivery at an increasing rate. The process of rapport-building in fostering the therapeutic alliance with clients has often been viewed as a challenge. The aspect of providing services through telehealth has further exacerbated this problem. At the same time, certain aspects of telehealth therapy have allowed more people to access services. “Telehealth is a viable option for addressing rural mental healthcare needs as it enables more effective care management, provides expanded access to services, and fosters integrating primary and mental healthcare services” (Myers, 2018). However, many individuals in the United States have faced digital barriers with telehealth, including those from racial/ethnic minority backgrounds, limited health literacy, and limited English proficiency (Nouri et al., 2020). Socioeconomic disparities have led to a challenge in receiving telehealth-based mental health services. COVID-19 has significantly impacted school-aged children who have been forced to adapt to remote learning across the world. Throughout the pandemic in-school services provided to children have transitioned to telehealth modules, such as speech/language, occupational, physical, and counseling therapy sessions. Many students do not have remote access to the technology necessary to receive these services effectively. The services are often not being provided or not effectively delivered due to various challenges, e.g., lack of computer-access, unreliable Wi-Fi, lack of privacy in the home, interruptions during a session, lack of adult support in the room for behavioral management and support. Given these challenges, telehealth rapport-building for professionals has become an increasingly difficult task to accomplish. The purpose of this presentation is to present research on effective telehealth practices with various populations and current platforms used to mitigate care barriers. The information provided will be geared toward any practitioner who engages in telehealth service delivery, particularly with children and adolescents. This presentation will deliver information on what rapport is and how it is built, why rapport-building is a necessary aspect of professional practice, and how rapport-building has changed with the shift to telehealth service delivery since the beginning of the COVID-19 pandemic. By the end of this presentation, participants will understand why and how practitioners can develop telehealth-focused rapport-building strategies for their school-aged clients and the implications for their practice within a variety of settings. Each participant will receive a handout with practical guidance for how to incorporate strategies for rapport-building and maintaining sustained engagement in telehealth service delivery for children and adolescents.

Summary

Abstract: Implementing and evaluating clinical innovations in healthcare settings is challenging, and the individuals conducting implementation projects vary in the level of implementation project familiarity, time, effort, and resources they can commit to the research and evaluation process. This presentation is designed to provide attendees with practical guidance for designing implementation and evaluation projects in order to maximize the usefulness of the findings in terms of both clinical utility and the potential for generalizability and contribution to the research literature. The presentation will review actionable evidence-based recommendations and resources that can be used throughout the project, from developing the implementation plan to reporting the results. To assist in illustrating the practical strategies, we will use the implementation of brief alcohol interventions within SBIRT as an example. After introducing the example and providing an overview of the strategies, attendees will participate in an interactive discussion (if virtual, this will occur within the chat) on applying the strategies to a fictional implementation of a brief primary-care based alcohol intervention for patient’s reporting high-risk alcohol use. Discussion will begin by reviewing resources and recommendations that can assist in ensuring the clinical intervention is well described. We will then share a resource of common implementation strategies and recommendations on how to use the current literature to guide choices in selection. Then, participants will be presented resources to help identify and select the outcomes of interest. As the design of the evaluation can differ, the presenters will provide overviews of different options for study design. Attendees will leave with a handout that includes resources and recommendations related to each of the covered topic areas.

Summary

The U.S. healthcare system has experienced a paradigm shift in the way it delivers care since the implementation of the Affordable Care Act. Its emphasis on improving the health of the population, enhancing the experience and outcomes of the patient, and reducing per capita cost of care for the benefit of communities (the Triple Aim for populations) has created opportunities and challenges for numerous health care entities, especially for those that have not implemented an integrated behavioral health component. Providers have also faced challenges in fulfilling the Triple Aim, leading to calls for a Quadruple Aim that includes a focus on provider well-being. Even prior to the COVID-19 global pandemic, the primary care setting has been the de facto mental health provider for many, treating and managing most patients with depression and anxiety diagnoses (Kessler & Stafford, 2008). For this reason, integrated behavioral health care with the use of Primary Care Behavioral Health (PCBH) Model has been an effective tool care and treatment of mental health diagnosis including, not limited to, depression and anxiety (Robinson & Reiter, 2016; Linde, et al., 2015) and bringing traditional psychotherapy treatment modalities to the primary care setting (Sawchuk, et al., 2020). Since the emergence of COVID-19, growing research shows evidence of a continued burden to the primary care setting in meeting the mental health needs of affected communities (Kanzler & Ogbeide, 2020; Rajkumar, 2020). Additionally, the pandemic has altered the health care service delivery. Given the nature of how COVID-19 is transmitted, patients have been encouraged to attend visits via telemedicine videoconferencing or phone sessions in order to limit community spread. Jefferson Health has continued to grow PCBH throughout sixty primary care practices with the transition to telemedicine due to the COVID-19 pandemic. Like many others working in integrated health care Jefferson Health has had many successes with the transition along with finding areas of continued growth and improvement as the future of patient care continues to evolve. The transition to telemedicine has enabled Jefferson Health to leverage the virtual platform to reduce disparity by expanding access to behavioral health services to patients across its southern New Jersey and Southeastern Pennsylvania campuses. Initial outcome metrics of the transition to telemedicine and a hybrid model of services have reflected continued impact of serving the community through PCBH with depression and anxiety as measured by the PHQ9 and GAD7; improving Jefferson employee well-being, and expanded options for long-term program financial sustainability. This hybrid transition has fundamentally transformed how team-based care is delivered at Jefferson Health and could offer valuable lessons to other organizations looking to implement a similar model.

Summary

Children spend the majority of their time in school where academic and many behavioral health needs are addressed. For example, many schools utilize multi-tiered systems of support to deliver behavioral health prevention and intervention programs to students in need. The school system and special education supports can be difficult to navigate. When children are having difficulty in school, families often first seek support from their primary care providers (PCPs). With the impact of the COVID-19 pandemic, direct interaction with teachers and school staff have become limited. Given these challenges, medical providers are receiving even more requests for school and behavioral health supports (Armitage & Nellums, 2020). These needs have been even greater for underserved and minority populations due to the growing needs for behavioral health supports and the often-limited access to high quality care. Integrated behavioral health consultants (BHCs) who have expertise in special education and training in schools can support pediatricians and families in navigating the nuances and complexities of the school system (Sheridan et al., 2019). Additionally, BHCs can facilitate multi-disciplinary collaboration across systems to best support the child. The presenters will discuss differences in school modalities (e.g., home schooling vs virtual schooling) and what special education supports look like in each modality. Additionally, they will present a variety of behavioral health concerns that impact children and families and what each stake holder (e.g., PCP’s, parents/guardians, educators, and behavioral health providers) can do to support children. Examples will be introduced on ways to successfully collaborate across multiple settings using data-based decisions to support children’s academic and behavioral health needs.

Summary

GMV’s are an innovative way to deliver care that enable clinicians to overcome individual and systemic barriers to accessing care. GMVs give patients access, education and advice from a primary care provider and diverse health professionals that might normally be inaccessible due to a number of variables including lack of private insurance. They allow providers to leverage resources and encourage authentic interdisciplinary collaboration thereby facilitating integrative care. A medical and a health promotional educational component geared toward lifestyle interventions typically comprise the visit. GMVs are suited for preventative, psychiatric care, psycho-education and chronic disease management (DMII, COPD, HTN, CVA, CHF). There is a growing body of research supporting improved health outcomes. The pandemic has necessitated migration to online forums for provision of care yet the format holds the potential to fragment care, moving away from an integrated approach. The GMV has the potential to enhance and strengthen collaboration through inclusion of diverse health practitioners whose expertise augment that of the primary care provider. Virtual GMVs could conceivably help address address issues that have disproportionally affected vulnerable groups by removing barriers related to mobility, transportation, finances, access and education. This increases patient engagement and promotes continuity of care. GMVs cultivate a sense of belonging and community among persons from diverse backgrounds with unique individual challenges. Similarly community can be fostered in the group format among homogenous groups of patients that self identify as a racial, ethnic or cultural group with unique needs. The group experience chips away at the stigma associated with illness particularly that of mental health diagnoses. GMV through virtual platforms help lessen the burden of isolation associated with the covid pandemic. GMVs increase access, decrease wait times, ER visits and enable patients to overcome significant systemic and individual barriers to accessing care. They are a more efficient use of time and resources. Subjective and objective evaluation measures are required to ensure that programming is effective and sustainable. By combining education, skill building and behavioral change patients are transformed from passive to engaged. The process if designed well cultivates community, enhances learning through vicarious sharing and combats the stigma associated with medical labels and diagnoses.

Summary

Diversity, equity, and engagement. Organizations use these words as they strive to become more diverse, yet many leaders are uncertain about the steps needed to turn dialogue – and intention – into action. There is a gap in understanding how health provider organizations have been successful in advancing Diversity, Equity, and Engagement (DEE) efforts for their staff and clients and there are limited options for organizations to learn from other’s successes and challenges. The ECHO model breaks down this barrier by bringing together diverse organizations in engaging virtual peer-to-peer learning, prioritizing case-based learning and open discussions. The ECHO style of learning provides a safe space for constructive discussions with a group of organizations who share the same vision and goal. With this in mind, the Center of Excellence for Integrated Health Solutions (CoE) launched the CoE Health Equity ECHO in February of 2021, as a way to fill the learning gap around practical implementation strategies for advancing DEE efforts within health organizations. How does the Health Equity ECHO model work? Participants share their challenges, questions, and concerns with advancing DEE with other organizations and experts to gather their feedback, ideas, and practical strategies to help improve their efforts. This modality allows organizations to share their vulnerable experiences without the feeling of shame, embarrassment, or disconnection. The ECHO model strives to create an environment of connection and support across diverse providers, breaking down silos of learning and subject matter expertise. This ECHO is the first of its kind to focus on DEE and has proven a successful strategy for advancing efforts on a national scale. Organizations from across the nation are involved from 20 different states ranging from state and local health agencies to federal health advocacy and education agencies. Topics discussed throughout this ECHO are focused on understanding and addressing: how to leverage integrated care best practices to engage marginalized communities; the impacts of bias on hiring and recruiting practices; moral and cultural safety; barriers and opportunities for improving access to care for racial and ethnic minorities; compassion fatigue and promoting resilience; and opportunities for engaging people with lived experience in a more meaningful way. Just after one session, 87% of participants noted that they plan to make improvements in their work based on the information discussed during the session and shared that “they were moved by the idea of cultural humility and the understanding of the term brought awareness to me,” and that the “the depth of the experience from BIPOC folks was the most powerful part of this meeting.” A summary of the ECHO evaluation findings will be shared during this presentation, as well as a review of the impacts the ECHO model has on de-monopolizing knowledge and skills across diverse regions.

Summary

The experience of COVID-19 has no precedents. The pandemic has pushed service providers to innovate and use creativity to cover community needs. The Primary Care Psychology Program (PCPP) has been training doctoral clinical psychology students in integrated behavioral health services for more than 10 years. As a response to the need a public health need, in October 2020, PCPP started providing behavioral health services to COVID-19 patients in collaboration with a Contact Tracing Program in Puerto Rico. The services provided include tele-behavioral health screenings, telephone based follow up interventions, and referral to other mental health services. During the presentation, the presenters will discuss the roles of the behavioral health team in the Contact Tracing Program, the protocol used to provide tele-behavioral health services, and lessons learned form this novel experience. Preliminary demographic data of the patients that received the services will also be presented. In addition to the demographic data of the patients we will present preliminary results of the behavioral health screenings (PhQ-9 and GAD-7) recovered during the interventions.

Summary

Depression is one of the most common mental health concerns treated in primary care settings. As underserved communities often struggle accessing traditional health care with the same regularity as other patients, treatment in primary care is vital for underserved populations who have higher rates of health disparities. Using smartphone apps has been one proposed solution to help increase access to care. Recently the MINDLamp mobile app has been used to supplement depression treatment and augment patient self-management of depression. Although new evidence suggests patients across the socioeconomic spectrum are interested in using apps to supplement depression treatment and more mental health apps are available than ever before, little guidance exists for medical and behavioral health integrated primary care providers interested in incorporating mobile apps in the treatment of depression. Filling this gap is crucial to facilitate implementation of app use in the treatment of depression in primary care clinics and develop evidence-based training in order increase access to underserved patient populations. Attendees, at any stage of their education or career, will learn about the process and results of a study that explored the implementation and use of a shared-decision making model to facilitate the use of the MINDLamp app in the treatment of depression in a primary care clinic. Adult patients with an active depression diagnosis were eligible to participate. Information from this study will enable attendees to efficiently evaluate patients who may benefit most from incorporating mobile app use into the treatment of depressive symptoms. The presentation will also include descriptive statistics, survey results, and future directions will be discussed.

Summary

Patient-centered care has become a dominant focus of the clinical interaction, yet related concepts like shared decision making (SDM) are inconsistently practiced. SDM is “a process in which decisions are made in a collaborative way, where trustworthy information is provided in accessible formats about a set of options…and contexts of patients and their families play a major role in decisions.” SDM is associated not only with greater patient satisfaction but also demonstrable improvements in chronic disease self-management, medication adherence, and clinical outcomes. SDM has also been linked in improved health equity: racial and ethnic differences in treatment preferences have been established in the literature and the family/cultural context in which these decisions occur can vary across patient subgroups. Despite the evidence, however, training in SDM often falls short of the highest standard. As a result, understanding of the essential elements of SDM among practitioners can be imprecise. Primary care is one clinical setting in which utilization of SDM is most relevant. Treatment options and healthcare decisions across the lifespan are routinely discussed with one’s primary care provider (PCP). The PCP is responsible for initiating referrals managing medications, suggesting the need to be highly skilled at engaging patients in treatment planning. Organizations that train PCPs therefore have a responsibility to adequately prepare their learners with skills that are commensurate with sound practice of SDM. Nevertheless, some data suggest that providers overestimate their skill level with SDM until they receive specific training in this area. In settings where training occurs, patient-centered communication skills are often described in a didactic format and time for applied practice can be limited. As a component of a larger, multipart training on patient-centered care we designed and implemented an intensive half-day training in SDM for PGY1 family medicine residents. We utilized our institution’s simulation center to forgo a didactic-based approach to training SDM in favor of simulated practice, peer-to-peer observation and feedback, guided reflection, and collaborative scripting. A multidisciplinary team of faculty facilitated. We approached the simulated encounter as a multi-stage interaction; residents performed and observed each stage multiple times, allowing for iterative growth in skill level across multiple trials. This represented a deviation in how we, and others, typically teach and review SDM. This presentation will (1) review the relevant literature as well as evaluate approaches to teaching SDM, (2) describe in detail the program model we developed in order to promote ease of replicability at other institutions, and (3) present preliminary learner evaluation data as compared to previous iterations of SDM training at our program as well as follow-up data assessing continued comfort with the skills covered.

Summary

There are 74 million children and adolescents under the age of 18 in the U.S., comprising 24% of the overall population (Census, 2019). Estimates are that approximately 20% of this group has a diagnosable behavioral health disorder. There is a disparity, however, in the number of BH training programs that are designed to educate professionals in child-adolescent assessment and treatment. This disparity is further exacerbated in the lack of training for BH professionals currently practicing in pediatric primary care settings. The majority of clinical psychology, counseling, psychiatry, SW, MFT, and psychiatric NP programs have an emphasis on adult mental health disorders. Similarly, highly recognized training programs in primary integrated BH care (such as Mountain View, UMass, AIMS, Cherokee, APA Div 38) also have a major focus on treatment of adult MH disorders. Consequently, many BH professionals entering or currently practicing in primary care are not well-prepared to work with children, adolescents and families. By way of example, a review of accreditation standards of CACREP (Council for Accreditation of Counseling and Related Educational Programs) indicates no required child-adolescent therapy coursework at the Master’s level. Needed, therefore, is pediatric training at both the graduate education and practitioner levels for BH professionals . This presentation will discuss the development of a Training Manual designed for use in graduate education training programs and/or as education for practicing BH clinicians in primary care settings. The training manual is divided into 13 chapters. For clinicians who are new, or who are planning, to integrate into primary care practices, there are chapters related to: 1. An introduction to models of Integrated BH in primary care, 2. Terminology & Definitions commonly used in primary care, 3. Developing an Integrated Behavioral Health Clinic 4. Supportive Data Collection 5: Business Models of Integrated BH in Primary Care For BH professionals already integrated into primary care, the following chapters are applicable as continuing education: 6. Integrated Behavioral Health: Clinic Operations 7: Successful Behavioral Health Providers – Characteristics and Competencies 8: Developing Clinic and Community Relationships 9: Screening Measures for Pediatric BH Disorders 10: Pediatric Coding and Diagnosis 11: The Electronic Health Record (EHR) 12: Working in the Medical Clinic – Terminology 13: Medication Management in Pediatric Primary Care This manual is designed is to be accompanied by a series of video modules that address specific BH disorders commonly found in pediatric care: A. Externalizing Disorders ADHD Oppositional defiant disorder Conduct disorder B. Internalizing Disorders Anxiety Depression OCD Habit Disorders C. “Other” Pediatric BH issues Sleep disorders Enuresis Encopresis School issues

Summary

Although expected to be leaders in their practices, many medical providers have not received formal training and guidance on how to lead a multidisciplinary team. This can lead to role confusion, unclear goals, and frustration for all team members. This session seeks to remedy that problem by sharing tried-and-true tips for medical providers to hear firsthand from a peer and for behavioral health providers to share with their medical colleagues. In this session, a physician and an integrated behavioral health provider share key insights into how medical providers can lead integrated care teams to be clinically, operationally, and financially successful. The session utilizes Peek (2008)’s Three World View as an organizing framework. Each section includes key conceptual questions about the role of the medical provider and several pragmatic tips that support a high-functioning, collaborative team. A few factors make this presenter team unique. Both clinicians can directly speak to clinical and operational aspects of practicing on a multidisciplinary team. In addition, the medical provider is a physician-owner in an independent primary care practice in a semi-rural setting, which is becoming more of a rarity as many practices become acquired by hospital systems. Finally, the behavioral health provider works as part of a practice transformation team at a regional health plan; this provides her a unique perspective to help clinicians see more clearly their role in preparing for alternative payment models and adapt their team functions as part of a cohesive practice strategy.

Summary

Attention Deficit Hyperactivity Disorder (ADHD) is a neurobehavioral disorder that is most seen in children and adolescents. However, recent follow up studies of children with ADHD show that ADHD persists from childhood into adulthood in 35-65% of cases. Furthermore, there is evidence that many adults meet criteria for adult ADHD despite not having met criteria during childhood. The task of assessing adult ADHD can be a challenging one, particularly because symptoms of ADHD can be present in other mental health disorders and non-psychiatric conditions and because ADHD is often comorbid. In a primary care setting, these assessment challenges are amplified by the fast-paced nature, highly complex patient population, and primary care providers (PCPs) who may lack experience and/or confidence in thoroughly assessing for the disorder. Unfortunately, this can lead to misdiagnosed or undiagnosed/untreated adult ADHD and significant occupational, academic, and social functional impairment. Clinical pathways can be effective in identifying streamlined approaches to addressing the behavioral health needs of a target population, thus ensuring identification and treatment, as well as improving treatment outcomes. The purpose of the presentation is to provide those working in integrated primary care clinics with a team-based clinical pathway to assessing and treating adult ADHD. This presentation will review signs and symptoms of adult ADHD, comorbidities and differential diagnoses, risks of misdiagnosed or undiagnosed and untreated adult ADHD, validated screening measures recommended for use in primary care, previously proposed evaluation approaches, and present the team-based clinical pathway the authors developed for a family medicine residency clinic. Qualitative data from team-members who have utilized this pathway will be discussed as well as recommendations using behavioral health to support primary care physicians in the assessment and treatment of adult ADHD.

Summary

More and more, epidemiological studies are indicating the wide prevalence of psychiatric and psychosocial problems in the community. Family physicians are the doctors who currently deliver the bulk of mental health care in the community. Thus, the training of family physicians assumes increased importance, with the goals being improved skills to detect and treat mental health issues in their patient population. In Canada, the family medicine residency is a two year program. In this paper, we discuss the development of a third year program in psychiatry for family medicine residents who have finished their second year. It is linked to the Department of Family Medicine at McMaster University. The program at McMaster University involves a core portion, along with significant periods of elective time. This flexibility allows candidates to pursue individual needs and interests. The program is divided into one or two month blocks of times, along with some horizontal placements that continue throughout the year. The blocks involve work in major psychiatric domains, such as mood disorders clinics, anxiety disorders clinics, and psychotic disorders clinics. The horizontal blocks involve psychotherapy supervision as well as working as a psychiatric consultant in different family medicine clinics, in the ”collaborative care” model. We hope to share our experiences as an administrator of this program. We will encourage discussion from the participants as to how aspects of this program can be brought to their communities.

Summary

In this communication, we focus on the experiences of young adults aged 18 to 35 years old accessing institutional and community-based mental health care services, defining the place, role and effect of these care trajectories in young adults’ lives. Our results come from the analysis of 30 interviews with young adults living with mental-related issues or diagnoses as well as 15 mental health care or social service workers involved in services for young adults living with mental health-related issues. One of our goals was to better understand the changing needs of this population and how services were adapting to their changing realities, in a context where experiences of transition into adulthood are also becoming more diverse. We also looked at how their different social and professional trajectories were articulated with institutional care trajectories. More specifically, we turn to defining how an increasing number of young adults who have accessed mental health care services in post-secondary institutions learn to use the knowledge they have developed and the diagnoses they have received in the process to facilitate access to services in other situations, outside of their education trajectory. In contrast, young adults who chose not to pursue post-secondary education, or were unable to, report more issues accessing mental health care-related services, including involuntary hospitalizations and experiences with health and social services characterized as traumatic.

Summary

With recent technological advances, behavioral health clinicians are challenged to learn behavioral intervention technologies (BITs) in order to promote positive change for patients. Over time, different schools of thought developed psychological, emotional, behavioral, and relational techniques, homework, and interventions to guide the time-sensitive behavioral health encounters with patients. Recent technological advances have introduced clinicians to the use of behavioral intervention technologies (BITs), which are applications that utilize mobile phones, tablets, computers, and other processes to assist patients in achieving behavioral health goals. In this workshop, we demonstrate through clinical case studies and experiential activities that integrating BITs not only enhances therapeutic techniques and goals but also helps the patients internalize the process of learning. Internalizing or developing personal mental models of change may help patients to sustain their gains and become effective problem solvers. Examples of web-based technologies, social media, and assistive technologies are reviewed for their clinical utility and ability to promote optimal functioning. We also integrate lessons from diffusion of innovation literature to help clinicians develop a framework they can use to translate technological and non-traditional means of behavior change into behavioral health work. While there are numerous technological advances occurring at a fast rate, there is a need for clinicians to help clients appropriately utilize BITs in a way that promotes positive change. We look to integrate a systemic lens on BITs that strengthen social ties and networks. We conclude with recommendations for future clinical, research, and policy implications for BIT and behavioral health clinicians.

Summary

It has long been recognized that perinatal mental health conditions are common and, if not treated, can lead to poor outcomes for mothers, infants and families. Despite this, a minority of women who experience mental health symptoms in the peripartum period receive treatment. Further, screening alone for mental health symptoms among women in the peri-partum is insufficient to ensure adequate treatment is obtained. There is therefore a critical need for effective and proactive programs to provide support, address barriers to care, and facilitate engagement in care, especially in at-risk populations where rates of mental health conditions are elevated. Obstacles to care include limited access to mental health services, inadequate information and education regarding perinatal mental healthcare and treatments, stigma, fragmentation of services, and difficulty navigating healthcare systems. Fortunately, the Collaborative Care Model provides an effective framework to address these obstacles. We present a Perinatal Care Management Program designed to promote engagement and address obstacles to care in one at risk population, women Veterans using VA maternity care in the Veterans Affairs San Diego Healthcare System, where all these challenges exist. This proactive program is based on the principals Collaborate Care Model with modifications to address the specific needs of women Veterans in the peripartum and includes targeted screening, education, triage, referral management, access to appropriate treatment, care management, measurement-based care, and coordination of care. Modern approaches including virtual care are leveraged to reduce patient burden and increase access. The interprofessional perinatal care coordination team, consisting of RN care manager, psychologist, and psychiatrist makes optimal use of limited resources to maximize timely access to specialized care and promotes interdisciplinary coordination of care. Presenters will give an overview of the program and how it is working in the VA San Diego Healthcare System including discussion of obstacles to implementation, lessons learned, and possible applications within other at-risk populations and in non-federal healthcare settings.

Summary

The Black Lives Matter movement has brought much needed awareness to the systemic racism and marginalization that plagues our country. This has caused many healthcare organizations to take a look at their role in this injustice and what they can do to enact change. At CWFM, the family medicine residents are taught how to use the Contextual Interview (CI) as a tool to develop a sense of patients lives outside of the clinic walls. This allows for a better understanding of symptoms, functioning, and values which in turn facilitate patient-provider relationship and treatment plans. Role-plays are one of the teaching modalities used for the contextual interview. During these role-plays specific prompts facilitate in-depth discussion about how the CI also provides a glimpse into sources of privilege and marginalization as well as how their identities impact a person’s experience with the healthcare system. This presentation will provide a brief overview of the CI and how it can be the launching pad for building awareness amongst medical and behavioral health learners about racism and marginalization during case discussions. Attendees will hear directly from one of our medical residents about her experience with this training. Lastly, attendees will have the opportunity to share their feedback and identify action steps to take against systemic racism.

Summary

Background: Trauma-informed primary care (TIPC) realizes the impact of trauma, recognizes the signs and symptoms of trauma, and responds in a manner to avoid re-traumatization. Screening for adverse childhood experiences (ACEs) is a component of TIPC as interventions can mitigate the development of poor health outcomes. Since 2012, the American Academy of Pediatrics has urged physicians to address toxic stress in primary care. Despite this, as few as four percent of physicians routinely screen and intervene for ACEs. Rational: This presentation highlights resident physicians’ perceptions of TIPC training and identifies how graduate medical educators can improve training and screening processes for ACEs. Method: Thirty-Eight Family Medicine residents completed a survey on TIPC. Survey responses that were quantitative were analyzed using aggregated descriptive statistics (means, standard deviations, frequencies) with SPSS (version 26.0). Open-ended survey responses were analyzed using a thematic analysis approach. Thematic analysis follows an inductive process of becoming familiar with the data, generating initial codes, and then identifying and refining common patterns or themes across qualitative data. Investigators independently coded the open-ended responses and reached a consensus on an agreed coding framework. Based on this framework, the study team then completed the remaining coding and recursively refined a thematic structure through discussion. Patterns of commonality and divergent views were identified. The research team then developed the final themes by consensus. Results: Fifty-percent of participants identified screening for ACEs as useful. However, only 38% were confident in “ability to screen for ACEs”, and only 21% were confident in “following-up with information collected during screening”. Forty-five percent indicated “usually” suggesting a behavioral health referral, and 29% “usually” offered medication to relieve relevant symptoms. Regarding barriers, 93% of participants indicated “lack of time for initial screening”, and 100% identified “lack of time to provide brief intervention”. Nearly 68% noted “discomfort in assessment”, 62% perceived “lack of ability to help”, and 51% perceived “competing primary care recommendations”. Presentation: We will provide an introduction to TIPC (10 min). Second, methods of this study will be shared (15 min). Third, results from the study will be identified (10 min). Fourth, we will discuss limitations, next directions, and conclusions of the study (5 min). Fifth, we will provide time for the audience to discuss their exposure to and experience with TIPC (10 min). We will conclude with Q&A (10 min).

Summary

Background: Children and adolescents living in families economically affected by the pandemic are more susceptible to experience negative mental health repercussions. This scoping review aimed to identify and synthesize relevant interventions and recommendations to better support children and adolescents’ mental health during the pandemic, while identifying ethical challenges. Description of the population sampled: Documents were included in this review based on 5 criteria: (1) addressing mental health or mental well-being; and (2) related to SARS-CoV-2, SARS-CoV-1 or influenza disease outbreaks; (3) targeting children and adolescents’ mental health; (4) applicable to the Canadian context; (5) published between 1990-2020; and (6) in English or French. Study Design: A rapid scoping review methodology was used to address our research question. Searches in Medline, CINAHL, and PsycInfo databases as well as Google and Governmental and Professional Associations’ websites were performed. Procedures and Measures Used to Collect the Data: Data were extracted to an Excel table, collated and summarized using numerical summaries and interpretive analyses. Data extraction and analysis were oriented by our review questions, following a pragmatic approach. It involved the use of a critical appraisal tools from the Joanna Briggs Institute. Key Results and conclusions: A total of 100 articles were included. All of the interventions are based on telehealth, whereas the recommendations pertain to technology use, daily routines, and child-caregiver relationship. Various types of telehealth interventions, such as telepractice and self-directed online programs, were implemented within diverse healthcare contexts. A key ethical challenge that arises due to the pandemic is equitable service access. Families’ varying socio-economic status and residing in rural and remote communities can be a limiting factor to accessing remote services.

Summary

Clinicians and administrators are often interested in implementing new interventions in integrated care settings to increase access to effective treatments but may lack training or experience in program evaluation (PE). This presentation will teach clinicians how to design program evaluations for group interventions. To illustrate this process, we will describe a PE we conducted of a primary care mental health group intervention: the Managing Stress and Emotions Group (MSEG), a brief five session group adaptation of the Unified Protocol, a transdiagnostic mental health treatment (De Paul & Caver, 2020). We conducted a PE to examine its impact on anxiety and depression among a racially and ethnically diverse Veteran patient population. We are now offering MSEG completely via telehealth to increase safe access to treatment during the pandemic, which has introduced some challenges for collecting outcome data . After briefly describing our PE (10 minutes), the presenters will teach how to design a program evaluation through identifying the problem and outcomes to measure, selecting the group/class intervention, selecting and administering measures, how to analyze the data, and special considerations for the unique challenges associated with PE for telehealth groups/classes (20 minutes). We will facilitate hands-on small group exercises via virtual break-out groups for participants to practice designing a PE using worksheets we will provide (15 minutes) and then provide an opportunity for the small groups to share their PE plans, receive feedback from presenters, and engage in large group discussion and Q&A (15 minutes). This presentation addresses the conference theme of telehealth and teaches clinicians helpful skills for evaluating interventions being delivered in their clinics, which will help to equip CFHA members to contribute to the empirical evidence base for integrated care.

Summary

American Indians and Alaska Natives born today are expected to die 5.5 years earlier than the United States all races population (73.0 years to 78.5 years, respectively). They die at higher rates than other Americans in many categories, including diabetes mellitus, assault/homicide, intentional self-harm/suicide, and chronic lower respiratory diseases. This presentation will describe barriers to health care experienced by Native Americans, including stigma and lack of a spiritual focus. The presenters will also suggest best practices for providing primary care services to Native Americans. A case presentation will be used to demonstrate a tool for better engaging Native Americans in care. Participants will have an opportunity to discuss recommended engagement strategies and the intervention tool (The Life Circle) illustrated in the case presentation.

Summary

Inequities in care stem, in part, from inequities in research. We conducted a comparative effectiveness trial on integrating behavioral health for people with multiple, chronic conditions (MCCs). We wanted to improve MCC community engagement and engage more voices of this marginalized, often silent, population. We asked 3,895 of our patient survey respondents for permission to contact them for an additional project; 90% agreed. The 398 respondents who agreed to receive more information were offered an opportunity to test a structured process of engagement in research using two virtual platforms: synchronous (Zoom) and asynchronous (Slack). Of these, 90 attended introduction orientation sessions and 59 patients and caregivers were able to participate in a series of 10 weekly conversations on these platforms. Participants represented 15 U.S. states with distributions of age, education, gender, race, ethnicity, marital, and employment status reflecting the population. Participants were grouped into five cohorts of 8-12 members, facilitated by providers, doctoral students, or patient advisors of the MCC community. Conversation was structured using 3 facilitated engagement processes: affinity diagraming, sharing lived experiences, and using an appreciative response process when engaged in collaboration. This workshop will introduce research stakeholders (patients, clinicians, researchers, and others) to the Partnering Guide tools and processes that resulted from this project. Attendees will trial the core tools of engagement. A timeline for a 60 minute workshop: 0-10: Introduction to the project, its development with MCC community members, and evaluation of outcomes 10-20: Review of the engagement tools on virtual platforms (if in person, attendees will use their own laptops or devices) 20-40: Trial of one engagement tool in small groups 40-55: Use of the appreciative response process to provide feedback 55-60: Final questions and access to the Partnering Guide for future use

Summary

SCOPE (Seamless Care Optimizing the Patient Experience) is a virtual, multidisciplinary, hub-based program that supports solo, community-based primary care providers (PCPs) in Toronto to navigate appropriate hospital and community services for patients with complex medical and psychosocial needs. A strongly identified need for mental health support led to the development of a mental health team consisting of a social worker and a psychiatrist in Fall 2016. Taking an iterative approach to adapt to PCP and patient needs, and with increasing efficiency, at 4 years of operation, the program has grown to serve 100 PCPs, with a total of 2121 referrals. SCOPE-MH uses a stepped-care approach, keeping the patient in the PCP’s care; connecting patients with appropriate and least intensive services; and, promoting equitable care and use of existing resources. The program’s level of intervention therefore varies in intensity, providing resource navigation, counselling, short-term case management, bridging support, psychiatric consults, and brief follow-up as needed. Past PCP and patient feedback, and referral tracking, have highlighted the success of direct patient support, particularly for patients with psychosocial complexity and who face barriers to accessing care through traditional pathways. The integration of social and psychiatric care, and the development of strong links with PCPs, has allowed SCOPE to develop as a flexible, low-barrier access service, resilient to the pandemic’s pressures around care delivery. Currently, a formal quality improvement (QI) evaluation is being conducted, which takes into account the impact of the Covid pandemic and the resulting shift to virtual care delivery. The evaluation follows the RE-AIM framework, measuring Reach, Adoption, Implementation and Maintenance (Midboe, Martino et al. 2018). To help us understand both patients’ and PCPs’ experiences, the evaluation includes a survey of Patient Reported Experience Measures (PREMS, n=30) related to the service and qualitative surveys with PCPs (target n=100). We will also collect demographic information, mental health diagnosis, and level of support received with the SCOPE MH program. We expect that the results of the QI evaluation will allow SCOPE MH to implement changes to further improve patient outcomes, create enhanced care pathways, and promote integrative and collaborative care. As of March 2021, there are 8 unique SCOPE hub sites, serving 829 PCPs total across Toronto and the GTA (Greater Toronto Area). The results of the evaluation will also inform expansion of care to other communities outside the initial area in which SCOPE-MH was developed (Midwest Toronto area).

Summary

The COVID-19 pandemic has led to the almost universal adoption of telemedicine technology to allow doctors, behavioral health clinicians, and other health team members to connect with patients. This wide implementation of telemedicine has outstripped the adaptation of team-based routines of successful integrated care to the technology. This is especially true for a group of patients with complex chronic illnesses and behavioral health needs who are best helped by a team offering “high touch care” (Long, et al., 2017). This program will be a public screening of a video that demonstrates the elements of team-based patient-centered care using telemedicine. The video will be approximately 20 minutes long and demonstrate the primary care visit of a patient with complex health needs with a team. The rest of the session will be commentary by Dr. Blount on the elements of patient-centered team-based care being enacted, plus questions and discussion.

Summary

Burn-out is prevalent among health care providers. Recent literature suggests burnout rates among mental health providers have been exacerbated by the COVID 19 pandemic, and behavioral health consultants (BHC’s) are not immune to this challenge. Many studies suggest that practicing resiliency techniques will lower rates of burn-out in various medical specialties. This pilot study hypothesizes that a virtual, interactive, small group format facilitated by a peer coach will reduce burnout over the study period. This interactive presentation will review the results of a pilot study aimed at improving resiliency in BHC’s and will engage participants in resilience building strategies. The content of this pilot study has been used to teach our residents and fellows about resiliency and is based on the book “Everyday Resilience”, which is a guide to developing resiliency written by master coach and physician, Gail Gazelle. Topics of discussion include coaching on connection, flexibility, perseverance, self-regulation, positivity, and self-care. The intervention consists of eight, 60 minute, virtual, interactive sessions occurring every 2 weeks led by a physician coach. These sessions are held during work hours which reflects the commitment of the institution to improving wellbeing among its providers. Pre-work is completed and reviewed at each session. Participants also receive an email each week that features a brief resiliency topic. Participants are encouraged to choose a resiliency buddy from the cohort to offer encouragement to and to hold accountable during the intervention. Pre and post intervention measures include the Mini-Z Burnout survey. Analysis will include comparison of group and individual pre and post intervention data. Data is being collected at the time of this submission. The presenters assert that resiliency interventions like this, performed by healthcare peers can improve wellbeing, camaraderie and reduce burnout among provider populations such as BHC’s. Further investigation as to the long-term retention of these resiliency habits has yet to be completed.

Summary

I will present the application and importance of collaborative-informed principles when working with fibromyalgia patients and other mental health and medical professionals. The presentation will include data of common lived experiences of fibromyalgia patients and the typical care provided so they are better understood while being treated. Some of the lived experiences being discussed will include the negative perceptions of fibromyalgia patients in the medical and mental health community and how this affects these population. By having dialogical conversations, it permits the learning of a patient’s language, meanings, experiences, and knowledge through their narratives enabling the ability to facilitate a conversation where all involved can co-create a treatment plan(s) and goals. A key factor is how accepting and acknowledging the expertise of the patient concerning their narratives and experiences opens an avenue to mutual respect within all professional and treating relationships. To give the audience a better understanding of the use of collaborative approaches I will provide contextual information regarding popular care and treatment planning allowing space for shifts on how mental health and medical professionals can improve the quality of care provided to fibromyalgia patients. In addition, an explanation on how diversity, culture, and inclusion plays a vital role in the joining and respect between patients and their mental health and medical team. An example of a form of collaborating work will be provided such as medical family therapy and how it can be beneficial. Keywords: collaborative-based principles, fibromyalgia, fibromyalgia patients, mental health and medical professionals, treatment planning, medical family therapy, lived experiences, language, meaning, narratives, diversity, culture, inclusion

Summary

As we grapple with the syndemic of the combined pandemics of systemic racism and COVID-19, many of us feel compelled to join the global call for social justice as we see the racialized disparities of death and despair, both locally and globally.  Dr. Edgoose has spent her career advocating for vulnerable and marginalized populations. She will share her story engaging others in promoting and developing inward and outward-facing strategies as her department strives to become an anti-racist, multicultural organization driven to improve health for all people.

“It is crucial for the future of the Black liberation struggle that we remain ever mindful that ours is a shared struggle, that we are each other’s fate.”

— bell hooks

Summary

This reprise from our 2020 conference will feature the same panelists plus new CFHA President, Colleen Cordes, engage in a discussion of the road we have traveled in 2021 as we cope with the aftermath of the pandemic. What did we learn? How are we changed? Did we make any progress with issues of equity and justice? Where do we go from here? Moderated by CFHA Chief Executive Officer Neftali Serrano, this powerful 2021 session will help us gather our thoughts as a community.

Summary

Tyler Simmonds speaks openly about his lived experiences with depression and anxiety – Rather that be through public speaking, or his award-winning film work. In this session he speaks about how the affects this pandemic has had on our mental health as a collective, not only because of the COVID-19 virus and lockdowns but because of the social injustice we have all been forced to give our attention.

Summary

Physicians and other medical professionals are crucial to the future of team-based, integrated care. How do we train and cultivate champions for integrated care within this crucial portion of the workforce? This panel, comprised of representatives from each of the key developmental stages of the medical workforce, from medical student to working professional, provide insight into how we can ensure that the workforce is prepared and transformed for the modern care team.

Summary

This presentation will provide details on the creation of an integrated behavioral health provider-training program for rural northwest Alabama that builds on the extension for community healthcare outcomes (ECHO) model. This intervention has been used successfully in other rural areas with substance use disorders and other complex health conditions. Arising from the Greater Rural Opioid Wellness (GROW) Project, this intervention combines the expertise of psychiatry, social work, and psychology, with the rotating expertise of invited speakers to provide regular opportunities for partners in the consortium to receive continuing education and training that builds competence with opioid use disorder treatment and management. The GROW ECHO uses a standard framework to provide training. 1) Brief introductions to build a sense of community, 2) A short didactic of 15 minutes on relevant content, followed by question and answer with all attendees, 3) De-identified case presentation(s) that prompt discussion and recommendations related to best-practices and advice on care, followed by additional questions and answers. Both experts and peers will share feedback and recommendations for providing high-quality care and resolving problems throughout the session. Didactic content covers topics such as harm reduction, mindfulness in recovery, best practices in opioid prescribing, opioid education for a novice patient, strategies to improve reimbursement from large payers, and ways of enhancing integrated behavioral health in a primary care setting. Notably, this model provides practitioners with educational resources and interactive consultation with experienced professionals that can produce enhanced access for community members to specialty expertise for opioid use disorders. This specialty consultation can enhance the confidence of providers to provide integrated opioid care to the top of their license. In addition to the information described above, the presentation will cover topics related to the resources available from the ECHO Program, types of assessments, recruitment and engagement techniques, and advice around scheduling and recruiting speakers. Discussion will be modeled on the GROW ECHO, allowing time for interactive question and answer sharing between peers and experts.

Summary

Kickstand is an Alberta-based, integrated youth services initiative that seeks to bring together a range of primary care, mental health, substance use and social services, as a one stop shop model of care. We hope to transform access to care by aligning existing youth services in such a way that young people and their families only need to walk through one door to be connected to all the services they need within Alberta’s health system. We know it can be hard to cope with everything that “growing up” throws at you; we’ve all been there. Exacerbating this, young people now face being physically separated from important people and activities in their support system. This is why Kickstand has partnered with Dr Vincent Agyapong, psychiatrist and professor (University of Alberta), to create MoreGoodDays, a supportive text messaging program designed to help alleviate these struggles. MoreGoodDays is a daily dose of inspiration and advice delivered to users’ phones via text message and has been created through extensive engagement with young people in Alberta. It is an evidence-based, evidence-generating tool proven to be helpful in developing healthy coping skills and resiliency. Evidence from two similar, Alberta-based, text messaging programs, Text4Mood and Text4Hope, had respondents report increased mental well-being, feelings of hopefulness and increased perception of being in-charge of depression and anxiety symptoms. Additionally, subscribers to Text4Hope who had received daily messages demonstrated lower prevalence rates for moderate/high stress, anxiety and depression symptoms, compared to people who did not receive daily messages. Our presentation will cover the approach we took to embed youth engagement into every phase of this project, tell you more about the project itself, as well as describe the evidence for supportive text messaging programs like it. MoreGoodDays is a small but important first step to help young people in Alberta to have more good days.

Summary

Background/Rationale: Indigenous peoples carry a heavier burden of chronic disease and associated risk factors than other populations in Canada, with rates of diabetes being particularly elevated. In Saskatchewan, for example, First Nations and Métis people are overrepresented on waiting lists for kidney transplants: while Indigenous people make up 16.3 per cent of the provincial population, over half of those on the waiting list for a kidney transplant self-identify as First Nations or Métis in an informal audit. However, to date there has been little research focused on Indigenous people and organ donation and transplantation (ODT) in Canada. A commonly held belief among Canadian health care workers is that Indigenous people are not in favor of organ donation or transplantation, and yet it is more complex than this, with varying beliefs dependent on the age group, rural or urban status, Indigenous identity (e.g. Cree, Saulteaux, Métis, Inuit), and immediacy of transplant need, among other factors. Population, Study Design: To explore this complex area of health more, we convened a think tank of Indigenous Elders and knowledge keepers, Indigenous transplant recipients and living donors, Indigenous and non-Indigenous researchers, transplant surgeons, physicians and other healthcare providers. This think tank has met monthly since May 2019, funded with several research grants. The think tank is part of a larger mixed methods study on ODT and Indigenous people in Canada. Key Results/Conclusions to date: What is clear from our ongoing discussions is the desire of Indigenous peoples to have more information about organ donation and transplantation, the need for greater inclusion of Indigenous health leaders in provincial and national ODT decision making, and healthcare systems to be better informed and responsive to the needs of Indigenous patients and families, including addressing questions of healthcare equity.

Summary

If you surveyed BHCs, how many would agree that traditional psychological batteries of any kind have a place in the PCBH model? We, the presenters, believe likely most if not all BHCs would answer “no”. The PCBH model is defined as a population-based care model that mimics the pace of primary care. If you considered visit length alone, most psychological batteries are much longer than 30 minutes. Time alone is often cited for the reasons behind a “no” response to including such batteries within this model of care while additional reasons may include: not within the scope of the role of a BHC, unnecessary to help patients with functional improvement goals, and the challenges of cost/billing of psychological testing services. But what if these batteries did have utility in the PCBH model, could BHCs adapt traditional several hour long batteries to fit the needs of primary care? This presentation will provide an overview of a clinical pathway for adult ADHD that used traditional psychological batteries in a “PCBH friendly” approach with a focus on functional improvements. The pathway consisted of an initial primary care provider visit and three behavioral health visits. All visits were kept within the traditional PCBH model timeframe, about 30 minutes in length. The audience will be provided both qualitative and quantitative data on how the pathway was designed, what psychological batteries were chosen and why, outcomes and lessons learned from this pilot study and possible other future pathways that may include psychological batteries within the PCBH model.

Summary

Suicide is a leading cause of death in the United States and a preventable public health problem. In 2019, suicide took the lives of 47,511 Americans and it is estimated that an additional 1.4 million adults aged 18 years or older made non-fatal suicide attempts. Primary care providers are uniquely positioned to identify suicide risk and intervene. Roughly 45 percent of people who die by suicide visit a primary care provider in the month before their death. This far exceeds the one in five that have contact with mental health services during the same timeframe before death by suicide. Taken together these statistics demonstrate that primary care providers have access to patients at risk for suicide during a crucial window for intervention. Suicide Safer Care, sometimes called Zero Suicide, outlines clinical elements for improving care for suicidal patients including identifying at risk patients through screening and assessment, counseling on access to lethal means and creating a collaborative safety plan, making a referral to mental health services, and staying in touch during transitions in care. Patients are typically identified for Collaborative Care through the use of the Patient Health Questionnaire-9 (PHQ-9), a depression screening tool that asks about recent suicidal ideation in Question 9. As a result of implementing this screening tool, many patients at risk for suicide are identified in primary care settings, necessitating further assessment, care, safety planning, resources, and treatment. This presentation will describe the development and use of a population health registry to manage suicide risk among approximately 3,700 primary care patients enrolled in Collaborative Care Management across seven states. The registry’s use in Collaborative Care settings allows for substantially higher access to needed services than would be received as part of a traditional mental health referral. It facilitates more flexible and comprehensive follow up than treatment as usual, despite outpatient mental health being viewed traditionally as a “higher level of care.” Criteria for inclusion on the registry include endorsement of suicidal thoughts or behaviors on the PHQ’s Question 9 or Columbia- Suicide Severity Rating Scale (C-SSRS). Variables include, among others, if a positive screening for suicide risk resulted in appropriate assessment, provision of evidence-based interventions for suicide including the Safety Planning Intervention and Lethal Means Counseling, and if a member of the care team has connected with the patient in the past seven days. Patients on the registry are prioritized for psychiatric consultation. Behavioral care managers can utilize the registry to manage their panel of at-risk patients and managers can report by patients assigned to their supervisees, practice, or larger geographic area to ensure the care provided is consistent with the organization’s suicide safe care practices and policies.

Summary

This presentation will provide details on the creation of an integrated behavioral health provider-training program for rural northwest Alabama that builds on the extension for community healthcare outcomes (ECHO) model. This intervention has been used successfully in other rural areas with substance use disorders and other complex health conditions. Arising from the Greater Rural Opioid Wellness (GROW) Project, this intervention combines the expertise of psychiatry, social work, and psychology, with the rotating expertise of invited speakers to provide regular opportunities for partners in the consortium to receive continuing education and training that builds competence with opioid use disorder treatment and management. The GROW ECHO uses a standard framework to provide training. 1) Brief introductions to build a sense of community, 2) A short didactic of 15 minutes on relevant content, followed by question and answer with all attendees, 3) De-identified case presentation(s) that prompt discussion and recommendations related to best-practices and advice on care, followed by additional questions and answers. Both experts and peers will share feedback and recommendations for providing high-quality care and resolving problems throughout the session. Didactic content covers topics such as harm reduction, mindfulness in recovery, best practices in opioid prescribing, opioid education for a novice patient, strategies to improve reimbursement from large payers, and ways of enhancing integrated behavioral health in a primary care setting. Notably, this model provides practitioners with educational resources and interactive consultation with experienced professionals that can produce enhanced access for community members to specialty expertise for opioid use disorders. This specialty consultation can enhance the confidence of providers to provide integrated opioid care to the top of their license. In addition to the information described above, the presentation will cover topics related to the resources available from the ECHO Program, types of assessments, recruitment and engagement techniques, and advice around scheduling and recruiting speakers. Discussion will be modeled on the GROW ECHO, allowing time for interactive question and answer sharing between peers and experts.

Summary

The COVID-19 pandemic has significantly altered daily life for most individuals. Its impact on mental health has been substantial, with increased isolation, an exacerbation of existing mental health concerns, including substance use, depression and anxiety. It has led to medical professional burnout and taxing on the healthcare system, grief, and loss (loss of job or financial stability/housing/normalcy/in person school/social activities) as well as concerns for an increase in suicidality, domestic violence and abuse. The COVID-19 pandemic has also impacted how integrated behavioral health or PCBH models of care are occurring. With the rapid expansion of telehealth services, and many during the initial months of the pandemic practicing exclusively remotely, team-based care shifted from sharing space, hallway discussions, and in-person warm hand-offs to virtual attempts to replicate this integration. The University of Colorado has a robust history of PCBH. Now, with 1 year into the pandemic, we have an opportunity to reflect on how we have risen to the challenge of meeting patient demands in a virtual and hybrid in person/virtual capacity, and what we have observed in terms of the shifting needs of individuals, the acceptability of telehealth for behavioral health services, and the access this has offered to underserved and marginalized populations. A program evaluation comparing how this work has shifted in the last year as compared to the year prior has yielded some interesting although perhaps not surprising findings. Primary care has seen a 313% increase in anxiety as primary presenting concern, a 290% increase for depression, a 458% increase in PTSD and a 477% increase in alcohol related disorders. The number of patients served between mid-March 2019-mid-March 2020 as compared to mid-March 2020-mid-March 2021 has increased by 574 individuals. Patients served in primary care with a behavioral health episode of care increased by 45%, from 1,238 in 2019-2020 to 1,802 in 2020-2021. The population served in the expanded integrated telehealth space has also grown more diverse, with a 366% increase in patients who identify as Hispanic, 437% increase in patients who identify as Black, and a 655% increase in patients who identify as Asian between the two years, reflecting a potential increase in access to behavioral health services with the expansion of telehealth. Implications for health care policy and health equity will be discussed.

Summary

The PPv2 (outil Psychoéducatif sur la Psychose) is a medium sized spiral bound 24 pages patient education document that can easily be carried around by mental health care professional (HCP) who often need to intervene with their patients in the community. The picture-rich document was developed 5 years ago in French and is used to explain the symptoms and implications of psychosis in a non-threatening way to patients. More than just being educational, it was found to foster therapeutic alliance as a relational medium between the HCP and the patient. It was also meant to standardize the practice of psychoeducational interventions with a challenging cohort that often has limited insight. With the feedback from users, the PPv2 has evolved and has been reedited many times over the years. It has been translated in English and Chinese. Only the most useful and practical elements of the PPv2 have survived the test of time. Among those are the ones depicting the modern patient-centered biopsychosocioexistential (BPSE) model of care which has been termed “the 4 pillars of treatment”. The model doesn’t only pertain to the treatment of psychosis or other mental health disorders, but to all conditions that require more than just the biological/pharmacological attention such as cancers, diabetes and other chronic diseases. The model reminds the patient that he/she is an active actor of his/her own health and life and that illness isn’t a fatality. He can do much more than just take his pills. An easily accessible electronic online PPv2 (ePPv2) assorted with over 60 additional web-integrated apps were quickly made freely available to everyone during the pandemic to provide patient education through the screen: repitpsychose.org That ePPv2 allows the user to resize different parts of the images, add text, draw over the original psychoeducational image… Hence, thanks to the share screen capabilities of videoconsultations, the HCP can co-create with his patient a personalized BPSE treatment plan which he can then easily be saved in an electronic medical record, sent to an email or SMS # with a few clicks. These become BPSE picture prescriptions. The required interactivity in the use of the ePPv2 helps maintaining the engagement of patients during videoconsultations, but also after, as patients can easily remind themselves what can do between appointments by reviewing a few pictures. In contrast with regular medical notes, HCP can also, at a glance, remember the treatment plan or the issues/solutions discussed during last appointment. Less time is spent reviewing charts, more time is spent in continuing the care and work from where things were left. As feelings of isolation, fear and guilt burden many during the pandemic, these personalized prescriptive pictures have been useful to remind patients to care for themselves with healing attitudes: self-compassion, mindfulness, patience, humility, trust to himself, but also trust in the future, which means hope

Summary

Evidence-based modalities developed to treat trauma have become commonplace in outpatient behavioral health practices, but we often struggle to adapt these therapies to the integrated setting where brief intervention is common. In this session, we will present Accelerated Resolution Therapy (ART) as a useful tool for treating trauma in an integrated setting. Accelerated Resolution Therapy has been shown to achieve benefits rapidly, usually within 1-5 sessions, and is effective in treating PTSD and complex trauma as well as other mental health problems such as anxiety, depression, phobias, grief, chronic pain, and relationship issues. We will explore the basics of Accelerated Resolution Therapy, highlight examples of how it has been used effectively in the primary care setting, and discuss both benefits and barriers to implementing this modality. We will focus on the compatibility of this therapy as a brief intervention within the PCBH model and the particular benefit of reduced exposure to vicarious trauma – critical to clinician self-care and preservation in these trying times.

Summary

Engaging clients in their care is a priority across healthcare settings because it improves care quality, lowers healthcare costs and enhances client experience and clinical outcomes. Engagement is also a mechanism through which equity and accessibility can be fostered as part of client-provider encounters and when planning and evaluating integrated care. We conducted a knowledge-to-action project that arose out of a rigorously conducted qualitative study and was guided by the tenets of participatory action research and user-centered design. The qualitative study began with five focus groups with 50 people living with mental health challenges in Toronto and Thunder Bay, followed by a team-based analysis and stakeholder consensus process, and then culminated with co-design sessions with 17 clients and 8 providers. Through this process we produced a toolkit that can facilitate dialogue about mental health challenges between clients and providers. The toolkit highlights client tips when navigating mental health care and can be a resource for providers in numerous clinical and community settings, as well as in the provision of virtual care. This session will: i) outline the rationale to co-develop client-centered practice tools (5 minutes); ii) detail the rigorous qualitative research, deliberative dialogue and consensus building process to refine the knowledge and principles that guided this work (10 minutes); iii) detail the toolkit contents and how it can be applied in diverse practice settings (10 minutes); iv) outline our co-design approach including how it can support program development and evaluation (10 minutes); and v) ensure time for attendees to think about how to apply the toolkit and co-design approaches within their care contexts (25 minutes).