2023 Extended Learning Opportunities

ELO 01 – It Takes a Village: Building Primary Care-School Collaborations for the Promotion of Youth Resilience & the Prevention of Suicide

Date: Thursday, October 19, 2023, 8:00 – 11:00 AM

Through didactic, reflective, and group work, participants will learn strategies for the promotion of resilience and the prevention of suicide in primary care and school settings, and collectively build tools for a successful implementation of a comprehensive multimodal collaborative approach to suicide prevention.

Suicide is the second leading cause of death for young people 10 to 24 years of age in the United States and worldwide (WHO, 2022). From 2008 to 2018 deaths by suicide in the US have continued to rise in 15–24- and 10–14-year-olds by 42% and 130%, respectively (CDC, 2020).

The evidence indicates that talking to youth about suicidal thoughts and behaviors is not harmful and could result in life-saving benefits (Ayer & Colpe, 2023). Findings from a systematic review and meta-analysis that synthesized the full spectrum of youth suicide prevention approaches suggested that interventions delivered in clinical, educational, and community settings appear to reduce self-harm and/or suicidal ideation (Robinson et al., 2018).

In accordance with international best practices for suicide prevention, most strategies recommend a comprehensive approach to suicide prevention spanning universal approaches (i.e., delivered to the whole population), selective approaches (i.e., delivered to groups or communities believed to be at higher risk of suicide) and indicated approaches (i.e., delivered to individuals displaying suicide-related behaviors). Strategies also recommend interventions operate across a range of settings, including clinical, educational, and community settings (Walsh et al., 2022). Integrated and multimodal suicide prevention programming efforts have been described in the literature as having the potential for a wider impact than stand-alone interventions (Byrne et al., 2022). Many youths—especially marginalized youth who are at increased risk for suicide—face numerous barriers to accessing behavioral health care due to an overall shortage of providers along with financial costs, mental health stigma, and discrimination. In contrast, nearly all US youth have access to school settings, and delivering suicide prevention in schools expands access, regardless of sex/gender, race/ethnicity, and other characteristics that are associated with unequal access to mental health care (Ayer & Colpe, 2023).

Pediatric primary care settings are well-positioned for fostering resilience and promoting peer and family connectedness (Horowitz et al., 2019), as well as providing an opportunity for intervention early in the suicidal trajectory that is currently being missed (Robinson et al., 2018). There is evidence that brief contact interventions in clinical settings and psychoeducation combined with screening in school settings can reduce the frequency of self-harm and suicidal ideation (Robinson et al., 2018).

Integrated behavioral health clinicians are uniquely positioned to foster collaborations and implement evidence-based strategies across clinical and educational settings for the prevention of suicide. In doing so, it is important to take an ecological systems perspective and address suicide prevention inequalities in the intersection among systems (Alvarez et al., 2022). This workshop will take a collective approach to develop these collaborations and strategies.

Objectives:

At the conclusion of this presentation, participants will be able to…

• List the components of a multimodal approach to resilience-building and suicide prevention
• Identify challenges and resources needed for building successful collaborations across primary care and school settings
• Develop a strategy for collaboration across settings

Presenter(s):

• Maria Arrojo, MA, CAGS, LMFT, LMHC, Senior Behavioral Health Integration Manager, Pediatric Physician’s Organization at Children’s (PPOC), Wellesley, MA
• Rachel Petts, PhD, Assistant Professor, School of Psychology and Counseling, Fairleigh Dickinson University, Teaneck, NJ
• Matthew Tolliver, PhD, Director of Behavioral Health, East Tennessee State University, Department of Pediatrics, Assistant Director, ETSU Institute for Integrated Behavioral Health, Johnson City, TN
• Allison Allmon Dixson, PhD, Section Chair of Integrated Care, Department of Behavioral Medicine, Pediatric Psychologist and Behavioral Health Consultant, Pediatrics, Gundersen Health System, La Crosse, WI
• Jessica Sevecke-Hanrahan, PhD, Psychology Internship Program Director, Associate Psychologist, Geisinger Health System-PCBH Peds, Department of Psychiatry and Behavioral Health, Danville, PA
• Tawnya Meadows, PhD, BCBA-D, Director of Pediatric Integrative Services, Geisinger Health System, Department of Psychiatry and Behavioral Health, Danville, PA
• Jonathan Larson, MS, Graduate Student, Wichita State University, Wichita, KS
• Amelia McClelland, PhD, Behavioral Health Consultant, Community Health of Central Washington, Yakima, WA

ELO 02 – The Psychotherapy of Non-Structural Chronic Pain: Challenging Cases

Date: Thursday, October 19, 2023, 8:00 – 11:00 AM

Recent controlled trials (see references) have documented relief of chronic pain (not merely improved coping) from new forms of psychotherapy that focus on trauma, stressful personality traits, unrecognized negative emotions, psychosocial triggers and limitations in self-care skills. However, a significant fraction of patients with nonstructural pain are challenging to diagnose or treat because they don’t recognize the nature or severity of the stresses that are responsible for their symptoms. A series of challenging cases will be presented to illustrate the principles of a successful approach to this population.

Objectives:

At the conclusion of this presentation, participants will be able to…

• Diagnose the psychosocial issues commonly responsible for non-structural pain and medically unexplained symptoms even in patients who don’t recognize their nature or severity
• Enable patients to understand and articulate their stresses despite prior lack of awareness
• Successfully treat patients’ newly revealed psychosocial issues

Presenter(s):

• David Clarke, MD, President, Psychophysiologic Disorders Association; Assistant Director, Center for Ethics. Oregon Health & Science University; Portland, OR

ELO 03 – PCBH Workshop: Do, Teach, Lead  

Date: Thursday, October 19, 2023, 7:00 – 11:00 AM

As an iteration of previous PCBH Community Conversation, this ELO will provide participants an interactive workshop focused on building skills to do the role of BHC, teach/train new BHCs, and lead a team of BHCs. Within all three domains, participants will be able practice and discuss provided interventions (e.g., Contextual Interview), as well as discuss the future iterations of the model.

Abstract – As Primary Care Behavioral Health continues to grow in popularity and implementation, efforts continue to be made to evolve many areas of the model. Particularly, efforts in direct patient care, teaching/training/onboarding new BHCs, and leadership development of PCBH directors have been made. This three-hour workshop hopes to tackle all three areas of focus. Specifically, during the first hour, presenters will briefly discuss the rationale of the model and application of functional contextualism via the Contextual Interview and a framework (i.e., ACCESS-V) when providing direct patient care. During the second hour, the presenters will provide an overview of an intensive and formal onboarding program, allowing participants at the end of the hour to outline their own plans of standardizing onboarding for new BHCs. Finally, the presenters will discuss the leadership strategy of Contextual Leadership and the importance of Seeing, Celebrating and Expecting of BHCs. Similar to the first two hours, participants at the end of the third hour will be provided time to develop their own goals and application of Contextual Leadership within their organization. This ELO will mostly be interactive, role-plays, with some didactic information provided.

Objectives:

At the conclusion of this presentation, participants will be able to…

• Apply the concepts of functional contextualism via the Contextual Interview and ACCESS-V framework
• Describe core components of a robust onboarding of new BHCs to PCBH, as well as develop their own onboarding schedule
• Describe Contextual Leadership via Seeing, Celebrating, and Expecting of BHCs and how this framework can improve BHCs’ overall employee engagement.

Presenter(s):

• David Bauman, PsyD, Behavioral Health Education Director, Community Health of Central Washington, Yakima, WA
• Bridget Beachy, PsyD, Director of Behavioral Health, Community Health of Central Washington, Yakima, WA 

ELO 04 – Principles for Incorporating Multiple Integrated Care Models to Care for an Organization’s Entire Health Care Population: Different Fruits, Same Bowl

Date: Thursday, October 19, 2023, 8:00 – 11:00 AM

This workshop features experienced clinicians and innovators in integrated behavioral health sharing knowledge and expertise in combining different care models to meet population needs. Presenters will offer insights about rewards and challenges to offering both PCBH and CoCM services within a single health care setting. They will provide an overview for these two approaches to integrated care and specific considerations for implementation and sustainability and best practices for workflow and care pathway development.  This workshop support attendees to identify the populations they want to serve, help with planning for their entire behavioral health population, define outcomes and plan to meet these goals.

Objectives:

At the conclusion of this presentation, participants will be able to…

• Discuss the differences and intersections between two distinct integrated behavioral health care models to best meet the needs for a target primary care population
• Describe different options and for workflow and staffing structures when considering more than one service model in integrated behavioral health.
• Describe ways to reach financial sustainability in integrated behavioral health offerings, informed by the billing environment and health system structure.

Presenter(s): 

• Tisha Deen, PhD, Director of Behavioral Health Integration, University of Arkansas for Medical Sciences, Little Rock, AR
• Virna Little, PsyD, LCSW, Co-Founder, Chief Clinical Officer, Concert Health,  Moore, SC
• Monica Williams Harrison, MSW, LCSW, Clinical Trainer & Practice Coach, AIMS Center, University of Washington, Seattle, WA
• Laura Sidari, MD, Director of Cayuga Integrated Behavioral Health, Consulting Psychiatrist, Cayuga Medical Associates, Ithaca, NY

ELO 05 – Collaborative Care Bootcamp

Date: Thursday, October 19, 2023, 8:00 – 11:00 AM

The Collaborative Care (CoCM) Bootcamp is designed for anyone who wants to know how to implement Collaborative Care in a variety of clinical settings and how to effectively sustain a CoCM program. Participants in this session will understand the evidence base for and principles of Collaborative Care, learn Collaborative Care tasks and team roles, develop a business case and billing strategies, initiate development of a shared vision for CoCM implementation, initiate development of clinical workflows, understand registry importance and options, and describe sustainment strategies. We will use a mix of activities and discussion to meet the session goals and you will leave with numerous resources to support your implementation journey. Come learn how Collaborative Care can work for you and your organization!

Objectives:

At the conclusion of this presentation, participants will be able to…

• Define the core principles of Collaborative Care and how they interact for program effectiveness.
• Describe the care team members and their roles in Collaborative Care.

Define the validated measurement tools used most frequently in providing Collaborative Care, their screening cut points and using them for measuring treatment outcomes.

Presenter(s):

• Diane Powers, MBA, MA, Co- Director, AIMS Center at University of Washington, Seattle, WA
• Patty Gibson, MD, Co-Founder and Chief Medical Director, Arkansas Behavioral Health Integration Network, Little Rock, AR

ELO 06 – Chakra Organized Acceptance and Commitment Therapy (COACT): Integrating Yoga Philosophy and ACT in the Treatment of Mind-Body Conditions

Date: Thursday, October 19, 2023, 8:00 – 11:00 AM

This workshop is an introduction to yoga psychology, including basic principles, mechanisms of change, and targets of treatment. Yoga psychology emphasizes a holistic approach and working with the mind and body to facilitate a complete experience of the self. Acceptance and Commitment Therapy (ACT) borrows much of its core philosophy from Yoga and Buddhist practices. This workshop will teach you how to integrate the evidence-based interventions of ACT within a more traditional yoga framework. Key areas for intervention include developing somatic awareness, self-integration, and values-based habits.

Objectives:

• At the conclusion of this presentation, participants will be able to…
  Describe key principles of yoga psychology, including philosophical background and clinical application
• Explain how the mind-body connection contributes to physical symptoms and emotional distress.
• Use Acceptance and Commitment Therapy (ACT) principles to select clinical interventions that facilitate somatic awareness, self-integration, and values-based habits.

Presenter(s):

• Rosemary Hale, PsyD, Behavioral Health Consultant, Riverview Health, Noblesville, IN

ELO 07 – Clinical Supervision in Primary Care: A Skill Development Workshop

Date: Thursday, October 19, 2023, 8:00 – 11:00 AM

The purpose of this workshop is to provide a hands-on training experience on elements of clinical supervision in primary care. Participants will learn how to assess trainee clinical skills, discuss relevant supervision models, employ competency-based training approaches, practice evidence-based precepting, and troubleshoot impaired trainee scenarios. This workshop is for behavioral health clinical supervisors who provide or will provide clinical supervision to prelicensure level behavioral health trainees within the primary care setting.

Objectives:

 At the conclusion of this presentation, participants will be able to…

• Describe the components of effective clinical supervision in primary care.
• Employ clinical teaching approaches for the primary care setting.
• Construct remediation plans for learners in training scenarios common in primary care.

Presenter(s):

• Stacy Ogbeide, PsyD, ABPP, CSOWM, Associate Professor of Family & Community Medicine, UT Health San Antonio, San Antonio, TX
• Yajaira Johnson-Esparza, PhD, Assistant Professor of Family & Community Medicine, UT Health San Antonio, San Antonio, TX
• Gabriela Gibson-Lopez, PsyD, Assistant Professor/Clinical, UT Health San Antonio, San Antonio, TX
• Maribeth Wicoff, PhD, Assistant Professor of Psychiatry, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, PA
• David Bauman, PsyD, Behavioral Health Education Director, Community Health of Central Washington, Yakima, WA
• Jessica Lloyd-Hazlett, PhD, LPC-S, Associate Professor of Counseling, University of Texas, San Antonio, TX
• Bridget Murphy, PhD, Post-Doctoral Fellow, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

ELO 08 – Advanced Skills for Collaborative Care Clinicians: Part II

Date: Thursday, October 19, 2023, 8:00 – 11:00 AM

This activity-based session was updated with different, high-value topics from last year’s session to be beneficial for both new and repeat attendees. This session will provide advanced skills for Collaborative Care clinicians, including primary care providers, behavioral health clinicians, and psychiatric consultants as well as implementation leaders. Activities include using a patient case to identify each team member’s role in managing medications; developing communication workflows for ending an active episode of treatment; and diagnosing and overcoming clinical and implementation challenges.  Participants will be encouraged to bring their own challenges and questions for discussion and problem-solving as a group.

Objectives:

At the conclusion of this presentation, participants will be able to…

• Describe the role of each CoCM team member in managing medications
• Develop or revise communication workflows for ending an episode of active treatment in CoCM
• Identify, diagnose, and implement interventions for clinical and implementation challenges

Presenter(s):

• Jessica Whitfield, MD, MPH, Acting Assistant Professor and Clinical Trainer, AIMS Center, University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA
• Annie McGuire, MS, LMHC, MHA, Clinical Trainer and Practice Coach, AIMS Center, University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA

ELO 09 – Integrated Care For the Medical Professional: How Building a BHI Team Can Help YOU Build Resiliency

Date: Thursday, October 19, 2023, 8:00 – 11:00 AM

PCP buy-in is critical to successful BHI implementation. But often, PCPs “don’t know what they don’t know” when it comes to Integrated Care. Some providers may be aware of different models and approaches to integration, but still feel they have much to learn. Additionally, when a “PCP Champion” is identified as a provider willing to “lead the charge”, he/she often does not have formal training in program development, leadership and managerial skills.

Target Audience:

Medical providers currently working on BHI teams and/or hoping to build integration into their healthcare teams; All members of BHI team, such has BH Clinicians, BH Care Managers and Consulting Psychiatrists

Objectives:

At the conclusion of this presentation, participants will be able to…

• Review Behavioral Health Integration Definitions, Models of Care, and Team Roles
• Discuss the concept of Equifinality and how this relates to building Integrate Care teams
• Apply an infinite mindset to leadership development in BHI

Presenter(s):

• Jennifer Thomas, MD, FASAM, Medical Director of Integrated Behavioral Health, Morris Hospital, Morris, IL
• Andrew Valeras, DO, MPH, FAAFP, FACPM, Director, Preventive Medicine Concord Hospital; Associate Program Director, Dartmouth- Health Leadership – Preventive Medicine Residency, Lebanon, NH
• Jim MacKenzie, DO, Director, Center for Pediatric Collaborative Care, Advocate Children’s Hospital, Park Ridge, IL
• Aimee Burke Valeras, PhD, LICSW, Faculty, NH Dartmouth Family Medicine Residency, Concord Hospital Family Health Center, Concord, NH

ELO 10 – Managing Chronic Illnesses: A Primer for Behavioral Health Consultants

Date: Thursday, October 19, 2023, 12:15 – 3:15 PM

You’re comfortable with the shallow end: treating depression and anxiety.  Come explore the deeper waters of treating chronic medical conditions!

While BHCs can greatly enhance the primary care management of chronic illnesses, these services are limited by our lack of basic knowledge about medical conditions and an understanding of how BHCs can ethically practice at the top of our licenses in this area.  This ELO will equip BHCs with the basics of treating diabetes, functional neurological disorders, and heart disease and provide a template to situate BHC services within the primary care team with other chronic illnesses.

Objectives:

At the conclusion of this presentation, participants will be able to…

• Understand the basics of diabetes, functional neurological disorders, and heart disease.
• Select and justify different interventions for common behavioral and relational struggles for patients with diabetes, FND, and heart disease.
• Identify the role of the clinician, BHC, family, and other significant persons in management and psychopathology of diabetes, FND, and heart disease.

Presenter(s):

• Randall Reitz, PhD, St. Mary’s Family Medicine Residency, Grand Junction, CO
• Krista Bland, MS, MFTC, St Mary’s Family Medicine Residency, Grand Junction, CO
• Tonya Cook, PharmD, St. Mary’s Family Medicine Residency, Grand Junction, CO
• Justin McCarthy, MD, St. Mary’s Family Medicine Residency, Grand Junction, CO
• Maya Obstfeld, MS, MFTC, St. Mary’s Family Medicine Residency, Grand Junction, CO
• Sara Warzecka, MD, St. Mary’s Family Medicine Residency, Grand Junction, CO

ELO 11 – Family Care Toolkit: Easy Steps for Increasing Family-Centeredness in Care

Date: Friday, October 20, 2023, 8:15 – 11:15 AM

This workshop will give participants specific tips, tricks, and tools for increasing family-centered care in their day-to-day practice. We will begin with a brief review of relevant literature on family-centered care outcomes followed by a discussion on applying a systemic/relational approach to family engagement in care and developing culturally responsive family-centered clinic processes.  

Family inclusion in adult and pediatric medical care has been shown to increase treatment plan adherence, improve outcomes, and reduce complications and readmission rates. Yet, for a myriad of reasons, family-centered care is not standard practice. It can be perceived as complex and/or resource intensive. Without sufficient training, practitioners are wary of opening the ‘Pandora’s Box’ that the addition of family brings to care. Additionally, those not trained in relational approaches to care may miss opportunities for family inclusion.

This workshop is intended to help practitioners learn how to use a more systemic/relational lens when approaching individual patient care and identify specific ways to embed that lens in their everyday interactions with families and clinical practice. We will briefly present research on family-centered care to emphasize the relevance of this approach in improving care outcomes and discuss indicators for family inclusion in care (e.g., developmental stage, complexity of care, barriers to care, concerns with treatment adherence, memory loss), steps practitioners can take for including families in patient care, and offer tips and brief interventions to help ‘bring family into the room’ such as asking relationship-centric questions.

Additionally, we will discuss examples of family-centered clinic processes and challenge participants to consider how to create or modify their own clinic processes to be more relationally focused. Lastly, we will offer examples of how different cultures define family, family power structures within groups, and how barriers such as language differences, cultural norms, and practices may impact how we provide culturally responsive, equitable family-centered care.

For each topic area, participants will engage in a facilitated activity to identify how they can apply the material to their clinic/site and build a personalized toolkit for family inclusion in care. We will have a brief break halfway through the workshop and time for questions at the end.

Objectives:

• At the conclusion of this presentation, participants will be able to…
  Understand the importance of including families in care and developing  family-centered interventions based on outcomes research
• Identify specific tools clinicians can use to enhance a relational approach to care with individual patients
• Identify key indicators and processes to include families in patient care

Presenter(s):

• Lisa Zak-Hunter, PhD, LMFT, Director of Behavioral Health, Assistant Professor, St. John’s Family Medicine Residency/University of Minnesota, St. Paul, MN
• Maria Arrojo, MA, CAGS, LMFT, LMHC, Senior Behavioral Health Integration Manager, Pediatric Physician’s Organization at Children’s (PPOC), Wellesley, MA
• Jessica Goodman, PhD, LMFT, Senior Instructor, Departments of Psychiatry and Medicine, University of Rochester, Director, Family Consultation Service, Monroe Community Hospital, Rochester, NY
• Brittany Huelett, PhD, AMFT, Assistant Professor, Texas Woman’s University, Denton, TX
• Daniel Robb, MSW, LICSW, Behavioral Health Integration Manager, Pediatric Physician’s Organization at Children’s (PPOC), Boston Children’s Hospital, Wellesley Hills, MA
• Ben Rosenstein, MA, MD, CAQ in Geriatrics, Assistant Professor, St. John’s Family Medicine Residency/University of Minnesota, St. Paul, MN