Webcast 04 – Training Medical Residents and Behavioral Health Learners to Manage High Risk Situations in Primary Care & Outpatient Care

Summary

When it comes to identifying and managing high-risk situations in primary care and outpatient care settings, there are many missed opportunities. Forty-five percent of people who have died by suicide attended a primary care appointment in the month preceding (SAMHSHA-HRSA, 2019), despite recommendation by the US Preventive Services Task Force (2016) to screen all adults for depression and validation of Questions 9 on PHQ-9 as a robust predictor of suicide attempts and deaths (Rossom, 2017). In terms of child abuse and neglect identification and management, primary care physicians’ and pediatricians’ reporting rate is very low with over a third of cases physicians classified as very likely to have been caused by child abuse not reported (Flaherty at al., 2008). These care gaps indicate a need for training and education of medical residents and BH learners to adeptly manage these high-risk situations and provide good patient care to those experiencing them (Foster et al., 2017; Hymel at al., 2018). High-risk BH-related situations in a primary care and outpatient care settings include suicidality and homicidality, duty to warn/report, child and elder/incapacited adult abuse and neglect reporting, and domestic and criminal violence reporting. Additional layers of complexity include different state-to-state requirements for medical and BH providers in terms of management and Department of Health and Human Services and/or law enforcement reporting and also related ethical considerations and nuances (Jordan & Pritchard, 2018). During this session, we will (a) identify medical resident and behavioral health learner training/education needs related to high-risk situations in primary care and outpatient integrated behavioral health care settings, (b) share and discuss one Family Medicine residency program’s curriculum for training medical residents in managing these situations, and (c) explore ways in which participants can take steps towards identifying and addressing high-risk situation training needs at their home institutions.