Making the Case for Behavioral Health in the New Health Care System
Public health data indicate the following impact healthcare outcomes: health care services (10-15%), genetics (10%), social determinants of health (40%), and behavioral factors (35-40%). Despite this, most of our health care dollars are spent on health care services, not on the factors that have the greatest impact on health. Social determinants include housing, food, poverty, education, air quality, external stressors, and there are a range of programs that can help with those areas. Behavior health is an area which can be integrated within health care, which includes: mental health, substance abuse, and health behaviors (such as sedentary behavior, smoking, and poor diet). In a system reimbursed for outcomes, the health behaviors are an area that can be targeted for improvement. Complex patients who have two or more chronic illnesses are drivers of health care costs; some estimates are that the top 5% of patients in complexity account for over 50% of costs and that these patients, most of the time, have co-morbid behavioral conditions. Thus for both high cost patients, and more typical consumers of services, integrating behavioral health services for all three domains has the potential to improve care and outcome. Improved outcome yields improved health, with cost containment or reduction one of the products of improved patient health. The new health care system is transitioning from fee for service to fee for quality and outcome. This requires both a public health approach and a focus on outcomes for patients.
Integrating Mental Health with Physical Healthcare
Integrated healthcare settings are increasingly turning to screening and evidence-based brief interventions to address treatment engagement, depression, substance use, and other behavioral health concerns in the context of whole-person care. Within the integrated model, Brief Motivational Interviewing (BMI) is one empirically supported approach used to address a variety of change targets seen in physical healthcare. BMI has helped participants progress toward healthy lifestyle goals that include improved physical activity, glycemic control, diet, weight loss, and utilization of mental health services. It is a conversational style applicable across professional roles in a patient-centered medical home environment. BMI is also an integration-friendly tool that can help providers rapidly and collaboratively find a focus within a brief consultation, strengthen the patient-provider relationship, and empower patients in the change planning process.
CE Objectives
At the completion of this workshop, participants will be able to:
- Identify the critical components of a Brief Motivational Interview, distinguishing relational factors from change talk development, while recognizing common motivational enhancement pitfalls
- Describe the 3-step CHANGE model of BMI and apply it to comorbid physical and mental health presentations in brief interactions
- Use a “real” play exercise to practice open questions, reflections, affirmations, summaries, and readiness rulers in moving from engagement to planning
- Describe how BMI fits within an interdisciplinary setting in terms of its training, timing, and use within a 15-minute primary care visit
- Define social and behavioral determinants of health.
- Recognize the three major classes or behavioral determinants of health.
- Identify methods to classify patients in a practice into low risk, moderate risk and high risk.
- Identify at least one quality and one outcome measure in health care that can be used to assess behavioral interventions.
Schedule
- 8:45-9:00 - Sign-in and Continental Breakfast (included)
- 9:00-12:00 - Dr. Tynan: Making the Case for Behavioral Health in the New Health Care System
- 12:00-1:00 - Lunch (included)
- 1:00-4:00 - Dr. Glassman: Integrating Mental Health with Physical Healthcare
About Drs. Tynan and Glassman
Doug Tynan has been with APA for one year as the Director of Integrated Health Care. Board Certified in Clinical Health Psychology and Clinical Child & Adolescent Psychology, he has had a long career health care settings. Following graduate school at Binghamton University, he went on to develop team programs at Cumberland Hospital, a children’s rehabilitation hospital that specialized in recovery from head injury and severe trauma, then a second program at Children’s National Medical Center that reduced re-admissions for children with Type I diabetes by 60% over five years. His most recent endeavor was to develop co-located health and mental health programs in pediatric clinics in medically underserved areas in Delaware. He also implemented effective evidence based group programs for parents and children with ADHD and oppositional defiant behaviors that have been successfully used for over 25 years. He has served as a consultant for Head Start on a national level, and was on the advisory board for the National Child Traumatic Stress Network. He serves on the Editorial Board of Population Health Management, and is a reviewer or editor on five other medical and psychology journals. At APA, he has served as a Council representative from Div. 53, on the Committee for Children Youth and Families and was a founding co-Editor of Clinical Practice in Pediatric Psychology. He also served on the Clinical Health Psychology Board of ABPP for 15 years. A Professor of Pediatrics at Jefferson Medical College, his interests are primarily in the coordination of health, mental health, education and social services to serve families more effectively and efficiently to address the needs of patients of all ages.
Scott Glassman earned his doctorate in Clinical Psychology from the Philadelphia College of Osteopathic Medicine. He is currently an Assistant Professor at PCOM and Associate Director of the Masters in Mental Health Counseling program. Scott is also a consultant for the Family Medicine department at PCOM for patient-centered medical home initiatives. He became a member of the Motivational Interviewing Network of Trainers in September 2012 and has trained for a number of organizations throughout the Philadelphia area. In addition to MI, Scott's clinical and research interests include hope, meaning-making, therapeutic process, interprofessional collaboration, cognitive-behavioral therapy, health psychology, and serious mental illness. His dissertation examined the effects of MI on hope, meaning, empowerment, and service participation in dually diagnosed individuals, highlighting the role of positive emotions in treatment engagement and recovery.
Target Audience
This presentation is intended for mental health professionals, researchers, and graduate students. The instructional level of this presentation is intermediate.
Continuing Education
Philadelphia Behavior Therapy Association is approved by the American Psychological Association to sponsor continuing education for psychologists. Philadelphia Behavior Therapy Association maintains responsibility for this program and its content.
This program provides six (6) hours of CE credits. PBTA is also an authorized provider for CE credits for Professional Counselors, Marriage and Family Therapists, and Clinical Social Workers licensed in the state of Pennsylvania.
APA guidelines do not permit PBTA to issue partial CE credits, thus those who want to receive CE must attend the workshop in its entirety. No refunds are provided for CE programs.
