Training the Future Child Health Care Workforce to Improve the Behavioral Health of Children, Youth, and Families Proceedings of a Workshop (2017) / Chapter Skim
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4 Promising Models
4 Promising Models
Pages 31-44
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From page 31... ...
(Melnyk) • The Primary Care Family Psychology Postdoctoral Fellowship in the Department of Psychiatry, and the Academic Family Medicine Fellowship in the Department of Family Medicine, at the University of Rochester bring psychology and family physician postdoctoral fellows together for interprofessional training in a family systems medicine seminar, assessment and treatment skills, facilitation of interprofessional teams, a professional writing seminar, and discipline-specific train ing, generating greater comfort and effectiveness in providing biopsychosocial health care for children and their families.
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From page 32... ...
Six presenters at the workshop described examples of such models, with a particular emphasis on multigenerational approaches, e vidence-based practices, the involvement of families from varied social demographic groups, interprofessional training, and team-based care. IMPROVING PEDIATRIC AND ADOLESCENT BEHAVIORAL HEALTH SERVICES AND EDUCATION AT OHIO STATE UNIVERSITY Primary care providers are in a unique position to screen, identify, and provide evidence-based management for behavioral health disorders, but many do not feel comfortable managing these issues, said Bernadette Melnyk, associate vice president for health promotion, university chief wellness officer, professor and dean in the College of Nursing, and professor in the College of Medicine at Ohio State University (OSU)
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From page 33... ...
"If we could just give every child and teen cognitive behavior skills-building coping skills as they are growing up as a preventive strategy, we might see much less serious mental illness." INTERPROFESSIONAL POSTDOCTORAL FELLOWSHIP TRAINING ON INTEGRATED HEALTH CARE AT THE UNIVERSITY OF ROCHESTER As Melnyk observed, interprofessional approaches to education and training can help create an integrated pediatric primary care workforce. Susan McDaniel, Dr.
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From page 34... ...
Begun in the late 1980s, the fellowship encompasses psychology postdoctoral fellows, family medicine postdoctoral fellows, medical students, and marriage and family therapy students. The interprofessional fellowship model includes a family systems medicine seminar with the psychology and family medicine fellows and with the family medicine residents during the residents' 5-month psychosocial rotation.
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From page 35... ...
A difficulty in scaling up this model is training pediatric faculty members to have strong collaborative family systems and psychosocial knowledge and skills, while also training psychology faculty members to have strong family systems and integrated primary care skills. A new off-the-shelf curriculum from American Psychology Association's Division of Health Psychology provides an excellent introduction to integrated primary care for psychology faculty who do not have this skill set but understand that their students need this preparation, said McDaniel.
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From page 36... ...
Prepare interprofessional teams to collaborate effectively Under the model, trainees are able to bill under the supervision of their trainers, which has gained the support of the administration. Training time is equally divided among primary care clinics, specialty care clinics, and ambulatory behavioral health clinics, providing a combination of experiences.
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From page 37... ...
PREPARING SOCIAL WORKERS AT THE UNIVERSITY OF NORTH CAROLINA Social workers have been partnering with physicians to address the social determinants of health since the 1800s, noted Lisa de Saxe Zerden, senior associate dean for master's in social work education in the School of Social Work at the University of North Carolina at Chapel Hill. Born out of the social problems exacerbated by the industrial revolution of the 19th century, the profession of social work is today a major provider of behavioral health services in the United States, and the Bureau of Labor Statistics has predicted a 20 percent growth of social work jobs over the next decade (U.S.
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From page 38... ...
A systematic review that eventually focused on 32 reports published between 2000 and 2016 looked at the role of social workers and integrated behavioral health care compared with routine or usual care. It found that social workers have three core functions: care managers, community engagement specialists, and behavioral health specialists and trainers.
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From page 39... ...
Nevertheless, Zerden concluded by pointing to the many opportunities for growth in interprofessional education and practice. INTEGRATED PRIMARY BEHAVIORAL CARE AT CHEROKEE HEALTH SYSTEMS Cherokee Health Systems, a comprehensive community health care organization with 56 clinical sites in 15 counties in Tennessee, has had to embrace training as a way of staffing itself.
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From page 40... ...
It also has training partnerships with five local academic institutions in the areas of family medicine, pediatric medicine, nursing, psychology, social work, nutrition, and pharmacy. The organization refers to its health care approach as "behaviorally enhanced family health care." Behaviorists are embedded in primary care clinics, and Cherokee provides a continuum of specialty behavioral health services.
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From page 41... ...
Other health care disciplines commonly training alongside colocated psychologists include child life specialists, medical specialty fellows, nurses and nurse practitioners, nutritionists, pediatric residents, physical therapists, and social workers. As an example of some of the knowledge competencies proposed for pediatric psychologists most relevant to chronically ill children and families, McCabe cited those developed by Palermo et al.
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From page 42... ...
However, when the medical student who started the program moved on to a residency, "it wasn't sustainable, which is really unfortunate." A range of outcomes for integrated training with chronically ill children and families can be measured, including the number of consults, referrals for services, changes in the length of hospital stays or use of medications, changes in language or communications about behavioral health, graduates' training practices and models of care, and qualitative feedback from families and professionals. For example, Maureen Monaghan in the Department of Endocrinology at Children's National Health System has stated that qualitative interviews with medical providers using a psychosocial screening tool for depression have impacted their management of patients with diabetes, McCabe reported.
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From page 43... ...
Colocation can be supported through medical specialty revenue and billing for behavioral health services. In particular, health and behavior codes can be used in the absence of a behavioral health diagnosis so that someone with a chronic illness or health condition can see a psychologist and the provider can be reimbursed.
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