CFHA Annual Conference

Saturday, October 17, 2015

G6: The Marriage Between Primary Care and Behavioral Health:

Elephants in the Room

Agenda

Brian DeSantis & Frank deGruy

3:30-3:35 Introductions DeSantis, deGruy

3:35-3:40 Overview DeSantis

3:40-3:45 First Exercise deGruy

3:45-4:00 First Elephant DeSantis

4:00-4:15 Second Elephant deGruy

4:15-4:30 General Discussion DeSantis, deGruy

October 2015

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There Are Elephants In This Room!The Marriage Between Primary Care and Behavioral Health: Some Elephants in

the Room

Brian DeSantis, PsyD, ABPP

Director, Behavioral Health

Peak Vista Community Heath Centers Inc.

Frank V. deGruy, MD MSFM

Professor and Chair, Department of Family Medicine

University of Colorado

Collaborative Family Healthcare Association 17th Annual ConferenceOctober 15-17, 2015 Portland, Oregon U.S.A.

Session # 5686472 (G6 in Period 6)

October 17, 2015

B,F

Faculty Disclosure

The presenters of this session have nothad any relevant financial relationships

during the past 12 months.

B

Learning Objectives

At the conclusion of this session, the participant will be able to:

• Identify common challenges to

making the (arranged) marriage of

integrating behavioral health into

primary care work.

• Discuss two covert marital

stressors (elephants in the room)

that should be addressed between

the marital partners.

• List two proposed solutions to

these “elephants” to help achieve

a collaborative and mutually

supportive marriage.

F

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Learning Assessment

• A learning assessment is required for CE credit. Evaluate this session at the end.

• We will leave time for questions and answers at the end of this presentation (and in the middle of it, too).

F

Overview

1. Our Premise: Team-based care is desirable.

2. Marriage and elephants as metaphors: differences

that don’t at first show but matter.

3. We’ll surface two and process them.B

Differences Between Health and

Mental Health Professionals

• Differences in emphasis within the

biopsychosocial model (medical vs relational).

• Language for problem appraisal, diagnosis,

management, and treatment.

• Treatment preferences:

what do you reach for first?

Red is

yummy!

B

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Exercise

Descriptors—adjectives—that reveal

perceptions about medical and behavioral

health professionals

F

Medical Professionals• Cold, insensitive

• Rigid, controlling

• Egotistical, arrogant

• Obsessive compulsive

• Pressed for time

• Technician

• Somatically fixated

F

Behavioral Health Professionals

• Impractical

• Flaky

• Touchy-feely

• Wishy-washy

• Not real docs

• Right-brained

and left-

winged

• Psychosocially

fixated

F

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I’m OK,

You’re Not.

Just eat both.

B

First Elephant

• George, a 65yo WM, w/ DM, RA.

• Wife died 6wks ago, now living alone.

• Can’t sleep, can’t think straight.

• PHQ-9 = 14.

• HbA1c = 9.5

• Joints hurt.

• 15 minute visit.

F,B

(Warm Handoff)F,B

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First Elephant Discussion

• Understanding of problem

• Intervention

• Roles

• Points of conflict

• Possible resolution

B

Second Elephant

• Lushawn, a 32yo BF “can’t

breathe.”

• Husband left her without

warning 1mo ago.

• Very distressed: can’t sleep,

can’t eat, can’t think, no

motivation.

• Best friend suggested

antidepressant.

• She’s here asking for Prozac.

(Warm Handoff)F,B

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Second Elephant Discussion

• Understanding of problem

• Preferred treatment

• Antidepressants vs

psychotherapy vs both

• Differences between clinicians

F,B

General Discussion

• Dealing with hidden

differences

• Patients are part of

the team: ask &

listen

• Strengthening the

partnership

• Leadership

• Other preconditions

for integrated careF,B

References1. Kathol, R.G., deGruy, F., & Rollman, B.L. (2014). Value-based financially

sustainable behavioral health components in patient-centered medical

homes. Annals of Family Medicine, 12(2), 172-175.

2. Duncan, B.L. & Reece, R.J. (2012). Empirically supported treatments, evidence-based treatments, and evidence-based practice. In G. Stricker & T.

Widiger (Eds.), Handbook of psychology: Clinical Psychology (2nd ed., pp. 997-1028). Hoboken, NJ: Wiley.

3. Sparks, J.A., Duncan, B.L. Cohen, D., & Antonuccio, D.O. (2010).

Psychiatric drugs and common factors: An evaluation of risks and benefits for clinical practice. In B.L. Duncan, S.D. Miller, B.E. Wampold. & M.A.

Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (2nd ed., pp. 199-235). Washington, DC: American Psychological

Association.

4. Special issue on integrating behavioral and primary care:http://www.jabfm.org/content/28/Supplement_1

5. Kelly JM, Kraft-Todd G, et al. (2014). The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis of randomized controlled trials.PLoS ONE 9(4): e94297. doi:10.1371/journal.pone.0094207

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Session Evaluation

Please complete and return theevaluation form to the classroom

monitor before leaving this session.

Thank you!