Primary Care Psychology

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Primary Care Psychology

• Lisa K. Kearney, Ph.D.
• Primary Care Psychologist
• South Texas Veterans Health Care System

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Models of Primary Care Psychology

• Co-located Clinics Model psychology services and
  medical in same building
• Psychologist in Primary Care provide traditional
  mental health services, but housed within primary
  care
• Behavioral Health Consultant Model fully
  integrated services for variety of mental and
  behavioral health problems
• Staff Adviser Model psychologist serves as
  consultant to PCPs alone
• (Gatchel Oordt, 2003)

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Behavioral Health Consultant Model

• Provides services to broad range of patients,
  with and without official MH diagnoses
• Primarily brief therapy model (1-4 sessions)
• Provide services to targeted disorders (e.g.,
  depression, diabetes, chronic pain) who are
  high-utilizers of clinic services
• Advantages serve more patients, greater access
  to psychologist, assists with psychiatry back log
• (Gatchel Oordt, 2003 Rowan Runyan, 2005)

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Behavioral Health Consultant vs. Specialty Mental
Health Clinic Models

• Differences fall in the following areas
• Primary goals
• Appointment structure
• Intervention structure
• Intervention methods
• Termination and follow-up
• Referral structure
• Primary information products
• (Runyan et al., 2003)

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Behavioral Health Consultant Skills

• Focused assessment
• Time efficiency 15-30 minute appts
• Use of cognitive behavioral techniques
• A stages of change model (Prochaska, DiClemente,
  Norcross, 1992)
• Appreciation for population health focus
• Good communication with physicians and other
  staff members of the clinic
• (Gatchel Oordt, 2003 Rowan Runyan, 2005)

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Behavioral Health Consultant Skills

• Function as a team member
• Respect for hierarchy of the system
• Flexibility in scheduling
• Understand medical conditions, procedures,
  medications
• Help PCPs become comfortable treating pts with MH
  diagnoses provide education
• (Bray et al., 2004 Gatchel Oordt, 2003)

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The Referral Process

• Language in referral process (e.g., behavioral
  health vs. psychology)
• Help pts understand behavioral health is part of
  primary care treatment
• Explain connection between behavioral and
  physical health (e.g., diabetes and
  depression/stress, HTN and stress levels
• Be first line referral for variety of problems
• Allow opportunity for PCP to introduce you
• (Gatchel Oordt, 2003 Haley et al., 2004)

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Setting Up Shop

• Build rapport with staff reveal how BH can meet
  needs in primary care
• Psychotherapy aint enough
• Find specific need and help address it
• Work as a team member
• Market your services and be available
• Learn primary care culture (e.g., clinic pace,
  how providers refer, feedback)
• (Gatchel Oordt, 2003 Haley et al., 20054

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Common Key Concerns

• Diabetes
• HTN and cardiovascular disease
• Chronic pain
• Sleep disturbance
• Non-compliance
• Depression, anxiety, and PTSD
• Coping with MMP
• Substance abuse and dependence

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VA Setting Examples

• Behavioral health orientation for initial intakes
• Pts initially referred to orientation for
  overview of BH services and referral options
• Pts complete 1 page intake form and brief
  depression screening
• Follow-up individual phone calls made to set up
  plan of care

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VA Setting Examples

• Group therapy model
• 5-6 groups run per week in primary care
• Example groups Diabetes Support, Mood Management
  Group, Chronic Pain, Healthy Living, Medical
  Problems Support, Trauma
• Connections with psychiatry through a PharmD
• Goal is to manage pts in primary care, assisted
  by Pharm D when necessary
• Appropriate referrals to psychiatry Bipolar,
  Schizophrenia, Psychotic Disorders, and
  non-responsive Depression after 2-3 initial
  trials of antidepressant in the clinic

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VA Setting Examples

• Interdisciplinary team approaches
• Talk to PCPs about perception of large needs in
  clinic (e.g., non-compliance)
• Collaborate with other professionals
• Dietitian and nurses in the MOVE! Program
• Creating healthy living programs (e.g.,
  hypertension, diabetes, vascular risk reduction)
  which incorporate a team including a dietitian,
  PharmD, psychologist, and a nurse

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VA Setting Examples

• Assist with management of pts newly diagnosed
  with depression and placed on anti-depressant
  medication
• Group co-led by physician and behavioral health
  consultant with 3 visits scheduled in 3 months
  after onset
• Use of patient workshops
• Create educational handouts
• Education of staff on key areas

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Initial Data

• Evaluation of all cases seen by BH in 9/05
• 123 pts with only 26 referred to psychiatry
  (21.1) referrals for Bipolar, Psychotic
  Disorder, or Dementia or failed 2 or more meds
• Workload comparison to traditional MH
  psychologist
• 967 vs. 275 uniques
• 7736 vs. 1740 encounters

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Primary Care Psychology

• Lisa K. Kearney, Ph.D.
• Primary Care Psychologist
• South Texas Veterans Health Care System