CFHA 2018 Conference Education Sessions. Plenary Sessions. Plenary Session 1 Thursday, October 18, :30 to 6:00 PM

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1 CFHA 2018 Conference Education Sessions DRAFT Last updated September 4, 2018 Plenary Sessions Plenary Session 1 Thursday, October 18, :30 to 6:00 PM Last updated August 28, 2018 PS1: Saving Lives and Providing Better Care: Insights from the Science of Teamwork Presenter Eduardo Salas, PhD, Professor, Rice University, Houston, TX Session Description Healthcare is a team sport. So, after over three decades of applied research, the science of teamwork has generated a number of evidenced-based principles with important implications for healthcare teams. This presentation will provide an overview of what we know about teamwork and how it can be applied to enhance clinical outcomes. The needed team-based competencies and why they matter will be highlighted as well as advice will be given on how to do to improve team functioning. Upon completion of this activity, learners will be able to: Learn what effective teams do, feel and think Understand the team-based competencies that matter Obtain on some practical advise on how to provide better care thru teamwork CFHA Annual Conference Concurrent Sessions Page 1 of 59

2 Plenary Session 2 Friday, October 19, :00 to 9:30 AM PS2: Caring for Amy: A Story of Family Caregiver Agency in Charting a Course of Care for Early Onset Dementia Presenter Carol Podgorski, PhD, MPH, LMFT, Associate Professor of Psychiatry, Director, Finger Lakes Center of Excellence for Alzheimer s Disease, University of Rochester School of Medicine & Dentistry, Rochester, NY Brian Norton, Family Caregiver and Advocate, Pittsford, NY H. Benjamin Lee, MD, John Romano Professor and Chair, Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, NY Session Description This presentation will chronicle a family caregiver s account of how he developed, coordinated, and executed a plan of care for his wife who was diagnosed with early onset dementia. The presentation will provide background information on the family s illness experience; an overview of collaborative care models for dementia with a focus on the caregiver s role; a discussion of how this caregiver s experience was influenced by individual, family, and life cycle factors; perspectives from his wife s neurologist and hospice physician on treatment considerations; and reflective comments on this family s experience of care by a geriatric psychiatrist with expertise in dementia. Upon completion of this activity, learners will be able to: Identify at least two unique features of collaborative care models in specialty care (e.g., dementia) Describe how specific patient, caregiver, and family factors influence approaches to care delivery Identify two ways in which caregiver-physician partnerships can improve patient and family experiences of care transitions References Coleman, E.A. (2016). Family Caregivers as Partners in Care Transitions: The Caregiver Advise Record and Enable Act, Journal of Hospital Medicine, VC 2016 Society of Hospital Medicine. Galvin, J.E., Valois, L., Zweig, Y. (2014). Collaborative transdisciplinary team approach for dementia care. Neurodegenerative Disease Management. 4(6), Khanassov, V., and Vedel, I. (2016). Family Physician Case Manager Collaboration and Needs of Patients with Dementia and Their Caregivers: A Systematic Mixed Studies Review. Annals of Family Medicine; 14: doi: /afm Podgorski, C. (2017). Neurocognitive Disorders: Systemic Functionality and Interconnectedness. In DSM-5 and Family Systems: An Applied Approach. Russo, J; Coker, JK; King, JH. New York: Springer Publishing, Schulz, R., and Eden, J. (2016). Families caring for an aging America. The National Academies Press: Washington, DC. CFHA Annual Conference Concurrent Sessions Page 2 of 59

3 Plenary Session 3 Saturday, October 20, :00 to 9:30 AM PS3: Battling Bias: Reforming Primary Care to Reduce Disparities Presenter Dayna Matthew, JD, PhD, Law Professor, William L. Matheson and Robert M. Morgenthau Distinguished Professor of Law, F. Palmer Weber Research Professor of Civil Liberties and Human Rights, University of Virginia Law School/School of Medicine Department of Public Health Sciences, Charlottesville, VA Session Description The IOM Reported in 2003 that physician bias was likely a contributor to the persistent prevalence of racial and ethnic health disparities in America. However, the IOM confessed that current scientific knowledge does not elucidate the mechanisms by which these attitudes, biases, and stereotypes may result in differences in clinical treatment, or the degree to which these attitudes might affect the outcome of patient care. This presentation sheds light on the mechanisms that link bias to poor health outcomes. It also addresses the limitations of focusing merely on physicians individual biases while ignoring patient bias, and systemic inequities that contribute to health disparities. This presentation will suggest more appropriate ways for primary care providers to attack health inequity. Upon completion of this activity, learners will be able to: Define health equity and its central importance to providing quality primary care Understand basic meaning of terms bias, racism, discrimination and their respective contributions to health disparities according to current empirical literature Identify approaches to primary care reform to reduce impact of bias on health disparities References Matthew, D.B. (2015) JUST MEDICINE: A CURE FOR RACIAL INEQUALITY IN AMERICAN HEALTH CARE, (November 2015, New York University Press) Matthew, D.B. Medical-Legal Partnerships and Mental Health: Qualitative Evidence that Integrating Legal Services and Health Care Improves Family Well-Being, 17 Houston Journal of Health Law & Policy 343 (2017) Matthew, D.B. The Law as Healer How Paying for Medical-Legal Partnerships Saves Lives and Money (Brookings Institution, January 2017) Blair, I. V., Steiner, J. F., Hanratty, R., Price, D. W., Fairclough, D. L., Daugherty, S. L.,... & Havranek, E. P. (2014). An investigation of associations between clinicians ethnic or racial bias and hypertension treatment, medication adherence and blood pressure control. Journal of general internal medicine, 29(7), Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), CFHA Annual Conference Concurrent Sessions Page 3 of 59

4 Pre-Conference Sessions PC1: Collaborative Leadership in Uncertain Times Half-day session 8:30 to 11:30 AM Session Description This 3-hour, interactive workshop will present principles of effective, collaborative leadership. Drs McDaniel and Campbell will begin with a brief history of hierarchical vs. distributed forms of leadership more appropriate for today s VUCA world (Volatile, Uncertain, Complex, and Ambiguous). The presenters will emphasize the importance of basing collaborative, distributed leadership on a foundation of respect, a shared mental model, complementary skill sets, and clear agreements about division of labor. Drs McDaniel & Campbell will provide examples of success and failure, with opportunities for participants to present leadership challenges in small groups. The workshop will conclude by developing a more extensive set of principles for collaborative leadership in healthcare. Upon completion of this activity, learners will be able to: Participants will understand the distinctions between hierarchical and distributed forms of leadership and the importance of the latter in today s world Participants will learn the basic principles of a collaborative distributed leadership and how to apply them. Participants will apply these principles to their own leadership challenges. Presenters Susan H McDaniel PhD, Dr Laurie Sands Distinguished Professor of Families & Health, Vice Chair, Department of Family Medicine; Director, Institute for the Family, Department of Psychiatry; University of Rochester Physician Communication Coaching Program; University of Rochester Medical Center, Rochester NY Thomas L Campbell MD, Wm Rocktaschel Professor and Chair, Department of Family Medicine, University of Rochester Medical Center, Rochester NY References Elkington R & van der Steege M (2017) Visionary Leadership in a Turbulent World: Thriving in the new VUCA Context. Bingley UK: Emerald Publishing. Kouzes JM & Posner BZ (2016) The Leadership Challenge; How to Make Extraordinary Things Happy in Organizations, 6 th Ed. New York: Jossey-Bass. McDaniel, S. H., Bogdewic, S., Holloway, R., & Hepworth, J. (2008). Architecture of alignment: Leadership and the psychological health of faculty. In: T. R. Cole, T. J. Goodrich, and E. R. Gritz (Eds.) Academic Medicine in Sickness and in Health: Scientists, Physicians, and the Pressures of Success. Humana Press, pp McDaniel SH & Kaslow N (2014) Stepping up to the plate: Opportunities and challenges for women in leadership. The California Psychologist. June 1. Metcalf J & Gilbert J (2015) Transformational Leadership. CreateSpace Independent Publishing Platform. Sinek S (2011) Start with Why: How Great Leaders Inspire Others to Take Action. New York: Portfolio Penquin. CFHA Annual Conference Concurrent Sessions Page 4 of 59

5 PC2: Stuck in the Middle: Strategies to Effectively Navigate Obstacles as an Early Career Professional Half-day session 12:00 to 3:00 PM Session Description There are natural transition periods in everyone s career, and this is no more true for Early Career Professionals (ECPs). These times often come with emotional processes, and involves encounters with power, learning to lead while still acquiring knowledge and skills, locating one s place within a team, and significant emotional processing as one s footing becomes firm again. This session is designed for ECPs to name and create solutions for these transitional challenges. Participants will hear from three ECPs who will address topics unique to this professional cohort. Participants will have opportunities and be encouraged to discuss obstacles and solutions in their professional lives. Upon completion of this activity, learners will be able to: Identify three common challenges faced by early career professionals in health-related professions. Identify three personal strengths and struggles in their current work context. Apply two strategies to effectively navigate their personal struggles in their current work context. Presenters Laura E. Sudano, PhD, LMFT, Associate Director, Collaborative Care, University of California San Diego (UCSD) Family Medicine and Public Health, San Diego, CA Eboni Winford, PhD, Behavioral Health Consultant, Cherokee Health Systems, Knoxville, TN Anna Jack, MD, Instructor of Clinical Family Medicine, University of Rochester, Primary Care Network, Rochester, NY References Earle Reybold, L. (2005). Surrendering the dream: Early career conflict and faculty dissatisfaction threshold. Journal of Career Development, 32, Fallon, N. (December 30, 2015). DiSC Assessment: What kind of leader are you? Business News Daily Managing Editor. Retrieved from Ghorob, A., & Bodenheimer, T. (2015). Building teams in primary care: A practical guide. Families, Systems, & Health, 33, doi: /fsh Green, A. G., & Hawley, G. C. (2009). Early career psychologists: Understanding, engaging, and mentoring tomorrow s leaders. Professional Psychology: Research and Practice, 40(2), doi: /a Jones, T. B., & Osborne-Lampkin, L. (2013). Black female faculty success and early career professional development. Negro educational review, Greensboro, 64, Lencioni, P. (2002). The Five Dysfunctions of a Team. San Francisco, CA; Jossey-Bass. The Executive Connection (June 24, 2015). 9 common leadership styles: Which type of leader are you? Accessed at Wang, D., Waldman, D. A., & Zhang, Z. (2014). A meta-analysis of shared leadership and team effectiveness. Journal of Applied Psychology, 99, doi: /a CFHA Annual Conference Concurrent Sessions Page 5 of 59

6 PC3: Toolkit for PCBH in Pediatric Primary Care Full-day session 8:30 AM to 3:00 PM Session Description Physical and mental health needs of children are distinctly different from adults. Unfortunately, there is a shortage of BH providers specially trained in pediatrics. This full day workshop will provide participants with the knowledge, skills, and a physical toolkit to operate in pediatric integrated care settings. All participants will receive an overview on the use of parenting interventions in primary care and how to incorporate BHCs into Well Child visits. Furthermore, participants will learn strategies for early identification, screening tools, and interventions. Participants will select 2 out of 4 breakout sessions on 1) Sleep; 2) Depression/Anxiety; 3) ADHD; 4) Toileting. Upon completion of this activity, learners will be able to: Discuss a broad range of best practices in pediatric integrated care and ways to integrate BHCs into Well Child Checks. Build and utilize a toolkit of integrated pediatric care resources for immediate implementation in medical settings Identify common care pathways, brief interventions, and screening measures/assessment strategies for the most common issues in pediatric integrated care (sleep, mood disorders, and/or ADHD concerns, toileting). Presenters Lesley Manson, Psy.D., Assistant Chair of Integrated Initiatives, Clinical Assistant Professor, Arizona State University, Phoenix, AZ Tawnya Meadows, Ph.D., BCBA-D, Co-Chief of Behavioral Health in Primary Care-Pediatrics, Geisinger, Danville, PA Matthew Tolliver, PhD, Assistant Professor/Psychologist, Eastern Tennesee State University Pediatrics, Johnson City, TN Allison Allmon Dixson, Ph.D., Pediatric Psychologist, Gundersen Health System, La Crosse, WI Cody Hostutler, Ph.D., Psychologist, Nationwide Children's Hospital, OH Sarah Trane, PhD, Assistant Professor, Division of Integrated Behavioral Health (Pediatrics), Mayo Clinic Health System, La Crosse, WI Brian DeSantis, Psy.D., ABPP, VP, Behavioral Health, Peak Vista Community Health Centers, Colorado Springs, CO References Asarnow, J. R., Rozenman, M., Wiblin, J., & Zeltzer, L. (2015). Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: A meta-analysis. JAMA Pediatrics. Advance online publication. doi: /jamapediatrics Roseman, M., Kloda, L. A., Saadat, N., Riehm, K. E., Ickowicz, A., Baltzer, F.,... Thombs, B. D. (2016). Accuracy of Depression Screening Tools to Detect Major Depression in Children and Adolescents: A Systematic Review. Canadian Journal of Psychiatry, 61(12), doi: / Huang, Y., Lee, P., & Chen, V.C. (2012a). Adolescent Mental Health in Primary Care. In G. Ivbijaro (Ed.), Companion to Primary Care Mental Health (pp ). London, UK: Radcliffe Publishing. Huang, Y., Lee, P., & Chen, V.C. (2012b). Child Mental Health in Primary Care. In G. Ivbijaro (Ed.), Companion to Primary Care Mental Health (pp ). London, UK: Radcliffe Publishing. Anyaoku, N. et al. (2009). Encouraging Healthy Active Living for Families, A Report of the Healthy Active Living for Families Project: American Academy of Pediatrics Institute for Healthy Childhood Weight. Retrieved from: CFHA Annual Conference Concurrent Sessions Page 6 of 59

7 Mindell, J. A., & Owens, J. A. (2015). A clinical guide to pediatric sleep: diagnosis and management of sleep problems. Lippincott Williams & Wilkins. PC4: Introduction to the Collaborative Care Approach Half-day session 8:00 to 11:00 AM Session Description This interactive workshop will provide an introduction to Psychiatric Collaborative Care Model (CoCM) for all providers interested in learning more about this approach or how evidence-base collaborative care principles could be used in any behavioral health practice. Core skills in using a team-based approach to mental health delivery will be reviewed with opportunities to learn from example cases and practice using a registry to drive treatment to target for common mental health disorders. New payment opportunities using CMS Psychiatric Collaborative Care Model codes will be discussed. This is idea for healthcare professionals considering implementing this model of care in the future. Upon completion of this activity, learners will be able to: List history of integrated care models and the evidence-base for the Collaborative Care Model (CoCM) Describe the differences in workflow between traditional psychiatry and psychiatric consultation in collaborative care Name the five core principles of collaborative care Apply knowledge of a registry to facilitate treatment-to-target and psychiatric case reviews. Presenters Anna Ratzliff, MD, PhD, Associate Professor, University of Washington, AIMS Center Director, Seattle, WA Kristin Kroeger, MA, Chief of Policy, Programs and Partnerships, American Psychiatric Association, Washington, DC Neil Korsen, MD, MS, Physician Scientist, Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME References Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev Oct 17;10:CD Huffman JC, Niazi SK, Rundell JR, Sharpe M, Katon WJ. Essential articles on collaborative care models for the treatment of psychiatric disorders in medical settings: a publication by the academy of psychosomatic medicine research and evidence-based practice committee. Psychosomatics Mar-Apr;55(2): doi: /j.psym Epub 2013 Dec 25. Unutzer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288(22): Unützer J, Katon WJ, Fan MY, et al. Long-term cost effects of collaborative care for late-life depression. Am J Manag Care. 2008;14(2): Whitebird RR, Solberg LI, Jaeckels NA, Pietruszewski PB, Hadzic S, Unützer J, Ohnsorg KA, Rossom RC, Beck A, Joslyn KE, Rubenstein LV. Effective Implementation of collaborative care for depression: what is needed? Am J Manag Care Sep;20(9): CFHA Annual Conference Concurrent Sessions Page 7 of 59

8 PC5: Maximizing The Team Within an Integrated Primary Care Clinic Half-day session 11:30 AM to 3:30 PM Session Description Want to learn how you can save time during your busy day in primary care while also improving patient care? This workshop will focus on helping primary care providers or nurses better utilize integrated providers, such as embedded behavioral health providers or care managers in their everyday practice. The workshop will open with personal stories from a physician and patient and then experts in integrated care will share how to utilize these providers for specific patient populations and employ team-based care to reduce provider burden and improve patient care. Primary care team members who do not regularly involve, but have access to, an embedded behavioral health provider are invited to attend. Upon completion of this activity, learners will be able to: Understand the value that an embedded behavioral health provider can bring to the primary care teams efficiency and effectiveness in providing good patient care. Identify specific presenting concerns where the embedded behavioral health provider can be utilized Identify how a group medical visit can be employed as another way to maximize efficiency and effectiveness Identify specific strategies to foster success as a member of interdisciplinary team Presenters Jennifer S. Funderburk, PhD, Clinical Research Psychologist, VA Center for Integrated Healthcare, Syracuse, NY Katherine M. Dollar, PhD, Associate Director for Implementation, VA Center for Integrated Healthcare, Buffalo, NY Kent A. Corso, PsyD, BCBA-D, President, NCR Behavioral Health, LLC, Springfield, VA David Edelman, MD, Professor of Medicine, Duke University, Durham, NC Angela Denietolis, MD, Physician & Executive Director Primary Care Operations, Veterans Health Administration, Washington, DC References Edelman, D., McDuffie, J., Oddone, E., Gierisch, J., Nagi, A., & Williams, J. (2012) Shared medical appointments for chronic medical conditions: A systematic review. Washington, DC. Edelman, D., Gierisch, J., McDuffie, J., Oddone, E., & Williams, J. (2015) Shared medical appointments for Diabetes Mellitus: A systematic review. Journal of General Internal Medicine, 30(1): Hunter, C., Funderburk, J., Polaha, J., Bauman, D., Goodie, J., & Hunter, C. (2017). Primary care behavioral health model research: Current state of the science and call to action. Journal of Clinical Psychology in Medical Settings Dollar, K., Kearney, L., & Wray, L. (2018) Achieving same day access in integrated primary care. Families, Systems, & Health, 2, Corso, K., Hunter, C., Owen, D., Kallenberg, G., & Manson, L. (2016) Integrating Behavioral Health into the Medical Setting: A Rapid Implementation Guide. Greenbranch Publishing, Phoenix, Maryland. CFHA Annual Conference Concurrent Sessions Page 8 of 59

9 Concurrent Sessions A1: So how Much Does Integrated Care Cost? Leveraging SBIRT as a Model for Cost Analysis SBIRT can be flexibly implemented in medical settings with a variety of staffing models and clinical workflow. It is often challenging for administrators and clinicians to determine the costs of starting or maintaining an SBIRT program. This presentation will provide an overview of the SBIRT cost estimates in the literature and underlying reasons for the variation in costs. Administrators and clinicians may also need tools to track their own program costs or demonstrate their program is cost-effective. The presentation will also provide a synopsis of the methods used to develop cost and cost-effectiveness estimates. The methods are broadly applicable to other integrated care models. Participants will learn about the design of an economic evaluation, data collection strategies, and approaches to estimating costs and cost-effectiveness. Building on these tools, the presentation will demonstrate an application to a randomized control trial of SBIRT conducted in a primary care clinics. Jesse Hinde, PhD, RTI International, Research Triangle Park, NC Zarkin, G. A., Bray, J. W., Hinde, J. M., & Saitz, R. (2015). The Costs of Screening and Brief Intervention for Illicit Drug Use in Primary Care Settings. Journal of Studies on Alcohol and Drugs, 76, Cowell, A. J., Dowd, W. N., Mills, M. J., Hinde, J. M., & Bray, J. W. (2017). Sustaining SBIRT in the wild: Simulating revenues and costs for substance abuse screening, brief intervention, and referral to treatment programs. Addiction, 112(S2), Bray, J. W., Mallonee, E., Dowd, W., Aldridge, A., Cowell, A. J., & Vendetti, Saitz, R., Palfai, T. P. A., Cheng, D. M., Alford, D. P., Bernstein, J. A., Del Boca F. K., McRee B., Vendetti J., Damon D. The SBIRT A2: Across the Lifespan: Screening for Anxiety and Depression in Older Adults & Screening for Autism in Young Children Screening for Anxiety and Depression in Older Adult ED Patients This study examined the utility of screening older adult patients in the emergency department for anxiety and depression. A sample of 103 patients 65 years or older were screened in the ED using the GAD-7 and PHQ-9, with 38% reporting at least moderate anxiety and 25% reporting at least moderate depression. Importantly, none of the patients reporting severe anxiety, moderately severe depression, or severe depression had visited a mental health provider in the past 6 months, and the majority reported at least one substantial barrier that limited their access to care. Beau Abar, PhD, Assistant Professor, University of Rochester Medical Center, Rochester, NY Courtney Jones, PhD, MPH, Assistant Professor, University of Rochester Medical Center, Rochester, NY Abar, B., Lee, J., Holub, A., & Nobay, F. Depression, anxiety, and access to care among adult ED patients. Academic Emergency Medicine, 24, (2017). Abar, B., Hong, S., Aaserude, E., Holub, A., & DeRienzo, V. Access to care and depression among emergency department patients. Journal of Emergency Medicine, 53, (2017) Capp, R., Hardy, R., Lindrooth, R., & Wiler, J. National trends in emergency department visits by adults with mental health disorders. Journal of Emergency Medicine, 51(2), (2016) Prettyman, R., & Banerjee, J. (2018). Depression in Acute Geriatric Care. In Geriatric Emergency Medicine (pp ). Springer, Cham. Hakenewerth, A. M., Tintinalli, J. E., Waller, A. E., & Ising, A. Emergency department visits by older adults with mental illness in North Carolina. Western Journal of Emergency Medicine, 16(7), (2015) Time 10:00 to 11:00 Cost Effectiveness/Financial sustainability SBIRT Model of Integrated Care Research and evaluation Cost analysis Understand cost-drivers for SBIRT programs Identify sources of data providers could use to capture program costs Discuss practical considerations for implementing an economic evaluation Time 10:00 to 10:30 Geriatrics Mood (e.g., depression, anxiety) Evaluate the potential utility of screening for anxiety and depression among older adult emergency department patients. Understand the barriers to care experienced by older adults with covert mental health concerns. Evaluate the potential for parallel service providers in the ED to enhance public mental and physical health. CFHA Annual Conference Concurrent Sessions Page 9 of 59

10 Identifying Autism in Primary Care: Screening Tool for Autism in Toddlers and Young Children (STAT) Pediatric WCCs are routine points in medical care that offer opportunities for wellness promotion, broad screening, and further engagement of children and families in clinic services and ongoing care planning. They allow for surveillance of sub-clinical concerns that may require intervention at later points. Developmental screening tools are an invaluable component of identifying psychoeducational needs, deficits in health literacy, delayed or atypical developmental milestones, as well as trauma, distress, and/or risks/safety concerns. Two screening tools utilized at CHS include the M-CHAT-R and the STAT-BHC (The Screening Tool for Autism in Toddlers and Young Children), which each address autism. This presentation will provide an overview of the WCC process at CHS; highlight the value and methods of screening for autism during WCCs; introduce the STAT-BHC; and provide preliminary data regarding the effectiveness of the STAT-BHC as a screening tool for use in primary care. Katheryn Christian, LCSW, Pediatric Behavioral Health Consultant, Cherokee Health Systems, Knoxville, TN Eboni Winford, PhD, Behavioral Health Consultant, Cherokee Health Systems, Knoxville, TN Hilary Duckworth PsyD, Licensed Psychologist/Behavioral Health Consultant, Cherokee Health Systems, Lenoir City, TN Glascoe, F. P. (2015). Evidence-based early detection of developmental behavioral problems in primary care: What to expect and how to do it. Journal of Pediatric Health Care, 29(1), Zwaigenbaum, L et al. (2015). Early screening of autism spectrum disorder: Recommendations for practice and research. Pediatrics, 136, S41-S59. Chlebowski, C., Robins, D. L., Barton, M. L., & Fein, D. (2013). Large-scale use of the modified checklist for autism in low-risk toddlers. Pediatrics, 131(4), e1121-e1127. Guevara, J.P., et al. (2013). Effectiveness of developmental screening in an urban setting. Pediatrics, 131(1), Robins, D., et al. (2016). Universal autism screening for toddlers: Recommendations at odds. Journal of Autism and Developmental Disorders, 46(5), A3: Inter-professional Teams: Family-Centered Exemplars from Teams & How Interdisciplinary Discussions are Shaping the Landscape Family-Centered Care: Exemplars from Interprofessional Team Experiences Research indicates that interprofessional teams can deliver higher quality care to families throughout the lifespan. A physician, a family therapist, a clinical psychologist, and a certified sex therapist will each share a clinical story of how trust between differing professionals led to better outcomes for the families they served. Presenters will also highlight the role of CFHA in the development of these perspectives and practices. Claudia Grauf-Grounds, PhD, LMFT, Professor, Seattle Pacific University, Seattle WA Alan Lorenz, MD, Associate Professor Family Medicine and Psychiatry, Rochester Institute of Technology and University of Rochester, Rochester, NY Mary Talen, PhD, Psychologist, Director of Primary Care Behavioral, Northwestern University Family Medicine Residency, Chicago, IL Tina Schermer-Sellers, PhD, Director Medical Family Therapy, Seattle Pacific University, Seattle, WA Brown, J.B., Hutchison, B., Ryan, B.L, Thorpe, C., & Markle, E.K.R. (2015). Measuring Teamwork in Primary Care: Triangulation of Qualitative and Quantitative Date. Families, Systems & Health, 33(3), Dongen, J.J.J., Habets, I.G.J., Beurskens, A., & Bokhoven, M.A. (2017). Successful participation of patients in interprofessional team meetings: A qualitative study. Health Expectations. 20 (4), Ulrich, B., & Crider, N.M. (2017). Using teams to improve outcomes and performance. Nephrology Nursing Journal, 44(2), Cote, G., Lauzon, C., & Kyd-Strickland, B. (2008). Environmental scan of interprofessional collaborative practice initiatives. Journal of Interprofessional Care. 22(5), Abrahamsen, C., Norgaard, B., Drabord, E. & Nielsen, D. (2017). Reflections on two years after establishing an orthogeriatric unit: a focus group study of healthcare professionals' expectations and experiences. BMC Health Services Research. 17, 1-9. Time 10:30 to 11:00 Pediatrics Assessment Primary Care Behavioral Health Model List two advantages of embedding BHCs into pediatric Well Child Check exams. Describe the rationale for implementing the STAT-BHC within Well Child Check exams. Describe two ways to utilize community health workers as extenders of the primary care team to reinforce autism spectrum interventions. Time 10:00 to 10:30 Across the Lifespan Interprofessional teams Family-centered care Describe how interprofessional teams can improved clinical outcomes Identify how interprofessional teams can be used throughout the lifespan Build bridges with other professionals to increase effective care CFHA Annual Conference Concurrent Sessions Page 10 of 59

11 Transforming BHC Integration into Primary Care in a Major U.S. City: How Interdisciplinary Discussions are Shaping the Care Delivery Landscape The integration of behavioral health into primary care in the nation's FQHCs and community health centers is becoming standard practice. The Behavioral Health Consultation (BHC) model of immediate provider handoffs to BHC and brief psychological services is often the template for services, but what does integration truly look like in these settings? This presentation shares the results of facilitated discussions with 26 Philadelphia health centers with team BHCs, medical providers, nurses, and administrators. The Integrated Practice Assessment Tool was utilized to measure the degree of behavioral health integration in primary care, and team-based goal plans were collaboratively established at each site to continue to enhance integration. The presentation will share results from these assessments, site BHC directors will discuss how this process helped improve their integrative practices, and implications for further replication will be shared. Travis Cos, PhD, Behavioral Health Consultant, Philadelphia Health Management Corporation, Philadelphia, PA Natalie Levkovich Chief Executive Officer, Health Federation of Philadelphia, PA Melissa Cruz, LCSW Behavioral Health Consultant, Delaware Valley Community Health, Philadelphia, PA Joel McIntosh, LCSW, Director of Integrated Behavioral Health, Philadelphia Dept. of Public Health, Philadelphia, PA Julia DeJoseph, MD, Senior Medical Director of Population Health, Delaware Valley Community Health, Philadelphia, PA Kessler, R.S., Auxier, A., Hitt, J.R., Macchi, C.R., Mullin, D., van Eeghen, C., Littenberg, B. (2016). Development and validation of a measure of primary care behavioral health integration. Families, Systems, & Health, 35, Macchi, C.R., Kessler, R., Auxier, A., Hitt, J.R., Mullin, D., van Eeghen, C., Littenberg, B. (2016). The Practice Integration Profile: Rationale, Development, Method, & Research. Families, Systems, & Health, 35, Waxmonsky, J., Auxier, A., Wise Romero, P., & Heath, B. (2018). Integrated Practice Assessment Tool (IPAT, Version 2.5). Sandoval, B.E., Bell, J., Khatri, P. & Robinson, P.J. (2017). Toward a unified integration approach: Uniting diverse primary care strategies under the Primary Care Behavioral Health (PCBH) Model. Journal of Clinical Psychology in Medical Settings. Published Online December Serrano, N., Cos, T.A., Daub, S., & Levkovich, N., (2017). Using standardized patients as a means of training and evaluating behavioral health consultants in primary care. Families, Systems, & Health, 35, A4: Technological Bridges to Care: Using ECHO to Support Behavioral Health Providers & Improving Access through Innovation and Interprofessional Collaboration Using the ECHO Model to Support Behavioral Health Providers Working in Collaborative Care Practices Project ECHO is a structured model developed to provide specialty training and case consultation to primary care providers for underserved specialties. It consists of TeleECHO clinics where televideo conferencing regularly connects a "hub specialty team to remotely located primary care "spokes. These TeleECHO clinics include both didactics on specialty topics as well as case presentations. We developed and implemented a TeleECHO Clinic for Behavioral Health Care Managers and other staff working in Collaborative and Integrated Care settings to address knowledge disparities that behavioral health providers of varying backgrounds inherently have, to provide psychotherapy supervision to maintain fidelity to "Brief Evidence-Based models, and to connect team members working remotely. We will share how we identified the need for this program, put together an interdisciplinary specialty team, developed the curriculum and incorporated this into Collaborative Care services. Eve Fields, MD, Medical Director of Integrated Care Services, Greenville Health System, Greenville, SC Heike Minnich, PsyD, Clinical Psychologist, University of South Carolina School of Medicine/Greenville Health System, Taylors, SC Time 10:30 to 11:00 Primary Care Behavioral Health Model Quality improvement programs Interprofessional teams Identify the different levels of primary care behavioral health integration and their importance for care Describe the process of how a network was able to hold an interdisciplinary meeting and review priorities and goals for improving integration Discuss steps to conduct a similar quality improvement project; with special focus on replication of an integration-based assessment. Time 10:00 to 10:30 Interprofessional education Collaborative Care Model of Integrated Care Quality improvement programs Identify knowledge gaps and supervisory needs that Collaborative and Integrated Care teams face Discuss how the ECHO model can be used in behavioral health Describe ways that the ECHO model can be used to support key aspects of the Collaborative Care model Hager B, Hasselberg M, Arzubi E, Betlinski J, Duncan M, Richman J, Raney LE. Leveraging Behavioral Health Expertise: Practices and Potential of the Project ECHO Approach to Virtually Integrating Care in Underserved Areas Psychiatr Services Feb 15:appips doi: /appi.ps Raney L. Integrating Primary Care and Behavioral Health: The Role of the Psychiatrist in the Collaborative Care Model Am J Psychiatry August 172:8. Komaromy M, Bartlett J, Manis K, Arora S. Enhanced Primary Care Treatment of Behavioral Disorders With ECHO Case-Based Learning Psychiatric Services 68: CFHA Annual Conference Concurrent Sessions Page 11 of 59

12 Zhou C, Crawford A, Serhal E, Kurdyak P, Sockalingam S. The Impact of Project ECHO on Participant and Patient Outcomes: A Systematic Review Academic Medicine. October 91(10): Raney, L., Bergman, D., Torous, J. et al. Digitally Driven Integrated Primary Care and Behavioral Health: How Technology Can Expand Access to Effective Treatment. Curr Psychiatry Rep (2017) 19: Technological Bridges to Care: Improving Access to Quality Integrated Behavioral Health Care through Innovation and Interprofessional Collaboration This presentation will briefly summarize practice issues that contribute to behavioral health provider retention barriers in integrated primary care settings (including unique considerations for underserved areas) and will provide creative recommendations for resolution. Innovative approaches to improve team-based care and interdisciplinary collaboration that ultimately improve patient care outcomes, will be presented and illustrated through case examples. Attendees will learn specific technology-based strategies and skills including the following: successful execution of a system-wide psychiatry Project ECHO system facilitated by behavioral health providers, utilization of internet based messaging systems to address provider isolation and streamline care and crisis management efforts during service delivery across health system sites, and programmatic tips to initiate the launch of a collaborative care model for tele-psychiatry services in an integrated care setting. Emily Selby-Nelson, PsyD, Director of Behavioral Health, Cabin Creek Health Systems, Charleston, WV Kathryn Hossfeld, PsyD, Behavioral Health Provider, Cabin Creek Health Systems, Charleston, WV Mackie, P. F-E. (2015). Technology in rural behavioral healthcare practice: Policy concerns and solution suggestions. Journal of Rural Mental Health, 39, Bischoff, R. J., Reisbig, A. M. J., Springer, P. R., Shultz, S., Robinson, W. D., & Olson, M. (2014). Succeeding in rural mental health practice: Being sensitive to culture by fitting in and collaborating. Contemporary Family Therapy, 36, Hastings, S. L. & Cohn, T. J. (2013). Challenges and opportunities associated with rural mental health practice. Journal of Rural Mental Health, 37, Lu, M. W., Woodside, K. L., & Ward, M. F. (2014). Making Connections: Suicide prevention and the use of technology with rural veterans. Journal of Rural Mental Health, 38, Oetinger, M. A., Flanagan, K. S., & Weaver, I. D. (2014). The decision and rewards of working as a mental health professional in a rural area. Journal of Rural Mental Health, 38, A5: A Qualitative Study of Patients and Family Members Affected by Opioid Use Disorder to Inform an Online/Mobile Engagement and Educational Resource Limited information exists regarding key perspectives of patients and their family members on what information was most salient when they were seeking information generally about Opioid Use Disorder (OUD), effective treatment, and support and resource information in their community. This research study and educational project targets established patients receiving addiction treatment in primary care and family members participating in a local support group focused on OUD and has two primary aims: (1) Qualitative analysis of focus group and semi-structured interview data from patients with OUD and family members of individuals with OUD, and (2) development of web-based educational modules for patients and family members affected by OUD, that can also also be utilized by the healthcare system to accurately inform and engage patients. This presentation will describe the research process, application of results to patient care, and overview of the engagement and educational resource. Amber Cahill, PsyD, Assistant Professor, University of Massachusetts Medical School, Worcester, MA Daniel Mullin, PsyD, MPH, Associate Professor, University of Massachusetts Medical School, Worcester, MA Lander, L., Howsare, J., & Byrne, M. (2013). The Impact of Substance Use Disorders on Families and Children: From Theory to Practice. Social Work in Public Health, 28(0), Stumbo, S. P., Yarborough, B. J. H., McCarty, D., Weisner, C., & Green, C. A. (2017). Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement. Journal of Substance Abuse Treatment, 73, Time 10:30 to 11:00 Innovations Team-based care Collaborative Care Model of Integrated Care Define prevalent behavioral health provider retention barriers and concerns in integrated primary care. Identify innovative solutions to address and actively prevent behavioral health provider burnout and isolation. Discuss strategies that improve access to quality and interprofessional behavioral health services including technologically based communication methods and collaborative models of consultation and service delivery. Time 10:00 to 11:00 Patient-centered care/patient perspectives Substance abuse management (e.g., alcohol, tobacco, illicit drugs) Family-centered care Define current challenges for patients and family members accessing evidence-based information about OUD Describe the benefit of using qualitative analysis of patient and family member perspectives in order to inform creation of an educational and engagement resource CFHA Annual Conference Concurrent Sessions Page 12 of 59

13 Nordstrom, B. R., Saunders, E. C., McLeman, B., Meier, A., Xie, H., Lambert-Harris, C., â McGovern, M. P. (2016). Using a Learning Collaborative Strategy With Office-based Practices to Increase Access and Improve Quality of Care for Patients With Opioid Use Disorders. Journal of Addiction Medicine, 10(2), Bentzley, B. S., Barth, K. S., Back, S. E., Aronson, G., & Book, S. W. (2015). Patient perspectives associated with intended duration of buprenorphine maintenance therapy. Journal of Substance Abuse Treatment, 56, Alves, P. C., Sales, C. M., & Ashworth, M. (2013). Enhancing the patient involvement in outcomes: a study protocol of personalised outcome measurement in the treatment of substance misuse. BMC Psychiatry, 13, Explain how an online/mobile based resource that engages all stages of change can assist this vulnerable population A6: Ask The Experts: Learn How to Effectively Advocate for Collaborative Care or Primary Care Behavioral Health To Different Healthcare Professionals Want to learn how to most effectively answer a question about Collaborative Care or Primary Care Behavioral Health if asked by a payer? A provider? As organizations contemplate on their own or individuals attempt to motivate practices to integrate, two prominent models of service delivery are often considered: Collaborative Care and Primary Care Behavioral Health. Each model has unique strengths and weaknesses. Knowing how the experts respond to these questions can help others learn how to respond effectively and in a way to motivate organizations or individual practices to devote resources towards integration. Dr. Laura Wray from the VA Center for Integrated Healthcare will host the event asking questions from a variety of different perspectives on issues, such as patient experience, implementation, evidence, etc. Drs. David Oslin and Jeff Reiter will be the experts in Collaborative Care and Primary Care Behavioral Health. Laura Wray, PhD, Director, VA Center for Integrated Healthcare, Syracuse, NY Jennifer Funderburk, PhD, Clinical Research Psychologist, Center for Integrated Healthcare (VISN 2), Pittsford, NY David Oslin, MD, Professor, University of Pennsylvania, Philadelphia, PA Jeff Reiter, PhD, Clinical Associate Professor, Arizona State University, Phoenix, AZ Hunter, C., Funderburk, J.S., Polaha, J., Bauman, D., Goodie, J., & Hunter, C. (in press). Primary care behavioral health model (PCBH) research: Current state of the science and call to action. Journal of Clinical Psychology in Medical Settings. Beehler, G.P., Lilienthal, K.R., Possemato, K.P. Johnson, E.M., King, P.R., Shepardson, R.L. Vair, C.L., Reyner, J., Funderburk, J.S., Maisto, S.A., & Wray, L.O. (2017). Narrative review of provider behavior in Primary Care Behavioral Health: How process data can inform quality improvement. Families, Systems, & Health. Advance online publication. doi: /fsh Robinson, P. & Reiter, J. (2016) Behavioral Consultation and Primary Care. A Guide to Integrating Services. Springer International. Oslin, D., Ross, J., Sayers, S., Murphy, J., Katz, I. (2006) Screening, assessment, and management in depression in VA primary care clinics: The behavioral health laboratory, J of General Internal Medicine, Gilbody, S., Bower, P., and Fletcher J. (2006) Collaborative Care for depression: A meta-anlaysis and review. Archives of Internal Medicine, A7: Trauma Informed Care Implementation & Utilizing Written Emotional Disclosure to Combat Burnout Among Residents Shifting Cultural Paradigms Across a Clinical System: Trauma Informed Care Implementation This presentation will outline how to promote and implement Trauma Informed Care (TIC) service delivery in a primary care system of any size. We will tell the story of one FQHC and the steps the clinic took to form a workgroup and highlight challenges and success of their process. The success of this initiative inspired our family medicine department, comprised of 6 clinics, to see the value of TIC, which has led to efforts to spread TIC across our system. We will share concrete tools that were developed to evaluate clinic culture and inform our implementation approach. Attendees will learn the steps to launching a clinic and system wide TIC transformation strategy. Joan Fleishman, PsyD, Behavioral Health Clinical and Research Director, Oregon Health & Sciences University, Portland, OR 5. Yatchmenoff, D., Sunborg, S., & Davis, M. (2017). Implementing Trauma-Informed Care: Recommendations on the Process. Advances in Social Work, 18 (1), DOI: Time 10:00 to 11:00 Collaborative Care Model of Integrated Care Primary Care Behavioral Health Model Identify the different aspects that are going to be a concern based on the role of the individual in the healthcare system Understand the strengths and weaknesses to both models Understand how to respond to questions from different members of the healthcare system Time 10:00 to 10 :30 Patient-centered care/patient perspectives Innovations Interprofessional teams Trauma Informed Care Identify the key strategies to furthering Trauma Informed Care in a primary care setting including training staff, formation of a workgroup, and identifying and addressing hotspots. 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14 3. Baker, C. N., Brown, S. M., Wilcox, P. D., Overstreet, S., & Arora, P. (2015). Development and psychometric evaluation of the attitudes related to trauma-informed care (ARTIC) scale. School Mental Health, 8(1), doi: /s Trauma Informed Oregon. (2015). Standards of practice for trauma informed care. Retrieved from 4. Substance Abuse and Mental Health Services Administration [SAMHSA]. (2014a). SAMHSA's concept of trauma and guidance for a trauma informed approach (HHS Publication No. SMA ). Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from 1. Family Resources [famresmarketing]. (2013, June 12). Laura Porter dealing with resistance to trauma informed care[video file]. Retrieved from Describe the role and function of a TIC workgroup and how to identify and address priority areas for change in a clinic. Describe how Trauma Informed Care can improve staff satisfaction and burnout and patient engagement and satisfaction. Utilizing Written Emotional Disclosure to Combat Burnout and Create Resiliency in Family Medicine Residents: A Pilot Study Concern has risen in the medical community about rates and impact of burnout in medical providers and it appears that family medicine providers are disproportionately burdened with burnout. Research demonstrates that burnout begins as early as medical school; in % of U.S. medical students reported experiencing burnout, and certain aspects of medical residency make trainees particularly vulnerable to experiencing burnout. To date, very little is know about interventions that might improve burnout and wellness in medical providers, and family medicine residents likely have a specific set of needs and interests. The current study will examine the effects of an emotional disclosure exercise on burnout, resiliency, and health in family medicine residents. The process of engaging family medicine residents in a wellness activity and outcome results will be examined and presented. Jennifer Carty McIntosh, PhD, Associate Director of Behavioral Medicine Education, McLaren Flint / Michigan State University, Flint, MI Ethan Eisdorfer, PhD, Psychology Resident, University of Massachusetts Medical School, Worcester, MA Christine Runyan, PhD, Professor, Dept. of Family Medicine, University of Massachusetts Medical School, Worcester, MA Time 10:30 to 11:00 Evidence-based interventions Interprofessional education Burnout, resident wellness Describe the negative impact of burnout on medical providers Understand the unique needs of family medicine residents related to improving effects of burnout. Understand the effects of a written emotional disclosure intervention on improving burnout among family medicine residents. Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: care of the patient requires care of the provider. The Annals of Family Medicine, 12(6), Panagopoulou, E., Montgomery, A., & Benos, A. (2006). Burnout in internal medicine physicians: Differences between residents and specialists. European journal of internal medicine, 17(3), Shanafelt, T. D. (2009). Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care. Jama, 302(12), Lumley, M. A., Cohen, J. L., Borszcz, G. S., Cano, A., Radcliffe, A. M., Porter, L. S.,... & Keefe, F. J. (2011). Pain and emotion: a biopsychosocial review of recent research. Journal of clinical psychology, 67(9), McCullough, M. E., Emmons, R. A., & Tsang, J. A. (2002). The grateful disposition: a conceptual and empirical topography. Journal of personality and social psychology, 82(1), 112. A8: Outcomes of a Reverse Integration Model: Providing Medical Care in a Community Mental Health Clinic This presentation will describe a grant-funded reverse integration model, in which over 200 patients with severe and persistent mental illness receive comprehensive medical care within the confines of the community mental health center. Interdisciplinary communication processes will be described and outcomes reported, including: ER utilization, hospitalization rates, psychiatric inpatient rates, as well as patient health outcomes, patient satisfaction and staff satisfaction. Carly Marquis Henson, APRN, Adult Nurse Practitioner, Concord Hospital Medical Group, Henniker, NH Substance Abuse and Mental Health Services Administration (2017). HRSA Center for Integrated Health Solutions. SAMHSA Primary and Behavioral Health Care Integration (PBHCI) Program; Substance Abuse and Mental Health Services Administration. (2017). SAMHSA's Performance Accountability and Reporting System (SPARS); Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adultsâ United States, Morbidity and Mortality Weekly Report 2016;65(44): ; Centers for Disease Control and Prevention. Overweight & Obesityâ Adult Obesity Facts. Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion; Time 10:00 to 11:00 Primary Care Behavioral Health Model Population and public health Across the Lifespan Describe reverse model of integration Understand a model of communication processes that includes and involves multiple interdisciplinary care providers and stakeholders CFHA Annual Conference Concurrent Sessions Page 14 of 59