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Taking a Team Approach

A seven-year-old boy wakes up in the middle of the night complaining of a stomachache. Mom takes the boy to the family doctor, who runs tests, asks routine questions, prods and probes, and concludes there’s no apparent physical reason for his distress. But what about his mental state?

In that quick 15-minute patient visit, no one ever mentions to the doctor that mom and dad are going through a vitriolic divorce and the family has just moved. The boy is asked only to describe his physical symptoms, not how he is coping emotionally with the situation at home.

Oversights like this are common – in fact, of the 10 most frequent physical complaints people go to the doctor for, only 15 percent are found to have a physiological cause. Addressing both physical and mental issues might help explain some symptoms and indicate that the patient needs to see a behavioral health specialist in order to get better.

To prepare behavioral health specialists to work as part of a close-knit, interdisciplinary team The University of Texas at Austin’s College of Education has launched an Integrated Behavioral Health Psychology Program in the Department of Educational Psychology. Graduates of this program will be prepared to smoothly segue into a very different kind of health care environment, one in which mental and physical health services are not separate.

This new approach to medical care is referred to as “integrated health care delivery.” For the patient, it’s a very convenient form of one-stop-shopping and for a health care professional it’s the best way to get the patient’s whole health story.

“Health care in the 21st century will treat the patient not only as a whole person but also as a member of a family and community that are actively involved in treatment,” said Cindy Carlson, chair of the Department of Educational Psychology. “Being a psychologist who offers psychotherapy in a private practice office and confers, when necessary, with other providers and being a team member in a primary care office where the team is collectively responsible for the outcome are two very different job experiences. In universities, we’ve been training students for the former, not the latter.”

Cindy Carlson Group Photo

Regional Advisory Board for Cindy Carlson’s integrated behavioral health grant: Front row (left to right): Michele Guzman, PhD, Hogg Foundation for Mental Health; David White, Texas Psychological Association; Michael Carey, PhD, Scott & White Healthcare; Cindy Carlson, PhD.

To prepare them for this different role, the one-year program teaches doctoral psychology students how to deliver culturally and linguistically competent, evidence-based behavioral health services in a community clinic setting as part of a blended health care team. Instruction focuses on the best ways to assist vulnerable and underserved populations, a particularly important aim since studies show these groups are typically the least likely to access behavioral health services.

The award finances the planning, development, and operation of a 15-hour program emphasis in integrated health services delivery, with preference given to applicants who are bilingual (Spanish-English) and/or members of ethnic minority groups.

Student Fellows complete 10-12 hours of supervised clinical practice in integrated healthcare settings at Federally Qualified Health Centers (FQHCs) like Lone Star Circle of Care, People’s Community Clinic, and Seton-Blackstock Family Clinic. The Fellows take additional course work for a curriculum emphasis in integrated behavioral healthcare, including a course devoted to inter-professional healthcare teams, and they receive training in motivational interviewing, which has proven effective in helping patients make health behavior changes.

Even though there are challenges to placing behavioral health experts in integrated healthcare settings, the benefits to patients far outweigh them, according to Carlson and other experts. In some blended healthcare setting, the patient sees the same front desk check-in person at each visit, for example, whether she’s there for depression or the flu, and her clinical records are shared among the entire health care team.

As Carlson points out, an enormous benefit of the team approach is that “proximity breeds familiarity” – simply being in the same physical environment tends to encourage more communication among team members. The cardiologist has access to information about a patient’s anxiety disorder, and the general practitioner knows that another patient just lost her son in a skateboarding accident, which may explain her blinding headaches, sleeplessness, and weight loss.

“The health care team approach has so many positive aspects,” said Elizabeth Walsh, a doctoral student in the UT Austin program and one of Carlson’s research assistants. “There’s a lot of evidence that having integrated health care teams ends up cutting healthcare costs and reducing employee and student absenteeism, for example, and both providers and patients report that the quality of care is much better.

Taking a Team Approach

IBHP trainee Leann Smith, Elizabeth Walsh, and Brittany Linton consults with Celia Neavel, MD, of People’s Community Clinic. (Photo by Megan Stanfield)

“Studies show that the majority of people don’t go to a mental health professional, even when their family doctor refers them, so there are a tremendous number of people walking around with unaddressed health problems. If the behavioral health specialist is right there, in the same building as the general practitioner, that becomes almost a non-issue. I’m really excited about becoming part of a health care team – as a behavioral health care specialist, you’re an absolutely integral member of that group.”

With her grant funding, and as part of the ongoing training of doctoral students like Walsh, Carlson convened a May meeting in Austin that drew integrated health care experts from all over the country. The experts talked one-on-one with students and shared presentations on what it’s like to be a behavioral health specialist on a multi-professional team.

“This is the scenario of the future, and what particularly excites me is the movement to locate health care in close proximity to the patient, such as in school-based clinics,” said Carlson. “Integrated health care teams will soon be the norm. Right now, here at UT Austin, we’re ahead of the curve in preparing top-notch, highly skilled students who can enter that environment and immediately start contributing.”