Family Medicine and Medical Family Therapy A Model

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Family Medicine and Medical Family Therapy: A Model of Integrated Care and Training William

Family Medicine and Medical Family Therapy: A Model of Integrated Care and Training William T. Manard, MD, FAAFP Max Zubatsky, Ph. D, LMFT Craig Smith, Ph. D, LMFT F. David Schneider, MD, MSPH Dixie Meyer, Ph. D, LMFT Saint Louis University School of Medicine Department of Family and Community Medicine

Disclosures • All participants: No relevant disclosures

Disclosures • All participants: No relevant disclosures

Objectives • • • Describe the benefits and challenges of combining behavioral health with

Objectives • • • Describe the benefits and challenges of combining behavioral health with medical training and practice. Outline methods to merge potentially competing models of care. Describe how to improve person-centered care available through a co-located collaborative care model.

Overview • • In 2013, the Department of Marriage and Family Therapy at Saint

Overview • • In 2013, the Department of Marriage and Family Therapy at Saint Louis University became the Division of Medical Family Therapy in the Department of Family and Community Medicine at Saint Louis University School of Medicine A new model of care was required to provide proper training to both our medical and therapy trainees • This new partnership has had challenges • There are many benefits to such collaboration • Although much has been done, much remains to be developed

Why a single department? • • In 2013, due to University realignment, Saint Louis

Why a single department? • • In 2013, due to University realignment, Saint Louis University restructured the Marriage and Family Therapy program The Department of Family and Community Medicine noted this: • Was an ideal collaboration opportunity fitting well with family medicine’s model of care • Would strengthen the division of behavioral medicine within the department

Why a single department? • • Beginning with the 2013 -2014 academic year, the

Why a single department? • • Beginning with the 2013 -2014 academic year, the Marriage and Family Therapy training program became the Division of Medical Family Therapy within the Department of Family and Community Medicine This provided an opportunity for an important program to continue, while affording needed behavioral health collaboration for the medical training programs

Curriculum changes • The Medical Family Therapy program restructured several courses and training opportunities

Curriculum changes • The Medical Family Therapy program restructured several courses and training opportunities to meet department needs: • Med. FT courses on theories, health, and clinical topics in medicine • Integrating residents in supervision and practicum courses at on-campus clinic • Primary care experience for students on their clinical rotations • Offering two clinical/research scholarships for students to work with other faculty in the department

Curriculum changes • Residency training changes • • Med. FT students at residency FMCs

Curriculum changes • Residency training changes • • Med. FT students at residency FMCs • Providing consultation services • Providing counseling services • Collaboration in integrated care teams Med. FT students on residency inpatient services • Provide consultation services as part of rounds • Some direct patient care • Limited by necessity

Curriculum changes • Predoctoral education for medical students • Opportunities for students and faculty

Curriculum changes • Predoctoral education for medical students • Opportunities for students and faculty to work with medical students on inpatient training • Med. FT faculty who are facilitating trauma informed care workshops with interprofessional education • Med. FT students training and mentoring medical students at the Health Resource Center

Challenges of integration • What does integration mean? • How to integrate care? •

Challenges of integration • What does integration mean? • How to integrate care? • How to integrate training? • How do we blend differing practice cultures?

Integration • Multiple facets to integrate • Funding streams to merge • Single clinical

Integration • Multiple facets to integrate • Funding streams to merge • Single clinical practice? • Collaboration and integration vs. co-location

Integrating care • Where to put more “bodies”? • Multiple practice sites with varying

Integrating care • Where to put more “bodies”? • Multiple practice sites with varying facilities • • • MFT’s “home” practice • Faculty practices • Residency practices Finding the best environment for collaboration • Meeting as a group • “Curbside consultations” Finding the best environment for direct patient care

Integrating training • Ph. D and MA training programs • • • Involvement in

Integrating training • Ph. D and MA training programs • • • Involvement in residency training • • • Where do differing levels of learners fit in? Do these training programs serve different goals? Teaching team-based care How best to integrate different training programs? • • MD model is different than MFT model • Supervision • Expectations • Patient care perspectives Gaining understanding of the impact of these differences

Integrating cultures • Similar goals for care, but different approaches • Do we speak

Integrating cultures • Similar goals for care, but different approaches • Do we speak the same language? • How do we prioritize what needs are most important for patients? • When do we have time to consult about cases?

Benefits to integration • Improved quality of training • Improved quality of patient care

Benefits to integration • Improved quality of training • Improved quality of patient care • Greater research and scholarly opportunities

Improved quality of training • MD training has aspects to offer to MFT training

Improved quality of training • MD training has aspects to offer to MFT training • • • MFT training has aspects to offer MD training • • Biochemical understanding of behavioral changes Navigation of health care systems Family systems theories Therapeutic techniques (MI, ACT, CBT, medical genograms) Interpersonal communication Faculty of both programs complement one another

Improved quality of care • Behavioral health consultation • • • Behavioral health referral

Improved quality of care • Behavioral health consultation • • • Behavioral health referral • • Discussion of complex cases in office Introduction of behavioral therapy for potentially resistant patients Ongoing therapy services in medical office Referrals to the Med. FT on-campus clinic Reduction of stigma Complex care management • • Participation on interdisciplinary team for complex patient care planning Offer further insights into care of one another’s patients

Research as an added benefit • Supporting each others’ research efforts • Collaboration for

Research as an added benefit • Supporting each others’ research efforts • Collaboration for topic development • Collaboration for actual studies • Differing approaches to scholarly activity complement one another

Research as an added benefit Initial question: What are the health concerns predominately treated?

Research as an added benefit Initial question: What are the health concerns predominately treated? • Pain Disorders • • Muscle Pain Headaches Back pain Arthritis Neuropathy Obesity All of the above comorbid with depression and/or anxiety

Research as an added benefit How do our physicians, staff and Med. FT students

Research as an added benefit How do our physicians, staff and Med. FT students view integrated care in our clinics? What are some of the common barriers and challenges that we see in practice? What roles can Med. FTs serve in this capacity?

Future directions • Continuous presence of consultative services • Increased counseling presence in practices

Future directions • Continuous presence of consultative services • Increased counseling presence in practices • Greater integration of Med. FT in MD predoctoral education • Greater cross-department collaboration with willing partners • Developing a Med. FT Fellowship position in the department

Conclusion • • Transitioning to a medical family therapy model can be challenging Integrating

Conclusion • • Transitioning to a medical family therapy model can be challenging Integrating into an existing faculty practices offers exciting opportunities, but barriers continue to exist • Co-location is a start, but integration remains a goal • Many scholarly opportunities that remain to be uncovered

Contact information • • Bill Manard – manardwt@slu. edu Max Zubatsky – zubatskyjm@slu. edu

Contact information • • Bill Manard – manardwt@slu. edu Max Zubatsky – zubatskyjm@slu. edu Dave Schneider – dschnie 13@slu. edu Craig Smith – csmith 112@slu. edu Dixie Meyer – dmeyer 40@slu. edu Doug Pettinelli – pettinj 3@slu. edu Jeff Scherrer – scherrjf@slu. edu Carissa van den Berk-Clark – cvanden 1@slu. edu

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