IMA Behavioral Health

Orientation

Session 1 of 6

SURVEY: PLEASE COMPLETE BEFORE PROCEEDING

Lauren Peccoralo, MD, MPH Shyam Sundaresh, MD Eric Woods, MD

Agenda

Overview of IMA BH CURRICULUM

Overview of IMA BH CLINIC

Review mental health resources for IM residents

Agenda

Overview of IMA BH CURRICULUM

Overview of IMA BH CLINIC

Review mental health resources for IM residents

Overview of IMA BH curriculum

We have been working hard to enhance the curriculum this year.

Pre survey: thank you for considering!

Post-session surveys

Post survey: end of year

Overview of IMA BH curriculum

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Goals

Objectives

Outline

Overview of IMA BH curriculum: GOALS

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Improve your familiarity with mental health

(and how it fits in with the rest of health)

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Improve your communication skills

(and your patient satisfaction)

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Overview of IMA BH curriculum: OBJECTIVES

1. Use the Patient-Centered Interview (PCI) technique to gather psychiatric history with relevant subtleties based on patient, family, and system needs (Patient Care)

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2. Use the Ask-Respond-Teach (ART) framework to educate patients about diagnoses for unipolar mood and anxiety disorders (Interpersonal and Communication Skills)

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3. Understand the mechanisms, indications, and evidence for therapies for unipolar mood and anxiety disorders (Medical Knowledge)

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4. Use principles of measurement-based care (i.e. use of Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 (PHQ-9 and GAD-7)) to monitor and revise treatment (Patient Care)

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5. Coordinate patient care with available mental health resources including collaborative care psychiatry and community resources (Systems-Based Practice)

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6. Practice principles of Trauma-Informed Care (TIC) in order to establish and sustain therapeutic relationships with patients (Professionalism)

Overview of IMA BH curriculum: OUTLINE

Overview of IMA BH curriculum: OUTLINE

Agenda

Overview of IMA BH CURRICULUM

Overview of IMA BH CLINIC

Review mental health resources for IM residents

Overview of IMA BH clinic

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Goals for patients

Outcomes

Workflow

Overview of IMA BH clinic: Goals

1) Evaluation

Listening: identification of patients not ready for change is OK

2) Medications

For those who desire

3) Referrals

For those who desire or need

4) Safety Planning

Overview of IMA BH clinic: Outcomes

27yoM PHQ-9 = 22 and GAD-7 = 21 (for years)

Visit #1: Listened to his story. Started an SSRI.

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Overview of IMA BH clinic: Outcomes

27yoM PHQ-9 = 22 and GAD-7 = 21 (for years)

Visit #1: Listened to his story. Started an SSRI.

Visit #2: No improvement. Listened more. Dx: SAD and ADHD.

Started an SSRI and adderall.

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Overview of IMA BH clinic: Outcomes

27yoM PHQ-9 = 22 and GAD-7 = 21 (for years)

Visit #1: Listened to his story. Started an SSRI.

Visit #2: No improvement. Listened more. Dx: SAD and ADHD.

Started an SSRI and adderall.

Visit #3: Improvement in social anxiety and inattention. Got a promotion!

No improvement in PHQ-9 or GAD-7.

Open to therapy referral.

Overview of IMA BH clinic: Outcomes

34yoM PHQ-9 = 4 and GAD-7 = 18 (recently lost employment)

Visit #1: Listened to his story. Dx: SAD. Started an SSRI.

Visit #2: GAD-7 = 4. SAD in remission.

Still seeking employment.

Overview of IMA BH clinic: Outcomes

66yoF PHQ-9 = 21 and GAD-7 = 18 (already in therapy)

Visit #1: Listened. Not happy with therapist. Reviewed treatment options.

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Overview of IMA BH clinic: Outcomes

66yoF PHQ-9 = 21 and GAD-7 = 18 (already in therapy)

Visit #1: Listened. Not happy with therapist. Reviewed treatment options.

> Supported self-efficacy to decline SSRI initiation

(hesitant about gastrointestinal side effects)

Overview of IMA BH clinic: Outcomes

66yoF PHQ-9 = 21 and GAD-7 = 18 (already in therapy)

Visit #1: Listened. Not happy with therapist. Reviewed treatment options.

> Supported self-efficacy to decline SSRI initiation

(hesitant about gastrointestinal side effects)

…

…

Visit #2: Ready to start SSRI.

Overview of IMA BH clinic: Outcomes

> Mood disorders

> Anxiety disorders

> Trauma-related disorders

> Personality disorders

> ADHD

> Substance use disorders

> Neurocognitive disorders

> Psychotic spectrum disorders

Overview of IMA BH clinic: Workflow

Patient is roomed and given symptom questionnaires

(video visits are not given questionnaires in advance)

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Interview!

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Present, Wrap-up, Complete Flowsheets and Note

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.EVAL

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Patient-Centered Interview

1) Introduce the patient to IMA BH

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2) Set the agenda

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3) Open-ended HPI

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4) Elaborate the HPI but keep it patient-centered

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5) Transition to the doctor-centered HPI

Patient-Centered Interview

1) Introduce the patient to IMA BH

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Welcome to our behavioral health clinic. My name is Dr. Sundaresh. I am a second year Internal Medicine resident who rotates in this clinic.

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2) Set the agenda

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Since this is your first time in our behavioral health clinic, I’d like to give you an idea of what to expect today. First I’d like to hear from you about your experience and how you think we can help. Some folks are looking for help finding a therapist. Others are interested in a medication. Some are not sure, and that’s ok too. Afterwards I will step out to review what we talked about with my attending before we finalize our plan.

Patient-Centered Interview

3) Open-ended HPI

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What brings you to our behavioral health clinic? [Listen]

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4) Elaborate the HPI but keep it patient-centered

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When did you first realize you were feeling that way?

Patient-Centered Interview

5) Transition to the doctor-centered HPI

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> Thank you for sharing your experience with me.

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> I want to make sure I’ve understood everything correctly. I’m going to summarize what I’ve heard so far. Afterwards please feel free to make corrections or additions.

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> In order to get more information that will be helpful, is it ok if I go through a list of questions?

Volunteered trauma disclosures

This might happen.

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Trauma experts believe it important for patients to choose to share, if they want.

Avoid reinforcing to the patient that they cannot handle sharing it.

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“Thank you for telling me.”

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“Thank you for sharing that with me.”

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“I’m sorry that happened to you.”

Agenda

Overview of IMA BH CURRICULUM

Overview of IMA BH CLINIC

Review mental health resources for IM residents

Mental Health Resources for IM Residents

Student & Trainee Mental Health Program (STMH)

FREE. Consultations, therapy, medications, referrals, burn out

212-659-8805

STMH@mssm.edu

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Mental Health Hotline

24/7 crisis support, or information about referrals

212-241-2400, school code ICAHN

Summary (this is in the app)

IMA BH CURRICULUM

Enhancement: Direct observations to improve communication skills.

IMA BH CLINIC workflow

Documentation Flowsheets & .EVAL

Expect broad DDx and range of progress

Use the Patient-Centered Interview technique to emphasize patient narrative.

Familiarize yourself with responses to volunteered trauma disclosures.

Review mental health resources for IM residents

STMH: 212-659-8805.