1. INTEGRATED CLINICS: Threat or Enhancement to Training? Cindy M. Bruns, PhD Association of Counseling Center Training Agencies – Baltimore, MD 2112

2. DISCLAIMER Oops! Please don’t mistake me for an expert. I just proposed this presentation in the spirit of ACCTA volunteerism. I do, however, work in an integrated clinic and am fairly competent at literature searches.

3. LEARNING OBJECTIVES  1) Participants will be able to describe at least 3 potentially problematic issues related to integrated medical and counseling clinics.  2) Participants will be able to describe at least 3 potentially beneficial outcomes of integrated medical and counseling clinics.  3) Participants will be able to describe at least 2 methods of facilitating collaboration in a multidisciplinary setting.

4. INTEGRATED CARE OUTSIDE THE UNIVERSITY SETTING  Have been discussions in the literature for the last 2.5 decades  Definitions vary widely: Biopsychosocial treatment Professionals from different disciplines working closely to provide continuity of care Behavioral or mental health consultants working with physicians Direct (assess to answer a specific question, chart answer) Informal (sit in on staffings and provide expertise) Collaborative (combines direct, informal, and often psychotherapy)

5. WHY INTEGRATIVE CARE IN THE “REAL” WORLD?  Mental health concerns constitute a significant percentage of presenting issues in primary care settings  Increased focus on biopsychosocial aspects of disease  Increased focus on wellness and prevention  Recognition of the psychological aspects of compliance with treatments and interaction of mental and physical health concerns  Lack of training for health care providers with respect of psychological functioning

6. WHY INTEGRATED SERVICES AT UNIVERSITIES?  Reduction of barriers (i.e., less stigma about going to the health center vs the counseling center)  Mental health concerns are large percent of presenting complaints at health centers  Ease of cross-referrals  Elimination of duplicate resource expenditure  Students may be less confused about where to go for what  Many of same reasons for integrating care in the “real” world

7. AMERICAN COLLEGE HEALTH ASSOCIATION - 2010

8. WHAT ARE WE REALLY DOING OUT THERE? AUCCCD Data on Collaboration and Integration

9. AUCCCD DATA - 2011 My counseling center collaborates with Student Health Services Not at all 3.90% A little 15.12% A fair amount 46.34% Extensively 34.63%

10. AUCCCD DATA - 2011 Is your center located adjacent or near a student health service? Yes 57.11% No 42.89% Is your center located in a student health service building? Yes 35.15% (up from 15% in 2009) No 64.85% Is your center administratively integrated within a health service? Yes 25.36% (up from 15.6% in 2009) No 74.64%

11. AUCCCD DATA - 2011 Do you and you Student Health Services share an electronic medical records system? Yes 16.01% No 83.99% Do you and you Student Health Services share access to your counseling records without needing additional informed consent? Yes 12.20% Yes but only with Psychiatry 6.34% No 81.46%

12. AUCCCD DATA - 2011 Are you (the Counseling Center Director) the chief administrator over the health service? Yes 11.35% No 88.16%

13. CONCERNS ABOUT INTEGRATION  Being over-taken by medical/disease model  Records/confidentiality  Loss of autonomy  Budget/resource allotment  Having a director who doesn’t understand counseling  Loss of counseling center identity  Basic philosophical differences…clients versus patients, etc.  Others?

14. POTENTIAL TRAINING DRAWBACKS  Training program seen as “extra” or “expendable” item in the budget when times are tight  Subtle or not so subtle pressure to change training or treatment philosophy toward medical model/problem-solving approaches  Interns exposed to “turf” wars or triangulation  Others?

15. POTENTIAL BENEFITS TO TRAINING  Exposure/introduction to behavioral health issues and practice  Development of cross-discipline consultation skills  Develop broader conceptualization skills using multiple perspectives  Education regarding interaction of medical diagnoses with psychological effects  Greater education about medication uses and side effects

16. POTENTIAL BENEFITS CONTINUED  Experience with truly coordinated care of a client/patient  Learning how to navigate medical system in order to advocate for clients in a supported and supervised setting  Develop appreciation for the difficult job of medical providers, nurses, etc.  Others?

17. IMPORTANT CONSIDERATIONS PRE-INTEGRATION  Talk, talk, talk, talk Goals of integration Roles Training Philosophy Legalities (e.g., records, confidentiality)  Respect, respect, respect  Clarity of structure  Common goal: Student Service

18. IMPORTANT CONSIDERATIONS POST-INTEGRATION  Talk, talk, talk, talk  Respect, respect, respect  Regular Multidisciplinary Team Meetings  Shared vision statement  Individual department mission statements related to vision  Continued clarification of roles, laws, ethics, boundaries, etc.