Patricia J. Robinson, PhD Mountainview Consulting Group, Inc. Zillah, WA USA The Primary Care Behavioral Health Model: A Platform for ACT in PC 1

Workshop Objectives Learn about a new job for behavior therapists (as part of a primary care team) Consider ways to deliver ACT in brief interventions that primary care colleagues can learn and support (ACT as a team approach) Consider case examples and participate in role plays of suggested ACT approaches 2

The Primary Care Behavioral Health (PCBH) Model Initial exploration in the USA started in the 1980’s Superior outcomes to usual care for depression (Katon, Robinson, et al., 1996) Clinical outcomes Patient satisfaction Provider satisfaction Better use of the limited health care dollar Decade spent refining a model delivery issues PCBH model adopted by Community Health Care System, many HMOs, and more recently in individual PC practices Economic reimbursement issues still being sorted out 3

Behavioral Health Consultant (BHC) MissionMethods To improve the health of the population of patients receiving care at the PC setting where the BHC works Health: Last (1988) “a state characterized by anatomical, physiological, and psychological integrity; ability to perform personally valued family, work, and community roles; ability to deal with physical, biological, psychological and social stress; a feeling of well-being; and freedom from the risk of disease and untimely death.” Consultation versus psychotherapy (Teach / coach / Advise, PC remains in charge) Work looks like PC (brief, episodic) Focus on population versus case Interventions range from pt focus to population focus to system focus 4

Sharing ACT with PC Colleagues Expanding from mechanistic to contextual Expanding from relational to functional BHC service models core principles of ACT Assessment of QOL (not dx focus) Focus on referral problem / question (complete contextual interview, use functional analysis skills) TEAMS Analysis (Thoughts, Emotions, Associations, Memories, Sensations) Tool to explore experiential avoidance Three Pillars Tool to identify patient needs regarding strengthening of ACT processes (Open, Aware, Engaged) 5

Example: Chronic Disease (Patient) 6

Example: Chronic Disease (Provider) 7

Three Pillars Assessment 8 Opening De-Fusion Acceptance Aware Present Moment Self as Context Engaging Clarifying values Supporting value-consistent action

Three Pillars: Chronic Disease 9

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Application of ACT PC Tools: TEAMS and Three Pillars (Role Play, Other Applications) 11 Role play Volunteers Pt Provider BHC “TEAMS” team “Three Pillars” team Other Applications of ACT in PC Training Practice Meetings Clinical Pathways involving ACT processes (e.g., chronic pain / Pain and QOL Pathway)