integrated clinics: threat or enhancement to training? cindy m. bruns, phd association of counseling...
TRANSCRIPT
INTEGRATED CLINICS:
Threat or Enhancement to Training?
Cindy M. Bruns, PhD
Association of Counseling Center Training Agencies –
Baltimore, MD 2112
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.
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.
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)
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
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
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%
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%
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 withoutneeding additional informed consent?
Yes 12.20%
Yes but only with Psychiatry 6.34%
No 81.46%
AUCCCD DATA - 2011
Are you (the Counseling Center Director) the chief administrator over the health service?
Yes 11.35%
No 88.16%
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?
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?
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
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?
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