Title: The Ideal Clinicians How Do We Find Him or Her Hint: Look at How They Were Trained
1The Ideal Clinician(s) How Do We Find Him or
Her? (Hint Look at How They Were Trained)
- Leighton Y. Huey, MD
- Birnbaum/Blum Professor and Chair
- Department of Psychiatry
- University of Connecticut School of Medicine
2The Continuum of Recovery
No Recovery
Partial Recovery
Fully Recovered
Resources and Support Required
3Old Description
- Well Trained
- What does this mean?
- Well trained in what?
- How is well trained assessed?
- .and by whom?
- Bio-Psycho-Social
- What does this mean?
4New Description
- Well-Trained Comprehensive Assessment,
Treatment, and Follow-up - Think in terms of multiple possibilities and
narrow the choices as one gets to know the
patient and the family - Differential Diagnoses based on strong training
in diagnostics - Competent in Research Literacy
- The approach to individuals with a First Episode
vs. the approach to individuals who have
experienced multiple episodes is there a
difference?
5- Well-Trained continued..
- Truly consider Biological, Psychological, Social
Factors in the context of how the individual
presents and what is ultimately desirable
(cont)
6Comprehensive, Assessment, Treatment, and
Follow-up (continued)
- Biological
- Physical Health, Physical Symptoms
- Heredity
- Possible Contributing Factors to the
Clinical Presentation - Possible endogenous factors contributing to
the clinical presentation (e.g. thyroid
disorder, etc.) - Possible exogenous factors contributing to the
- clinical presentation (e.g., drugs, etc.)
7New Description
- Psychological
- State of mind of the individual and their
family - Events impacting the presentation (e.g.
trauma, incarceration, etc.) - Style of the individual
8New Description
- Social
- Life circumstances (e.g. socioeconomic,
living situation etc.) - Level of Function
- Supports
- Legal
- Educational
- Spiritual
- Other
- Prior Assessment and Treatment
- Response to Prior Treatment
9Old Description
- Evidence Based
- What does this mean?
- We want evidence, but what is the evidence?
- How does a clinician take the evidence into
account? - What compels a clinician to consider the evidence
and utilize it? - How broad is the application of the evidence?
- When do we run out of evidence and have to rely
on common sense?
10New Description
(from Gray, 2004)
- Evidence-Based
- Formulate the Question
- Search for Answers
- Appraise the Evidence
- Apply the Results to the Patient
- Assess the Outcome
11- Evidence-Based (continued)
- Track Improvement and Outcomes
- A Form of Services Research Built Into the
Multidisciplinary Effort (i.e. what works and
what does not work)
12New Description
- Treatment Algorithims
- Integration of Biological, Psychological and
Social approaches using only what is most
appropriate, what is needed, and what the
evidence tells us to do - Tracking Outcomes, Quality of Life, Function
13Old Description
- Culturally Competent What does this mean?
- Can only African Americans treat African
Americans? - Can only Asian-Americans treat Asian-Americans?
- Can only Hispanic-Americans treat
Hispanic-Americans? - Can only Caucasian-Americans treat Caucasian
Americans? - Can only First-Generation Americans treat
First-Generation Americans? - Can only Middle-Class Americans treat Middle
Class Americans?
14- Can only women treat women?
- Can only children treat children? Etc.
- How about, for starters, we insist on just being
competent?
15New Description
- Culturally Competent
- In providing care, clinicians must understand the
beliefs that shape a persons approach to health
and illness - Knowledge of customs and healing traditions in
the design of treatment and interventions
16Old Description
- Patient and Family Focused
- What does this mean?
- Does it really happen?
- What is meant by Focused?
- Is taking a history, doing an assessment, coming
up with a diagnosis, translate into Patient and
Family Focused?
17New Description
- Shared Decision-Making
- A basic principle of treatment, i.e., a
collaboration
Consumer/patient
Treating System
Family
- Setting the tone early at the first visit
18New Description
- Multidisciplinary in scope
- Conscious utilization in a cost-effective manner
- Use whatever resources are directly necessary for
the individual and their family
Nursing
Social Work
Public health
Psychiatry
Primary care
Psychology
Consumer/patient family
Legal
Educational
Occupational
Supports
19Old Description
- Transformation
- What does this mean?
- Transform like casting a magic wand and
suddenly things are better? - Transform because this concept is used, it
means we all agree on what the transformation
should be?
20New Description
- Turn the System Upside Down
- Consumer/Patient and Family are the Center of the
attention - But a caveat, if at the center , does this
establish a dependent position unintentionally
vs. shared decision making where the
consumer/patient and family are part of the
health care system?
Patient/Family
vs
Patient/Family
21Old Description
- Fee-for-Service
- Fee for what service?
- Piece-work and therefore fragmented
- By definition, not comprehensive and not
integrated
22Old Description
- Capitation
- Still not integrated, not comprehensive covers
only the medical health side
23New Description
- Need for New Economic Models
- Pay for Performance within a Quality Improvement,
Cost-Effectiveness Paradigm - Multidisciplinary a Requisite
- Outcomes and Follow-up Essential
- Fund Innovation Models
24Enter the Annapolis Coalition
- Charged by SAMHSA to develop a National Strategic
Plan on Workforce - A broad-based, consensus-building national effort
focusing on pre-professional and the established
workforce in the context of Consumers/Patients
and Families, Children, Information Technology,
Dual Diagnosis, Rural Behavioral Health,
Integration with Physical Health, etc.
25New Description
- Multidisciplinary in scope utilizing a
consciously cost-effective manner
26The Annapolis Coalition on the Behavioral Health
Workforce
Board of Directors
27The Annapolis Coalition on the Behavioral Health
Workforce
Steering Committee
28The Annapolis Coalition on the Behavioral Health
Workforce
Steering Committee (continued)
29The Annapolis Coalition on the Behavioral Health
Workforce
Consumer/Patient and Family Work Group Executive
Committee
30The Annapolis Coalition on the Behavioral Health
Workforce
Consumer/Patient and Family Work Group Executive
Committee (continued)
31New Description and Clinical Curriculum Reform
- Each discipline starts training by itself
- Build interdisciplinary seminars and clinical
case conferences into the training experience
focusing on the integration and coordination of
care among disciplines - Place multidisciplinary teams into clinical sites
and have them function in the way they were
trained - Create Interdisciplinary Workgroups/Institutes to
develop Innovation Models - Study the Models and their Outcomes compared with
treatment as usual
32New Description
- Developing a Strategy for Curriculum and Training
Reform (Get Political!! Time for Return on
Investment - Identify Innovators
- Mobilize the Strength of the Respected National
Advocacy Organizations to Work Together - Press the Education and Training Establishments
in each discipline to modify the way it educates
and trains - Focus on both pre-professional training and on
the established workforce - Develop funding systems that will drive and
sustain innovation at the Federal and State Level