Patricia J. Robinson, PhD

1
The Primary Care Behavioral Health Model A
Platform for ACT in PC

• Patricia J. Robinson, PhD
• Mountainview Consulting Group, Inc. Zillah, WA
  USA
• patti1510_at_msn.com

2
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

3
The Primary Care Behavioral Health (PCBH) Model

• Initial exploration in the USA started in the
  1980s
• 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

4
Behavioral Health Consultant (BHC)

• Mission

• Methods

• 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

5
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)

6
Example Chronic Disease (Patient)
7
Example Chronic Disease (Provider)
8
Three Pillars Assessment

• Opening
• De-Fusion
• Acceptance
• Aware
• Present Moment
• Self as Context
• Engaging
• Clarifying values
• Supporting value-consistent action

9
Three Pillars Chronic Disease
10
Three Pillars Chronic Disease
11
Application of ACT PC Tools TEAMS and Three
Pillars (Role Play, Other Applications)

• 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)