Advancing the science of integrated behavioral health in primary care

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Enhancing training, improving access

We bring together a multi-disciplinary community of trainees, clinicians, researchers, educators, and community stakeholders.

Our team has methodological and content expertise in epidemiological and health delivery research, using a variety of designs as well as mixed methods. Mixed methods research uses qualitative and quantitative methods in the same study and is well-suited to the development, evaluation, and dissemination of primary care based training and intervention strategies.

We also have a track record of training students, residents, and junior investigators in developing successful research careers. The following projects are a springboard for the developmental phases to come and have a high potential to improve primary care training programs and enhance integrated behavioral health care.

Best Practices in Integrated Behavioral Health Training and Practice

This project aims to identify and disseminate best practices in the implementation of IBH training models, identify barriers and facilitators to IBH training and implementation in primary care and develop curriculum that is informed by stakeholders as a crucial step for establishing benchmarks and measuring adoption and dissemination.

Project Leads: Peter Cronholm, MD, MSCE, FAAFP; Julie Sochalski, PhD, FAAN, RN

Drivers of opioid prescription duration for acute pain: A retrospective cohort study of opioid-naïve patients in primary care

Primary care physicians (PCPs) represent the largest group of opioid prescribers in the United States. Our study examines the opioid prescribing patterns of PCPs for the treatment of acute pain and the likelihood of long-term use. We identify factors associated with time to opioid discontinuation based on the type, strength, and quantity of opioids, as well as by medical condition, geographic region, and patient demographics. The goal of our research is to help inform PCPs in assessing the risks associated with differing prescribing practices.

Project Leads: Rebecca Harris, MD

Resident Education in Integrated Behavioral Health: CAFM Educational Research Alliance (CERA) Program Directors' Survey

This project seeks to identify the prevalence of behavioral health instruction in Family Medicine residency curricula nationally. We will further analyze which knowledge based and skills based topics are being taught within residencies. We will contribute to the national interest in competency based assessment by studying professional consensus regarding appropriate level of training for behavioral health clinical skills. This knowledge could lead to more in depth development of this aspect of the AAFP Recommended Clinical Guidelines and help accelerate workforce readiness for models of behavioral health and primary care integration. More importantly, understanding relationships between the attitudes of program directors with regard to whether or not residents can or should learn these skills is a question of national regard. In gaining understanding on these themes, a standard for best practices can be determined and disseminated in order to prepare residents for professional practice in an IBH environment. In a collaboration with colleagues from Saint Louis University, this project entails a national survey of U.S. Family Medicine Program Directors through the Council of American Family Medicine Educational Research Alliance (CERA) to analyze these themes.

Project Leads: Renée Betancourt, MD; Kent DW Bream, MD; Mario P. DeMarco, MD, MPH; Peter Cronholm, MD, MSCE, FAAFP; Margaret Baylson, MD, MPH


Determining the Current State and Future Needs of Primary Care Training in Trauma Informed Care

This project aims to understand the current state of primary care training for medical residents and nurse-practitioner students related to Trauma-Informed Care (TIC),in order to identify best practices, gaps in training, and metrics for ongoing assessment of TIC-related training and training needs. We will identify primary care trainees’ perspectives on how training on TIC practices are integrated into their workflow, system-level barriers and facilitators to implementation of TIC practices, and inter-professional development needs to provide improved TIC practices.

Project Leads: Melissa Dichter, PhD, MSW; Peter Cronholm, MD, MSCE, FAAFP; Anne Teitelman, PhD, FNP-BC, FAANP, FAAN

Opioid Use Disorder in Primary Care Training and Practice

This project aims to enable the adoption of OUD prevention, screening, and treatment in primary care through training. It seeks to increase the identification and management of OUD in primary care settings as well as settings such as dental practices in which opioid prescriptions may be initiated. We will identify barriers to OUD education for primary care and dental providers, explore potential solutions to address gaps in training, and identify strategies to increase the adoption of evidence based training models.

Project Leads: David Oslin, MD; Courtney Wolk, PhD

Medical Student Education in Behavioral Health: CAFM Educational Research Alliance (CERA) Clerkship Directors' Survey

There is significant overlap between patients with behavioral health disorders and medical illness and separate systems for behavioral health and primary care have not addressed the needs of these patients. Newer models of care are relying heavily on the integration of behavioral health care into primary care settings. In order to meet the needs of these care models, providers must receive education and training in the skills that are required to diagnose and treat behavioral health conditions including substance use. A national survey was performed to identify behavioral health topics, tools and techniques that are being taught amongst medical students learning primary care. Understanding the prevalence, distribution and barriers to implementing curriculum in this area is critical to developing best practice guidelines that can inform the AAMC and undergraduate medical training.

Project Leads: Mario P. DeMarco, MD, MPH; Renee M. Betancourt, MD; Kent Bream, MD

Improving the Training of Primary Care Providers in the Treatment of Alcohol Use Disorders

Alcohol dependence is the fourth leading cause of disability worldwide, yet no more than 15% of individuals with AUD are actively engaged in treatment.  The goal of this investigation is to develop strategies that improve the training of primary care providers and clinical staff on the treatment of alcohol use disorders. The purpose of this research project is twofold: First, we want to conduct a formative evaluation prior to and during implementation to assess barriers and facilitators to implementation of alcohol treatment. Second, we want to compare the effectiveness of three different training programs (academic detailing, academic detailing plus staff education, and academic detailing plus offering of care management) on increasing access to treatment.

Project Leads: David Oslin, MD; Puneet Sahota, MD, PhD