"Collaboration In "Collaboration In Primary Care Primary Care Psychology"Psychology"

"Collaboration In "Collaboration In Primary Care Primary Care Psychology"Psychology"

Jeff Baker, Ph.D.Jeff Baker, Ph.D.The University of Texas Medical BranchThe University of Texas Medical Branch

Galveston, Texas 77555-1152Galveston, Texas 77555-1152jbaker@utmb.edujbaker@utmb.edu

409 772-9576409 772-9576

Funding Preferences for Collaboration

• Identify major health care training programs that would be interested in collaborating training with psychology

• 7 Current HRSA grants on our campus• Department of Physician Assistants• Department of Occupational Therapy

The Psychology Resident Training Program, Department of

Occupational Therapy (OT), Department of Physician Assistant (PA) Studies, Shriners Childrens

Hospital for Burns, Rehabilitation Services and the ACE (Acute Care

for Elders) Geriatrics Unit located at the University of Texas Medical

Branch at Galveston (UTMB) propose to develop the Primary

Care in Psychology (PCP) project.

• Define the Purpose and how it relates to the funding priorities of the GPE funding request.

The purpose of this project is to increase the number of clinical psychologists (CPs), Occupational Therapists (OT), Physician Assistants (PA) preparedness to provide primary care to at risk populations, especially those from underrepresented minority/disadvantaged backgrounds, practicing in medically underserved areas (MUAs) in Texas.

• Identify How the Collaboration would work at our site.

Through established relationships with current treatment facilities (psychology internship rotations), this project will develop an interdisciplinary course for CP, OT and PA students with clinical experiences in pediatrics, the rehabilitation center, anesthesiology pain clinic, acute care for elders (ACE), spine surgery clinic, and the Shriners Burns Hospital (all of whom support psychological services to address quality of life with their patients).

• Identify Goals• Identify Expected Outcomes

UTMB GalvestonGoal: to expand current and establish new clinical

training sites for these students and interns that provide collaborative primary care and mental health services to underserved populations, and serve as an innovative model to link Allied Health practitioners and CP clinical practice, education, and research. Program completers of the PCP project will be better prepared to provide culturally competent and sensitive allied health and psychological services to residents living in medically underserved communities.

UTMB Galveston – PCP Goals• Goal I. Improve access to quality health care

through appropriate preparation, composition, and distribution of the health profession workforce.

• Outcome: Prepare an appropriate number of health professionals necessary to support quality primary care.

• Indicator: Number of program completers of health professions that choose rural settings for their clinical affiliations or choose postdoctoral training in rural settings and/or provide primary psychological care to under represented populations.

UTMB Galveston – PCP Goals• Goal II. Improve access to a diverse and

culturally competent and sensitive health professions workforce.

• Outcome 1: Increase the number of allied health and psychology interns sensitive to cultural and economic issues of patients from rural settings and/or who are traditionally underserved by health care systems.

• Indicator: Number of allied health students and psychology interns participating in cross cultural training as related to mental health of patients from under served populations.

UTMB Galveston – PCP Goals• Outcome 2: Increase the number

of underrepresented/disadvantaged program completers.

• Indicator: Number of minority/disadvantaged program completers.

UTMB Galveston – PCP Purposes• Relationship of PCP Project to Statutory

Purposes• The Allied Health Projects Grants Program, Section

755 of the Public Health Service Act, as amended, authorizes the Secretary to make Allied Health Project grants to be eligible entities to assist them in meeting the costs associated with expanding or establishing programs that will increase the number of individuals trained in allied health professions. The Program Announcement indicates that programs funded under this section must address at least one of nine statutory purposes. The PCP project addresses two of these purposes:

UTMB Galveston – PCP Purposes

Statutory Purpose 1:A training curriculum that

emphasizes knowledge and practice in the areas of prevention and health promotion through an integrated clinical psychiatry course.

UTMB Galveston – PCP Purposes

Statutory Purpose 2:Expand and support clinical

training sites for allied health professionals to medically underserved populations in order to increase the number of individuals trained.

UTMB Galveston – Funding Preference

• Funding Preference• We are requesting a funding

preference based on our high rate of placing graduates in practice settings that have a focus on serving residents of medically underserved communities. See Allied Health Grant Funding Preference Request Form, Appendix A.

UTMB Galveston – Funding Priority• Funding Priority• We are requesting a funding priority based on our high

rate for placing program completers in practice settings having the principal focus of serving residents of medically underserved communities. For 2000-2001 program completers UTMB CP residents (interns) were placed at the following institutions: 1) MD Anderson Cancer Center (two program completers, one in adult and one in children’s health); 2) Harvard University (Kellog Foundation grant); 3) Baylor College of Medicine (Women’s Health Program faculty member); 4) a Postdoc in Mississippi with a high patient population from underserved areas and 5) one went into I/O psychology. This accounts for 5/7 (70%) working in rural or centers that provide services for under represented populations.

UTMB Galveston – PCP Special Initiatives

• SPECIAL INITIATIVES• The PCP project addresses the high profile HRSA

initiative of developing linkages with geriatric, underserved populations (Hispanic and African American), patients in rehabilitation, patients with chronic pain, and child and adolescent populations in our Children’s hospital and Shriners Burns Hospital and community service agencies that have predominantly under served populations that focus on substance abuse, mental health, and populations that do not readily have access to health and mental health care.

UTMB Galveston - PCPThe PCP project responds to local, state, and

national needs for PAs, OTs and CPs, especially those from underrepresented minority backgrounds, who are trained to provide hospital and community-based mental health services to underserved populations or in underserved communities. The majority of the training will take place in Galveston County which is a medically and mental health underserved area through continuing clinical services provided to specific inpatient and outpatient hospital and community services

UTMB Galveston – PCP Collaboration

The PCP project will develop joint learning opportunities for PA, OT and the CP internship program. Over a one-year period 20 OT and 40 PA students will collaborate with the 5 CP interns to provide services to UTMB inpatient and Galveston community-based mental health services.

UTMB Galveston – PCP CollaborationAt least three community-based clinical training

sites will be used to provide collaborative PA, OT and CP mental health services, including those that focus on alcohol and drug recovery, health promotion, prevocational and vocational skill development, peer resistance and skill building for youth at-risk, and life skills coaching. These sites are already established as OT and CP training sites in partnership with CSAs in the city of Galveston (ADA Center, Discovery Club, Our Daily Bread).

UTMB Galveston – PCP Collaboration

Learning activities that span both the OT and PA curriculum and CP internship program are classes in clinical psychiatry and current involvement in the Partnerships grant funded by HRSA. PA, OT and CP participants will interact in the clinical psychiatry course and will then participate in delivering mental health services at our adult rehab center, the Galveston Teen Health Center, Alcohol & Drug Abuse (ADA) House, Discovery Club (at risk youth) and Our Daily Bread (Homeless Shelter) to discuss their professions’ unique and collective contributions to the community-based assessment and service delivery process.

UTMB Galveston – PCP CollaborationThrough this joint interaction psychological

services from clinical psychology interns, physician assistants and occupational therapy students will provide services to patients in the rehab center, a surgery outpatient clinic, and the community agencies listed above. This collaboration will enhance interaction among these disciplines, increase psychological services to under served populations and develop a better appreciation for patients in need of psychological services.

UTMB Project Background

Demand and Need for Health Professionals

Towards a Diverse Health Professions Workforce

UTMB Galveston – PCP Grant Specific

Objectives• Objective 1• Develop the interdisciplinary clinical psychiatry course for

UTMB PA, OT students and CP interns, especially those from underrepresented minority/disadvantaged backgrounds, emphasizing knowledge and practice in prevention and health promotion in medical psychology in inpatient services and CSAs that will increase the number of PA graduates, OT graduates and CP program completers practicing in underserved areas or choosing affiliation placements in underserved areas as OT and PA will not complete their curriculum by the end of year one, (20 OT and 40 PA students and 5 CP interns over a one-year period)

UTMB Galveston – PCP Grant Specific

Objectives• Objective 2 (HP2010)• Support a joint PA, OT and CP training experience

emphasizing knowledge and practice in case based learning for prevention and health promotion in inpatient work and CSAs that will increase the number of OT and PA program completers to choose rural affiliations and CP program completers, especially those from underrepresented minority/disadvantaged backgrounds, choosing practice or choose an affiliation in underserved areas. (20 OT, 40 PA, and 5 CP interns over a one-year period)

UTMB Galveston – PCP Grant Specific Objectives

• Objective 3 (HP2010)• Utilize multiple clinical training sites at UTMB and in

the Galveston community (Rehab Center, Surgery outpatient, Cancer outpatient, Shriners Burns Hospital, Children’s Hospital and community service agencies: ADA Center, Discovery Club, and Our Daily Bread) to include collaborative PA, OT and CP mental health services provided to underserved populations in order to increase the number of OT students/interns and CP interns, especially those from underrepresented minority/disadvantaged backgrounds, trained to provide these services in underserved areas in the future.

UTMB Galveston – PCP Grant Specific Objectives• Objective 4• Establish a new clinical training site, in

partnership with the ACE unit in Geriatrics, to include collaborative PA, OT and CP mental health services provided to underserved populations in order to increase the number of PA, OT students and CP interns, especially those from underrepresented minority/disadvantaged backgrounds, trained to provide these services in underserved areas in the future.

UTMB Galveston – PCP Grant Specific Objectives

• Objective 5 (HP2010)• Establish the PCP project as an innovative

model using a case based approach that links PA, OT and CP clinical practice, education, and research in an interdisciplinary curriculum and training experiences that emphasize prevention and health promotion in hospital and community-based practice.

UTMB Galveston – PCP Grant Specific Objectives• Objective 6• Evaluate the PCP project to determine

its achievement of its goals and objectives for the purposes of future planning, budgeting, and sharing experiences with other educators and health care professionals for this one year program.

UTMB Galveston – Grant Evaluation

Three ultimate outcomes of this project will be (1) increased numbers of PAs, OTs and CPs prepared to provide mental health services to support primary care, (2) increased numbers of PAs, OTs and CPs practicing in underserved areas, and (3) increased numbers of PA and OT program completers and CP program completers from minority/disadvantaged backgrounds. Program completers of the PCP project will be better prepared to provide culturally competent and sensitive PA, OT and CP mental health services to Texans living in medically underserved communities. These outcomes will be achieved through development and implementation of an interdisciplinary PA, OT and CP clinical psychiatry course and a combined PA, OT and CP internship clinical experience in inpatient and community service agencies emphasizing prevention and health promotion providing services to underserved populations.

UTMB Galveston – Grant Evaluation

Summative evaluation of the overall outcomes of this project will consist of collection and analysis of the following data: (1) numbers of OT and PA participating in rural clinical affiliations and CP program completers prepared to support primary care, (2) numbers of PA and OT program completers and CP program completers who enter practice in underserved areas, and (3) numbers of PA and OT completers and CP program completers from underrepresented minority backgrounds. See BHPr goals, objectives, and indicators.

UTMB Galveston – Grant Evaluation

Summative evaluation of the integrated clinical psychiatry course will include indicators of student/intern learning and effectiveness of academic and clinical experiences. Measures are in place to evaluate and document the learning activities on the adult rehabilitation unit and geriatrics unit as well as a web based note documentation form for PA, OT, and CP interns are automatically submitted to a database form and will be evaluated to focus on identifying student/intern perceptions of their learning and their experiences in the PCP project. Specific indicators of learning are revealed through this analysis, pre and posttests, using surveys will be identified or developed, will be employed to capture these indicators quantitatively.

UTMB Galveston – Grant Evaluation

Quantitative measures of student/intern learning will consist of classroom case based discussions and exams for PA and OT clinical psychiatry students after their participation in either the integrated clinical psychiatry course. Student/intern learning related to multicultural competence will be measured using the Multicultural Sensitivity Scale (Jibaja, Sebastian, Kingery, & Holcomb, 2000).

UTMB Galveston – PCP Project Support

5 Faculty members (5% ) $71,0005 Psychology Interns (20%) $16,700Travel ($1200)M&O ($1800)