Certificate Program in Integrated Primary Care

The Certificate Program in Integrated in Primary Care is a 20-week distance-based program offered through Fairleigh Dickinson University that prepares mental and behavioral health providers for working in integrated care settings. The program consists of five units, each of which is divided into four week-long modules. Each module includes a video lecture, interaction with the instructor and colleagues through discussion boards and, when relevant, additional readings. Completion of the entire program is associated with continuing education credits.

Program Outline

Unit 1. Basic Concepts

Module 1. The Integrated Care Perspective

This module reviews various ways that behavioral health can be integrated into primary care as well as literature on efficacy and implementation. The perspective of population-based care, or systematic management of health conditions in communities, is described in this module. The population-based care approach is used to inform the basis of discussion for all models of integrated care. Integrated care models are contrasted with traditional mental health practice to provide concrete guidelines for successful integration.

Module 2. Basic Concepts in Integrated Care

The following topics are introduced: collaborative care (care manager) models; population-based care approaches; introduction to outcomes measurement and registry management; consulting psychiatry models; and telehealth.

Module 3. Billing

The module describes the use of current procedural terminology (CPT) codes and translation of diagnoses from diagnostic and statistical manual of mental disorders (DSM-IV) to international classification of diseases (ICD) systems. Methods for analyzing the financial impact (cost/benefit analyses) of integrated care are introduced.

Module 4. Record Keeping

Best practices in recording patient contacts and storing patient records are reviewed. Common barriers to integrated billing and record-keeping are discussed, including state-by-state variations in regulations and setting-specific issues.

Unit 2. Provider Competencies and Characteristics

Module 1. Functional/Strategic Patient Care

The methods and theoretical basis for patient care in brief interactions are reviewed. Emphasis is placed on the transition from a traditional mental-health perspective to that of a primary care provider. Topics include: the step-wise care model/functional diagnostic skill development; core components of a primary care behavioral health visit; language and pace of primary care; and cultural, economic, and spiritual factors in treatment and health behavior change.

Module 2. Communication with Primary Care Providers

Best practices in communicating effectively with primary care providers and other staff are reviewed. Motivational interviewing is introduced as a tool for improving the effectiveness of mental and behavioral interventions throughout the clinic. Topics include: 30-second curbside case presentation; and motivational interviewing as applied to enhancing medication adherence.

Module 3. Adapting Established Interventions to Primary Care

Topics include: motivational interviewing; adapting evidence-based cognitive-behavioral interventions; and implementing acceptance and commitment therapy perspectives.

Module 4. Practical Psychopharmacology

Evidence based approaches to medication co-management are reviewed including assisting primary care providers with templates for medication decision-making. The ethics of the participation of non-prescribing mental health professionals in co-managing medication-related issues are discussed. Syndromes discussed include: depression; anxiety; Bipolar Disorder; Attention Deficit Hyperactivity Disorder (ADHD); dementia; and Schizophrenia.

Unit 3. Practice Standards

Module 1. Algorithms for Mental Health Conditions

Algorithms for integrated biopsychosocial treatment of mental disorders are reviewed, with special emphasis on those that are particularly prevalent in community health settings: affective, bipolar, and anxiety disorders. Practical thresholds for referral to specialty mental health care are explored.

Module 2. Behavioral Medicine

This module focuses on the ways in which mental health professionals can help clinics systematize the care of medically-related health issues. Brief overviews of common interventions for the most common of these behavioral health concerns are provided. In addition, the development and use of registries is discussed from simple to complicated systems. Topics include: system-based care for chronic diseases, obesity, smoking cessation; and developing and using registries to improve patient interventions.

Module 3. Concepts in Assessment

Topics include: methods of tracking the use of screening tools; methods of tracking response to treatment and patient satisfaction; tools for tracking screening and response to treatment; reporting procedures and data-based goal-setting; and measuring primary care provider satisfaction.

Module 4. Team-Building

Topics include: understanding the primary care culture; communication; and dealing with crisis in the setting.

Unit 4. Problem-Based Assessment

Module 1. Affective, Anxiety and Somatic Disorders

The most common mood disorders are reviewed, focusing on utilization of relevant assessment tools. Triage of suicidal, homicidal, and psychotic patients is discussed and co-management of at-risk patients are reviewed including practical tools for making well-informed patient-centered clinical decisions in adverse situations. Overlap between affective and somatic disorders, high utilization patients, patients with diffuse medical concerns, and patients with formal somatization disorders are reviewed.

Module 2. Pediatric Disorders and Obstetrics

The module focuses on assessment tools for affective/behavioral conditions, symptoms of ADHD, depression, and behavioral disturbances. The most common pediatric behavioral and mental health issues are reviewed, as is the use of brief family-based intervention and consultation with pediatricians and other child care providers in preventative care. The well child check is described. Obstetric screening and care is also discussed, particularly screening for perinatal depression.

Module 3. Geriatic, Cognitive, and Memory Disorders

The most common geriatric disorders are reviewed, focusing on assessment instruments relevant to screening for affective disorders and pseudo-dementia, mental status, activities of daily living, and dementia.

Module 4. Chronic Disease

Behavioral complications and causal factors that underlie most chronic diseases are discussed. Examples of disorders reviewed include: diabetes; hypertension; dyslipidemia; cardiovascular disease; and asthma.

Unit 5. Program Development

Module 1. Systems of Care

Systems of care in the United States are reviewed including the community mental health care system, the community health center system, the public health system, and private systems of care. This module focuses on ways that behavioral health consultants work within each of these systems.

Module 2. Community Relationships

This module focuses on activities of the behavioral health consultant outside the clinical setting. Topics include: accessing resources for alcohol and other drug abuse (AODA) and smoke cessation assistance; models for collaborating with local community mental health centers and private agencies; and communicating with the public about the role of the behavioral health consultant.

Module 3. Program Development

Common issues related to developing an integrated care program are reviewed including workforce development, hiring strategies, enhancing employee wellness, development of training programs, and intra-organizational barriers.

Module 4. Ethical Issues

Ethical and legal issues unique to the primary care setting are reviewed including differences in standards for sharing information between medical and mental health personnel, informed consent procedures, charting requirements, state-by-state differences in regulation of mental health service delivery, dual relationships with co-workers who are clinic patients, etc. Anticipatory strategies are reviewed to help behavioral health consultants adapt quickly and work concurrently with clinic administration on resolving these issues.