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Integrated Primary Care Tools

Behavioral Medicine for Mental Health Professionals

A Training Resource

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS-T

The AMHCA Integrated Primary Care Webinar Series

AMHCA conducted a three session webinar series January 28, February 11 and February 25, 2015, entitled: "Integrated Medical Settings Webinar Series." What follows are the session Lecture PowerPoints and Case Studies: A fourth one followed on November 6, 2015. Here are the four AMHCA Integrated Primary Care Webinar Series Presentations:

Webinar 1: Do You Have The Tools? Essential Tools for Assessment, Psychoeducation and Treatment needed by Behavioral Health Consultants in Integrated Primary Care Medical Settings. Click here for PowerPoint  and  PCBH Brief Intervention Competency Assessment Tool (BI-CAT)
Click here for Post Test For answer sheet contact jamesjmessina@coping.us

Webinar 2: Do You Have the Language? Essential Knowledge, Terminology and Communication Skills Needed in Integrated Medical Settings
Click here for Post Test For answer sheet contact jamesjmessina@coping.us

Webinar 3: So What Say You? Problem Solve Treatment Interventions in a Hands on Case Conference Concerning Behavioral Health Interventions for Patients in Integrated Medical Settings
Click here for PowerPoint   Case Studies   For the Template of Behavioral Health Consultant Plans for the 10 Case Studies contact jamesjmessina@coping.us  Click here for Post Test For answer sheet contact jamesjmessina@coping.us

Webinar 4: Behavioral Medicine approaches for Patients who have had either a Heart Attack or Stroke A review of the immediate crisis intervention, in hospital rehabilitation and out patient rehabilitation and potential mental health disorders as a result of these physical  catastrophic events.
Click here for PowerPoint  Click here for Post Test For answer sheet contact jamesjmessina@coping.us

AMHCA Conference July 2016 Presentations

Workshop 1: Evidence Based Practices, Imperative within Integrated Medicine - An explanaton why it is imperative for Mental Health Professionals who wish to work in Integrated primary care settings must be ready to demonstrate that the treatment models they use are backed up by scientfic research as to their effectiveness since that his the Medical Model which requires all treatment modalities be back up with research evidence as to their effectiveness with patients. Click Here to Download Presentation

Workshop 2: Marketing yourself to Integrated Medicine Communities - A presentation on the steps which Mental Health Professionals can take to market themselves to primary care professionals and to the larger community. Easy steps which are based on their prior experience in the mental health field are presented. Click Here to Download Presentation

Video Demonstrations of Integrated Medicine Procedures


1. Warm Handoff - Motivational Interviewing: The Primary Care Physician (PCP) using a warm handoff to a Behavioral Health Consultant (BHC who is a Mental Health Worker) when there is a concern about the behavioral health of a patient. When the PCP meets with the patient the PCP uses Motivational Interviewing to engage the patient’s cooperation and willingness to participate in meeting the BHC, to put a plan into action. The steps of the Motivational Interview are:

  1. Use reflective listening: The PCP seeks to understand the patient’s idea about the issue for which a handoff from the PCP will be made to the BHC. The PCP in this step then offers a recap of the patient’s ideas so as to confirm an understanding of the ideas offered.
  2. Ask permission: The PCP asks the patient if he/she is open to talking with the Behavioral Health Consultant (BHC).
  3. Ask open-ended questions: When the BHC meets the patient, the BHC avoids asking questions with yes or no answers to engage the patient in conversation on the issues for which the handoff has been made.
  4. Enhance motivation: The BHC elicits talk from the patient about change and the patient’s desire, ability, reason and need to change.
  5. Determine patient’s readiness: The BHC determines the patient’s stage of readiness for change.
  6. Negotiate a plan: The BHC negotiates a plan with the patient based on what steps he/she is ready to take.

Video available at: https://www.youtube.com/watch?v=GpSU7zMZ6xA


2. Warm Handoff – Anxiety: The Primary Care Physician (PCP) using a warm handoff to a Behavioral Health Consultant (BHC who is a Mental Health Worker) when there is a concern about anxiety as the behavioral health issue of a patient. When the PCP meets with the patient the PCP uses Motivational Interviewing to engage the patient’s cooperation and willingness to participate in meeting the BHC, to put a plan into action to address the anxiety. The steps of the Motivational Interview are:

  1. Define Integrated Healthcare: The PCP explains to the patient how primary health and behavioral health work together
  2. Ask permission: The PCP asks the patient if he/she is open to talking with a BCH.
  3. Team communication: The Primary Care and BHC consult together about the patient
  4. Build rapport: The BCH forges a nonjudgmental connection with the patient
  5. Raise the subject: The BHC explains the role of BHC, introduces the process and asks permission to have a discussion about the anxiety issues which the patient is experiencing
  6. Reflect on change: The BHC summarizes what has been discussed with the patient about the anxiety related issues.
  7. Establish next steps: The BHC assists the patient with scheduling a follow-up appointment.

Video available at: https://www.youtube.com/watch?v=pkKZ4e0iUqg


3. Brief Intervention: SBIRT: Screening Brief Intervention Referral to Treatment is an evidence based intervention which can be used within Primary Care Setting to assist patients to address their problematic substance abuse issues.

SBIRT involves the following steps:

  1. Build rapport: The staff person (usually a Behavioral Health Consultant-BHC) forges a nonjudgmental connection with the patient.
  2. Raise the subject: The BHC explains the role, the process and asks for permission to have discussion about the substance/alcohol use.
  3. Provide feedback: The BHC share pertinent information and elicits patient feedback.
  4. Enhance motivation: The BHC uses reflections and other tools to increase a patient’s readiness to address and change health behaviors.
  5. Negotiate a plan: The BHC negotiates a goal with the patient based on what steps she/he is ready to take

Video available at: https://www.youtube.com/watch?v=T4EFmjw7Epc


4. Morning Huddle: The staff of an Integrated Primary Care Center have brief morning meetings to go over their list of patients and their specific needs which the team can address when the patients come in that day:

There is no set formula for Morning Huddles, so they can be adapted by each team for the steps that work for them.

The steps involved in such huddles are:

  1. Conducting check-in: This is a motivational building activity of checking in with the members of the team to build morale
  2. Reflect on the week: This gives the team a chance to discuss any successes or challenges their patients gave them over the past week
  3. Overview of patients: The staff reviews patients’ physical health, behavioral health and any high risk issues.
  4. Agree upon tasks and integrated activities: The team members decide on the day’s consultations and warm handoffs.
  5. Agree upon follow-up and communication: The team members make a plan of action items.

Video available at: https://www.youtube.com/watch?v=-8lDsdru0Hs


NOTE: You will see that each video has DSRIP labeled on it. To clarify what this means we looked at what is DSRIP. The Delivery System Reform Incentive Payment (DSRIP) Program is the main mechanism by which New York State will implement the Medicaid Redesign Team (MRT) Waiver Amendment. DSRIP´s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health.


It was for this program that the National Council for Behavioral Health developed the above set of training videos to explain various components of Integrated Medicine. Since these are excellent quick videos they are being presented here so that you can get a better idea of what integrated medicine teamwork and patient interventions look like.

Clinical Tools for Behavioral Health Consultants
Behavioral Health Consultants who work in Primary Medical Setting need to have a whole arange of tools readily at their disposal.
They need:
  1. Assessment Tools
  2. Clinically Appropriate Homework Handouts
  3. List of Apps which they can refer patients to
  4. A Model for Ongoing Support Groups in the Primary Medical Setting

Behavioral Health Consultants also need to have have sufficient background information about the various tests, measures and descriptions of medically related conditions for which their patients present in such settings.

Finally Behavioral Health Consultant need examples of case which they will face in the Integrated Primary Care Settings so as to acquaint them with the type of problem solving and interventions which occur in these settings.
Assessment in Integrated Primary Care

There is a comprehensive list of Assessment which you can use in the Clinical Assessment Tools at http://www.coping.us/cliniciantreatmenttools/assessmenttools.html


The Assessments available for download cover the following areas:

1.Overall Client's Self-Assessment of Personal Functioning
2.Depression
3.Anxiety
4.Physical Symptoms
5.Sleep Disturbance
6.Physical Pain Assessment


Also listed are the organizations which offer these assessments:

1.DSM-5 Assessments
2.Patient Health Questionnaire (PHQ)
3.PROMIS (Patient-Reported Outcome Measurement Information System)
Apps to be used in Primary Health Settings by Behavioral Health Consultants
A number of links to Apps are available on: http://www.coping.us/cliniciantreatmenttools/appsthatwork.html

There are APPs for:

1.Behavioral Change and Resilience Building
2.Breathing and Relaxation Training
3.Sleep Problems
4.Weight Management
5.Suicide Prevention
6.For Kids

Apps have made 24/7 mental health intervention possible and it is important for Behavioral Health Consultants to be aware of these free tools which can be downloaded to patients iPhone or Smartphones

Behavioral Health Consultant Psychoeducational and Interventional Tools
There is a whole array of material which can be used by Behavioral Health Consultants in Integrated Primary Care Settings at:  http://www.coping.us/cliniciantreatmenttools/worksheetsforclinicians.html 

The Materials include Thought Records, Daily Diaries, Journal Writing Outline and a huge variety of Handouts such as:
1.Guidelines for Better Sleep
2.Stages of Change
3.Values
4.What is CBT?
5.How Breathing Affect Feelings
6.Safety Behaviors
7.Thoughts and Depression
8.Unhelpful Thinking Styles
9.What is Rumination
10.Core Belief Magnets
11.Thought Suppression and Intrusive Thoughts
12.Fear of Bodily Sensations
The following are the primary source of most of the worksheets listed above: 
  1. Psychology Tools at: http://psychology.tools/download-therapy-worksheets.html
  2. Therapist Aid at: http://www.therapistaid.com/therapy-worksheets/cbt/none
  3. Morning Light Counseling's "Handouts on CBT Skills and Strategies" on  their website at: http://www.morninglightcounseling.org/healing-a-recovery/tools-for-recovery/handouts-cbt
  4. Cognitive Behavior Therapy Self Help Resources at:  http://www.getselfhelp.co.uk/freedownloads2.htm
Group Programming in Primary Medical Care Settings 

On Coping.us are three distinct support group programs which involved a combination of emotional healing, psychoeducation and creating a network of supports for patients.

1. The SEA's Program: The Self-Esteem Seeker's (SEA's) Program is a support group modeled after the 12 Steps of AA. However it is addressed at the emotional growth of its participants who suffer from a whole array of mental health and substance use disorders. The online manual contains instructions on how to conduct the program for patients, a 12 Step Workbook for patients, SEA's Tools for Recovery, and the SEA's Lifestyle Skills Handbook. It is available at: http://www.coping.us/seasmanual.html

2. Tools for a Balanced Lifestyle: A Support Program for a  Guilt Free System of Healthy Living: This program was developed for patients who needed to turn their lifestyles around to lose weight, eat well, implement an exercise program and deal effectively with the irrational drivers involved in their weight management. This program has a number of powerpoints which were included in the next program to be discussed. You can get directly to the Balanced Lifestyle Support Group Model at: http://www.coping.us/balancedlifestyle/strategiesforsuccess.html 

3. Strategies for Success in Personal Health Management: This program is aimed directly at patients who are referred to Behavioral Health Consultants and it is available at http://coping.us/behavioralmedicine/strategiesforsuccessinhealthmanagement.html  for you to utilize. 
Videos about Integrated Medicine

What is Integrated Care-Published August 2015 by National Council for Behavioral Health on YouTube at: https://www.youtube.com/watch?v=S-029Yf7AYM&feature=youtu.be


Health Care: Plain & Simple - "Patient Centered Care"- Directed to patients about Patient Centered Medical Homes in Hawaii on YouTube at: https://www.youtube.com/watch?v=D6RltGOVetY


What is Patient-Centered Health Care? - Directed to patients on YouTube at: https://www.youtube.com/watch?v=QgdBXWUZcrM


What is a Medical Home and Why Do I Need One? - Directed to patients on YouTube at: https://www.youtube.com/watch?v=P9_pD70bDxM


"Ted" (What is an ACO?) - Directed to patients who are patients of OSF on YouTube at: https://www.youtube.com/watch?v=tTm2GtL0xSs


Patient Centered Medical Home - Directed to patients sponsored by the Patient Centered Primary Care Collaborative  on YouTube at: https://www.youtube.com/watch?v=btsGDHO_4lU


Patient-Centered Medical Home Video - Directed to patients on YouTube at: https://www.youtube.com/watch?v=CvroxEpoyNY