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Tools Needed in Behavioral Medicine

Behavioral Medicine for Mental Health Professionals

A Training Resource

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

Do You Have the Tools? 
Essential Tools for
  • Assessment
  • Psychoeducation
  • Treatment
 Needed by Behavioral Health Consultants In Integrated Primary Care Medical Settings
Let’s See if you have what it takes?

Before we begin take the Brief Intervention Competency Assessment Tool (BI-CAT) to determine if you have the competencies needed to be a Behavioral Medicine Consultant in a Primary Care Setting


The BI-CAT measures:

  • PRACTICE CONTEXT. This area concerns your ability to consistently promote optimal behavior change opportunities for your clients in the setting where you work
  • INTERVENTION DESIGN. This area concerns your ability to design strong brief interventions.
  • INTERVENTION DELIVERY. This area concerns your ability to integrate brief interventions into your system of care, so that more clients benefit from your brief services.
  • OUTCOMES-BASED PRACTICE. This area concerns your ability to use outcomes to plan and evaluate treatment.
 

The BI-CAT is available for download at: http://www.coping.us/images/Robinson_2013_PCBH_BI-CAT.pdf

Use this scale to assign a “rating” to your competence level at this time.


0 = not adequate 5 = adequate 10 = exemplary


PRACTICE CONTEXT. This area concerns your ability to consistently promote optimal behavior change opportunities for your clients in the setting where you work.


Do you . . .


_____1. Understand the most common problems of patients in your setting and promote their access to your services for these problems?

_____2. Address barriers to patients access of your service (e.g., minimize stigma, select optimal location)?

_____3. Work to share your skills with other members of your team so that they can support your interventions with patients?

_____4. Define the demands of your practice setting and make necessary adjustments to your practice with patients(e.g., numerous clients and limited providers / shorten visit times)?



0 = not adequate 5 = adequate 10 = exemplary


INTERVENTION DESIGN. This area concerns your ability to design strong brief interventions.


Do you . . .


_____5. Introduce yourself and your services to patients in ways that promote change (e.g., My job is to help you help yourself, I may only see you once; we will come up with one or more strategies to help you today)?

_____6. Target problem of concern to the patient at time of visit?

_____7. Identify and use patients’ strengths in intervention design?

_____8. Normalize the patient’s problem or avoid pathology explanations of the problem?

_____9. Complete assessment prior to beginning behavior change planning

_____10. Offer patients a case conceptualization in a problem summary statement

_____11. Focus on small changes (“one step at a time”)?

_____12. Frame intervention as “an experiment to see what happens” (i.e., create permission to fail)?

_____13. Assess confidence in behavior change plan at all visits

_____14. Identify and address barriers to patient’s follow through with behavior change plans?

_____15. Encourage patients to take ownership of behavior changes?

0 = not adequate 5 = adequate 10 = exemplary*


INTERVENTION DELIVERY. This area concerns your ability to integrate brief interventions into your system of care, so that more clients benefit from your brief services.


Do you . . .


_____16. Establish a care pathway (or routine procedure) for consistent delivery of acceptable, effective interventions for common patient’s problems (e.g., skill groups for patients with depression, lifestyle problems or chronic disease; workshops for patients with high stress, or sleep problems)?

_____17. Offer open access groups to patientss to enhance access to skill practice and social / emotional support?


OUTCOMES-BASED PRACTICE. This area concerns your ability to use outcomes to plan and evaluate treatment.


Do you . . .


_____18. Use outcomes tailored to delivery of brief interventions (e.g., problem severity rating)?

_____19. Demonstrate willingness and ability to change intervention based on assessment results (e.g., confidence rating)?

_____20. Use outcomes in aggregate to evaluate the effectiveness of your practice (e.g., patient’s change in mental health or health-related quality of life scores from initial to last follow-up visits)?


*To relate item scores to BI-CAT behavioral anchors use these category labels: “low” for scores of 0-3 , “adequate” for scores of 4-6 and “exceptional” for scores of 7-10.
 Assessments to Use


There is a comprehensive list of Assessment which you can use in the Clinical Assessment Tools with older adults 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)
Promis: Emotional Distress – Depression – Short Form 8a

Please respond to each question or statement by rating it 1-5:

1-Never 2-Rarely 3-Sometimes 4-Often 5-Always


In the past 7 days...

1. I felt worthless
2. I felt helpless
3. I felt depressed
4. I felt hopeless
5. I felt like a failure
6. I felt unhappy
7. I felt that I had nothing to look forward to
8. I felt that nothing could cheer me up


Scoring: add up value on 8 items= Raw Sum then multiple by number of items on form and divide by 8 which gives a T Score: T Score of 50 = average anything over 50 is a sign of some depression, the higher the T Score the greater the depression


You can gain information on all PROMIS assessments at: https://www.healthmeasures.net/explore-measurement-systems/promis  
Other Assessments You can use

Health Anxiety Thought Record

Situation Date & Time

Trigger for health anxiety 

  • Did you notice a symptom, 
  • have a thought, 
  • or hear about an illness?


Emotion: (Rate intensity 0-100%)

Negative thought: (Rate belief 0-100%)

How I responded - How did you respond to the negative thought?

Rational response to negative thought - Ask yourself:

  • Am I making a thinking error?
  • Am I catastrophizing?
  • Am I focusing on the worst case?

Outcome (Re-rate belief in negative thought)

  • How does the rational thought make you feel?
  • Was there anything else you found helpful?

Thought Records

Situation: 

  • Who, 
  • what, 
  • when, 
  • where?

Feelings: 

  • What did you feel?
  • Rate your emotion 0 -100%

Thoughts

  • What was going through your mind as you started to feel this way? (Thoughts or images)

1. Daily Activity Diary


2. Daily Monitoring Form


3. Pain Diary (rate pain 0-10, time of day, day of week for entire week


4. Panic Diary (Answer: Situation; Body sensations/mental events (e.g. racing heart, breathless, dizzy, racing thoughts); Negative Thoughts; Answers to Negative Thoughts; Total Number of Panic Day each day and total for the week


5. Sleep Diary (complete each day of week)

In Morning answer: 
  • I went to bed last night at (time); 
  • I got up this morning at (time); 
  • I slept for a total of (hours); 
  • I woke up during the night (# times)

In Evening answer: 

  • Number of caffeinated drinks today; 
  • Time of last caffeinated drink; 
  • Exercise completed today (minutes); 
  • What I did in the hour before I fell asleep; 
  • Mood today? (0=awful, 10=great)
Information Sheets to use
1. Guidelines for Better Sleep
2. Stages of Change
3. Values
4. What is CBT?
5. How Breathing Affects 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

These and more handouts are available at: http://www.coping.us/cliniciantreatmenttools/worksheetsforclinicians.html  


The following are the primary source of most of the worksheets listed above:
Apps to be used in Primary Health Settings


There are APPs for:

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


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
Strategies for Success in Health Management:  
Patient Support Group Model


There are PowerPoints and handouts to be used by Behavioral Health Consultants in conducting Support groups with patients in their Integrated Primary Care Settings. The Topics are:


1. What do these Terms (medical) Mean?

2. Tips from "Eat, Drink and Be Healthy"

3. Benefit of Exercise over the Lifespan

4. Introduction to the Use of Exercise in Your Life

5. Rationale for Exercise for Weight Management

6. All About Heartrate in Exercise

7. Tips on Walking

8. Stretching

9. Sustaining a Healthy Outlook

10. Overcoming Perfectionism in Changing Your Lifestyle

11. Making Peace with Food

12. Your Support Team

13. Open Admission to Support Team .

14. Support Team as a Healing Environment

15. Strengthening Your Support Team

16. The Importance of Sleep

17. What is Stress

18. What are the Sources of Stress

19. Tips for Relaxation of Stress Response

20. Tips for Pain Management


The materials can be downloaded from: http://www.coping.us/behavioralmedicine/integratedprimarycaretools.html