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CFHA - 18th Annual Conference: Celebrating the Many Faces and Places of Integration
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Objective 1: Provide skill building training based on evidence-based prevention, treatment, and care management practices for chronic disease (e.g. diabetes, major depression, PTSD care, obesity…etc.)
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
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Objective 2: Define and describe population or public health interventions aimed at the prevention and early intervention of physical and mental health problems
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Objective 3: Identify strategies, practices and tools proven to be effective in expanding roles for patients and family members to better manage their own health in primary, specialty, and tertiary care settings
By meeting the above objective my professional competence will increase because I have acquired new strategies to use in my practice.
By meeting the above objective my professional performance will improve because I should be able to implement the new strategies.
By meeting the above objective my patient outcomes should improve due to the implementation of newly-learned strategies.
Determine the difference between these approaches to integration
Identify the core concepts and practice elements of each integrated care approach
Discuss how each model is applied, the populations they serve, and the challenges associated with implementation and sustainability of each
Identify the rationale for behavioral health IT
Identify three key functions of successful behavioral HIT
Identify three ways behavioral HIT can help meeting Triple Aim goals of improved quality of care, patient experience, and cost efficiency/value of care
Identify how your spiritual beliefs impact your work as a provider
Identify two or more ethical dilemmas in primary care and possible ways to manage those dilemmas
Describe a two-fold strategy to increase support for ethical challenges as they arise in the workplace
Summarize selected findings on the interaction between physical and mental health conditions and evidence-based integrated care models for older adults with chronic health conditions and mental health disorders
Describe efforts to redesign primary care practices to engage in screening, care coordination, and integrated care delivery for co-occurring conditions leveraging nurse-team annual Medicare Wellness visits and Complex Care Management
Describe recent finding on the effectiveness of automatic telehealth in older adults with mental illness and chronic health conditions supporting illness self-management and care management in the community
Describe and discuss common health disparities affecting LGBT groups
Identify steps for create culturally competent and welcoming health care environments for LGBT individuals
Identify acute and chronic health concerns prevalent among LGBT populations and explore evidence-based team interventions designed to address these concerns
Describe current national and state trends in opioid use
List three innovative community approaches to intervention and treatment which have shown successful outcomes
Describe the challenges and opportunities which arise from working collaboratively as a community of care in approaching work for these populations
Describe the role of primary care and collaborative care teams in responding to the opioid epidemic
Identify the challenges and successes of caring for patients with opioid use disorders in primary care from the perspective of a physician and a behavioral health provider, with an emphasis on skill development and interdisciplinary training
Describe a practice-specific model of buprenorphine and counseling services highlighting procedures such as the treatment contract, a tiering system, behavioral health integration, and the role of family support and staff education
Critically consider how personal experiences impact clinical work in collaborative care settings
Discuss assets and liabilities of incorporating personal patient experience into professional functioning
Describe why collaborative care may be the ideal setting within healthcare to shift the culture to one where clinicians' experiences as patients are welcomed
Identify process and outcome improvement metrics which promote sustainable models of integrated care delivery for families and patients
Describe and discuss data mining options for collecting metrics to demonstrate fidelity, quality improvement, and fiscal sustainability related to integrated care programs
Identify, evaluate and select tools for effective financial strategic planning and management in integrated care.
Describe the applicability of the VA model of integrated care in other population based settings
Identify barriers and facilitators to implementation of integrated care
Assess the utility of an evidence based implementation facilitation model in various settings
Illustrate a current working model of integrated care that treats the individual and family system in a way that is both unique and systemic
Describe a system that treats high-risk individuals who may otherwise not receive the necessary care for themselves and/or their families
Illustrate a model of collaboration that treats the individual and their families from a bio-psycho-social-spiritual perspective
Identify unique aspects of spirituality and meaning that are relevant to your particular medical setting
Learn ways to help engage and train supervisees in the importance and practical application of evidence-based spiritual assessments and interventions
Understand ways to overcome supervisees discomfort and challenges in providing spiritual-based clinical care
Articulate the need for and describe the key components of an effective behavioral health home model such as Behavioral Health Home Plus
List the steps used in wellness coaching to effect clinical and health outcomes
Identify the population management components to improving population health
Describe how to determine the quality and rigor of a quality improvement/program evaluation project
Identify general strategies for improving the quality and generalizability of quality improvement/program evaluation efforts
Describe how you can improve the quality and/or generalizability of a project that you are planning or currently implementing
Describe at least three best practices for how behavioral health clinicians can positively impact medical residents' learning about behavioral health through co-management of patients
Identify common reasons why residents may feel less involved with their patient when behavioral health providers are involved and at least one strategy to mitigate this
List at least 3 ways in which family medicine training differs from internal medicine and pediatrics, and how principles from family medicine training can be adapted to different training models
Identify action steps that facilitate coordination of care between behavioral health and primary care practices for individuals with serious and persistent mental illnesses and/or substance abuse disorders
Identify chronic illness self-management strategies for this population
Identify evidence based practices that facilitate improved health and wellness for this population
Identify three aspects of how the care delivery system is structured in foster care settings
Describe three characteristics of the HCPS IHC program for children in State custody that differ from usual
List three recommendations for future design and implementation of practice, program and policy considerations of IHC with foster care children
Identify strategies for overcoming financial barriers to implementing integrated primary care
Discuss ways that an organization can maintain a financially sustainable model of integrated care
Define the "hybrid" model of integrated primary care
Define the term "learning healthcare system" and its application to Champion teams
Describe the utility of and keys to implementing Champion Teams
Describe two examples of Champion Teams and the application of this mechanism to making data-informed changes toward team-based care in their own setting
State the 3 core justifications for integration methods development
Critique the method of methods development and implementation
Offer at least two suggested improvements to the proposed metrics and implementation
Describe how the ICC was strategically planned and carried out in a family medicine residency program from the perspective of a behavioral health faculty, family medicine faculty, and pharmacy faculty
Describe the specific components of the Integrated Care Clinic, how components were measured and initial feasibility results and financial data related to the utilization of the ICC.
Discuss how integration of behavioral health is occurring at their respective clinics, lessons learned from the process, and next steps in their respective transformations
Identify diagnosis data trend differences between Latino families and other ethnic families in the primary care setting
Describe differences in PHQ-9 and ACE scores by racial/ethnic categories and utilization pattern differences by racial/ethnic categories
Describe the impact of familism on patient response to and engagement with the PCBH model and healthcare in general
Describe how to determine the quality and rigor of a quality improvement/program evaluation project
Identify general strategies for improving the quality and generalizability of quality improvement/program evaluation efforts
Describe how you can improve the quality and/or generalizability of a project that you are planning or currently implementing
Teach medical providers basic skills in behavioral health interventions for patients with co-morbid depression and diabetes
Discuss the value of collaborative care in the treatment of depression and diabetes and the potential outcomes for both diagnoses
Use role plays to provide similar training at their clinics going forward
Define terminology related to gender diversity
Identify the physical and mental health care needs of gender diverse patients
Identify resources for best practices in gender diverse healthcare
Identify the unique clinical needs of parents and children when a family member has a chronic, complex illness such as cancer
Engage and intervene with family members through frameworks and evidence based assessments and interventions
Describe the differences in care at the primary and specialty care levels and the importance of collaboration between settings
Describe the benefits of leadership development for individuals, teams, and systems
Identify untapped leadership potential within their own workplace
List three practical leadership development strategies specific to integrated behavioral health
Identify successful intervention strategies for spreading integration
List centralized structural elements that support a system-approach to integration
Incorporate new strategies into their ongoing work to develop integration
Identify effective selection criteria to use when selecting students to train within the PCBH model.
Describe strategies for training the core competencies of the PCBH model among students of various developmental levels
Discuss effective supervision processes that can be used within the primary care setting in integrated care.
Summarize how interprofessional teamwork trainings enhance practice-based skills and assist in meeting the triple (and quadruple) aim
Critique and appraise the benefits of aligning IPE Core Competencies for Interprofessional Collaborative Practice with the SAMHSA-HRSA Standard Framework for Levels of Integrated Healthcare to enhance integrated care team based functioning
Identify key elements of interprofessional training to enhance teamwork skills within integrated care settings
Identify strategies for gathering data to assess program outcomes
Explain statistical and data management strategies for assessing outcomes
Identify strategies for reporting outcomes to stakeholders and clients
Recognize the prevalence and implications of Type 2 diabetes
Discuss patient perception, satisfaction, and improvements in health-related outcomes stemming from participation in a SMA for patients with Type 2 diabetes
Understand how to implement a SMA within an integrated care setting
Identify the unique clinical needs of family caregivers when a patient has a later life complex illness
Engage and intervene with family members through frameworks and evidence based assessments and interventions
Describe the differences in care at the primary and specialty care levels and the importance of collaboration between settings
Identify barriers and facilitators to referring patients to behavioral health providers for brief tobacco and alcohol interventions in the primary care setting
Identify barriers and facilitators to implementing brief alcohol and tobacco interventions as described by behavioral health providers working in primary care
Describe ways that behavioral health providers and primary care providers might work together to increase delivery of brief alcohol and brief tobacco interventions
Describe collaborative care approaches to depression care
Identify the essential elements of program implementation
Discuss the relationship between IMPACT outcomes the application in emerging healthcare models
Identify evidence based protocols for assessment and treatment of patients seeking MAT in primary care setting
Identify specific and generic difficulties with delivery of MAT in primary care setting
Identify specific and generic benefits of delivery of MAT in primary care setting
Demonstrate family-centered care
Highlight the experience of illness within the context of family
Demonstrate how medical and behavioral health clinicians can discuss such a case
Describe and implement the needs assessment necessary at their organizations
Identify grant resources that will support program implementation and sustainability, and describe key components of successful grant writing
Identify future collaborators for program development at their organizations
Describe the current tensions in the academic environment around IPE programming
Identify crucial "next steps" for IPE programs in better fitting with health care evolution
Discuss how IPE could, if empowered to do so, fuel an even stronger team care capacity within health care
Identify the unique cultural and biopsychosocial needs of Karen refugees in the U.S
Explore the use of cultural case formation to deliver integrated medical, behavioral, and complementary and alternative medical care
Apply a culturally-formed medical, behavioral, and complementary and alternative medicine integrated primary care model in one practice using a case study
Discuss two advantages that traditional primary care BH screening measures provide to integrated care practitioners
Identify three significant shortcomings of traditional primary care BH screeners
Describe two possible advantages that the Outcome Rating Scale may provide to primary care BH screening
Identify basic metrics that can be used for program/implementation evaluation
Describe ways of expanding basic metrics into more complex program evaluation strategies
Discuss the rationale for implementing a robust metrics tracking system for their own program evaluation
Describe the core steps of the initial medical and behavioral health screening for newly resettled refugees
List and described 3 lessons learned while implementing this integrated care delivery model for newly resettled refugees
List 3 advantages to newly resettled refugees' access to the continuum of care offered in a fully integrated health care system
Explain the difference between BH assessment and psychological testing, as well as strategies for implementing both in primary care
Identify specific measures that can be utilized to address the most common reasons for testing referral in primary care
Develop strategies for implementing psychological testing in primary care, including approaches to workflow and personnel
Identify factors that define patient complexity and how to combine them in a way that preemptively identifies complex patients
Discuss developmental learning experiences that build a culture of population focused, team-based care
Identify attitudes, cultural issues, and systems of care barriers that impede change
Describe a state Provider Monitoring Tool used in behavioral health audits
Identify key partners to include in audit preparation work groups
Identify ways to plan for behavioral health services when utilizing a medically oriented electronic health record
Describe what is known about patient preferences for care through the Collaborative Care and PCBH models
Describe and apply a framework for patient and community engagement
Develop ideas for using participatory action methods for evaluating perceptions of integrated care models in their own clinical setting
Discuss how their values and personal definition of "family" impact how they provide family-centered care
Differentiate between patient-centered and family-centered care
Cite which aspects of family-centered care are best supported by the scientific literature
Identify opportunities to use interprofessional workplace learning activities to meet the educational and patient care needs of training clinics
Describe shared educational goals across different healthcare professions
Acquire information on the process of implementation for three workplace learning programs
Describe how psychosocial screening aids in the identification of social determinants of health
Identify strategies for implementing psychosocial screening tools
Discuss how psychosocial screening can enhance integrated care initiatives
Describe several models of integration
Describe the key principles of integrated care
Identify existing tools to support development of integration in their own setting
Describe at least (2) integrated behavioral health models that are being implemented with a majority Hispanic population
Identify at least (2) methods of evaluating integrated behavioral health models
Recognize at least (1) one innovative element in the IBH models delivered in this study
Identify the systemic relationships and dynamics related to poorly controlled type 1 diabetes in adolescents
Explain key barriers to diabetes management for adolescents with poorly controlled type 1 diabetes and their families from patient, family, and provider perspectives
Identify potential points of intervention in the patient/family/provider dynamics to improve diabetes management in this at-risk population
Describe the importance of same day or advanced/open access to mental and behavioral health services as part of integrated care
Identify six different models of program design for implementing same day access
Discuss key same day access implementation considerations, including barriers, facilitators and strategies for success
Summarize the existing research on LGBT populations in integrated care settings
Recognize the benefits of expanding research of LGBT populations in integrated care settings
Identify current benefits of using collaborative care with LGBT populations
Synthesize research findings that support primary care based treatment, effective patient engagement, brief integrated behavioral health treatment, group treatment approaches, and mobile phone apps as a treatment adjunct
Describe new models of healthcare contracting and payment in the ACO model and how population-based treatment of psychophysiologic disorders can meet this need
Calculate cost savings and return on investment for population-based treatment of psychophysiologic disorders
Evaluate the FCOF as it relates to core family interview skills in primary care
Apply the FCOF to two videotaped medical encounters
Critique the FCOF content, design and application in primary care settings
Describe the ways in which family of origin interactions influence patients' expectations of healthcare experiences and mental and medical health outcomes
Apply principles of family legacies to the biopsychosocial management of various chronic and acute illnesses
Develop an individualized plan for how to integrate the concept of family legacies into assessment and history taking, rapport-building, and biopsychosocial intervention
Explain the inception and development of a stepped-care protocol set within a pediatric primary care clinic as conceptualized by the Consolidated Framework for Implementation Research
Describe the function and utility of an Ecomap to understand a family's social determinants of health
Apply the RE-AIM model to evaluate a clinical intervention implemented within an interdisciplinary pediatric primary care clinic
Define the components of burnout and how to assess burnout in integrated behavioral health clinicians
Articulate several reasons behavioral health providers are at conspicuous risk for burnout in an integrated care setting
Respond to burnout in oneself and among trainees by practicing specific wellness and resiliency methods for preventing and managing burnout
Identify barriers to forward progress in the integration movement in the domains of care delivery, finance, training and education, workforce, and technology
Discuss a broad range of recommendations generated by expert opinion and consensus to advance integration of behavioral health and primary care
Identify and discuss barriers and recommendations specific to on-the ground delivery of care within an integrated setting
Describe how to set up an evaluation protocol to track performance outcomes of behavioral health consultants and health coaches
Outline steps to successful implementation of screening protocols and fidelity measures without disruption of the work flow
Construct a plan of action, including strategies to identify what outcomes should be measured, how to build necessary evaluation templates, and implement evaluation protocols
Describe patterns of suicide for patients receiving health and behavioral healthcare
Describe key elements of care pathways, and the evidence for these elements for individuals who may have suicide risk, including screening and assessment, steps for patient safety and effective treatments
Define how these elements have been assembled in a care model (Zero Suicide in Healthcare) and implemented in advanced primary care and behavioral health
Identify the various ways the team can communicate about suicide within this healthcare organization
Identify the barriers and facilitators that are present that may impact the communication within the team
Identify potential ways for future examination on team communication and its potential impact on suicide prevention
Identify and describe innovative strategies for maximizing BHC services in the primary care setting
Identify the essential team members' and administrators' role in executing these innovative strategies for maximizing BHC services in the primary care setting
Describe medical conditions, health behaviors, and aspects of a patient's social health that warrant involvement of a BHC in the primary care setting
Describe the evidence-base for pediatric IHC programs
Identify several different models of care for children and adolescents at risk of emotional and/or behavioral health problems
Develop an understanding of unique challenges to (and potential solutions for) implementing and evaluating pediatric integrated behavioral health programs
Describe the health issues, service utilization, gaps, and trends experienced by children and adults with intellectual and developmental disabilities in North Carolina
Describe practical application of clinical skills that meet the needs of individuals with I/DD and their families and are relevant for other populations seeking collaborative care
Describe the family perspective on the contribution of collaborative care to access, health outcomes, quality, and patient experience
Identify the theoretical underpinnings of the PCBH model
List at least four common controversies and confusion points regarding the PCBH model
Apply the theoretical underpinnings of PCBH to reconcile the controversies and confusion points
Describe the need for a set of competencies in common across a large mainstream implementation such as in Colorado
Describe a repeatable process that can be used to create consensus competencies in your own state or organization
Apply suggested guidelines to tailor these competencies for their own state or local use while preserving the essence so that common meaning and language becomes additive for the field over time and place
Describe the importance of a Health Risk Assessment to guide treatment decision-making in primary care based on the example of the "My Own Health Report" (MOHR)
Describe the importance of psychological assessment to guide treatment decision-making in primary care using the "Health Dynamics Inventory" (HDI) as an example
Explain how the MOHR and HDI can be utilized selectively in a primary care, population health management program such as the collaborative care model and the business case
Outline the types of beliefs about health and healing that affect the relationships among patients, family caregivers and healthcare professionals
Delineate the impact on collaborative team functioning of specific factors such as meaning-making, decision-making power, and cultural norms
Describe specific clinical means of creating better fit among the beliefs of patients, family caregivers and healthcare professionals
Describe the benefits of real time collaborative care for patients with diabetes and co-morbid behavioral health challenges
Identify patients who are likely to benefit from this model
Formulate a plan for how they can apply the model in their own clinical practice
Define clearly the theoretical underpinnings of the PCBH model
Describe the empirical rationale for the PCBH model
List at least 2 clinical and 2 systems outcomes studies on the PCBH model
Define peer support
Describe the evidence base supporting peer support within mental health care
Identify at least five roles or functions that a peer support provider could serve within integrated primary care
Increase awareness of opportunities to connect with schools to better serve children in the school setting
Discuss barriers to inclusion of school personnel in the treatment team and to be able to identify possible solutions to barriers
Explain three basic, evidence-based interventions that can be successful for improving behavior in a classroom
Define the social determinants of health and their impact in contributing to and maintaining inequities in healthcare outcomes for disenfranchised patient populations
Describe multiple and diverse opportunities for decreasing the disparities that under-represented patient populations experience through addressing the social determinants of health and the health-care system
Discuss several reasons why it is in our country's best interest to focus increased attention on our most vulnerable healthcare populations, including increased population health outcomes for all
Describe potential impact of fidelity to integrated care model on outcome
Identify accessible ways to measure cost offset through medical claims data
Identify systems' barriers (through case discussion) and potential solutions
Describe importance of an integrated training model within primary care
Describe patient and system outcomes of this integrated training program
Discuss future directions and implications of learner-to-learner training
Define the need for screening for Perinatal Mood and Anxiety Disorders (PMADs) in the primary care setting and the two-generational impact of screening on the family system
Identify key stakeholders and infrastructure needed to implement screening, assessment, referral, and address (SARA) PMADs in primary care to improve maternal mental health outcomes
Discuss the importance of behavioral health, particularly integrated behavioral health, on the health care team and how a collaborative approach in primary care can reduce stigma and increase patient's willingness and ability to access needed resources
Know where to find a web-based guide for integrating behavioral health care into ambulatory care on the AHRQ website
Utilize the self-assessment available through the Academy Playbook to learn where their organization stands with respect to all aspects of integration
Describe how the AHRQ Academy Playbook could be used by a practice wanting to implement integrated primary care
Describe major steps in the preparation of a peer reviewed manuscript
Identify personal barriers to pursuing publication
Define some tips for publication success
Describe key steps in implementing a clinic wide shift in chronic pain management initiates (consistency in electronic health record documentation, deriving opiate pain management registry, systematization of urine drug screen and opiate medication refill
List salient risk factors for sub-optimal self-management and describe treatment and recovery goals for patients with chronic pain conditions
Explain how multi-disciplinary team meetings have been instrumental in shifting provider attitudes, treatment planning, and prescribing patterns while facilitating reciprocal cross discipline education through a collaborative, supportive work group
Explain the rapid transition from fee-for-service to fee-for-value based payment models
Discuss strategies and opportunities to address payment and care delivery reforms
Identify health disparities and life expectancy differences between rural and urban patients
Describe three tools that can be used to engage sites in technical assistance
Identify the main barriers that sites have in implementing evidence-based models
Identify key boundaries that technical assistance must have to be sustainable and effective
Identify the importance of patient-centered communication using MI, which leads to enhanced outcomes and decreased physician stress levels
Understand how brief MI interventions support the quadruple aim
Describe key components of provider-patient interaction that will decrease provider stress and increase patient satisfaction
Describe key components of the Banner Health Network population health management program
Define the effective changes in utilization, cost of care and quality improvement in the Banner Health Network Pioneer ACO model
Discuss the basic areas of responsibility of the disease manager in a comprehensive population health management program in an ACO model
Explain existing descriptions of behavioral health core competencies needed to effectively perform in primary care
Identify overlapping competencies required of each profession on a care team
Discuss components needed to develop valid, reliable measurement tools of core competencies
Describe a collaborative process used to gather information about and develop recommendations to address payment and workforce barriers to integrated health care
Identify at least five recommendations to address payment and/or workforce barriers to integrated care
Discuss how a similar process and/or such recommendations could be utilized in participant' own communities/states
Describe major steps in the preparation of a peer reviewed manuscript
Identify personal barriers to pursuing publication
Define some tips for publication success
Please rate the following:
The program was relevant to my work.
Content matched stated objectives.
Usefulness of handouts/AV.
Quality of facilities.
How well did the educational sessions give a balanced view of therapeutic options, including the use of generic names?
If you rated any of the above questions with 'fair,' 'poor,' 'disagree,' or 'strongly disagree' please explain in detail (e.g. session title, speaker name, situtation):
Do you believe this activity was appropriate for the scope of your professional activities?
Was the educational content scientifically sound?
If faculty spoke about off-label or investigational uses of a product, was that information disclosed to you?
Was the mode of education effective to learning?
If you answered "No" to any of the above questions, please explain.
Did you perceive any product/service/company/commercial bias in any educational session you attended or materials you received?
If you answered "Yes" to the above question, please detail the situation below (e.g. session title, speaker name):
Were you solicited by sales personnel in an educational room (other areas do not matter) while you attended this educational activity?
If you answered "Yes" to the above question, please explain in detail (e.g. who, when, where):
How much did you learn as a result of this education program?
What specifically did you learn during this activity that you intend to integrate into your practice?

What questions have arisen in your practice for which you need answers/strategies that you can implement?

What patient/client problems or patient/client challenges do you feel you are not able to address appropriately or to your satisfaction?
What problems are your patients/clients communicating to you that need attention or follow up?

Are you interested in basic, intermediate or advanced level trainings?

What barriers might you have that would interfere with implementation of new information learned from this training?

How can this training (the overall meeting) be improved to better impact competence, performance and/or patient/client outcomes?

Additional comments:

Mr question