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Primary Care Behavioral Health Track Description 2022-2023

Track Overview: This track will engage psychology interns to a variety of models of integrated behavioral care including co-located care, and interprofessional team-based models such as Primary Care Behavioral Health (PCBH) and Collaborative Care (CoCM). The training sites offer a stepped care approach to integrated behavioral health care to address diverse patient needs. The training sites also offer MAT for substance use concerns and psychology interns will have the opportunity to collaborate with DATA-waived MAT prescribers and patients in integrated care treatment approaches.

Training will build a solid foundation in understanding the interplay of physical illness and emotional wellbeing, knowledge of common chronic health care conditions, and knowledge of medical culture. A key element of this will be a focus on using tele behavioral health modalities in effective ways to reduce barriers to access to care. Interns will work as a part of interprofessional teams including family physicians, social workers, psychiatrists, nurses, dieticians, pharmacists, etc.

The clinics within this track serve a diverse patient population. Interns will receive training and supervision with a focus on cultural sensitivity and cultural humility. Supervisors are committed to fostering a climate of inclusion, belonging, and antiracism. Didactics are aimed at increasing trainee knowledge of oppression and marginalization issues as they relate to our patients and our clinical practice.

 

APPIC Program Code:

Clinical Rotations and Patients:

  • UNC Family Medicine Center (Linda Myerholtz, PhD)

The UNC Department of Family Medicine is an academic medical training program in holistic primary care. The department has several full-service family medicine clinics which provide health care for individuals and families over the course of their lives. Care is provided in integrated teams that focus on the unique needs of patients and families (including behavioral health, nutrition, social work, tobacco cessation, weight management, medication assisted treatment for substance use disorders, etc.). The DFM also works to promote the health of the people of North Carolina and the nation through leadership and innovation in clinical practice, medical education, research and community service. We are a “safety-net” clinic, serving a diverse patient population including marginalized, low-income and racially diverse individuals.

  • Piedmont Health Service: Federally Qualified Health Centers (FQHC) (Linda Myerholtz, PhD)

PHS is a multi-site FQHC organization serving a multi- county service area in north-central North Carolina. PHS served more than 47,000 individuals of all ages in 2020 at ten community health center sites, the vast majority of whom are low-income and hail from minority populations facing significant health disparities (21% African American, 50% Hispanic/Latinx). Many face multiple additional barriers to consistent primary and behavioral healthcare access (e.g., uninsured, cultural/language barriers, unstable housing and food insecurity). To address access, the health centers are “one- stop shops” for comprehensive sliding-fee primary care services including family medical and dental care, integrated behavioral health, laboratory, pharmacy, nutrition and other care support services (e.g., WIC supplemental nutrition, eligibility assistance, and care management outreach).

Interns will spend 12 hours/week, or 30% full-time effort (FTE), in one of two FQHC primary care settings to develop competencies in integrated, interdisciplinary behavioral health in high need, high demand area. Interns will spend an additional 8 hours/week, or 20% FTE, in the UNC Family Medicine clinic working within a large multidisciplinary clinical care team providing integrated behavioral health.

Training and supervision will include a holistic assessment strategy that focuses on a patient’s SDOH factors. Interns will learn rapid psychological assessment strategies. This will include the integration of screening tools frequently used in primary care settings. Interns will learn skills in brief psychotherapy, single session work, motivational interviewing, health behavior change counseling as well as longer term individual therapy. Common clinical issues will include anxiety disorders, mood disorders, ADHD, trauma concerns, somatic symptoms and related disorders, substance use concerns, chronic pain management and the impact of chronic illness on emotional wellbeing. Additional clinical skills in assessment, intervention (trauma informed, CBT, motivational interviewing, dialectical behavioral therapy, acceptance and commitment therapy), clinical consultation, as well as supervision and teaching will be included. Patient progress will be monitored with standardized screening tools (e.g., PHQ-9, GAD-7, PCL-5, AUDIT, etc.) to link patient-centered services to outcomes.

 

Recommended Minor Rotations:

  • Addiction Medicine
  • Pain Management
  • Inpatient SUD Treatment
  • Posttraumatic and Acute Trauma Recovery rotation (PTATT)
  • Psychiatric Emergency Service
  • Center for Excellence in Eating Disorders

 

All Elective Rotations

Didactics:

Didactics will include sessions provided by Dr. Myerholtz and her team as part of the Psychology Internship weekly seminar series provided to all interns as well as a weekly Family Medicine-specific seminar series provided to trainees across disciplines, including family medicine residents and fellows, medical students, and social work students.

Didactics for family medicine residents occur on Wed mornings from 8:00-1:00; interns are invited to participate in interprofessional learning with the residents during this time, particularly when topics are relevant to behavioral health.

 

Professional Development:

Training and professional development goals are set at the beginning of each rotation.

Supervision will include a focus on understanding the professional roles of psychologists in integrated primary care settings and interprofessional collaboration. Interns may have the opportunity to present at an academic conference, provide training to medical residents and other behavioral health professionals.

 

Research Opportunities:

There are multiple opportunities for interns to collaborate on research within the Department of Family Medicine. One potential opportunity is to participate in ongoing research evaluating the effectiveness of the Collaborative Care model at the FQHCs.

 

Supervision Training and Opportunities:

Interns will have opportunities to provide education and training to medical students and family medicine residents. Interns will be trained and supervised by core faculty.

 

Track Coordinator:

Linda Myerholtz, PhD

 

Clinical Supervisors:

Linda Myerholtz, PhD