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Behavioral counseling is integral for the overall health of individuals with a mental health diagnosis. For instance, diabetic patients treated with cognitive behavioral therapy (“CBT”) for depression have been shown to have better glycemic control and patients with coronary artery disease treated with CBT for stress management have decreased risk for recurrent myocardial infarction. Above all, for nearly all mental health diagnoses, behavioral counseling is an effective treatment strategy for achieving remission. In primary care, mental health therapy oftentimes starts with a referral to a counseling center or psychiatric professional. With strong patient commitment, behavioral therapy can ultimately improve health outcomes and the day to day functioning for that patient. Unfortunately, the initial step can be the most difficult and the journey never begins. In our clinic, a residency clinic in a semi-rural area with a high percentage of underinsured, we noticed that a lower than preferred number of patients that we refer to our most accessible behavioral counseling center do not even schedule their first appointment. Additionally, we are limited by a scarcity of affordable psychiatric resources and this counseling center is often our only option for referral. For this purpose, we implemented the following changes consecutively to the referral process. First, our in-house referrals coordinator made the first appointment, instead of the patient having to call themselves. Next, we took this a step further, and an employee from the counseling center came onsite to initiate the intake process on the day of the referral or at the patient’s convenience. We then measured their success by comparing the percentage of patients that completed the intake process before and after each implementation. There was a statistically significant increase in the mean percentage of intakes completed after each intervention. We conclude that although the reason patients are unable to follow-up with a behavioral health referral is often multi-factorial, simplifying the process for the patient seems to help a great deal. While this is encouraging, more evaluation is needed to determine if patient outcomes are improved, and if these interventions are cost effective and sustainable options.

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Florence O. Holmes, for the Masters Of Science Degree in Behavioral Analysis and Therapy, presented on July, 2015, at Southern Illinois University Carbondale. TITLE: ACCEPTABILITY OF INTERVENTIONS OF STAFF IN SHORT TERM CARE SETTING FOR CHILDREN WITH BEHAVIORAL HEALTH ISSUES COMPARING RATING AND HIERARCHICAL SELECTION MAJOR PROFESSOR: Dr. Mark Dixon, Ph.D. The present study asked twenty active treatment team members, in a children’s behavioral health hospital in Springfield, IL to answer a pen and paper survey. This study extended research on treatment acceptability by replicating, Baker and LeBlanc (2011), who compared ratings and hierarchical selections in a long term care facility with older adults. Specifically, participants were given the opportunity to rate treatments using a treatment acceptability survey, and were then given a choice (i.e., asked to select which they would be most comfortable implementing) between various treatment options with using a variety of scenarios and choices. In this study it was interesting to find that though an individual selected a treatment as being a good treatment, when asked what they would feel comfortable using in a pinch did not always match what they related as being acceptable. In comparison the results of Baker and LeBlanc are very similar to the current study. In contrast, the rating for the behavioral intervention was higher in the present study and was also selected much more than in Baker and LeBlanc. Baker and LeBlanc reported statistically significant correlations between selections and ratings. Although this study did not recruit enough participants to allow for a statistical analysis, 50% of the participants in this study had a match for what they rated the highest compared to what they selected the most.

Behavioral and mental health issues contribute to the needs of many patients presenting to emergency departments, and yet these needs often go unrecognized. Patient processing procedures in emergency departments may not include mechanisms to consistently identify and triage patients whose care is complicated by behavioral illness. The purpose of this project was to plan a program to improve early identification and management of behavioral health patients presenting to the emergency department. The objective of this project was to develop a rapid mental health screening tool and policies guiding use of the tool in the emergency department. A multi-disciplinary team of emergency department providers cooperated in the selection and evaluation of available screening tools. A literature search was done with the inclusion criterion of behavioral screening tools to be used at time of triage, and results were brought to the team for further consideration. The HEADS-ED pediatric screening tool was chosen through the expert opinions of the team members. The team evaluated and approved adaptations to the tool for its use in adults. Policies were developed to guide the future implementation of the screening tool in the emergency department. A plan for process and outcome evaluation was included in the developed program. Process will be evaluated by monitoring provider use of the screening tool, and patient length of stay in the emergency department will serve as the outcome measure. The program may contribute to social change through improved emergency department care of patients with behavioral illnesses.

Dissemination and Implementation (D&I) Science is an evolving field of models and methods aimed at closing the research-practice gap. This chapter provides an overview of D&I Science with particular emphasis on its relevance for academic and clinical medical family therapists (MedFTs) and/or graduate students in training. It begins with a discussion of the poor reach of evidence-based treatments, building a case for the evolution of D&I Science. Basic definitions of dissemination research and implementation research are provided, followed by a description of the characteristics of D&I Science. Two exemplary D&I models are described with examples that relate to MedFT. The chapter closes with a discussion about how the reader can learn more about this dynamic and growing field.

Successful implementation of the American Academy of Pediatrics evidence-based practice guidelines for ADHD management in primary care settings is challenging. Despite widespread use of these guidelines and the adoption of strategies to overcome barriers to care, no research has looked at how providers spend their time in managing ADHD and how this relates to the feasibility of practice guidelines in community settings. The present study aimed to assess pediatricians’ self-reported experiences in using the AAP guidelines for ADHD management and barriers to using an evidence-based approach, especially related to time demands. Five pediatricians from five pediatric primary care settings were interviewed on their experiences in ADHD management. Time demands was shown to be related to on-site behavioral health services and innovative scheduling strategies. Implications for primary care practice and future research are discussed.

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Dr. Pack is the Associate Dean for Academic Affairs & Professor of Community and Behavioral Health at East Tennessee State University. He is serving as the Principal Investigator for the ETSU Diversity-promoting Institutions Drug Abuse Research Program (DIDARP): Inter-professional Communication for Prescription Drug Abuse Prevention in Appalachia