Faculty:
- Daubney Boland, Ph.D., MSCP. – Behavioral Science Faculty, Prescribing Psychologist
- Donna Winslow, Ph.D., MSCP – Behavioral Science Faculty, Prescribing Psychologist
- Iván de la Rosa, Ph.D. – Behavioral Science Faculty, Social Worker
ACGME Program Requirements (See IV. C.):
IV.B.1.b).(1) Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. (Core)
IV.B.1.b.(1).(a).(iii) diagnose, manage, and coordinate care for common mental illness and behavioral issues in patients of all ages;
IV.B.1.c Medical Knowledge Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care. (Core)
IV.C.1. The curriculum must be structured to optimize resident educational experiences, the length of these experiences, and supervisory continuity. (Core)
IV.C.1.b Clinical experiences should be structured to facilitate learning in a manner that allows residents to function as part of an effective interprofessional team that works together longitudinally with shared goals of patient safety and quality improvement.
IV.C.2. The program must provide instruction and experience in pain management if applicable for the specialty, including recognition of the signs of addiction. (Core)
IV.C.7.a The experience must include functional assessment, disease prevention and health promotion, and management of patients with multiple chronic diseases.
IV.C.17. The curriculum must be structured so behavioral health is integrated into the residents’ total educational experience, to include the physical aspects of patient care.
IV.C.18. There must be a structured curriculum in which residents are educated in the diagnosis and management of common mental illnesses.
General Information
The Behavioral Health team will coach residents in the development of knowledge and skills throughout all three years of residency training. The team will provide curriculum and coach residents in clinical management with patients with mental health disorders, substance use disorders, and social needs, building each year as residents evolve in their training. The schedule for this rotation will include:
- Monthly didactics on behavioral health topics
- Seven half-days a year over the course of three years
- This will include direct coaching, didactic, and observation
- Assess, treat, track and follow patients needing support with lifestyle medicine, behavioral interventions, and pharmacological treatment
- Present behavioral health cases to behavioral health preceptor during outpatient clinic and during the Behavioral Health Consultation Group
Expectations for Residents and Faculty:
Roles of Residents on the BH rotation:
- Didactics- Residents will participate and present in monthly didactics specific to the management of routine behavioral health conditions.
- Precepting & Presentations- Residents will precept with behavioral science faculty and present patient cases both in clinic setting and Behavioral Health Consultation Group
Roles of Faculty Members/Healthcare Professionals and community members on BH Rotation:
It should be noted that there is overlap in many of the professions listed. When working in a team, role-clarification should be established for the best results of team-based work and resident education.
Behavioral Science Faculty– Behavioral Science Faculty will deliver relevant and current monthly didactics specific to the management of routine behavioral health conditions in the primary care setting. Faculty will coach residents in the use of motivational interviewing. Faculty will assist with identification of resources for addressing psychosocial needs. Faculty will be available in clinic to coach residents on the use of interviewing techniques, diagnostic clarification, medication management, crisis management, and identification of resources.
Role of the Psychologist– Will provide education regarding psychological, behavioral and social components in care. Will model how to conduct a clinical interview, observe residents and give feedback.
Role of the Psychologist Prescriber– In addition to the role of the psychologist, the psychologist prescriber will provide education and consultation of psychotropic medication management, drug-drug interactions, and other considerations for medication management.
Role of the Social Worker – Will provide education on social components of healthcare. The social worker will educate residents on the use of community resources to help patients cope with the emotional, financial, and social needs that arise with a diagnosis.
Role of the Pharmacist– will discuss and offer education about common pharmacological interventions for the treatment of common psychiatric conditions; education about common medications that can cause or negatively affect psychological state or conditions, education about the cost of medication treatments and alternative options with good efficacy and low risk.
Role of the Family Medicine Faculty– Will model the role of a Family Medicine Physician in addressing psychological and behavioral health needs in patient care across multiple settings (hospital, clinic, nursing homes, patients’ homes). Faculty will model care of patients needing behavioral, psychological care or lifestyle medicine. Medical faculty will precept patients and offer evidence-based recommendations for treatment.
Role of Family Medicine Nurse Practitioner– Will model how to address psychological and behavioral health needs in patient care across multiple settings (hospital, clinic, nursing homes, patients’ homes) from the perspective of a medical provider.
Role of the patient and family– The patient and/or family will be at the center of their care. Patients will make decisions about their care whenever possible and be included in all aspects of decision making, will be given education to help understand their condition or health needs. When possible, at the permission of the patient, incorporate family support in care.
Role of Community Liaison– Community members and other healthcare professionals will provide exposure, education, and awareness of behavioral and mental health conditions and needs within the community.
Goal 1: Over the course of the longitudinal behavioral health curriculum, residents will develop the skills to apply lifestyle medicine and routine behavioral interventions used in the primary care setting, such as smoking cessation, weight management, diabetes management, substance use harm reduction, and sleep hygiene coaching.
| Objective (competencies) | Educational Strategies | Assessments |
| Objective 1: At the end of the first year, residents will be able to identify primary health concerns in which behavioral health treatments are the first line or important adjunct treatments. (PC, MK) | Residents will participate in and deliver didactics and coaching in lifestyle medicine. Residents will apply lifestyle medicine in the management of clinic patients. | Faculty will ask residents during precepting and patient presentations Review of case presentation during behavioral health consultation group Direct observation in clinic and other settings |
| Objective 2: By the end of the third year, residents will be able to use brief motivational interviewing skills to address health concerns in the primary health setting. (MK, PC, ICS) | Residents will participate in didactic courses on motivational interviewing (MI) and practice MI skills. Residents will participate in guided practice in motivational interviewing in simulations at least annually. | Faculty will observe and give feedback during a motivational interviewing simulation Direct observation in clinic and other settings |
| Objective 3: By the end of the third year, residents will be able to utilize health coaching with patients regarding health behaviors and lifestyle medicine (such as sleep hygiene, stress management and , diabetes education) (MK, I&CS) | Behavioral health faculty will deliver didactics on lifestyle modification such as sleep hygiene. Residents will participate in guided practice using role-plays. | Faculty will observe and give feedback during simulations in didactics Direct observation Faculty will assess residents’ abilities during precepting and patient presentations |
Goal 2: Over the course of the longitudinal behavioral health curriculum, residents will develop skills to accurately evaluate, diagnose and treat common mental health diagnoses in primary care, residential, and inpatient settings.
| Objective (competencies) | Educational Strategies | Assessments |
| Objective 1: By the second year, residents will learn to diagnose frequently occurring behavioral health conditions using screening tools and clinical interview. Residents will learn to refer appropriately to behavioral health providers when necessary for diagnostic clarification. (MK, PC, SBP, & ICS) | Residents will participate in monthly didactics on mental health diagnoses frequently encountered in the primary clinic setting, which include diagnostic screening. Resident will participate in consultation and mentoring. Residents will participate in didactics and practice clinical interview skills. | Direct observation in clinic and other settings Debrief with verbal feedback after role plays End of didactic evaluation |
| Objective 2: By the end of their third year residents will be able to manage first line medicines, evaluate effectiveness, and engage patients in shared decision-making about treatment for behavioral health conditions. (MK, PC, ICS, PBLI) | Resident will participate and present in monthly didactics on medication management for the mental health diagnoses frequently encountered in the primary clinic setting. Resident will participate in consultation and mentoring. Residents will use the most relevant tools and up to date research to inform treatment. | Review of case presentation in individual didactic Review of case presentation during behavioral health consultation group |
| Objective 3: By the end of their third year, residents will utilize appropriate interventions for breakthrough symptoms for behavioral health diagnoses (MK, PBLI) | Residents will participate in and present monthly didactics on medication management for the mental health diagnoses frequently encountered in the primary care setting. Resident will participate in consultation and mentoring Residents will use the most relevant tools and up to date research to inform treatment. | Review of case presentation in individual didactic Review of case presentation during behavioral health consultation group |
| Objective 4: By the end of their third year, residents will develop skills in collaborating with other health care professionals that provide social, psychological and psychiatric care (ICS, PROF, SBP) | Resident will participate in behavioral health consultation group meetings and learn from psychology, social work, and pharmacology. Resident will consult with members of behavioral health team in both coordination of care and treatment in clinic and other settings | Feedback from behavioral health care team members, patients, and faculty (360 evaluations) |
Goal 3: Over the course of the longitudinal behavioral health curriculum, residents will develop the skills to help patients identify resources to manage the social, financial, legal, and other difficulties that impact health.
| Objective (competencies) | Educational Strategies | Assessments |
| Objective 1: By the beginning of the second year, all residents will routinely query patients about their environment and resources needed to manage their health conditions. (PC, SBP, PROF, ICS) | Residents will include social determinant questions in patient encounters. Residents will participate and address social determinants in weekly didactics and other core curriculum. Residents will work alongside other behavioral and social professionals to learn about social and environmental factors that impact health. | Faculty will ask residents during precepting and patient presentations Review of case presentation during behavioral health consultation group Direct observation in clinic and other settings |
| Objective 2: By the end of the third year, residents will be able to identify and begin to address the impact of social determinants such as access to adequate and nutritious food, stable housing, transportation, and a safe and supportive community. (ICS, PROF, SBP, PC) | Residents will include social determinant questions in patient encounters. Residents will address social determinants in weekly didactics and other core curriculum. Residents will work alongside other behavioral and social professionals to learn about social and environmental factors that impact health. | Direct observation in clinic and other settings Residents will address social determinants in a case presentation during other social medicine rotations Review of case presentation during behavioral health consultation group Feedback from behavioral health care team members, patients, and faculty (360 evaluations) |
Goal 4: By the end of the longitudinal behavioral health curriculum, residents will be able to appropriately manage behavioral health crises such as drug or alcohol overuse/intoxication/withdrawal, acute psychosis, or suicidal ideation.
| Objective (competencies) | Educational Strategies | Assessments |
| Objective 1: By the end of the first year, all residents will understand basic components of crisis planning to include suicide assessment, acute psychosis, safety planning, as well as Child and Adult Protective services. (MK, SBP) | Residents will participate in didactics covering safety planning and risk assessment Residents will work alongside other behavioral and social professionals for consultation for safety planning and risk assessment. | Review of case presentation during behavioral health consultation group End of didactic evaluation |
| Objective 2: By the end of the third year, all residents will become familiar with current methods for managing the presentation of acute substance use disorders presenting in clinic. Residents will provide evidence-based medication assisted therapy when appropriate and identify/refer for additional care if needed. (MK, PC, SBP) | Residents will participate in didactics on MAT and treatment of substance use disorders. and management and use of controlled substances. | Review of case presentation during behavioral health consultation group End of didactic evaluation. Faculty will assess residents’ abilities to treat substance use disorders during case presentations and precepting. |
| Objective 3: By the end of the third year, all residents will be able to directly query patients about suicidal thoughts, develop a safety plan, and assist patients in connecting with a higher level of care when needed. (SBP, PC, ICS) | Residents will work alongside other behavioral and social professionals for consultation for safety planning and risk assessment. | Direct observation and assessment during clinic precepting. |
Resources:
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision. Arlington VA, American Psychiatric Association, 2022.
Alcoholics Anonymous: https://www.aa.org/
Leading Change: Integrating Lifestyle Medicine into Your Practice: https://www.aafp.org/dam/AAFP/documents/patient_care/lifestyle-medicine/lifestyle-leading-change.pdf
Medication Assisted Treatment for Opioid Use Disorder: https://www.mayoclinicproceedings.org/article/S0025-6196(19)30393-3/fulltext
Motivational Interviewing for Brief Encounters: https://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-education-and-research-center-for-occupational-safety-and-health/ROHC%202014%20handouts/Miller_AAOHN-Washington%20PPT.pdf
Narcotics Anonymous: https://m.na.org/
Opioid Use Disorder: Medication Options: https://www.aafp.org/afp/2019/1001/p416.html
Patient Safety Plan template: file:///C:/Users/jio7278/Downloads/Patient-Safety-Plan-template—Niendam%20(1).pdf
Prescription Monitoring Program NM: https://newmexico.pmpaware.net/login
Psychopharmacology Institute https://psychopharmacologyinstitute.com/dashboard
Safety Planning Guide, a quick guide for clinicians: https://www.sprc.org/sites/default/files/SafetyPlanningGuide%20Quick%20Guide%20for%20Clinicians.pdf
Social Determinants of Health: Guide to Social Needs Screening Tool and Resources: https://www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/sdoh-guide.pdf
Team-based Competencies- Building a Shared Foundation for Education & Clinical Practice: https://ipec.memberclicks.net/assets/Team-Based.pdf
The U.S. Department of Health & Human Services- Think Cultural Health: https://cccm.thinkculturalhealth.hhs.gov/
Up to Date: https://www.uptodate.com/contents/search
SNMFMRP Curriculum 