Integrating mental health care in primary care

Dr. Anna Ratzliff, associate director for Education for the AIMS Center

Behavioral health issues such as depression and anxiety are debilitating conditions and, unfortunately, common. But the integration of behavioral health and primary care services is proving successful in improving patient outcomes.

The College is exploring such an integrated model of care for University Medical Center, which it operates. In September, the College hosted a group from the University of Washington AIMS Center, short for Advancing Integrated Mental Health Solutions, that presented its Collaborative Care model to College faculty and resident physicians who care for patients at UMC.

“This is a way to improve access to mental health care,” said Dr. Tom Weida, UMC’s chief medical officer. “This is a great opportunity for folks who have mental health needs to get the care they need.”

Collaborative Care treats common mental health conditions such as depression and anxiety that require systematic follow-up due to their persistent nature. Components of the AIMS model include: primary care providers and embedded behavioral health professionals; a behavioral care manager; a patient registry that allows providers to track patients and their response to treatment over time; the provision of medications and/or psychosocial treatments; and psychiatric consultation.

“Collaborative care gives mental health care support to primary care physicians,” Dr. Anna Ratzliff, associate director for Education for the AIMS Center, said during the presentation at the College. “When you deliver collaborative care, it doubles the effectiveness of treatment. Collaborative care results in improved outcomes – less depression, less physical pain, better functioning and higher quality of life.”

Ratzliff, also an associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington, said key to the AIMS Collaborative Care model is the oversight provided by a behavioral care manager, as well as the use of a patient registry and tracking. She said some health-care facilities “drop a mental health provider into a primary care setting, but without coordination, it might not be effective.”

She also said the population health approach of the model – the patient registry and tracking – is important “because it makes sure patients don’t fall through the cracks and it’s a way to go out and actively engage them in care. Providers can also see who is improving and who isn’t, and tracking also helps patients see the progress they’re making, which is important when they feel stuck.”

According to the AIMS Center, offering mental health care in primary care is convenient for patients, builds on existing provider-patient relationships and can help improve care for patients who have both medical and mental issues.

“Collaborative care saves medical care costs and helps patients lead high-quality lives,” Ratzliff said.

College welcomes new Behavioral Health Fellow

The College of Community Health Sciences welcomes Dr. Danielle Andrews to the Behavioral Health Fellowship.

The Behavioral Health fellowship along with Obstetrics, Sports Medicine, Emergency Medicine, Geriatric Medicine, Hospital Medicine, and Rural Public Psychiatry comprise the seven fellowships offered by the College. Each fellowship is a year-long program designed to offer additional, specialized training to physicians.

The Behavioral Health Fellowship for family medicine physicians, one of few in the country, trains family medicine physicians, particularly those planning to practice in rural communities, to better care for patients with psychiatric concerns.

The goal of the fellowship is to provide administrative training and public psychiatric experience for psychiatrists interested in practicing or serving in a community setting.

Andrews received a bachelor’s degree in Biology from Clark Atlanta University. She earned a master’s degree in Public Health at Boston University School of Public Health, concentrating in Social and Behavioral Sciences.  She completed her medical degree at Boston University School of Medicine and family medicine training at Phoebe Family Medicine Residency in Albany, Georgia.

Boxmeyer selected for Leadership U

Dr. Caroline Boxmeyer, the College’s assistant dean for medical education, was selected to participate in Leadership U, a University of Alabama program that prepares faculty and staff in leadership positions to take on increasing levels of responsibility within their organizations.

Boxmeyer is also a professor in the College’s Department of Psychiatry and Behavioral Medicine and a practicing psychologist at University Medical Center, which the College operates.

Leadership U is offered by the Office for Academic Affairs and serves all areas on campus. In addition to Boxmeyer, this year’s other participants come from Advancement, Financial Affairs, Intercollegiate Athletics, Student Life and Strategic Communications.

The current program began in September and will run through August 2018. The class recently participated in a two-day professional development workshop designed to assess their personal strengths leaders and to help them hone interpersonal skills. They will meet with University leaders throughout the academic year to learn more about the University, its goals and mission and the leadership styles of UA’s top administration.

Faculty participants also are part of the Southeastern Conference’s Academic Development Leadership Program, and they will visit LSU and Auburn for three-day workshops this year.

For participants, the Leadership U curriculum seeks to: broaden their perspectives on how the vision and mission of UA is realized; enhance capacity for collaboration and relationship building; strengthen practical skills essential to effective leadership; and increase their sensitivity to the influence of culture in the academic setting.

Faculty to be honored by National Alumni Association

Dr. Heather Taylor, associate professor of Pediatrics and Director of Undergraduate Medical Education at the College, is being recognized by The University of Alabama National Alumni Association with the “Outstanding Commitment to Teaching” award.

Each year, four UA faculty members are honored based on their commitment to teaching and the impact they have had on students throughout their time as faculty.

“Teaching is my favorite part of my job by far,” said Taylor. “So, it is exciting to be honored for doing something I love.”

Alumni, faculty, and students are open to submit nominations.

“I had such fabulous teachers along that helped me along the way. I see teaching as my way of paying my mentors back in some way.”

Orientation held for College’s Rural Medical Scholars and Rural Community Health Scholars

Members of the incoming 2017-18 classes of Rural Medical Scholars and Rural Community Health Scholars, programs of the College of Community Health Sciences, attended an orientation August 22 at Moundville Archeological Park in Moundville, AL.

Eleven students are Rural Medical Scholars and nine are Rural Community Health Scholars. The orientation included program expectations, faculty and staff introductions and allowed students to get to know each other and faculty they will work with.

“Your being here is important for the state and the region,” said Dr. Richard Streiffer, dean of CCHS, which also serves as the Tuscaloosa Regional Campus of the University of Alabama School of Medicine. “There are groups in society that don’t have access to health care. A lot of it is our need to address workforce needs, and that’s why you’re here.”

The Rural Medical Scholars and Rural Community Health Scholars programs are part of the College’s efforts to address the shortage of primary care physicians in Alabama, particularly in rural Alabama.

The Rural Medical Scholars Program is for rural Alabama students who want to become physicians and practice in rural communities. The program includes a year of study, after students receive their undergraduate degree, and leads to a master’s degree in rural community health and early admission to the University of Alabama School of Medicine.

Rural Community Health Scholars are graduate students not enrolled in the Rural Medical Scholars Program who are interested in health-care careers. The program prepares them for leadership roles in community health in rural areas. Graduates of the program have entered the fields of public health, health administration, nursing and physical therapy.

Also attending the orientation was Dr. Kevin Leon, associate dean for undergraduate medical education at the University of Alabama School of Medicine. Rural Medical Scholars spend the first two years of medical school at the School of Medicine’s main campus in Birmingham and then return to CCHS for their final two years of clinical education.

“Rural areas and health disparities are not unique to Alabama, but we are one of very few schools that dedicates ourselves to rural care,” Leon said. “It’s in our mission statement.”

In addition to Leon, other guest speakers at the orientation included Maija Braaten and Jill Sharp from the UAB Office of Student Success, as well as fellows from Dr. John Dorsey’s Project Horseshoe Farm in Greensboro, AL.

Rural Medical Scholars:

  • Austin Brooks – Heflin, AL
  • Bailey Bryant – Albertville, AL
  • Jeb Cowen – Jasper, AL
  • Charity Cypert – Florence, AL
  • McKenzie Donald – Chatom, AL
  • Kathryn Gray – Alexander City, AL
  • Brionna McMeans – Fort Deposit, AL
  • Peyton Powell – Monroeville, AL
  • Kristin Pressley – Harvest, AL
  • Ashlyn Shields – Hokes Bluff, AL
  • Robert Weaver – Alexander City, AL

Rural Community Health Scholars:

  • Sierra Cannon – Haddock, GA
  • Nandini Chandra – Tuscaloosa, AL
  • Chelsey Clark – Birmingham, AL
  • Raven Eldridge – Montgomery, AL
  • Corey Key – Courtland, AL
  • Bradford Lepik – Jasper, AL
  • Paris Long – Coosada, AL
  • Kendra Mims – Bessemer, AL
  • Christina Witt – Warrior, AL

The Spectrum of Heat-Related Illness

 

It’s a very common thing to hear about in the news. Heat-related illnesses are seen often in the summer months and athletes are not the only ones subject to this. People who participate in recreational activities outdoors are exposed to heat related illness as well.

“It’s not just athletes,” said Dr. Brett Bentley, assistant professor of Sports Medicine for the College of Community Health Sciences, during his September 14 presentation as part of the Mini Medical School Program hosted by the College and UA’s OLLI program.

Bentley’s presentation “The Spectrum of Heat-Related Illness” taught the signs and prevention of many common illness that are caused by heat.

The spectrum of illnesses ranges from minor illness, such as cramps and rashes, to the more serious, like heatexhaustion or heat stroke.

While more common in the summer, heat-related illnesses can occur throughout the year.

“You’re at a higher risk when its warmer because you’re sweating more and losing more salt through sweat,” said Bentley. “But you can absolutely get these in cool weather as well.”

 

Treatment for the majority of heat-related illnesses is the same. Put the person afflicted in a cool area, elevate their legs, remove excess clothing and ice them. Cool them down by pouring ice-cold water, or placing ice towels on the person. It’s also important to hydrate the person, so give them fluids orally if they can drink and only IV if necessary.

 

After addressing and treating symptoms of heat-related illnesses, it is important to monitor the person because they can slip back into suffering from the heat-related illness quickly.

 

Preventing heat-related illnesses are the most important part. Some ways to prevent heat-related illnesses include: acclimatize, be educated, wear proper clothing, be well rested, the timing of event, and being hydrated.

New curriculum in global health

Increased globalization, the opportunity to learn about diseases in developing countries and caring for some of the world’s poorest people are among the reasons the College is offering a curriculum in global health for medical students and residents.

“There’s a lot of interest in this area,” said Dr. Jane Weida, associate professor of Family Medicine and associate director of the College’s Family Medicine Residency.

As part of the two-year curriculum, students and residents meet at least once a month for presentations on global health topics, some of which will include tuberculosis, water and food safety, malaria, polio and ethics. Students and residents will also be required to spend two weeks working in a developing country. At the end of the two years, they will receive certification in Global Health.

Weida provided information about the new curriculum during a recent lecture at the College, where she was joined by Dr. Catherine Scarbrough, assistant professor of Family Medicine and associate director of the College’s Family Medicine Residency, and residents Drs. Elizabeth Junkin and John Lundeen. All have traveled internationally to provide health care services and each spoke about their global health experiences.

Dr. Elizabeth Junkin
Junkin made trips in 2016 as a fourth-year medical student at the College to El Salvador and Honduras. In El Salvador, she and members of the church group she was with assisted at medical clinics and purchased medications with donated money – “Ibuprofen, anti-biotics, simple things, but these people don’t have access even to the simple things.” During her time in Honduras, she worked in a one-room clinic at a school, stitching wounds and removing toenails of children injured as they played flip flops. “The people there would wait for hours and hours to see us, just to get Tylenol. It’s always a very humbling experience,” Junkin said. “It makes you appreciate what you have.”

Dr. John Lundeen
Lundeen said his experience in Guatemala “was eye-opening. There was no clean or reliable water, food or health care for the people there.” He accompanied a group from his church that traveled to the country as part of the Hope of Life organization, which has a compound there with a water treatment and electricity plants, a school and a hospital. “Outside the compound was the most crushing poverty I’ve seen in my life,” Lundeen said. The American group set up a clinic in a school in the mountains where he helped treat everything from dog bites to malnutrition. The group also provided meals to the local residents “to try and minimize the suffering that way. There was never enough to go around,” he said.

Dr. Catherine Scarbrough
As a medical student, Scarbrough spent eight weeks in the mountains of northeast Thailand, and as a resident she spent four weeks in Niger and completed a surgery rotation in Central Asia. After her residency training, she spent 14 months as faculty at two different hospitals in Central Asia, where she provided care in family medicine, obstetrics and pediatrics and worked in clinic development and administration. For the last five years, she has made annual trips to Egypt where she has provided care in family medicine, pediatrics, obstetrics and provided teaching sessions and workshops.

Dr. Jane Weida
Wedia has made a number of trips to Haiti as part of Family Medicine Cares, a humanitarian program of the American Academy of Family Physicians that works to provide sustainable health care to underserved populations in the United States and throughout the world. She traveled to Haiti shortly after a 7.0 magnitude earthquake in 2010 devastated the country, one of the poorest in the Western Hemisphere. More than 100,000 people perished in the first 60 seconds of the earthquake, and rescue efforts were hampered by no electricity or cellular phone reception and hospitals overwhelmed with patients. Some 250,000 homes and 30,000 commercial buildings were destroyed or severely damaged and tent cities struggled to accommodate more than 1.5 million people left homeless, a number that remained at 150,000 as late as 2014.

“And seven years later, they’re still coping,” Weida said.

She returned to Haiti in 2015 as part of Family Medicine Cares and the group divided into three teams to provide patient care, medical education and service projects. The patient care team treated between 500 and 600 patients. “People would walk for miles and miles and wait for hours and hours to see the doctor,” Weida said. The medical education team provided symposia on topics chosen by Haiti family medicine residency directors and met with officials the ministry of health and the US Embassy. The service team worked to improve the quality of life for children, painting schools and orphanages, donating balls, jump ropes, crayons, books and backpacks, and hosting parties.

College faculty recognized with Argus awards

Students from the University of Alabama School of Medicine have named faculty, residents and clinical departments, including those on the Tuscaloosa Regional Campus, winners of the 2017 Argus Awards.

The College also functions as the Tuscaloosa Campus in providing clinical education to a portion of third- and fourth-year School of Medicine students, and operates The University of Alabama Family Medicine Residency.

Created in 1986, the Argus Awards give medical students the chance to honor their mentors, professors, courses and course directors for outstanding service to medical education. Faculty members are nominated by course evaluations, and students vote to select award winners in each category.

Tuscaloosa campus winners of the 2017 Argus Awards are:

  • Best Clinical Department: Pediatrics
  • Best Clinical Educator: Dr. Heather Taylor, associated professor, Department of Pediatrics
  • Best Resident Educator: Dr. Blake DeWitt, resident, The University of Alabama Family Medicine Residency
  • Best Community-based Educator: Dr. Julia Boothe, Pickens County Primary Care

Dr. Blake DeWitt (second from left) with medical students from the Tuscaloosa Regional Campus.

 

Dr. Julia Boothe and Dr. Kevin Leon, associate dean for Undergraduate Medical Education.

 

Dr. Heather Taylor (third from left) with medical students from the Tuscaloosa Regional Campus.

Medical students selected to Alpha Omega Alpha Honor Society

Three medical students receiving their clinical education at the College were selected to the Alpha Omega Alpha Honor Medical Society.

The students are Salmaan Kamal, Paul Strickland and Ben Walters.

Alpha Omega Alpha is a professional medical organization that recognizes excellence in scholarship and outstanding commitment and dedication to caring for others.

In its role as a regional campus of the University of Alabama School of Medicine, the College provides clinical education to a portion of third- and fourth-year medical students.

About 3,000 students, alumni and faculty are elected to Alpha Omega Alpha each year. The top 25 percent of a medical school class is eligible for nomination to the honor society, and up to 16 percent may be selected.

The society has 120 chapters in medical schools throughout the United States and has elected more than 150,000 members since its founding in 1902.

Integrating mental health care in primary care

Behavioral health issues such as depression and anxiety are debilitating conditions and, unfortunately, common. But the integration of behavioral health and primary care services is proving successful in improving patient outcomes.

The College of Community Health Sciences is exploring such an integrated model of care for University Medical Center, which it operates. In September, the College will host a group from the University of Washington AIMS Center, short for Advancing Integrated Mental Health Solutions, that will present about its Collaborative Care model to providers and resident physicians who care for patients at UMC.

“This is a way to improve access to mental health care,” says Dr. Tom Weida, UMC’s chief medical officer. “This is a great opportunity for folks who have mental health needs to get the care they need.”

Collaborative Care treats common mental health conditions such as depression and anxiety that require systematic follow-up due to their persistent nature. Primary care providers and embedded behavioral health professionals provide medications or psychosocial treatments and are supported by psychiatric consultation.

According to the AIMS Center, offering mental health care in primary care is convenient for patients, builds on existing provider-patient relationships and can help improve care for patients who have both medical and mental issues.

Weida said the use of such a model at UMC could have a social worker or psychologist working with a patient and linking the patient with a psychiatrist if needed. He said the social worker and psychologist would keep in regular contact with the patient to monitor outcomes.