James D. Tew

The Behavioral Health Laboratory: building a stronger foundation for the patient-centered medical home.

The Veterans Health Affairs is in the process of implementing a new model for the delivery of primary care: The Patient-Centered Medical Home (PCMH). One critical challenge of any PCMH model will be the integration of basic mental health treatment into primary care. Such a mental health integration program must be flexible enough to incorporate new evidence-based treatments as patient demographics and health care needs evolve over time. This paper summarizes the Behavioral Health Laboratory (BHL) care management model, a program already in place in more than 20 Veterans Affairs facilities along with private sector insurance providers, as ideally suited to fill this role in the PCMH. The BHL uses a platform of standardized, software-aided mental health assessments and clinical care managers to deliver evidence-based treatments for depression, anxiety, and substance abuse in primary care settings. The authors review this comprehensive program of screening, assessment, treatment, and referral to specialty care when needed. The BHL program is consistent with the guiding principles of the Patient-Centered Medical Home: applying chronic illness disease management principles to provide more continuous, coordinated, and efficient primary care services to patients with diverse needs. Just as importantly, the authors review how this standardized platform for delivering integrated mental health services provides the flexibility to incorporate novel interventions for a changing population.

Developing a Clinician Educator Faculty Development Program: Lessons Learned

Over the past 25 years, the roles of physicians as clinicians, educators, and administrators in academic medicine have received increasing attention [1, 2]. Awareness of the complex nature of this career path has also been heightened [3]. A review of the literature revealed several types of programs intended to help Clinician Educator (CE) faculty with career development and advancement. The first type of program, available through universities or professional organizations, is open to applicants from a variety of disciplines [4]. The second type of program, developed at several academic medical centers, focuses on comprehensive development of physician faculty members across medical school departments [5]. These types of programs typically provide a certificate or advanced degree in medical education. They also require significant financial and time commitments from departments and participants, including protected time from clinical work. A third type of program emphasizes peer mentorship and skill building. These programs, which require less financial and time commitment than the first two types, have generally been grass roots programs developed by faculty members within a department [6]. More recently, departments are developing systematic programs for their early career faculty members with a focus on skill development and mentorship and guided by the expertise of more senior faculty [7]. In developing the Clinician Educator Faculty Development Program (CEFDP), we evaluated these program models and designed a program that was focused within our Department, required relatively few resources and required limited time investment. The program was encouraged and supported by the Department Chair and hospital leadership and expanded on our Department’s CE development track for residents [8, 9]. This paper describes the development of a CEFDP pilot in our Department of Psychiatry from 2012 to 2013. We provide an overview of the program’s conceptualization, implementation, and evaluation, as well as reflections on lessons learned in the process that may be instructive to other departments seeking to pursue similar initiatives.