Inter-professional Education and Practice

Inter-professional Education and Practice
Dr. Garret Sacco | garret.sacco2@va.gov

Inter-professional education is a cornerstone of training for psychologists in integrated healthcare and academic settings. The Inter-professional Education (IPE) postdoctoral fellowship offers unique clinical, didactic, and experiential, opportunities for trainees to acquire advanced training in integrated care. Trainees in this track become ambassadors of inter-professional practice across the hospital and outpatient clinics while providing Veteran-centered clinical care. Residents in this track will have the unique opportunity to provide clinical services in one of the VA Community Based Outpatient Clinics (CBOC) at least one day per week. The two CBOCs that residents are assigned to are Haverhill and Lynn.

This role allows the resident to provide therapy in a mainly primary care clinic and to practice their inter-professional and collaboration skills. Residents provide individual and group psychotherapy in a range of settings (e.g., VA hospital, CBOC), and have the opportunity to receive training and experience offering treatment via tele-mental health and VA Video Connect (VVC). The track offers a unique opportunity to provide mental health care in the communities where Veterans live, work, and attend school.

To complement this community-based care, trainees also are in engaged in multidisciplinary Behavioral Health Integration Program (BHIP) teams within VA Bedford’s Mental Health Clinic (MHC). These five inter-professional teams are comprised of psychologists, social workers, nurses, Veteran peer support specialists, and psychiatrists who share a team-based and Veteran-centered approach to our Veteran’s care. A range of psychological issues and severity are represented in the MHC, including PTSD (combat and non-combat related), anxiety disorders, mood disorders, couples/family issues, and disorders of addiction, personality disorders, and SMI. Individual psychotherapy is informed by an overall Veteran centered and strengths-based approach to integrative therapy. A variety of time-limited psychotherapy groups are offered, (e.g., a CBT series, ACT for PTSD, a mindfulness series, positive psychology groups, and a series of PTSD skill development groups). All psychotherapy groups are co-led with either two psychology students or a psychologist supervisor and student.

On a clinical level, the MHC operates from an integrative psychotherapeutic orientation. In addition, a focus on strengths and recovery from a psychosocial rehabilitation perspective is embodied in the overall approach of the clinic. Within this larger integrative orientation, an appreciation of and training in specific evidence-based psychotherapies (EBPs) is also a key component of training and practice within the program. Residents will have an opportunity to learn and implement at least one of VA’s

Evidence-Based Psychotherapy protocols.
Residents are afforded significant opportunity to tailor their clinical work in accord with their interests. Supervisors represent a range of theoretical and clinical expertise, including cognitive-behavioral, psychodynamic, humanistic, positive psychology, experiential, and transpersonal/integral orientations.

Many supervisors also work from third-wave cognitive-behavioral approaches that emphasize mindfulness and acceptance. Many staff members have expertise in the treatment of PTSD, and a numb of staff also have training in a variety of other EBPs relevant to care of the Veteran population. In addition to one’s clinical and BHIP team work within the larger MHC, trainees exercise their inter-professional skills by carrying out a year-long, sustainable, program evaluation and improvement project. Fellows are typically paired with a small team of integrated social work interns, primary care behavioral health psychology postdocs, and post-Master’s nursing residents. This interdisciplinary student team works together with other inter-professional supervisors to engage program development activities within VA Bedford. Project teams are mentored by supervisors within the inter-professional training program who provide guidance and supervision at all stages of the student’s team project(s). At the end of the year, fellows will have added measurable levels of improvement while incorporating relevant shareholders to bolster long-standing change at the institution.

This track is particularly well-suited for residents who wish to immerse themselves in the conceptualization and practice of inter-professional care. Residents in this track will have ample opportunities to deepen their understanding, perspectives and skills with regard to the nature of inter-professional care in a large healthcare system. Fellows who complete this year-long sub-rotation are competitive in most work placements due to sharpening quality improvement, leadership, integration, and healthcare system navigation skills. Graduates of this program would likely be suited for inter-professional practice in general mental health programs, program development, education, training, hospital administration, and care coordination.

Learning Objectives
1. Describe the roles, responsibilities, and healthcare contributions of at least three unique healthcare professions

2. Explain at least 3 key strategies for how interdisciplinary clinical teams successfully work together to provide care to complex patient populations

3. Define quality improvement as it relates to IPE and identify two ways to promote and lead change within an organization

4. Demonstrate the ability to understand healthcare problems through a patient centered perspective

5. Apply communication techniques to communicate effectively with healthcare stakeholders (including patients and other professionals) in a responsive and responsible manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease

6. Demonstrate competency in addressing difficult conversations and describe two ways to promote conflict resolution in healthcare settings

7. Identify at least three strategies to promote collaborative leadership within an inter-professional and complex healthcare setting

8. Evaluate the various aspects of the clinic’s inter-professional care in order to determine necessary program needs and modifications

9. Develop ability and initiative to design and implement programmatic changes

10. Explain the roles of inter-professional mental health providers within the treatment team

11. Value and respect the contributions and expertise of other inter-professional mental health providers

12. Effectively communicate and collaborate within an inter-professional team

13. Effectively address inter-professional conflict

14. Understand the optimal principles and practices of high functioning mental health inter-professional teams to achieve positive outcomes with regard to Veteran clinical care and recovery

15. Collaboratively contribute to inter-professional treatment planning and care

16. Demonstrate positive attitudes toward Veteran-centered care

17. Provide clear constructive feedback to the Training Director and supervisory faculty regarding the nature and structure of the inter-professional training experience

Target professional experiences
1. Carry a caseload of approximately 12-15 psychotherapy clients, providing about 14 hours/week of individual treatment

2. Co-facilitate a psychotherapy group related to one’s particular area of clinical interest

3. Collaborate with inter-professional trainees and faculty on an inter-professional MHC team to provide and promote Veteran-centered clinical care and recovery

4. Provide consultation and outreach to clinicians and professionals across the medical center

5. Provide supervision to earlier-in-training psychology students

6. Determine specific clinic/program needs and modifications

7. Assume relevant administrative responsibility with regard to the functioning of one’s MH subtrack

8. Design and initiate program development activities, in collaboration with administrative staff and supervisors affiliated with one’s subtract