Beyond Behavioral Plans! Integrated Psychologists on the Psychiatry Consultation Service – An Effective Whole-Health Approach to Patientcare in Acute Medical Settings

Abstract:

Psychiatry Consultation-Liaison services are consulted for anxiety, acute stress disorder symptoms, behavioral dysregulation, and complex disposition issues among others. In the post-pandemic healthcare landscape, high rates of depression, anxiety, and PTSD in patients admitted to medical hospitals for acute medical illnesses are comparable to those admitted with traumatic injuries (Carlson EB et al, 2023). The increasing rates of prolonged lengths of stay in the emergency department and medical floors for pediatric and adult patients with co-occurring mental health needs have increased the demands on consult services nationwide. Whole person-focused health interventions are associated with improved quality measures including safety, patient-centeredness, timeliness, efficacy, and equity. Clinical interventions provided by Integrated and Collaborative psychological services include suicide risk assessments, identification of patient needs- including psychological, spiritual, nutritional, and environmental needs, and providing supportive psychotherapy, and family support interventions. Psychologists can play diverse task-shifting and task-sharing roles to provide complimentary services to ensure whole-person focused care to patients with complex needs. Psychological services can be justifiably a cost-neutral intervention with the value-addition of improved quality measures providing offsets to some of the operational and personnel costs.

The interactive session will feature a comprehensive review of the complementary clinical interventions provided by psychological services from a diverse range of perspectives.

Dr. Khosla, the medical director of a psychiatry consultation liaison service will distinguish between Integrated and Collaborative models for psychological services in a community hospital setting. Using polling and case-based learning, Dr. Khosla will describe task-shifting and task-sharing of clinical interventions on an interdisciplinary service facilitating quality and efficiency of patient care driven by consultations focused on whole-person health. (15 minutes)

Dr. Holmes, a Ph.D. psychologist working with the Integrated Pediatric Psychology Services at the Pediatric Emergency Department at Denver Health, Colorado, will describe the role of a collaborative service to the Psychiatric Emergency Services at an academic medical center. Dr. Holmes will list the clinical interventions provided by her team including providing brief psychological assessments, risk assessment/safety planning, and bed-side psychotherapy interventions. Dr. Holmes will use case-based examples to demonstrate whole-health-based clinical interventions for children and adolescents in the emergency room setting with pragmatic input on engagement with families. (15 minutes)

Dr. Falkowski, a PsyD psychologist with an emphasis on Clinical Health Psychology embedded within an interdisciplinary psychiatry consult service will discuss whole-health-based bedside interventions including trauma-informed engagement, assessment of complex needs, and skills-based supportive therapy with a focus on high-risk populations. Using case-based examples Dr. Falkowski will demonstrate clinical interventions in critically ill patients including practical guidance on engagement the caregiving nursing team. (15 minutes)

Dr. Shah, Chief of the Division of Medical Psychiatry at the Brigham & Women’s Hospital, Harvard Medical School, and the Associate Vice-Chair for Clinical Services will review the association of whole-health-focused clinical interventions on quality and Safety measures and discuss reimbursement structure for these services. Dr. Shah will provide utilitarian recommendations for formulating proposals to justify the operational costs of integrating psychological services within a psychiatry consultation service. (15 minutes)