Primary Care Behavioral health fellows are an integral part of family medicine resident training as well as clinical services provided to patients.
Our curriculum is a longitudinal one, with the ultimate goal of developing clinical competency to provide evidence-based psychological services in a primary care setting, including mental health and behavioral health patient care and integrated behavioral health services.
The fellowship is also designed to advance skills in conducting scholarly activity that advances the field of behavioral health. There are required training activities, including a minimum of two hours of individual clinical supervision per week, plus two hours of additional learning, including one hour of group supervision per week, one hour of didactic, one hour of interdisciplinary team meetings, and additional supervision as needed. In addition, the fellows will develop a research plan that is carried out under supervision and completed at the end of the fellowship. It is expected that fellows will present the project at a local or national meeting. The ultimate goal of this part of the curriculum is to develop research skills to carry out independent research.
In addition, fellows will learn methods of primary care behavioral health and upon completion of the fellowship, will be able to:
- Develop curriculum and provide medical education on behavioral medicine concepts to medical students and residents
- Effectively train and work with primary care physicians and other health care professionals
- Develop new programming and services appropriate for the primary care setting
The training is designed to meet requirements for psychology licensure in Minnesota as well as the competencies required for integrated behavioral health.
Clinical Supervision, Didactics, & Evaluation
Primary Care Behavioral health fellows receive clinical supervision as follows:
- Fellows receive a minimum of 3 hours per week of clinical supervision:
- 2 hours of individual face-to-face supervision
- Supervisors are responsible for all cases (reviewing and countersigning all clinical assessments, notes, treatment plans, case summaries)
- 1 hour of group supervision per week, rotating among the primary fellowship supervisors and Training Director
In addition, fellows receive additional supervision as follows:
- 1-2 hours of face-to-face individual research supervision per month with research supervisor
- 1 hour a month to meet with each other for peer supervision
- Meet with the Training Director face to face a minimum of 2 times a year for overall evaluation, monitoring progress, career development, and supervision
- Ongoing supervision/consultation provided by clinical supervisors as needed
- Supervisors available on-site
Fellows participate in the following activities:
- Twice monthly clinical didactic lectures
- Required on-line HIPPA and IRB, and clinical practice courses
- EMR training courses
- Monthly department-wide behavioral health meetings
- Residency and fellowship lecture series
- Monthly department grand rounds
Fellows attend the following courses and conferences:
- Primary Care in Psychiatry: Management and Medications course
- Professionals in Residence (PIR) Program at Hazelden Chemical Dependency Center (5-day residence program with classroom instruction and patient observation)
- Psychiatry Review conference
- Integrated Behavioral Healthcare Conference
- Minimum of one regional or national scientific conference yearly focused on behavioral health
Fellows are evaluated at 6, 12, and 18 months and at the end of their fellowship (2X a year). Evaluations are conducted in a face-to-face meeting with the fellow's supervisors. Evaluations provide fellows the opportunity to give and receive feedback about how the fellowship is going.
Evaluation methods are given to them at the beginning of their fellowship. If fellows do not meet required levels of competency on fellow evaluations, the due process guidelines may be initiated.
Due Process & Grievance Procedures
Fellows are informed at the beginning of their fellowship about due process and grievance procedures. Information is given to them as well as made available on the Google Drive related to all of their training activities.
Fellows provide integrated behavioral health care and patient care at either Bethesda and Smiley’s family medicine clinics or at Broadway Family Medicine Clinic and North Memorial Medical Center.
Bethesda, Smiley’s, and Broadway are integrated care clinics. Fellows are available to see patients as they are attending appointments with their primary care providers. Examples of some of the issues that come up during these visits include:
- Chronic pain
- Crisis intervention
- Health behavior change
- Mental health assessment
- Pediatric obesity prevention
Fellows also see their own patients, referred by the primary care providers at the clinics. Issues that fellows see patients for include:
- Acculturation issues
- Chronic pain
- Health behavior changes
- Post-traumatic stress disorder
- Somatization disorders
Finally, fellows will participate in population management efforts in the clinics that include:
- Population health management
- Chronic pain and complex patient management
- Post-hospitalization team visits
Each clinic serves economically and ethnically diverse populations. Fellows have the opportunity to work with refugee and immigrant populations, particularly from the Hmong, Karen, and East African communities.
Fellows as Teachers
Fellows are involved in the training of family medicine residents regarding psychosocial aspects of patient care.
Behavioral health teaching is done in many ways:
- Review digital recordings of patient encounters with residents
- Shadow residents while engaged in patient care (inpatient and outpatient) and provide feedback on patient-centered communication skills
- Co-precept and co-visit with residents
- Provide lectures on relevant primary care behavioral health topics
- Facilitate the second- and third-year resident support group at Smiley’s Family Medicine Clinic
Fellows are required to complete a scholarly project. It is expected that fellows will present the project at a local or national meeting. It is hoped that this project can be turned into a publishable article under faculty supervision.