The Montana Model: Integrated Primary Care and Behavioral Health in a Family Practice Residency Program

Abstract

To address the local health care needs of both patients and primary care providers in Montana, an integrated primary care and behavioral health family practice clinic was developed. In this paper we describe our experience with integrating mental health and substance abuse services into a primary care setting (a community health center) while simultaneously teaching family practice physicians to take the lead in providing these services. The Deering Community Health Center in Billings, Montana, is a Federally Qualified Health Center serving a largely low-income patient population. The medical care at the clinic is provided primarily by the faculty and residents of the Montana Family Medicine Residency. The teaching model was founded on the belief that improved care will result when physicians have increased comfort with, and are able to enjoy the challenges of, patients with mental illnesses. The enhanced longitudinal curriculum incorporates mental health across the 3 years of the family practice residency. Unique characteristics of this model include staffing and the concurrent delivery of a high volume mental health service while teaching family practice resident physicians and the faculty to integrate this competency into their primary care practices.

Reframing Teacher Professional Learning: An Alternative Policy Approach to Strengthening Valued Outcomes for Diverse Learners

“…Another approach has been to bring together rigorous reviews of disparate evidence about what works around a theme of importance for teachers, educational leaders, and policymakers. The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI) began at the University of London in 1993 "with the aim of developing and promoting participatory and user-friendly systematic reviews addressing important questions in policy, practice and research in the public interest" (Gough, 2007;Oakley, Moore, Burford, Fahrenwald, & Woodward, 2005). The EPPI and its linked enterprise, the Centre for Research Evidence in Education (CUREE), increasingly seek to involve practitioners, including teachers, and use their questions in knowledge development.…”

A compatible model of family medicine residency training in Iran

“…Table 2 summarizes a set of FMRs' training methods in THCs mentioned in the available electronic resources. Among these educational methodologies, the most important and updated learning systems were: (1) learning about residency along with providing service under the faculty supervision, (2) learning of FMRs with the theoretical educational programs in terms of counseling videos which display clinical skills, (3) their training in the outpatient operating or procedure room setting, ( 4) training them through electronic learning techniques, (5) implementing the engaging programs for residents as a teacher and ( 6) new strategies for the medical education, such as TBL, PBL, CBL, GDL and SGT (Entezari et al, 2017;Justino et al, 2016;Karimi Moonaghi, 2015;Mbuka et al, 2016;Oakley et al, 2005;Rieselbach et al, 2013;Zweifler, 1995). Table 3 also shows a 19 list of major educational content involved in training courses of FMRs in healthcare centers in the world.…”

“…Table 3 also shows a 19 list of major educational content involved in training courses of FMRs in healthcare centers in the world. The educational content of family medicine residency training in THCs is categorized as follows: community-oriented primary care, management of risk factors in individuals, families and community, the patient management, community visits, leadership skills, mental health, primary healthcare in all age groups, health management, communication skills, requesting Para clinical tests with logical reasons, rational administration of medicine, proper referral and follow-up of patients, outpatient care, necessary clinical and procedural skills, the management of medical emergencies, online research methods by searching scientific information in electronic resources, medical ethics and professional behavior (Akoojee and Mash, 2017;Entezari et al, 2017;Firnhaber and Kolasa, 2012;Kelly et al, 2009;Longlett et al, 2001;Ludden-Schlatter et al, 2018;Oakley et al, 2005;Rieselbach et al, 2013;Shariati et al, 2018).…”

“…Many of the assessed standards to train Item no Educational content 1 Community-oriented primary care (COPC): the health needs assessment and the design of population-level interventions, disease prevention, promoting the community health, cross-sectoral cooperation and coordination, leadership skills in a multidisciplinary environment and team skills especially working with specialists in other disciplines (Longlett et al, 2001;Morikawa, 2020) 2 Risk assessments and risk reductions in the individual, family and community (Entezari et al, 2017) 3 Patient management and treatment (Green et al, 2007;Flinkenfl€ ogel et al, 2014) 4 Visit in the community (home, schools, etc.) (Rieselbach et al, 2013;Entezari et al, 2017) 5 Mental health (Oakley et al, 2005;Green et al, 2007;Rieselbach et al, 2013) 6 Primary health cares in the elderly (Rieselbach et al, 2013;Green et al, 2007) 7 Primary health cares for mothers (Entezari et al, 2017;Green et al, 2007;Morris et al, 2008) 8 Primary health cares in children (Rieselbach et al, 2013;Entezari et al, 2017;Morris et al, 2008) 9 Primary health cares in adolescents, youth and middle-aged adults (Entezari et al, 2017;Green et al, 2007) 10 Health system management (Entezari et al, 2017) 11 Communication, thinking and interpersonal skills (Okolie et al, 2020;Green et al, 2007;Maizes et al, 2006;Mbuka et al, 2016) 12 The rational referral of patients to do paraclinical tests (Entezari et al, 2017;Rieselbach et al, 2013) 13 The reasonable drug administration (Entezari et al, 2017;Rieselbach et al, 2013) 14 Appropriate referral and follow-up of patients (Shariati et al, 2018;Green et a...…”

“…Educational techniques used in Botswana were monthly journal clubs, weekly case presentations, communal consultation videos and presenting the clinical skills to train FMRs (Mbuka et al, 2016). Also, the noon conferences in Montana were held to educate residents at the health centers (Oakley et al, 2005). However, there were some standards in the final remarks of experts, which were not in the extracted literature list.…”