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+ young artists and entrepreneurs were able to benefit from 1-on-1 mentorship sessions with accomplished industry experts. + artists and producers. Author manuscript; available in PMC Apr We first asked experts to generate elements to adapt the PCMH, using the National For example, the Adverse Childhood Experiences (ACE) studies found that 7) Engaging in activities to understand and meet the cultural and linguistic needs of its patients/ families;. For example, an ACE score of 4 increased the risk of suicide by percent and alcoholism by percent. Of those 50, four to six people began meeting regularly. a Child Trauma Expert,” that took questions from the viewing public. In , the consortium hosted the state's first Child Well-Being.
Experts reported that the most critical elements in such a PCMH included using a standardized screening tool to recognize psychosocial adversity; training the health care team to address psychosocial adversity; having a member of the health care team that specializes in mental health; providing care that is culturally competent; and having printed patient information available that is visually appealing and written at an appropriate reading level.
In addition, patient engagement and self-management are potentially limited by experiences with psychosocial adversity Modi et al. Many thoughtful commentaries about the need to transform the PCMH model support the need for such a framework. In a similar commentary, Laraque and Sia ; Dr Sia was one of the original founders of the PCMH proposed that the PCMH should be re-conceptualized as a family-centered medical home FCMHdescribing the case of an adopted nine year old girl who had been sexually abused and who suffered from post-traumatic stress disorder.
To our knowledge, prior empirical work has not provided specific recommendations for holistically adapting the PCMH to address psychosocial adversity; however, the general concept of integrating behavioral health and primary care has garnered recent attention.
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For example, the Substance Abuse and Mental Health Administration recommends uniting behavioral health services and primary care, and outlines suggestions for effective integration Solutions, Hunter and Goodie posit that the PCMH will not achieve its goals until mental health needs are adequately addressed, and describe models of integration as well as key operational and clinical components of these models. Our expert panel suggested that having a team member with expertise in behavioral health is one of the most critical aspects of an adapted PCMH, but that changing other components of the medical home, such as promoting regular meetings between the medical team meeting and community-based organizations, may also be important.
Our expert panel also highlighted the need for continued professional training to allow providers to become trauma-informed and culturally competent. Just as health care training programs e. Some of the elements recommended in this study can be readily and directly measured.
For example, performing standardized psychosocial screening can be assessed using chart review. In contrast, other elements may be less straightforward, with an element such as providing culturally sensitive care requiring alternative measurement strategies such as patient surveys.
As a key limitation, we concur with the experts who commented that this framework is too lengthy, and that implementing all elements may not be feasible. For example, experts stated that it was critical to use a standardized measure to assess psychosocial adversity. Numerous standardized tools exist for measuring individual adversities, such as intimate partner violence exposure, but a single tool that holistically assesses multiple adversities and their impact on functioning has yet to be developed for use in health care settings Garg et al.
Further, any future screening tool should capture current and past stressful life events, risk for mental health disorders, the perceived impact of these stressors, and sources of support and coping. Future research is needed to develop a comprehensive, yet succinct, instrument that is also psychometrically valid. A second limitation to this study is that, although there was diversity among participants, the results are derived from a select number of experts.
Though some of the experts were practitioners, further insight from practitioners is critical. In addition, other office staff and patients have yet to provide their insights; obtaining this feedback from front line providers and from patients is an essential next step before these elements can be operationalized.
As a final limitation, anchoring questions to NCQA standards and elements may have inadvertently induced participants to limit their suggestions to ones that are feasible within the currently designed medical system. For example, respondents did not provide specific suggestions about the need for the medical home to become increasingly situated in community locations like schools, day cares or nursing homes.
Future work will include incorporating patient, provider and payer perspectives to further refine the model.
Payment is key, so I suggest you contact some payers to share this idea and gather responses from them. I think this is where people get stuck- at the operational level. In particular, different staff with different capacities particularly therapeutic and partnership development are necessary as well as a comprehensive shift toward building organizational capacity to address conditions outside the clinic that are leading to adverse experiences….
The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agency. The study sponsor did not have any part in the design or implementation of this work.
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Footnotes The authors have no other financial conflicts or affiliations to disclose. Primary care-based interventions for intimate partner violence: American Journal of Preventive Medicine. A nationwide survey of patient centered medical home demonstration projects.
Journal of General Internal Medicine. Health care utilization and costs associated with physical and non-physical only intimate partner violence.
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Health care utilization and costs associated with childhood abuse. Brown earned a B. Carvalho served for seven years as associate provost and senior international officer at the University of Kentucky UK. At the University of Kentucky, Dr. Carvalho guided the expansion of the Office of International Affairs into a full-fledged International Center, and served as a resource to the president, provost, and campus leadership teams for the development of global competitiveness.
Carvalho holds a B. Back to top Barbara Hill, Ph. Prior to joining ACE, Dr. Hill has also served as a senior consultant to the Higher Education for Development program formerly the Association Liaison Office for University Developmentworking to develop organizational infrastructure to serve international development through university partnerships and organizing conferences to disseminate expertise in international development.
She was a participant in the Visiting Advisors Program of the Salzburg Seminar, consulting with universities in Russia and Eastern Europe about governance, management, finance, academic structure and program quality.
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Back to top Robin Matross Helms, Ph. Campuses study, and overseeing administration of the Internationalization Laboratory. She has also worked as a consultant to a number of organizations in the international and higher education fields, including the World Bank, the Institute for Higher Education Policy, the Observatory on Borderless Higher Education, and the Collaborative on Academic Careers in Higher Education at the Harvard Graduate School of Education.
In her role at ACE, Dr. Helms works with a broad range of institutions to gather and disseminate good practices for internationalization.
Her publications include Internationalizing the Tenure Code: A Global Review of Standards and Practices. Helms holds an A. Back to top Gil Latz, Ph.