How APA’s Collaborative Care Training is Leading to Improved Care

Child psychiatrist Adair Parr, M.D., is among a growing cadre of clinicians looking to collaborative care models to extend their psychiatric expertise to primary care patients.

Mark Moran

“As an individual psychiatrist in private practice, I am limited in the number of people I can see,” she told Psychiatric News. “I love my private practice and clinical work with individual patients, but I feel constrained that I can see only a certain number of patients in a day.”

Parr is one of some 80 APA members who are participating in or have completed one of APA’s online learning collaboratives—one of several APA programs on the Collaborative Care Model (CoCM) that are supported by the federal government’s Transforming Clinical Practice Initiative (TCPI). Online learning collaboratives offer advanced training to APA members who have completed introductory training modules in CoCM.

The TCPI is a $2.9 million, four-year federal grant from the Centers for Medicare and Medicaid Services. APA is one of just 39 organizations chosen to participate in the TCPI. As one of the Support and Alignment Networks supported under the grant, APA is committed to training 3,500 psychiatrists in the principles and practice of collaborative care, a specific model of integrated care developed by the late Wayne Katon, M.D., Jürgen Unützer, M.D., M.P.H., and colleagues at the AIMS (Advancing Integrated Mental Health Solutions) Center at the University of Washington.

In addition to her private practice in child psychiatryParr works as a staff psychiatrist three days a week at Potomac Pediatrics in Rockville, Md. She said the APA trainings have offered her new insight into how to implement collaborative care. Parr’s work in the pediatric practice to date falls under what is known as the “hybrid” model; she works partly as an on-site psychiatrist seeing patients in the office and partly in a consultative role to the primary care physicians.

“Educating the pediatricians is a big part of what I do—helping them feel comfortable that they can manage basic anxiety and depression themselves with patients,” she said.

“Ever since I completed my [child and adolescent] fellowship, I have been interested in working with pediatricians,” Parr said. “I also have been interested in population health, thinking about how I can make a difference to a population rather than just the individual patient in my office.”

APA offers a four-hour introductory training in the collaborative care model both online and on site at local district branch meetings, allied meetings, the Annual Meeting, and IPS: The Mental Health Services Conference. There is also an advanced course that is offered online. To date, more than 1,200 psychiatrists from 49 states have taken the training.

For those who complete the introductory training, APA offers online learning collaboratives that allow clinicians who are interested in CoCM or already practicing collaborative care to share ideas and discuss ways to apply the principles of the model within their own practices.

The collaboratives consist of a group of 10 to 12 practitioners who meet online and in conference calls with a moderator over 12 weeks to discuss ways to apply the training they received in the earlier stages of didactic training. The content of the learning itself consists of a mix of reading material and conference-call discussions with the moderator and other participants. Additionally, each participant completes a “performance-in-practice” quality improvement project within his or her practice. Graduates of the learning collaboratives also earn an important benefit—credit toward Part II and Part IV of Maintenance of Certification as well as CME credit.

Ten psychiatrists completed the first two sessions of the online collaborative, first offered at the end of 2016; 30 clinicians are currently enrolled in two ongoing collaboratives.

“I found the APA training very helpful, giving me a better sense of what collaborative care is and how to implement it,” she said. “And it’s great to have an ongoing way to connect with other people doing this work. Everyone knows there are not enough child and adolescent psychiatrists to go around. And we know that most behavioral and emotional problems children experience get overlooked, so we need to educate primary care clinicians to help them identify and treat appropriately, or to refer to specialty care.” ■