COLLABORATIONS IN CARE

Grant calls on interprofessional collaboration to address opioid use

A unique grant celebrates East Carolina University’s commitment to using interprofessional collaboration to address emerging and challenging trends in health care, including opioid use and substance abuse prevention and treatment.

The Harriot College of Arts and Sciences’ Department of Psychology and the Brody School of Medicine’s Department of Family Medicine were awarded an $890,000 Graduate Psychology Education Program Grant from the Health Resource and Services Administration. The grant will support training for doctoral-level psychologists to provide integrated, interdisciplinary behavioral health as well as prevention and treatment services for opioid use disorder and other substance use disorders.

“In order to better address the gaps in our current health care system and improve access to high-quality care for patients who are experiencing a wide array of physical and mental health concerns, we must integrate behavioral health and substance abuse treatment into medical care settings,” said Dr. Marissa Carraway, principal investigator and clinical assistant professor in the Departments of Family Medicine and Psychology. “This grant funding is so exciting because these issues are paramount to the health and well-being of the individuals we serve—and align perfectly with the mission of ECU and the Brody School of Medicine.”

Carraway will work with Dr. Robert Carels, principal investigator and professor in the Departments of Psychology and Family Medicine; Dr. Christy Walcott, associate professor in the Department of Psychology; and Jane Trapp, clinical associate professor in the College of Allied Health Sciences’ Department of Physician Assistant Studies.

Preparing the next generation

The Graduate Psychology Education Program Grant will support training for doctoral-level psychologists to provide interdisciplinary behavioral health in delivery settings including primary care. (File Photo)

Complementing ECU’s mission to serve eastern North Carolina and focus on access to care, the project will emphasize cutting-edge training in primary integrated care to students with a passion for working with poor, rural and underserved patients.

“We are training the next generation of psychologists to function well within a team-oriented approach to treatment,” Carels said. “The grant allows us to teach our students an interprofessional approach to address all patient needs, including mental health and substance abuse.”

Over the next three years, the grant will produce 18 total doctoral students with critical skills in integrated primary health care delivery among the rural and/or underserved. Training experiences will include rural primary care collaborations with medication-assisted treatment providers and physician assistant students; substance abuse treatment and prevention in primary care, specialty care, and in the schools through tele-behavioral health; trauma informed care and treatment; the treatment of chronic pain; holistic assessment of the social determinants of health including adverse childhood events, adult trauma and substance use and abuse risk; and collaboration with first responders.

Among the benefits of the grant program, the integrated care trainees will act as behavioral health consultants who collaborate with medical and other multidisciplinary health providers including residents, physician extenders, nutritionists, pharmacists, nurses and social workers.

ECU’s clinical health psychology concentration trains future psychologists not only in clinical psychology but in the delivery of clinical services in settings including primary health care, substance abuse treatment, VA medical centers, cardiology, diabetes, pain management, and sleep medicine.

“From the psychology department’s perspective,” Carels said, “it is our goal to provide our students with hands-on, state-of-the-art training in clinical health psychology.”

Dr. Alan Christensen, chair of the Department of Psychology, said the grant highlights the standard of care in an already nationally unique academic program.

“It has become clear that reducing health disparities and addressing the needs of rural and underserved populations is the central issue not only in the present but for future generations,” Christensen said. “ECU is ideally situated to address these issues for those future generations. Interprofessional and interdisciplinary work is essential to that mission—as is engagement with the community.”

Timely trends in health care

Integrated care is at the forefront of medical education and practice, due in part to a better understanding of the complexities of treating patients facing an array of health challenges in cost-effective and outcome-driven ways.

The grant comes at a time when opioid abuse deaths are plaguing the country—and North Carolina’s communities as well. According to the Centers for Disease Control, there were more than 70,200 drug overdose deaths in the United States in 2017, with opioids the main driver of overdose deaths. North Carolina was one of 23 states that saw a significant increase in drug overdose death rates from 2016 to 2017.

“Psychologists play an important role in helping prevent patients from developing an opioid addiction, whether by educating them about the appropriate use and disposal of opioids or helping them cope with chronic pain without the use of opioids,” Carels said.

In a more positive trend, it is becoming increasingly more common for medical settings including primary care to incorporate behavioral health providers into their teams, Carraway said.

“I hope this trend will continue,” she said. “At ECU Family Medicine, graduate-level trainees are providing behavioral health services to family medicine patients at medical visits under the supervision of licensed faculty—and are receiving invaluable training and experience in this practice.”

The grant will also highlight ways to integrate care from a cost perspective.

“Given skyrocketing health care costs and the opioid epidemic, health care providers need training in efficient health care delivery models,” Carels said. “Integrating these services is a way to improve and better coordinate care, and it is cost effective.”

Collaborating with colleagues

ECU received a similar grant in 2016, but the most recent award builds on that foundation of training future psychologists to practice in primary care settings—by specifically focusing on the opioid crisis and substance abuse through collaborative care teams. The latest grant will be a partnership between ECU Family Medicine, ECU psychology, PORT Health, the Greenville Community Shelter Clinic and Greenville Fire Rescue to provide students the skills and experience they need to adapt to a variety of care settings.

“Brody’s Department of Family Medicine is uniquely positioned to develop interprofessional collaborations with our health sciences colleagues, who are literally in our backyard,” said Dr. Chelley Alexander, professor and chair of the family medicine department. “We are constantly looking for innovative ways to collaborate with colleagues to improve care for our patients, and to transform training for the next generation of health care providers.”

The new grant also takes advantage of evolving technology for treatment options.

“It requires us to train students in telehealth, trauma informed care, social determinants of health and the psychological treatment of chronic pain,” Carels said.

Because of the multi-faceted nature of the grant, the impact of the project could have a ripple effect of benefits for all involved.

“The grant could not have come at a better time,” Carels said, “for our students, the university and the people of eastern North Carolina.”

At Family Medicine, behavioral health consultants meet with patients during medical visits on an as-needed basis. (Photo by Cliff Hollis)