Behavioral+Medicine

=Behavioral Health / Psychiatry=

__Wright Institute - Health Coaching__

 * Exam room consultation and/or warm hand-offs, __please page__:
 * WCHC Health Coach pager (510) 349-0089 (can use Cook Paging)


 * What: Behavioral health coaching services, including:
 * Exam-Room Consultation and Warm Hand-Offs - please page us Mon-Fri, 8:00-12:00 and 1:00-5:00 at (510) 349-0089
 * Groups (see below)
 * Individual Brief Intervention - short-term psychotherapy; 1-6 sessions)
 * Neuropsychological Assessment - conducted Fridays at WCHC
 * How to Refer: Pager for warm hand-off; CC-Link Referral for Groups, Individual Brief Intervention, or Neuropsychological Assessment:
 * New Order: **__Health Coaching INT REF__**
 * Select department: **MHC Health Coaching**, **NRC** **Health Coaching**, or **WCHC** **Health Coaching**
 * Select type of service requested: **Individual**, **Groups**, OR **Neuropsych Assessment**
 * If Neuropsych, select reason for referral: Differential Diagnosis, Change in Cognitive/Function Level, Safety and/or Capacity, or Other
 * Clinical Information: Please clarify reason for referral and include relevant clinical information
 * Groups:
 * WCHC [[file:WCHC Health Coaching Group Provider.docx]]
 * Building Healthy Habits: Mondays 4:30-6:00 p.m. in Group Room A (rm 1193) [[file:WCHC Health Coaching Group Healthy Life Styles (1).docx]]
 * Individuals coping with substance use, eating challenges, nicotine dependence, and/or are struggling with changing adverse health behaviors are all well-suited for this group
 * Finding Ease in a Stressful World 3:00 - 4:30 p.m. in Group Room A (rm 1193) [[file:WCHC Health Coaching Group Anxiety.docx]]
 * Individuals coping with psychosocial stressors (relationship, financial, or other), anxiety, or worry
 * Individuals interested in stress management techniques, relaxation strategies, or assertive communication skills
 * Loss, Change, and Transformation: Grief Group: Thursdays 10:30-12:00 p.m. in Group Room A (rm 1193) [[file:WCHC Health Coaching Group Grief.docx]]
 * Individuals dealing with grief, loss, and bereavement
 * We address loss of loved ones, but we also focus on anticipatory grief; loss related to changes in health status; and complicated grief
 * MHC - Held at Miller Wellness Center (MWC)
 * Living Well with Difficult Emotions: Tuesdays 5:30-7:00 p.m.
 * Individuals coping with depression, bipolar disorders, overwhelming emotions, including anger, sadness, grief
 * Seeking Safety - From Trauma to Resilience: Wednesdays 10:30 - 12:00 p.m.
 * Individuals who have experienced overwhelming or traumatic life events, PTSD, co-occurring substance use disorders, such as alcohol use, polysubstance use, or opiate addiction, etc.
 * Finding Ease in a Stressful World: Thursdays 5:30-7:00 p.m.
 * NRC (Groups on break until October 2014 - NRC pts are welcome to attend WCHC groups in the interim)
 * Stress Management Group: Tuesdays 3:00 -4:30 p.m.
 * Individuals coping with psychosocial stressors (relationship, financial, or other), anxiety, or worry
 * Individuals interested in stress management techniques, relaxation strategies, or assertive communication skills
 * Mood Group: Wednesdays 9:30-11:00 a.m.
 * Individuals coping with mood management challenges, specifically managing depression in everyday life.
 * Who:
 * Michael Changaris, PsyD (925) 335-7435 at Martinez Health Center (Training Coordinator and Groups Facilitator) @ MHC/MWC Tuesdays-Wednesday, Thursdays evenings, Friday; @ WCHC Mondays, Thursdays, and Tuesday afternoons
 * Emma Hiatt Wilson, PhD (510) 231-9572, ext 4 at West County Health Center (West County Site Liaison) @ WCHC Monday-Thursday
 * Franca Niameh, PsyD (510) 231-1371 at North Richmond Center for Health (North Richmond Site Liaison) @ NRC Monday-Thursday
 * Sharon Perlman Berry, PsyD (Clinical Neuropsychologist)
 * Temre Uzuncan, PsyD (925) 899-9038 (Training Director)

__Behaviorist__

 * WCHC - Alva Leung. Mobile (925) 381-2960. Pager (510) 349-0232

toc [|IMPACT] program
>> @ PHC Mondays and Thursdays, @ BHC 3rd Friday of each month >> @ MHC on Thursdays
 * What: Evidenced-based depression care for patients over 60
 * Eligibility:
 * Contra Costa County Medi-Cal
 * Medicare/Medi-Cal
 * Uninsured/ Basic Health Care
 * NO MEDICARE ONLY - Patients ineligible for IMPACT will be screened and redirected to the appropriate resource by the Depression Care Manager.
 * Where: Martinez, Richmond, Pittsburg, Brentwood, North Richmond
 * How to refer:
 * Call Depression Care Manager at your clinic to leave a confidential voice mail with patient's name, MRN and DOB or to see if available to meet patient on the spot.
 * Send an IN BASKET message via CCLINK to regional Depression Care Manager to your clinic.
 * CHART CHECK patient's chart to regional Depression Care Manager via CCLINK.
 * Who:
 * Brenda Luna, LCSW (925) 431-2751 at Brentwood and Pittsburg Health Centers (serving East County)
 * Amanda Dold, MFT (925) 521-5635, Cell (925) 348-1021 at Martinez Health Center (serving Central County)
 * Albert Fam, LCSW (510) 531-9570 at West County Health Center (serving West County)
 * @ WCHC Monday-Friday
 * Relevant EBM articles: Unutzer et al JAMA 288 (22):2836-2845 Dec. 11 2002

Depression
Screening
 * Antidepressant Medications:
 * [[file:ccrmc/Antidepressant Medication Management chart, Kaiser, 2009.pdf|Antidepressant Medication Management chart, Kaiser, 2009]]
 * AHRQ guide to choosing antidepressant
 * 1) PHQ-2: Over the past 2 weeks, have you often been bothered by:
 * Little interest or pleasure in doing things? Yes No
 * Feeling down, depressed or hopeless? Yes No
 * 1) [|PHQ-9 Depression Screen]
 * The PHQ-9 can be used as a diagnostic tool and as a tool to monitor response to treatment.
 * Learn more about [|Depression screening in primary care] sponsored by the MacArthur Foundation
 * 1) Beck (available in clinic), reference - [] Zung or Hamilton screening scores
 * 2) Always follow-up any positive depression screening with questions about mania or hypomania to evaluate bipolar disorder as well.
 * MAP for diagnosis [[file:MM - PSY - Depression - SAD MAPper as word.doc]]


 * Generalized Anxiety Disorder**

Autistic Spectrum Disorders

 * See also pediatrics
 * (includes Autism, Aspergers, Pervasive Developmental Disorder) Prevelance - (?) 1 in 140, Boys 4:1
 * Dx observations - Listen to parent carefully, Altered social engagement (eg won't play peek-a-boo), Speech delay or very odd use of language (eg echolalia), Abnormal-intense focused interests and repetitive behaviors (eg hand flapping, rigid routines )
 * Screening Test - @18-24 mo visit - M-CHAT ([])
 * Family Practice role - coordinating care for family, Referral to Child Development clinic (x5270 - SW Krista Peterson ), who will do comprehensive DDx (fragile X, etc)
 * Parent Information - [|www.autismspeaks.org] has a neat video comparing normal and autistic child, references, numbers, etc

Counseling Resources:
Crisis and counseling/therapy referrals, as well as other community resources (STAND, Caregiver Support, Senior Services, AA/NA), provided by Patty Hennigan, August 2012.

**Mental health clinic records**:
Per an email from Chris Farnitano, January 2009: "For access to the paper mental health chart, the best way that was suggested [by one of the psychiatrists] was to fax the form for Record Transfer (MR 205) to the mental health clinic in question and they will fax you back the requested information. The relevant fax numbers are as follows:

Pittsburg MHC: 925-431-2608 Concord MHC: 925-646-5622 Richmond MHC: 510-231-1261 Richmond Children's Mental Health: 510-374-3857

End of Life Care
California has endorsed the discussion of end of life issues to help improve the care provided for people. It is used to encourage doctors to discuss end of life decision making beyond DNR/DNI and advance directive forms.

POLST (Physician ordered life sustaining treatment): PDF forms in multiple languages, to be printed on PINK cardstock.

**Dementia:**
Certainly, some of the most troubling symptoms for demented patients and their caregivers are insomnia or behavioral problems (agitation, wandering, etc.). Obviously the first issue is their safety, as they may need a higher level of care if behavioral problems place them or others in danger. The medications listed her are obviously in addition to other treatments for the cognitive issues associated with dementia (Aricept, Namenda, etc.) which can also help with behavioral problems. Medications that should be avoided are: benadryl or tricyclic antidepressants (amitriptyline, nortriptyline) due to anticholinergic properties, can cause delirium. Ambien or benzos probably not good for same reason. For antidepressants, Paxil is the most anticholinergic SSRI and Prozac can build up in system because the half-life is very long, and should not be the first choices. One thing to note is that no medications are FDA approved for behavioral symptoms of dementia. However, as we know, they are often necessary. For insomnia, low dose trazodone 25-100 mg qhs or remeron 7.5-15 mg qhs are good options for elderly, very few side effects or drug interactions. For behavioral problems, of course antipsychotics can be helpful, but then there's the issue of increased risk of overall death (i.e. increased incidence of stroke), both older and newer antipsychotics cause this. Nevertheless, when patients' behavior needs to be controlled, low dose Zyprexa (1.25-10 mg daily), Seroquel (12.5-200mg daily) or even Haldol (1-10mg daily) are good choices. Abilify is a reasonable choice and generally less sedating and can be used at doses of 2-15mg daily. Risperidone is ok but has a higher incidence of Extrapyramidal symptoms. SSRIs such as Citalopram or Sertraline can be used as well for depressive symptoms.