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Transdisciplinary education approach for collaborative health

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Transdisciplinary education approach for collaborative health

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Content Running head: TEACH 1
Transdisciplinary Education Approach for Collaborative Health
Amelia Roeschlein
University of Southern California

TEACH 2
Table of Contents
Executive Summary ............................................................................................................ 3
Transdisciplinary Education Approach for Collaborative Health ...................................... 7
References ......................................................................................................................... 38
Appendix ........................................................................................................................... 47

TEACH 3
Executive Summary
Integrated care has been shown to make treatment easier to access, patients more engaged
in their wellness, which leads to healthier individuals (Hughes et. al, 2016). In practice- joint
approaches between addiction, physical health, and psychiatric providers, barely exist.
The American Academy of Social Work and Social Welfare (AASWSW) has created the
Grand Challenge initiatives in an effort to focus on evidence-based approaches to solve social
problems. Although each of the challenges has a noble mission, this project will focus on
“Closing the Health Gap”. The AASWSW has recently put forth a call for measurable goals
within Grand Challenge networks, which include interprofessional collaboration and workforce
transformation (AASWSW Mission and Goals Draft, 2019), both of which are integral to the
concept of a team-based culture.
Directly addressing Health Gap
This writer will prototype an integrated transdisciplinary training program. It will begin
at an academic outpatient psychiatry clinic with mental and physical health providers who will
receive training didactics in an integrated way. These providers will see patients in the same
room at the same time, so that all clients are seen by multiple specialists concurrently. It will give
the providers of tomorrow the ingredients necessary to create and build fully functioning
integrated care teams of their own.
This approach will lead to better treatment outcomes for patients, as well as increased
collaboration and team-based decision making amongst providers. The next step will be to
publish outcomes, and then replicate at other psychiatric residency programs nationwide.

TEACH 4
Grounded in Literature and Practice Models
Research shows that integrated care facilitates the achievement of goals that cannot be
reached when individual professionals act on their own (Parks et al., 2006). Transdisciplinary
education and collaborative practice competencies (IPEC, 2016), were designed to promote the
development of team-based healthcare identities. A key component of that identity is
development of individual and team-based competencies to work collaboratively with all other
health professions. The goal of these competencies is to support the triple aim of quality patient
care, improving population health, and reduce costs (Berwick, Nolan & Whittington, 2008).
Interprofessional domain competencies, applied in conjunction with behavioral health
knowledge and skills, prepare all health professions’ trainees to collaborate effectively within the
changing healthcare environment, and service delivery systems focused on enhancing individual,
family, and population health. To date, there are no set standards for integrated training in
graduate programs or medical school. This innovative program will set the standard for
transdisciplinary education among numerous providers in physical and behavioral health. It will
be the first academic outpatient psychiatry clinic where mental and physical health providers will
receive training didactics in an integrated way and see patients in the same room at the same
time. This design will provide more efficient and effective healthcare for those with syndemic
illness and train the providers of tomorrow to work in integrated care settings in hopes of closing
the health gap.
Innovation Landscape
The Transdisciplinary Education Approach for Collaborative Health (TEACH) program
will utilize a framework of non-hierarchical team-based curriculum to train behavioral and health
providers . The framework is linked to tenets implemented in the Patient Protection and
TEACH 5
Affordable Care Act in 2010, the importance of public health metrics, and the Institute for
Healthcare Improvement’s Triple Aim goals to improve the patient experience of care (including
quality and satisfaction), improve the health of populations, and reduce the per capita cost of
health care (IPEC, 2016; Englander, 2013). Transdisciplinary domain competencies, applied in
conjunction with behavioral health knowledge and skills, prepare all health professions’ trainees
to collaborate effectively within the changing healthcare environment, and service delivery
systems focused on enhancing individual, family, and population health.
Project Methodology
The program will attempt to improve several related outcomes: trainee surveys (including
emotional intelligence, team decision making behaviors, training experience standardized scales)
as well as patient surveys (including measurement scales for depression, anxiety; trauma,
medication compliance, and satisfaction scales). We will measure all scores and pull data on
appointment attendance as well as psychiatric hospitalization.
Aims
Four aims guide this project through implementation and beyond, all of which ask;
1. Does TEACH increase team decision making behaviors in psychiatric and primary care
trainees in an academic outpatient setting?
2. Does TEACH increase trainee and patient satisfaction?
3. Does TEACH decrease patient psychiatric hospitalization and emergency room visits as
well as patient functional impairment?
4. Does TEACH decrease patient no shows?

TEACH 6
Initial process and outcome scores are positive, but we will need to publish results in hopes of
replication at other residency sites for national impact. Due to the small amount of evidenced-
based transdisciplinary team protocols, any dissemination of protocols or findings may be
helpful to add to the practice literature of diverse health team training, which is why the TEACH
program will publish initial, and continued findings.
Innovation
The Transdisciplinary Education Approach for Collaborative Health (TEACH)
program will develop a systematic framework for transdisciplinary training, in hopes of engaging
patients in a more effective way through team-based healthcare. This transdisciplinary approach
will consist of two or more behavioral health providers (psychiatry residents, family medicine
residents, psychiatric nurse practitioners, and graduate level allied mental health trainees)
meeting with the patient at the same time in therapeutic alliance to improve patient treatment
outcomes. This innovative program will disrupt the current social norms of graduate behavioral
and physical health training – and create a non-hierarchical approach that manifests a team-based
culture. It is our hope that this approach will be replicated at other residency training programs,
and will foster innovative research and scholarship, strengthen a variety of health-related
partnerships, support faculty development, facilitate health policy and leadership and lead to the
creation of enhanced collaborative practice models.

TEACH 7
Transdisciplinary Education Approach for Collaborative Health

The TEACH program aims to answer if transdisciplinary training increases team decision
making behaviors and emotional intelligence in psychiatric and primary care trainees, in an
academic outpatient setting.
Conceptual Framework
The American Academy of Social Work and Social Welfare (AASWSW) has created the
Grand Challenge initiatives in an effort to rally support and incite innovative solutions for some
of our nation’s most challenging social issues. “Closing the Health Gap” is one challenge which
disproportionately impacts the most vulnerable in our society. By creating the first
transdisciplinary residency training program, this writer will set the standard for integrated
behavioral health training, in hopes that it can be replicated throughout the country as the gold
standard for community psychiatry and mental health training. Transdisciplinary medicine and
training are one of the AASWSW recommendations for treating those with mental health,
substance use, and corresponding addictive illness (Fong et al., 2018).
Indirect Link to Other Challenges
Only through developing value-based healthcare interventions and integrated payment
systems may the healthcare landscape look towards change. Moving towards a payment model
that combines behavioral health and medical care is vital for sustainability of integrated care
(Mandersheid & Kathol, 2014).
This program will attempt to close this gap through a transdisciplinary training program.
Although this capstone will focus on health equity issues, it also touches on Advancing Long and
TEACH 8
Productive Lives, Eradicating Social Isolation, and Harnessing Technology for Social Good
(AASWSW).
Literature and Practice Review of Problem and Innovation
Effective teamwork in medical settings is believed to: achieve superior patient outcomes,
increase patient satisfaction, improved staff morale and cost containment (Hughes et. al, 2016).
In its 2001 report, Crossing the Quality Chasm, the Institute of Medicine (IOM) included the
development of effective teams as a recommendation for how to improve health care quality.
The nation’s largest payer for health care services for the poor and underserved, Medicaid,
agrees, recommending a transdisciplinary approach for all services, suggesting that providers
“learn and work together across traditional disciplinary or professional boundaries to optimize
outcomes, in particular with those most at risk” (Schlesinger, 2004) in order to close the health
gap.
Although healthcare reform has increased access to healthcare services for many
people, recent statistics show that issues with access to care continue with over 56% of adult
Americans not receiving treatment for mental health care (Mental Health America, n.d.). People
with severe mental health conditions (such as Bipolar or Schizophrenia) have a shorter life span
than those in the general population (De Hert et al., 2011). Empirical evidence shows us that
those with syndemic conditions die 25 years before their peers (Parks et al., 2006). , and there is
a strong belief that transdisciplinary care facilitates the achievement of goals that cannot be
reached when individual professionals act on their own (Hughes et. al, 2016).
The Institute of Medicine has observed that current educational models in health care fail
to bring together students from diverse disciplines, so they can learn each other’s strengths,
weaknesses and potential contributions (IOM, 2001). At this time, there is a large gap between
TEACH 9
research and healthcare education practice; joint approaches between addiction, physical health,
and psychiatric providers barely exist (Davis et al, 2015). Less than 30% of schools have any
formal transdisciplinary experiences in their residencies or practicums (Nandiwada & Dang-Vu
2010, ACGME). These problems are compounded by the limitations of some disciplines (Davis
et al, 2015), limited understanding of the roles and expertise of other professionals (IOM, 2001),
increased requirements for accountability and documentation (Hughes et. al, 2016), and complex
diagnoses and treatment methods (Schlesinger, 2004).
Not all treatment team models, however, are equally effective, especially when working
with persons who have multiple medical and social deficits. Mental health care teams, in
particular, can demonstrate significant differences based on their purpose, composition, size, and
working relationships (Jones & Phillips, 2016). When it comes to serving the needs of clients
with co-occurring disorders of psychiatric illness, physical health conditions, and addictions, the
types of team models used in conventional mental health settings over the years
(multidisciplinary, interdisciplinary) have significant shortcomings (Ruddy & Rhee, 2003). A
transdisciplinary model, in contrast, that adopts an integrated and fluid team approach to client
care appears to be particularly well suited to meeting the needs of this profoundly disadvantaged
population (Nandiwada, Dang-Vu, 2010).
Social Significance
When these individuals do reach out for care, their physical health needs are often
overlooked due to the focus on social issues such as homelessness, mental health behaviors, or
substance use problems (Hunt et al., 2016). “Syndemics emerge when two or more health
conditions co-occur in environments of aggravated adversity and interact synergistically to yield
worse health outcomes than each affliction would likely generate on its own” (Willen et al.,
TEACH 10
2017, p. 965). We have found that those with syndemic illness require more frequent
hospitalizations and have poorer outcomes because they are unable to maintain the numerous
specialists and medical providers that they see, if they seek care at all (De Hert et al., 2011). This
treatment of patients with complex and co-related conditions requires integrated treatment
services that go beyond siloed management of substance use and psychiatric and medical
symptoms (Roeschlein, 2017, p.3-4).
A central feature of transdisciplinary care and training is that each team member is
exposed to foundations of health, chronic illness management, addictive illness, and mental
health training (Little, 2010). On a continuum of healthcare teams, the transdisciplinary team
works together for a common purpose, as they make different, complementary contributions to
client-focused care (Hunt et al., 2016). Borrill and Haynes (2000) found that teams with greater
occupational diversity reported higher overall effectiveness. The innovations introduced by
these teams were more radical and had significantly more impact both on the organization and on
client care. When students and trainees from “different fields work and train side by side there is
hope that they may practice differently, consult each other more often, and perceive each other in
a less hierarchical fashion” (Beck, 2005, 218). Results from several studies show that healthcare
may be more effective in certain professional groups (Waltmann et al., 2012). .By learning the
principles of transdisciplinary care during their training, clinicians learn how to use a
multidisciplinary team to provide comprehensive care for their patients, while addressing
environmental and social determinants of health, no matter what the patient’s motivation level is
towards health outcomes (Nandiwada & Dang-Vu, 2010).
Comparative Analysis
TEACH 11
To our knowledge, there are over thirty interprofessional training programs in the United
States, most of which do not include behavioral health and primary care healers. Of those that do,
only two current medical training programs have published some outcomes related to integrated
training experiences, neither of which are doing anything as innovative as the TEACH program.
The Vanderbilt Program in Interprofessional Learning (“VPIL”, n.d.) provides team experiences
during medical school for two students a year one half-day each week, as well as one half-day each
month the teams come together for a variety of classroom-based activities. The small scale of this
program (2 students annually), as well as non-randomized sampling makes any proposed outcomes
limited in their scope. The Yale Consultation Liaison Service (“Yale Consult”, n.d.) features
integrated teams of psychiatrists, social workers, and clinical nurse specialists in training working
together in a hierarchical fashion where they provide referrals between the disciplines as needed.
Again, the outcomes that have been linked to this program have been mostly patient focused
outcomes, none of which have included random sampling or provider training focused.
Logic Model Overview/ Theory of Change
The TEACH program aims to answer if transdisciplinary training increases team decision
making behaviors and emotional intelligence in psychiatric and primary care trainees, in an
academic outpatient setting.
The program will attempt to improve several related outcomes (see logic model in
Appendix): trainee surveys (including emotional intelligence, team decision making behaviors,
training experience standardized scales) as well as patient surveys (including measurement scales
for depression, anxiety; trauma, medication compliance, and satisfaction scales). We will
measure all scores and pull data on appointment attendance as well as psychiatric hospitalization.
Thus, four aims guide this conceptual framework:
TEACH 12
1. To test if transdisciplinary behavioral health training increases team decision making
behaviors in psychiatric and primary care trainees in an academic outpatient setting.
2. To test if transdisciplinary behavioral health training increases trainee and patient
satisfaction.
3. To test if transdisciplinary behavioral health training decreases patient psychiatric
hospitalization and emergency room visits as well as decreases patient functional
impairment
4. To test if transdisciplinary behavioral health training decreases patient no shows.
Aim 1. The transdisciplinary approach creates a dynamic of professional development,
where team members from different disciplines can learn from each other in the moment
(Nandiwada & Dang-Vu 2010).
This dynamic of professional development and team-based decision making can happen
across multiple domains, such as during attendance at integrated didactics, in clinic during
assessment, which lead to improved attunement of the providers and more importantly to the
patient’s emotional state (Pellechia et al, 2017). This creates a harmony or unity of intellectual
frameworks that goes beyond the disciplinary perspectives and creates something new that
allows the providers to achieve more than could be achieved by the same professionals acting
independently (Davis et al., 2015). By learning the principles of transdisciplinary care during
their training, clinicians learn how to use a multidisciplinary team to provide comprehensive care
for their patients, while addressing environmental and social determinants of health, no matter
what the patient’s motivation level is towards health outcomes (Nandiwada & Dang-Vu, 2010).
We anticipate that this will support the goals of Aim 1.
TEACH 13
Aim 2. This study proposes that transdisciplinary behavioral health training will increase
provider training satisfaction. There is currently no evidenced based curriculum for training
behavioral health practitioners in a transdisciplinary approach. Identifying clear goals, ensuring
that outcomes are due to the intervention (Schorn et al., 2014) will be challenging for TEACH
due to the lack of evidenced based curriculum. Integrated training program literature outlines
possible threats to positive outcomes for trainees including; institutional bias against non-
hierarchical training (Neuhauser et. al, 2007; Danhausen et al., 2014), and lack of clear directives
within a team setting (Schorn et al., 2014).
Integrated training literature does point to several positive outcomes for trainees
including how it can enhance communication between interdisciplinary team members (Jones &
Phillips, 2016). Interprofessional training can build professional confidence and creativity, as
well as advance professional value and comfort with shared-decision making (Chan, Chi, Ching,
& Lam, 2010; Sims, 2011). This model supports the well- being of the clinical team, offering a
sense of support greater than could be found during treatment team meetings or clinical
supervision (Nandiwada & Dang-Vu, 2010). The TEACH program will hope to address these
facilitators through the outcome measures used by the various trainees at the beginning and end
of the academic year, in hopes of seeing increased communication, value, and comfort with
shared-decision making. We believe this will support the goals of Aim 2.
Aim 3 & 4. It has been suggested that a transdisciplinary model may decrease patient
psychiatric hospitalization, missed visits, and psychiatric functional impairment. People who are
dealing with the devastating effects of comorbid chronic health conditions, mental illness and
chemical dependency, present with exceptionally high levels of clinical and social complexity
(McQuistion et al., 2003). In fact, most people with comorbid conditions have unmet needs that
TEACH 14
far exceed what any one health care provider, can realistically meet. Hence, a team approach to
care has been a central feature of clinical initiatives designed to address the needs of this highly
underserved sector of the community (Nandiwada, Dang-Vu, 2010).
Even when they do attend their appointments, people with syndemic illness continue to
experience health inequalities, particularly in relation to the provision of healthcare. This may be
due to the tendency of “diagnostic overshadowing” (Hunt et al., 2016). This is the tendency of
healthcare providers to under treat or ignore physical health symptoms due to the focus placed on
behavioral health conditions such as schizophrenia or substance misuse (Hunt et al., 2016).
Problems of Practice and Proposed Innovation
Proposed Innovation/ Logic Model and Theory of Change
This writer will prototype an integrated transdisciplinary training program. This
innovative program will disrupt the current social norms of graduate behavioral and physical
health training and reclaim how to connect providers in a deeper way to support patients having
long and productive lives worth living. On the continuum of innovation- this falls between
Upheaval and Revolution. The TEACH program has already begun- using two teams of three
trainees, and multidisciplinary faculty for supervision. The teams manage one-hundred patients,
and have clinic three days a week, as well as attend integrated didactics together.
There are three major innovations to the project: First, this is the first academic outpatient
transdisciplinary behavioral health training residency clinic for mental and physical health
providers. Second, what makes this model different from any other program, is that instead of
seeing separate providers on separate days, patients go to one place, and see all of their
specialists, that all come into the treatment room at the same time. Third, all trainees will attend
TEACH 15
didactics together, with a curriculum focused on the social and behavioral determinants of health,
systems of care, and population and community health, in addition to training as usual didactics.
Due to the lack of evidenced-based transdisciplinary team protocol, any dissemination of
protocols or findings may be helpful to add to the practice literature of diverse health team
training, which is why the TEACH program will publish initial, and continued findings. These
will ensure sustainability as well as move the field of transdisciplinary medicine forward. Social
Learning theory will be used toward towards solving the Health Gap Grand Challenge
(AASWSW), exposing trainees to use the knowledge of their own role and those of other
professions to appropriately assess and address the health care needs of patients and to promote
and advance the health of populations.
Views of Key Stakeholders
The TEACH program will operate under the University of California (UCSD), San
Diego’s Department of Psychiatry. This is located in the School of Medicine, which is part of
the Health Sciences Division of the University of California and overseen by the Chancellor of
UCSD, Pradeep Chosla, PhD (Health Sciences Organizational Chart, 2017). UCSD has over
forty-one years of experience in development and administration of mental health and alcohol
and drug treatment services in San Diego County in addition to its academic and research
programs. UCSD Outpatient Psychiatric Services is part of a larger system and must answer to
not only the Department of Psychiatry, but also the UCSD health system, medical school, and
health sciences department. All of these have resources that were instrumental for
implementation.
As a large governmental agency, UCSD has a structure that is complex and nuanced.
Innovation or change is challenging and slow due to the systemic issues, politics, and frequent
TEACH 16
academic rivalries. Within the department of psychiatry there is a political divide between the
medical school residency training office, research, and clinical services.
The different disciplinary training offices may resist the idea of their trainees being
trained with other disciplines out of worry that their scope will be lost, or that their individual
training requirements are not being met. It has been important to work with these internal and
external stakeholders to find champions and build support during this prototype phase, as well as
secure IRB approval through UCSD.
Evidence and Current Context for Proposed Innovation
The University of California San Diego Outpatient Psychiatric Services- Hillcrest (OPS-
H) is located in central San Diego area and has over 2000 active patients. OPS-H operates as a
training site for residents in psychiatry, psychiatric nurse practitioner students, medical students
and psychology, social work and MFT trainees. It also serves as a site for family medicine and
psychiatry combined residents in their third year of training.
The current academic site has thirty multidisciplinary trainees that change annually. The
prototyped transdisciplinary training program began with twenty-one trainees using the treatment
as usual approach. An additional nine trainees a year, a mixture of all disciplines, will carry a
caseload of around two hundred syndemically ill patients, and engage in the new model of
transdisciplinary care. Assignment to either condition (training as usual or TEACH track) will be
self-selected by the first nine trainees. Patients will also be given the opportunity to choose their
care track.
The TEACH program is led by two OPS-H attendings, a faculty licensed clinician in
conjunction with a faculty medical doctor. The attendings lead the transdisciplinary team
TEACH 17
training, as well as educational didactics and oversee all medication management and clinical
supervision.
All trainees are provided psychoeducation on this new model during the annual
orientation at OPS-H and will be able to self-select into the TEACH track. All trainees will
receive integrated didactics and treatment teams weekly. The majority of trainees will begin
seeing patients using the current siloed approach, different types of providers on different days
depending on specialty and client need. The TEACH track trainees will see patients in the same
room at the same time in teams of three, as well as receive multidisciplinary supervision in real
time .
Measures. Data will be collected from providers at two time points (before and after the
academic year) and clients at each visit. Provider outcomes will be matched by typical training
program trainee measures vs TEACH track trainee measures. Patient outcomes will be reviewed
by typical patients vs TEACH track patient measures.
Provider Surveys. All trainees will be provided psychoeducation on this new model, as
well as be given provider outcome measures of emotional intelligence; TEIQue-SF (Petrides,
2009), and Team Decision Making; TDMQ (Batorowicz & Shepherd, 2008) and prior training
experience standardized scales before they begin seeing patients.
At the end of the academic year, trainees will be provided provider outcome measures
again, including emotional intelligence; TEIQue-SF (Petrides, 2009), and Team Decision
Making; TDMQ (Batorowicz & Shepherd, 2008), as well as training experience standardized
scales. We will also offer opportunities for qualitative feedback from trainees. We anticipate
that the trainees in the TEACH track will have increased levels of emotional intelligence and
increased team decision making behaviors and values.
TEACH 18
Patient Surveys. All patients will be given measurement scales for depression; PHQ-9
(Kroenke et al, 2009), anxiety; GAD-7 (Spitzer, 2007), trauma; BTQ (Schnurr, 2002), and
assessed for medication compliance at every appointment. The patients will also receive Press
Ganey Satisfaction scales (“PG”, n.d.) throughout the year to complete. We will also offer
opportunities for qualitative feedback from patients .
We will measure all scores and pull data on appointment attendance as well as psychiatric
hospitalization. We anticipate both client functional outcomes as well as process measures (such
as patient attendance and medication compliance) will indicate reduced functional impairment,
hospitalization, as well as increased patient satisfaction.
Specific Measures:
Construct Measures Sources
Anxiety GAD-7 Spitzer, 2007
Decision
Making
Team Decision
Making -TDMQ
Batorowicz &
Shepherd, 2008
Depression PHQ-9
Kroenke et al,
2009
Emotional
Intelligence
TEIQue-SF Petrides, 2009
Patient
Satisfaction
Press Ganey
Satisfaction Scales
PG
Trauma
Brief Trauma
Questionnaire
Schnurr, 2002

TEACH 19
Data Analysis. We will collect and review all three data sets; administrative data
(hospitalization and emergency room visits, appointment show rates), provider surveys and
patient surveys and utilize a linear regression analysis between treatment as usual training and
TEACH training scores. Although it will be challenging to determine causal relationships, we
hope to determine areas for future exploration and design.
Comparative Assessment of Other Opportunities for Innovation
We anticipate numerous potential challenges within the program design. First, there is
bias when all trainees are volunteers, due to the fact that bias can be rampant in these types of
design. Volunteer bias can occur at all stages of the project, from trainee and patient recruitment,
to attitudes and beliefs towards the project and the institutions involved. Due to all the design of
the program, any trainee that chooses to do their practicum work in TEACH will likely be more
biased towards interdisciplinary settings, which may not be representative of all behavioral
health trainees. Second, most data sources were self- report – which also may be biased due to
desire to please the project staff. The students tool (a pre and post measurement of training
satisfaction), as well as individualized learning plans appear to not be validated tools, therefore
do not have much reliability, which may account for a greater risk of bias. Third, even if
outcomes show promise, further research and exploration is needed to determine if team-based
behaviors make the team more capable of making the best decisions, and more positively
influencing patient care (Batorowicz & Shepherd, 2008).
Project Structure and Methodology
Capstone Deliverable/Artifact
A non-hierarchical team-based curriculum is attached (see appendix) to address the key
features of the TEACH program. This handbook outlines didactics and protocols with
TEACH 20
corresponding activities that can be used to replicate and foster a team-based culture in a
behavioral health academic setting. Integrated teams where students learn to become skilled in
transdisciplinary competencies and experiences lead to improved health of patients and
populations (Hughes et. al, 2016). This curriculum will foster innovative research and
scholarship, strengthen a variety of health-related partnerships, support faculty development,
facilitate health policy and leadership and lead to the creation of enhanced collaborative practice
models.
Comparative Market Analysis
The health care system in the United States is undergoing dramatic redesign encouraged
by health care policy changes; in particular, the passage and implementation of the Patient
Protection and Affordable Care Act (ACA, n.d.). While team-based healthcare certainly is not a
new concept, the ACA specifically recognizes the impact of transdisciplinary education, training,
and care on quality health care and cost effectiveness (cf., Section 3502, Establishing Community
Health Teams to Support the Patient-Centered Medical Home). Rozensky (2014) has noted, no
matter what occurs politically or in the courts surrounding U.S. healthcare policies and
healthcare reform, integrated professional education and integrated team-based care are here to
stay. He notes that healthcare in the 21
st
century is far too complex to be effectively carried out
by one professional or one profession alone.
In response to this focus on integrated care, there has been increased attention to training
health care professionals using team-based education to develop the competencies necessary for
quality collaborative practice (Brandt, 2015). While it is important to note that team-based
interventions date back decades in the literature (Brandt, 2015), the current, rapidly changing
TEACH 21
health care environment in the U.S. is fostering an environment that widely supports adoption of
this type of pedagogical approach to learning and ultimately, to practice.
To date there are over 30 academic institutions in the United States that have some type
of interdisciplinary educational training (Interprofessional Education Collaborative, 2016). They
vary in level of educational training (medical or graduate school experiences or residency
experiences) and classroom or clinical placement. Many of them integrate some type of
simulation or shadowing with other disciplines (Brandt, 2015). The majority of these appear to
focus on medical providers (such as Physicians, Nurses, Physician Assistants, Dentists instead of
behavioral health providers). Of the programs that do include behavioral health providers, most
use masters level therapists as case managers or care managers. To date this writer has found no
interdisciplinary educational training programs where masters level therapists are used to the
fullest extent of their training, in a non-hierarchical team-based culture, seeing patients at the
same time as medical providers or in all didactics (which is the current TEACH model).
A foundation for organizing many of the modules within the TEACH program, is the
Core Competencies for Interprofessional Collaborative Practice: 2016 Update. This document
outlines four core competencies and associated sub-competencies necessary for transdisciplinary
collaborative practice. Its development was guided by a model from Canada (Canadian
Interprofessional Health Collaborative, 2010). Transdisciplinary education is a prominent
component of health professions education in other countries; for example, the Center for the
Advancement of Interprofessional Education based in the United Kingdom.
Project Implementation Methods
When it comes to implementation of any curriculum across several healthcare
professions, with significant coordination of their respective training schedules, there is a wide
TEACH 22
range of challenges and barriers that require significant effort to address in advance. This
includes identifying local challenges and enlisting an interdisciplinary team to solve those
challenges. To date we have outlined several key steps.
1. Identify one or more partners in other health professional education programs
a. To begin, identifying a faculty partner within each profession was integral to the
success of TEACH. These individuals were repeatedly called upon to champion
TEACH within their program and to maintain a level of leadership, as TEACH
was built and implemented.
b. All health professions are currently moving towards greater emphasis on team-
based competencies and skills, so finding collaborating partners is easier in
today’s climate than ever before.
i. We were fortunate that our current site included a large group of
disciplines from several local universities. We are looking into further
local partnerships and professional relations to include as many
professions as interested, including physical therapy, occupational therapy,
dieticians and pharmacists. All professions have some level of
multidisciplinary expectations in their accreditation standards and quality
of care ethics.
c. Selecting partners was based initially on engaging a coalition of those interested
at our current university and including others as the momentum built. We began
with our allied mental health training director and psychiatry residency training
director. We then were able to engage nursing education coordinators and the
residency training director in family medicine at another training institution. We
TEACH 23
found that all wanted their trainees working in collaborative interdisciplinary
teams. Like social work training, these programs with more advanced trainees
have significant didactic requirements imposed by their accrediting agencies (e.g.,
ACGME) and are frequently looking for opportunities to participate in
collaborative teaching of their trainees and residents. We found it helpful to
include all disciplines in crafting TEACH program didactics to ensure that they
met individual institutional requirements.
d. We partnered with community health professionals at a Federally Qualified
Health Center so that we could work with the underserved population.
e. One idea we have explored is using technology in the future to create virtual
teams and training with other academic institutions if there are timing difficulties.
2. Competency focus
a. Appealing to specific professional competencies required to meet accreditation
standards were the most effective way to obtain broad buy-in among colleagues.
3. Getting resources from program leadership to support the time necessary
a. Finding a “champion(s)” within the academic institution leadership structure who
was willing to provide top-down support and assistance was an important aspect
in securing the right partners.
b. We were able to use our own funding sources (some of which came from the
County of San Diego which funds our Community Psychiatry Program) in order
to get buy in and support by leadership, which was key to moving forward.
c. Additional incentives for faculty development and participation have included;
university/department funding to attend national meetings, university awards for
TEACH 24
innovation, publications in educational journals as a result of developing of
curriculum measurement of outcomes, inclusion as a part of promotion
requirements for faculty.
4. Logistics of scheduling TEACH among learners from two or more training programs.
a. Finding a time, calendar schedule and location for TEACH were challenges,
especially with the varied schedules and segments of training (e.g., semesters,
quarters, rotations) within each profession’s training program.
i. We requested a longer commitment up front from all participants, one that
went beyond some of their programs rotations.
b. In the future, we would like to see TEACH as a requirement rather than an
elective since
i. trainees are likely not yet aware of the importance and value of this type of
training. Younger trainees tend to be focused on developing basic clinical
skills.
ii. In larger training programs (i.e., medical schools), having transdisciplinary
training tied to a particular clerkship or clinical rotation is perhaps the best
course of action, in order to keep TEACH a manageable size.
5. Finding a location may be challenging
i. We initially struggled to find a location due to our own clinic undergoing
construction. We were able to collaborate with a local FQHC to use their
site for our preliminary year. Since then, we have added our internal
health system clinic so now have two locations.
6. Faculty development
TEACH 25
a. Faculty are required to co-teach with other disciplines’ educators and teach numerous
disciplines learners, including use of interactive learning strategies.
b. Faculty must model collaboration and embrace collaborative learning.
c. Training opportunities need to be available to faculty regarding effective strategies
that can be used when teaching transdisciplinary seminars. This may require
additional training for the Faculty member, as well as new approaches that they have
not used previously. We found seeking consistent feedback from all trainees as a
helpful process for developing strategies to engage all disciplines in learning material.
d. We found that faculty should consider themselves as transdisciplinary learners when
engaging in transdisciplinary education. This non-hierarchical approach is necessary
to model.
7. Pedagogy is an important issue to consider carefully, we chose an active
learning style.
a. From the beginning we knew that we did not want a single lead faculty member.
The TEACH program offers a great opportunity to model shared leadership
among faculty members.
b. We knew that the focus should be active learning experiences that simulate team
activities in a clinical setting, even during seminar. An effective approach to
interactive learning is to use break-out discussions among smaller teams of
trainees that simulate the size of a typical healthcare team (i.e., 3-8 practitioners).
Didactic presentations by faculty should be kept to a minimum, with a goal of
75% of the time spent on interactive learning. This approach can be facilitated
by having trainees complete readings before class, utilize online modules with
TEACH 26
posttest quizzes to demonstrate learning, such as the pre-existing free ones
available at the Institute for Healthcare Improvement website (www.ihi.org).
c. We found it helpful to review other examples of different ways to structure
transdisciplinary training (Falk et al.,2015, Reeves et al., 2012, WU Toolkit, n.d.).
d. Using an interactive learning vs passive learning approach was an optimal format
for a transdisciplinary seminar. We asked all faculty involved in the seminars to
utilize this approach in advance (WU Toolkit, n.d.).
e. TEACH utilized technology to encourage pre-meeting communication and
activities in order to keep the focus during the meeting time on interactive
learning.

Summary of Challenges and Actions/Strategies

Challenge Action/Strategy
Finding partners in other health professional
training programs
Masters level therapists, psychiatrists, nurse
practitioners and family medicine physicians
good place to start. Do not overlook
programs such as pharmacy, physical and
occupational therapy and dietetics
Getting “buy-in” from administration and
other program colleagues
Look for a “champion” within leadership.
Focus on being a part of the cutting edge of
healthcare training and future need for
interdisciplinary competencies
Each participating professional program
having its own academic schedule
Accommodate to program with the shortest
time segment available
Curriculum overload that makes adding new
course difficult
Emphasize 1 seminar with most of learning
taking place within the seminar
Providing resources and incentives for
participating faculty
Course buy-in, collecting data to publish
outcomes in peer-reviewed outlets, applying
for internal or external grant awards for initial
design and implementation of the model
TEACH 27
Choosing a pedagogical approach that
matched overall goals
Choose approach that engages learners in
active small group discussion, paralleling the
experience of working in a healthcare team

Financial Plan and Staging
Sources of Revenue. TEACH is fully funded for its first five years of operation. The
funding for the psychiatric residents and attending psychiatrists and psychotherapists will be
from Medicare (who provides stipends to teaching hospitals that agree to taking on certain
percentages of Medicare clients), as well as the generated income from the billing that is
submitted during clinic time. We are also funding a portion from a community psychiatry grant
from the state of California and the County of San Diego that has been secured for the next five
years. The administrative staff for tracking outcomes and checking in patients will be funded
through the UCSD Health System, who will secure the funding from the Department of
Psychiatry and their mutually agreed upon operational expense budgets for each fiscal year of
operations.
Budget Format & Cycle. The budget format that will be used will be a combination of
line item and program budgeting. This will allow the program to track everything in real time
and utilize YTD actuals as well as forecast future budget totals. The fiscal cycle will be
academic, so July to June.
Revenue Projections
Medicare (Training) 318,000
Comm Psych Grant 200,000
Insurance Reimbursement 20,000
Health System Supplement 20,000
__________
TEACH 28
558,000 annual revenue projection
Staffing Plan and Costs. All costs are based off of this fiscal year budget with projected
rate increases for 2019-2020 academic year. All attendings will be utilizing .10 of their time for
program evaluation.

STAFF/ FTE ANNUAL SALARY BENEFITS
Psychiatric Attending
.40 FTE

120,000

18,400
Mental Health Clinician
.50 FTE

50,000

15,000
Resident Trainees
2 FTE

140,00

37,800
Medical Assistant
.40 FTE

16,000

8000
Administrative Assistant
.40 FTE

14,080

7800

Other Spending Plans and Costs. The UCSD interdisciplinary training program has
already existed for over 40 years, has ample space and staffing, as well as pre-existing
computers, supplies such as telephones, and more. TEACH will only need to focus on ongoing
costs.
TYPE AMOUNTS
Building Costs/ Overhead
Rent
Utilities (Electricity, Water, Phones)
Maintenance (Building, Janitorial,
Grounds, Parking, IT)

20,000
10,000
12,000

Supplies
Office Supplies (Paper, Pens, Copiers,
Computers, Phones)

40,000
Indirects
Security
Labs/ Pharmacy
Interpreter Services
Licenses
Staff Development

5000
5000
2000
1000
3000
TEACH 29
Travel

5000

Line Item Budget

REVENUE ANNUAL BUDGETED
Medicare (Training) 318,000
Comm Psych Grant 200,000
Insurance Reimbursement 20,000
Health System Supplement 20,000
TOTAL REVENUE

558,000
EXPENSES
Salaries 340,080
Benefits 87,000
Building Costs/ Overhead
Rent 20,000
Utilities 10,000
Maintenance 12,000
Supplies
Office Supplies, Computers, Phones 40,000
Indirects
Security 5000
Labs/ Pharmacy 5000
Interpreter Services 2000
Licenses 1000
Staff Development 3000
Travel 5000
TOTAL EXPENSES

530,080

EXCESS REVENUE OVER
EXPENSE
27,920

Revenue vs. Costs
Total revenue is higher than cost based off of this projected budget. This could lead to a
potential surplus, which could be utilized if we have any staff turnover, or insurance
reimbursement does not meet projected numbers. It could also be utilized to put more time into
program evaluation, purchase more supplies, such as I-Pads for outcome measures or other types
TEACH 30
of technology such as apps that could track outcome measures closely or for statistical analysis
of outcomes.
Project Impact Assessment Methods
We will collect and review all three data sets; administrative data (hospitalization and
emergency room visits, appointment show rates), provider surveys and patient surveys and
utilize a linear regression analysis between treatment as usual training and TEACH training
scores (see Logic Model in Appendix). Initial outcomes indicate decreased hospitalization and
emergency room usage which indicate downstream cost savings, as well as decreased functional
impairment and increased training satisfaction. At this time, we are publishing initial outcomes
and plan to expand.
In order to move towards replication and continued sustainability we will need to show
sustained impact. While the scope of this project was not designed to build an exhaustive, how-
to curriculum for transdisciplinary behavioral health training, we have attempted to design a
curriculum that can serve as a stand-alone lecture inserted into an existing course, as a special
topic lecture at grand rounds, or as part of a comprehensive seminar that includes all the modules
provided. Each module contains suggested learning activities that are designed to promote
learner reflection on specific constructs. Self-reflection and problem-based learning through
clinical case examples are central to the implementation of TEACH.
When assessing impact, it is important to assess at the patient, trainee, faculty, and
programmatic levels. There are tools that are amenable to pre-post self-evaluations of
interprofessional learners. Examples include the Interprofessional Education Collaborative
Competency Survey and the Readiness for Interprofessional Learning Scale (NCIEP). Feedback
from faculty regarding their experience can be collected. In addition, faculty ratings of learners’
TEACH 31
demonstration of the learning objectives are a critical part of the feedback loop. Impact of the
TEACH clinical experiences or curriculum to promote transdisciplinary education can also be
collected to determine the need for modifications in content or delivery.
Two models commonly applied to transdisciplinary learning experiences are the
model developed by Kirkpatrick (1994) and another by Leicester (2008). The Kirkpatrick
model provides a framework to address trainee, patient and organization impact, while the
Leicester Model emphasizes experiential learning in the patient context (including the
community as the ‘patient’). Such frameworks guide decisions about assessments that are tied to
expected levels of performance. For example, deciding if demonstration of knowledge is the
expected outcome or demonstration of skills. An additional resource on conceptual models for
measurement is found in the IOM report, “Measuring the impact of interprofessional education
on collaborative practice and patient outcomes” (IOM, 2015). Specifically, the report includes a
framework for evaluating interprofessional education experiences that looks at the learning
continuum from education to practice; a variety of outcomes including learning, systems and
health; and factors that either enable or inhibit outcomes.
Stakeholder Engagement Plan
Internal Stakeholder Perspectives. UCSD Outpatient Psychiatric Services is part of a
larger system and must answer to not only the Department of Psychiatry, but also the hospital
system, medical school, and health sciences. All of these have resources that will be
instrumental for implementation.
At this time, we have the approval of key internal stakeholders, but that could change if
we seek additional funding or are unsustainable based off of fee for service models.
TEACH 32
External Stakeholder Perspectives . To build, enhance, and maintain treatment
infrastructure and capacity, UCSD capitalizes on extensive collaborative relationships with other
academic institutions, state and federal government agencies, substance abuse and mental health
treatment providers (local, statewide, nationwide and international), and consumer advocates.
UCSD has long-standing and productive relationships with the addiction treatment field,
local authorities, community recovery advocates, and state departments of government. In
collaboration with the California Department of Alcohol and Drug Programs, the Superior Court
of California, and the California Association of Drug Court Professionals, UCSD Psychiatry
Department provides training, education, and technical assistance to every county in the state
toward the successful implementation of the Substance Abuse and Crime Prevention Act of 2000,
including: how to work collaboratively, motivational interviewing, dual diagnosis, relapse
prevention, medication issues in substance abuse treatment, pharmacotherapy for addictive
disorders (CCARTA, 2017). Extensive statewide needs assessments have been conducted
through over 40 focus groups, training efforts have been built upon these needs, and evaluation
of the project confirmed a significant positive system impact (Urada et al., 2007).
Clients as stakeholders may be opposed to seeing multiple providers at the same time,
which may be due to discomfort or prior traumas. Initial results have not indicated this, and in fact
have provided us with increased satisfactions scores compared to treatment as usual approach.
Another issue may be that this program also requires approval from the affiliated training
schools including the University of Southern California, San Diego State University, the
University of San Diego, San Marcos State University, and the UCSD Psychology Training
Program. It is often a challenge to align individual school training requirements and class
TEACH 33
schedules to accommodate clinic and client needs, in particular with this program due to the team-
based model.
Communication Strategies and Products
TEACH's campaign or communication goal is to recruit new trainees to the program,
gain more donations so that the program may grow, and keep it successful and thriving. TEACH
also hopes to attract other residency training programs in an effort to replicate. Through our
research we found that in the past, most of the entities that sustain partnerships with TEACH
were the UCSD health system, as well as state grants in conjunction with the County of San
Diego. We centered our communications plan around the mantras “Educating Your Future
Employees” and “Building a Community of Practice”. These slogans were developed in order to
create positive feelings within our target publics about the organization. The way we saw it was
that the people enrolled in the TEACH program could one day end up working for the entities
that donate to their cause. Why wouldn't these stakeholders want to help their potential future
employees thrive and prosper? While the majority of our budget will go towards staffing, we
plan on holding special events such hosting numerous community workshops and opportunities
for funders to visit the organization, in addition to a social media campaign and speaking at
numerous national conferences to discuss our innovative program and initial findings. Our plan
will be evaluated through the number of media impressions, attendance at the events , as well as
an observed increase in the amount of requests for collaboration.
Effectiveness of Approach. Creating a communication plan that allows for vital and
credible information being presented to the viewer in a new way that will set it apart from others
will be key throughout the development and dissemination process (Perloff, 2017). In particular
during times where there may be opposition or challenges (Tropman, 2016).
TEACH 34
We plan on marketing this as a heath information campaign using a social marketing
approach to increase acceptability of this pro-social idea for consumers – which will be a
combination of academics and millennials (Perloff, 2017). By using social media, as well as a
social norms perspective that people like to be in sync with what other people in the field are
doing (Perloff, 2017) we believe the campaign will address the current social norms, and social
pressure or personal obligation to best standards and the desire to be part of innovation will kick
in, and individuals will want to learn more, and ultimately, replicate. We also believe that by
targeting these two audiences we will be able to cast a wide net that will hit on the current
zeitgeist of whole person care, health equity, and health homes. This will change the culture of
behavioral health training and prove to be a relatively inexpensive and effective campaign that
we can utilize without a lot of resources, as long as we are able to brand effectively.
Campaign. The logic of our campaign is simple, we believe that “Educating Your Future
Employees” and “Building a Community of Practice” will appeal to both trainees as well as
academic centers.
We plan to use students, faculty, and patients with lived experience of the model as
speakers, some of which are nationally known as industry change-makers. This eclectic group
will provide experiential accounts of this dynamic training program, and hopefully influence
others to learn more.
We believe this can be done through speaking at national conferences, diffusing
information through publishing of data, as well as op-eds and social media outlets through our
training program and within our academic community. We have already reached out to NPR and
other local talk shows, as well as others that are working on behavioral health team training
within the country.
TEACH 35
Social Media will be utilized as a way to disseminate information regarding events,
statistics, as well as podcasts and conferences that we attend, our own website and newsletters.
We are active on Twitter and engage frequently with others in the field that are working on
similar issues.
Ethical Considerations
There are numerous ethical considerations when it comes to transdisciplinary training as
well as practice. One ethical concern that has been raised is patients being opposed to seeing
multiple providers at the same time, which may be due to discomfort or prior traumas. It will be
important to roll out the concept to clients gradually and ensure that they are comfortable
working with multiple providers. To date, clients seeing treatment team vs siloed providers have
displayed far less no shows, and no re-hospitalization or emergency room visits.
Another ethical concern is that the health teams bill for services appropriately. We are in a
fee for service health setting and are unable to bill for team-based care. Due to this, we bill to
the highest complexity code when possible or keep track of time-based activities if we plan to
bill for them depending on the service (such as psychotherapy). This requires strict adherence in
order to ensure that there is never double billing happening for the same service. We have rolled
this into our quality management oversight and perform spot checks on submitted billing
monthly.
TEACH is committed to ensuring that staff, and clinicians are thinking in terms of diversity,
inclusion, and equity for themselves, patients, and community that they learn and train in.
TEACH has integrated cultural humility and ethics into seminars as well as onboarding practices.
Ethical considerations are part of the daily rounds and explored in every session. There is an
expectation that all team members are committed to mutual respect and non-hierarchical
TEACH 36
practice. Learning the values and ethics of the different disciplines as well as individual team
members is part of the curriculum, as well as a willingness to reflect upon role of self and other
team members.
Conclusions
We propose the transdisciplinary treatment training model as an innovative training
paradigm. Shown to have efficacy in other fields, team-based healthcare is useful to improve
health outcomes and wellbeing among highly traumatized individuals living with mental,
physical, and addictive health issues. The syndemic nature of these conditions requires a more
comprehensive treatment approach that is capable of addressing the complexity of multiple
diseases. In other words, just as illnesses are not separate, training providers separately will not
provide the most therapeutic effect for patients with complex conditions.
The entire program is focused on creating interest and curiosity amongst potential
stakeholders and providers and remind them of their own positive experiences within a culture of
non-hierarchical community of peers, which will assist us in creating a norm of team-based
healthcare training.
Project Implications for Practice and Further Action
Initial process and outcome scores are positive, but we will need to publish results in
hopes of replication at other residency sites for national impact. The TEACH program will lead
the charge towards reducing the health gap by engaging those with syndemic illness. By
educating the mental health practitioners of tomorrow in an integrated way, they will be able to
lead and create transdisciplinary teams nationwide.

TEACH 37

Project Limitations
Although it is financially feasible due to the current programs budget and focus on
training, this writer will need to work with the health system to move towards a more value-
based model for sustainable funding if we are able to replicate in other clinic settings.
Project Conclusions
This capstone is Mission Possible, given this writers financial and systemic support to
prototype this training program. Policy and prior research support transdisciplinary training,
however there are no current transdisciplinary integrated training programs. This writers hope is
that this will lead in a new era of transdisciplinary value in training programs

TEACH 38
References
Affordable Care Act (ACA). (n.d.). Retrieved from
https://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf
ACGME Accreditation Counsel for Graduate Medical Education. (n.d.). Retrieved from
http://www.acgme.org/Residents-and-Fellows/The-ACGME-for-Residents-and Fellows
American Academy of Social Work and Social Welfare. (n.d.). Grand Challenge Initiatives.
Retrieved from http://aaswsw.org/grand-challenges-initiative/12-challenges/close-the-
health-gap/
American Academy of Social Work and Social Welfare. (1.11.2019). Grand Challenge Mission
and Principles Draft. Retrieved from
http://grandchallengesforsocialwork.org/news/gcsw-mission-principles-draft-available-
for-feedback/
Batorowicz, B. & Shepherd, T.A. (2008). Measuring the quality of transdisciplinary teams.
Journal of Interprofessional Care, 22 (6): 612-620.
Beck, E. (2005). The UCSD Student-Run Free Health Clinic Project: Transdisciplinary
Health Professional Education. Journal of Health Care for the Poor and
Underserved, V ol16(2)207-219.
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008). The triple aim: care, health, and cost.
Health Affairs, 27(3), 759-769. doi: 10.1377/hlthaff.27.3.759.
Borrill, C., Haynes, C. (2000). Managers’ Lives. Stressed to kill. Journal of Health Service.
V ol. 10;110(5691)24-5.
TEACH 39
Brandt, B. F. (March, 2015). Interprofessional education and collaborative practice: Welcome to
the “new” forty-year old field. The advisor online. Retrieved from:
http://www.naahp.org/Publications/TheAdvisorOnline/Vol35No1/35102.aspx.
Canadian Interprofessional Health Collaborative (2010). A national interprofessional
competency framework. Retrieved from: www.cihc.ca/resources/publications.
Carter Center Mental Health Program (2011). Five prescriptions for ensuring the future of
primary care. Proceedings from the health education summit. October 5 and 6, 2010.
Retrieved from
http://www.cartercenter.org/news/pr/ReinvigoratingPrimaryCareSystem.html.
CCARTA. (2017). Retrieved from
https://healthsciences.ucsd.edu/som/psychiatry/research/Pages/CCARTA.aspx

Chan, E. A., Chi, S. P. M., Ching, S., & Lam, S. K. S. (2010). Interprofessional education:
The interface of nursing and social work. Journal of Clinical Nursing, 19(1–2), 168–176.
doi:10.1111/j.1365-2702.2009.02854.x
Davis, T. S., Guada, J., Reno, R., Peck, A., Evans, S., Sigal, L. M., & Swenson, S. (2015).
Integrated and culturally relevant care: A model to prepare social workers for primary
care behavioral health practice. Social Work in Health Care, 54(10), 909.
De Hert, M. et al. (2011). Physical Illness in patients with severe mental disorders. 1.
Prevalence, impact of medications and disparities in health care. World Psychiatry,
10(1)52-77.
Falk, A. L., Dahlberg, J., Ekstedt, M., Heslyk, A., Whiss, P., & Dahlgren, M. A. (2015). Creating
TEACH 40
spaces for interprofessional learning: Strategic revision of a common IPL curriculum in
undergraduate programs. Interprofessional education in Europe: Policy and practice, pp.
49-66.
Fong, R., Lubben, J. E., & Barth, R.P. (2018). Grand challenges for social work and society.
New York: Oxford University Press.
Health Sciences Organizational Chart. (2017). Retrieved from
http://adminrecords.ucsd.edu/ppm/docs/10-0.4.pdf
Garr, D. R., Margalit, R., Jameton, A., & Cerra, F. B. (2012). Commentary: educating the present
and future health care workforce to provide care to populations. Academic Medicine,
87(9), 1159-1160. doi: 10.1097/ACM.0b013e3182628d59.
Hughes et al. (2016). Saving Lives: A Meta- Analysis of Team Training in Healthcare.
Journal of Applied Psychology © 2016 American Psychological Association 2016, Vol.
101.
Hunt, C.M., Spence, M., McBride, A. (2016). The role of boundary spanners in delivering
collaborative care: a process evaluation. BMC Family Practice, 17:6. doi
10.1186/s12875-016-0501-4.
Hussain, M., & Seitz, D. (2014). Integrated models of care for medical inpatients with
psychiatric disorders: A systematic review. Psychosomatics, 55(4), 315.
Institute of Medicine (2015). Conceptual framework for measuring the impact of IPE.
Measuring the impact of interprofessional education on collaborative practice and
patient outcomes pp. 25-38. Washington DC: National Academies Press.

TEACH 41
Institute of Medicine (IOM). 2001. Crossing the Quality Chasm: A New Health System for the
21st Century. Washington, DC: National Academy Press.
Interprofessional Education Collaborative (2016). Core competencies for interprofessional
collaborative practice: 2016 update. Washington DC: Interprofessional Education
Collaborative.
Jones, B., & Phillips, F. (2016). Social work and interprofessional education in health care: A
call for continued leadership. Journal of Social Work Education, 52(1), 18–29.
doi:10.1080/10437797.2016.1112629
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a Brief
Depression Severity Measure. Journal of General Internal Medicine, 16(9), 606–613.
http://doi.org/10.1046/j.1525-1497.2001.016009606.x
Leinster, R.S. (2008). AMEE Guide no 34: Teaching in the clinical environment. Medical
Teacher, 30, 347-364. doi.org/10.1080/01421590802061613.
Little, V. (2010). Transdisciplinary Care: Opportunities and Challenges for Behavioral
Health Providers. Journal of Health Care for the Poor and Underserved, V ol.21(4)1103-
1107.
Mandersheid, R., Kathol, R. (2014). Fostering Sustainable, Integrated Medical and Behavioral
Health Services in Medical Settings. Annals of Internal Medicine, 160 (1); 61-65.
McDaniel, S. H., Grus, C. L., Cubic, B. A., Hunter, C. L., Kearney, L. K., Schuman, C. C., ... &
Miller, B. F. (2014). Competencies for psychology practice in primary care. American
Psychologist, 69(4), 409. doi.org/10.1037/a0036072.

TEACH 42
McDaniel, S. H., Hargrove, D. S., Belar, C. D., Schroeder, C. S., & Freeman, E. L. (2004).
Recommendations for education and training in primary care psychology. In R. Frank, S.
McDaniel, J. Bray & M. Heldring (Eds.) Primary care psychology, (pp. 63-92).
Washington, DC, US: American Psychological Association. doi.org/10.1037/10651-004
McQuistion, H.L., Finnerty, M., Hirschowitz, J. (2003). Challenges for psychiatry in serving
homeless people with psychiatric disorders. Psychiatric Services, May;54(5):669–76.
Mental Health America; The State of Mental Health in America. (2017) Retrieved from
http://www.mentalhealthamerica.net/issues/state-mental-health-america
Nandiwada, D., Dang-Vu, C. (2010). Transdisciplinary Health Care Education: Training
Team Players. Journal of Health Care for the Poor and Underserved, 21; 26-34.
Neuhauser, L., Richardson, D., Mackenzie, S., & Minkler, M. (2007). Advancing
transdisciplinary and translational research practice: Issues and models of doctoral
education in public health. Journal of Research Practice, 3(2), Article M19. Retrieved
[date of access], from http://jrp.icaap.org/index.php/jrp/article/view/103/97
Parks, J. et al. (2014). Population Management in the Community Mental Health Center-
based Health, Center for Integrated Health Solutions Home.
http://www.integration.samhsa.gov/integrated-
caremodels/14_Population_Management_v3.pdf
Peek, C.J. & the National Integration Academy Council (2013). Lexicon for behavioral health
and primary care integration: Concepts and definitions developed by expert consensus.
AHRQ Publication No.13-IP001-EF . Rockville, MD: Agency for Healthcare Research
and Quality. Available at:
http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdf.
TEACH 43
Pellechia, K., Roeschlein, A., Lewis, J., Zuniga, M. (2017). Conjoint Treatment: A
Novel Approach to Target the Syndemic Conditions of Trauma, Substance Abuse,
and HIV in Women Living with HIV. Southern Medical Journal, v 110(11): 705-
708.
Perloff, R. (2017). The dynamics of persuasion: Communication and attitudes in the twenty-first
century (6th Ed.). New York, NY: Routledge Press.
Petrides, K. V. (2009). Psychometric properties of the Trait Emotional Intelligence
Questionnaire. In C. Stough, D. H. Saklofske, and J. D. Parker, Advances in the
assessment of emotional intelligence. New York: Springer. DOI: 10.1007/978-0-387-
88370-0_5
Press Ganey “PG”. (n.d.) Retrieved from http://www.pressganey.com/solutions/patient-
experience/consumerism-transparency/about-the-press-ganey-survey
Reeves, S., Tassone, M., Parker, K., Wagner, S. J., & Simmons, B. (2012). Interprofessional
education: An overview of key developments in the past three decades. Work, 41(3), 233-
245. DOI: 10.3233/WOR-2012-1298
Roeschlein, A. (2017). Transdisciplinary Treatment and Training to Reduce Health
Inequalities. Unpublished Manuscript, University of Southern California.
Rozensky, R.H. (2012). Health care reform: preparing the psychology workforce. Journal of
clinical psychology in medical settings. 19, 5-11. doi:10.1007/s10880-011-9287-7.
Rozensky, R.H. (2014). Implications of the Affordable Care Act for Education and Training in
Professional Psychology. Training and Education in Professional Psychology, 8, 1-12.
doi: 10.1037/tep0000021.

TEACH 44
Ruddy,G. & Rhee, K.S. (2005). Transdisciplinary Teams in Primary Care for the
Underserved: A Literature Review. Journal of Health Care for the Poor and
Underserved, V olume 16, Number 2, pp. 248-256.
Schlesinger,M. (2004). Editor’s Note: On Government’s Role in the Crossing of Chasms.
Journal of Health Politics, Policy and Law. 29(1), 1-10. Duke University Press.
Schnurr, P.P., Spiro, A. III, Vielhauer, M.J., Findler, M.N., & Hamblen, J.L. (2002).
Trauma in the lives of older men: Findings from the Normative Aging
Study (PDF). Journal of Clinical Geropsychology, 8, 175-187. doi:
10.1023/A:1015992110544 PILOTS ID: 24928
Schorn, M.N., Wu, A., Davidson, H.A., Black, E., & Rockhold, R. (2014). Interprofessional
Education (IPE): Synchronous, asynchronous, clinical practice, simulation across
disciplines, across universities. Medical Science Educator 24(1) Supplement, 9-11.
Sims, D. (2011). Achieving collaborative competence through interprofessional education.
Lessons learned from joint training in learning disability nursing and social work. Social
Work Education, 30(1), 98–112. doi:10.1080/02615471003748056
Spitzer RL, Kroenke K, Williams JB, Lowe B. (2006). A brief measure for assessing
generalized anxiety disorder: the GAD-7. Arch Intern Med.; 166:1092-1097.
Steffen, A. M., Zeiss, A. M., & Karel, M. J. (2014). Interprofessional geriatric health care:
Competencies and resources for teamwork. In N. Pachana and K. Laidlaw (Eds.) The
Oxford handbook of clinical geropsychology, (pp.733-752). Oxford: Oxford University
press.
TEACH 45
The Vanderbilt Program in Interprofessional Learning. (n.d.). Retrieved from
https://medschool.vanderbilt.edu/vpil/
Tropman, J. (2017). Team Impact: Achieving Twice as Much in Half the Time. Congella.
UCSD Psychiatry Residency. (2017). Retrieved from
http://psychresidency.ucsd.edu/about/Pages/ImportantLinks.aspx
Urada, D., Gardiner, C., & Anglin, M. (2011). Stakeholder Consensus and Circumvention in
Drug Diversion Programs: Findings from California's Substance Abuse and Crime
Prevention Act (Proposition 36). Journal of Drug Issues, 41(1), 45-67.
Waltmann, E., et al. (2012). Comparative effectiveness of collaborative chronic care models
for mental health conditions across primary, specialty, and behavioral health care settings:
systematic review and meta-analysis. American Journal of Psychiatry. Aug, 169(8) 790-
804.
Western University of the Health Sciences Ambulatory Team Objective Structured Clinical
Evaluation (ATOSCE) Toolkit. Retrieved from:
https://www.westernu.edu/interprofessional/interprofessional-resources/atosce-toolkit/
https://medicine.wright.edu/medical-education/faculty-development/team-based-
learning/introduction
World Health Organization (2010). Framework for action on interprofessional education and
collaborative practice. Retrieved from:
http://apps.who.int/iris/bitstream/10665/70185/1/WHO_HRH_HPN_10.3_eng.pdf?ua=1
Willen, S., et al. (2017). Syndemic vulnerability and the right to health. The Lancet, V olume
389, Issue 10072, 964-977.
TEACH 46
YALE Consult Liaison Psychiatry Section. (n.d.). Retrieved from
https://medicine.yale.edu/psychiatry/psychosomatic/clinical/consultationservice.aspx

TEACH 47
Appendix
Logic Model

TEACH 48
Artifact: TEACH Curriculum (see attached)

Abstract (if available)

Abstract The Transdisciplinary Education Approach for Collaborative Health (TEACH) program will utilize a framework of non-hierarchical team-based curriculum to train behavioral and health providers. The framework is linked to tenets implemented in the Patient Protection and Affordable Care Act in 2010, the importance of public health metrics, and the Institute for Healthcare Improvement’s Triple Aim goals to improve the patient experience of care (including quality and satisfaction), improve the health of populations, and reduce the per capita cost of health care (IPEC, 2016

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Asset Metadata

Creator Roeschlein, Amelia L. (author)

Core Title Transdisciplinary education approach for collaborative health

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 05/27/2019

Defense Date 05/10/2019

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag buildings,collaborative,education,Mental Health,OAI-PMH Harvest,team,Training

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Karim, Nadim (committee chair), Mandershied, Ronald (committee member)

Creator Email ami.roeschlein@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-169511

Unique identifier UC11660959

Identifier etd-Roeschlein-7454.pdf (filename),usctheses-c89-169511 (legacy record id)

Legacy Identifier etd-Roeschlein-7454.pdf

Dmrecord 169511

Document Type Capstone project

Format application/pdf (imt)

Rights Roeschlein, Amelia L.

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA