CGI Experts to Present at NACIC24: A Global Discussion on Integrated Care

September 19, 2024

We are excited to announce that several members of the Cummings Graduate Institute for Behavioral Health Studies (CGI) community will be presenting at the 2024 North America Conference on Integrated Care (NACIC24). This prestigious conference, co-hosted by the International Foundation for Integrated Care (IFIC), IFIC Canada, the North America Center for Integrated Care, the International Journal of Integrated Care (IJIC), and the Health System Performance Network at the Dalla Lana School of Public Health at the University of Toronto, will take place from October 15-17, 2024, at the Westin Calgary in Canada. With the theme “Creating Health with Integrated Care,” NACIC24 will bring together global leaders, researchers, clinicians, managers, community representatives, patients, and caregivers who are committed to advancing the design and delivery of integrated health care. CGI is proud to join this important conversation, supported by premier partners Health Standards Organization (HSO) and Accreditation Canada.

Introducing the CGI community members presenting at NACIC24:

Dr. Cara English, DBH, CEO and CAO

Oral Presentation: Interprofessional Integrated Care: Addressing the Educational Determinants of Health in the Integrated Care Workforce
October 16, 2:30 PM – 4:00 PM

Description

Background:
Workforce education and training has a direct impact on health outcomes. In this workshop, participants will define educational determinants of health, discuss barriers to professional and community education, identify barriers for different populations, and review strategies that can be used to address disparities, including best practices from integrated care settings. Education and training in integrated care is understood to be a fundamental requirement for teams and systems to navigate the change from siloed care. Definitions for key terms vary from system to system, sometimes within the same country or region, leaving large gaps in the preparation of an integrated care workforce, and by extension, a lack of understanding among the population as a whole as to what integrated care is or could be. At the macro level, professional organizations, licensing boards, and training program curricula continue to operate in antiquated silos, and funding for professional development is often left up to the specific system, hospital, clinic, or individual. At the meso level, we often see practice change mandated without an understanding of the data and evidence, and infrastructure, investment, and good examples are often missing. At the micro level, patients and carers are often left out of the care process entirely while professionals cling to siloed identities and roles without a shared language for team competencies in integrated environments or an environment that fosters learning and supports change. This workshop will present key statistics and share case examples that illustrate strategies that have been used to address educational disparities including community partnerships, patient/community education programs, and advocacy. Small group discussions will be offered for workshop participants to share successful examples and best practices from their local communities, and each discussion group will be invited to share analysis and proposed recommendations and solutions that can be generalized to other communities.

Audience:
This session will be relevant for any stakeholder who is interested in advancing integrated care through education and training of both the workforce and community members.

Approach:
A combination of presentation of data and case examples and small group discussions will be used to provide information and discuss participants’ experiences with barriers and strategies to address barriers in their local settings, and to discuss the generalizability of evidence-based recommendations and strategies from case studies. Approximately half of the workshop will be used for presentation and half will be used for group discussions and reporting back to the large group to generalize learning.

Outcomes:
After group discussions, key takeaways from group discussions will be summarized in the large group, and a question/answer session will be held to provide further clarification and resources. Information and follow up opportunities will be provided in closing remarks and notes on the workshop will be captured and shared with participants. Overall outcomes desired are a greater understanding of the impact of educational determinants of health, as well as strategies that the audience can bring home to address these determinants in their local communities.

Danyelle Lincoln; MA, BCBA, LBA-NV, DBH Student

Oral Presentation: Models of Integrated Care for Specific Populations: Bertolotti’s Syndrome Unveiled: A Systematic Review of Current Research and Clinical Practices
October 16, 2024, 11:30 AM – 1:00 PM

Description

Background:
Bertolotti’s Syndrome is a congenital anomaly of the spine characterized by lumbosacral transitional vertebrae (LSTV) that is associated with lower back pain. For much of the world, back pain has been found to be the leading cause of loss of activity, work restrictions, and absenteeism. This has been associated with enormous economic burdens on a personal level, as well as for the wider economy. However, Bertolotti’s Syndrome is commonly overlooked both in terms of differential diagnosis and the treatment of back pain. Research indicates that 65-80% of people will experience back pain during their lives, and thus far, 4.6%-7% of those occurrences in adults have been associated with LSTV.

Audience:
This presentation aims to raise awareness of Bertolotti’s Syndrome among both patients and physicians.

Approach:
A literature review was conducted using a systematic search of academic databases, such as PubMed and NIH, using keywords including “Bertolotti’s Syndrome,” and “transitional vertebrae.” Inclusion criteria focused on peer-reviewed articles published within the last ten years, emphasizing clinical studies, diagnostic methods, and treatment approaches. Landmark studies were included and referenced despite falling outside of the ten-year criteria. Relevant articles were then analyzed and synthesized to provide a comprehensive overview of current understanding and management practices related to Bertolotti’s Syndrome.This presentation was originally designed for a Pathophysiology course at Cummings Institute for Behavioral Health. Elements of this presentation were gathered from collaboration and insight gained from the Facebook group “Bertolotti’s Syndrome Education Group (USA)” – a support and education group for sufferers of this condition.

Results:
Key findings indicate that Bertolotti’s Syndrome is often underdiagnosed due to its overlapping symptoms with other, more common, back pain generating conditions, as well as an erroneous perception amongst physicians that LSTV cannot cause pain. Diagnostic advancements, such as the use of MRI and CT scans, have improved accuracy in identifying LSTV, yet variability in diagnostic criteria persists. Treatment approaches range from conservative management, including physical therapy and pain relief medication, to surgical interventions such as resection of the transitional vertebra or spinal fusion. The review suggests a trend towards individualized treatment plans, however, further studies are necessary to raise awareness of this condition and to develop standardized diagnostic and treatment guidelines.

Implications:
This review highlights the pressing need for increased awareness, as well as standardized diagnostic criteria and treatment protocols. The findings underscore the importance of accurate diagnosis to differentiate Bertolotti’s Syndrome from other pain generators. The audience will gain a deeper understanding of Bertolotti’s Syndrome, including its prevalence, diagnostic challenges, treatment options, and patient frustrations. Bertolotti’s Syndrome is a significant yet often overlooked cause of lower back pain, contributing to the broader issue of back pain that affects a large portion of the population and imposes substantial economic burdens. Despite advancements in imaging techniques, Bertolotti’s Syndrome remains underdiagnosed due to symptom overlap with other conditions and misconceptions among healthcare providers regarding its potential to cause pain. There is a wide range of treatment options, from conservative management to surgical interventions, but the lack of standardized guidelines leads to variability in care. There is a need for increased awareness among healthcare providers about Bertolotti’s Syndrome and its impact. Providers and patients should be updated on recently released literature that redefines how physicians approach this condition.

Kenneth Roberts, MPS, LPCC, LADC, DBH Student

Oral Poster Presentation: Demonstrating Integrated SDoH Impact in Behavioral Health
October 16, 2024, 1:25 PM – 2:25 PM

Description

Background:
Minnesota’s (USA) largest non-profit SUD/MH treatment provider collaborated with a respected local academic institution to conduct voluntary research with patients engaged in co-occurring SUD/MH treatment services on a novel model integrating subsidized recovery housing support with clinical services.

Approach:
Collected longitudinal data during and up to 16 months post treatment to compare outcomes of patients utilizing an integrated recovery residence support resource during the treatment episode with those who did not.

Defined study aims were:

To understand the characteristics of people who choose to live in a recovery residence while receiving intensive outpatient (IOP) treatment compared to those who do not.
To understand the impact of living in a recovery residence during IOP treatment on client retention and outcomes, such as discharge status, substance use, self-care, relationship problems, material resources, life outlook, depression severity, anxiety severity, and sober days.

Results:
Results demonstrated patients utilizing recovery residence support during the treatment episode achieved statistically significant differentials in days abstinent from substance use, length of treatment engagement, successful treatment completion and reduced mental health symptomology.

Implications:
The ongoing study outcomes highlight the impact and need for innovative, integrated strategies to recognize and address the impact of social determinants of health (SDoH) as a component of effective whole-person care.

Destinee Rodriguez, ABA, DBH Student

Oral Presentation: Models of Integrated Care for Specific Populations: Closing the Gaps for Families: Assessing What Matters Most to Families
October 16, 2024, 11:30 AM – 1:00 PM

Description

Background:
Autism Spectrum Disorder (ASD) is classified as a neurological brain-based disorder impacting an individual’s ability to communicate, socialize, and manage behavioral symptoms to varying degrees. The science of behaviorism is rooted in three branches of experimental analysis of behavior, behavior analysis, and applied behavior analysis (ABA). In emerging years, ABA services have been recommended as a form of treatment for individuals with ASD. Utilizing a scientific approach to research the relationship between behavior and the environment, through the manipulation of environmental variables paired with concepts of conditioning and reinforcement, ABA is recommended to aid individuals through challenges that may negatively impact their daily life while also supporting the improvement of socially significant behaviors.MethodsIn any event ABA services are recommended, families are expected to adhere to a recommended number of treatment service hours. Historically, it is believed treatment services hours are needed to occur at an intensive rate in order to produce any significant improvements. However all too commonly, treatment service hours are recommended with little to no consideration for what types of social determinants may affect a family’s ability to adhere to a full treatment service hour recommendation. In time, the gap between recommended versus accepted treatment service hours frequently leaves families in question as to if their efforts will ever produce any significant improvements for their child and family. For this reason, clinicians are urged to assess evidence-based outcomes versus perceived outcomes to support families in closing the gap in question, developing a service outcome that is equally meaningful and significant to their child and family.

Approach:
Before clinicians continue to advocate for full treatment adherence to produce meaningful outcomes, it is recommended clinicians consider the assessment of evidence-based outcomes compared to perceived outcomes of treatment adherence, attendance and desired outcomes. The three domains of treatment adherence, attendance, and desired outcomes are the most influential factors in measuring a family’s ability to accept a full recommendation of treatment service. While evidence-based outcomes are concrete, comparing what measures are most important to the families will more largely reveal underlying social determinants within or beyond a family’s control, reflective of their ability to accept a recommended treatment service.

Results:
The assessment and diagnosis of ASD is changing, and more recent studies recommend further consideration of social determinants including the functioning of family systems, impact of stress, and family perspectives on care needs are critical in determining what a “successful intervention” may look like. To better understand family perception of the three domains while also assessing social determinants, clinicians should discuss whether data collection is reflective of families’ desired outcomes. In these consultations, clinicians may prepare to lead larger conversations of what treatment outcomes are most meaningful, desirable, and preferred for the families and their children.

Implications:
Upon receiving an ASD diagnosis, ABA services will likely be recommended to families. Commonly, families are not familiar with the time investment needed to participate in a full recommendation of services. When families do not accept a full recommendation of services, they are often left to wonder if the efforts they can realistically make will produce significant improvements for their child and family. To support families in making these difficult decisions, clinicians are encouraged to explore evidence-based outcomes compared to perceived outcomes with the family while embracing a service outcome that is meaningful, desirable, and preferred. Ultimately, supporting families in receiving a service that is most meaningful and desirable to their child and family should be a critical goal for ABA Clinicians.

To explore the full NACIC24 program, packed with a range of workshops, oral paper and oral poster sessions as well as a wide range of networking activities, click here.

With over 300 abstracts submitted and a diverse range of workshops, oral sessions, and networking activities, NACIC24 is set to be a unique opportunity to explore all aspects of integrated health and care. Bringing together 500 delegates from across North America and around the world, the conference will foster collaboration among professionals, patients, caregivers, and community members. There’s still time to register and attend NACIC24. To learn more, visit: http://www.integratedcarefoundation.org/NACIC24

Testimonials

“The totally online DBH program offered by Cummings Graduate Institute of Behavioral Health Studies is focused on the professional I have grown into: a synergistic disrupter for the healthcare industry, who is passionate about Wholistic Healthcare (e.g., health, behavioral health, and Social Determinants of Health and Mental Health), rendered skillfully through interprofessional teams. The program pillars of medical literacy, integrated behavioral health interventions, and entrepreneurship resonate loudly with me. The healthcare industry will continue to change, with doctoral level professionals needed to play a major role in any successful transformation. My goal is to further advance my knowledge-base, professional standing, and industry commitment to be part of these transformational efforts. In this way I can heed the Quadruple Aim: assuring quality-driven patient-centric care is rendered at the right time, through the right population-based treatment processes, at the right cost, and by empowered professionals embracing the work and committed to their charge.”
Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRPDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 11, 2020

“In the time that I have been a student at CGI, I have learned that integrated healthcare is no longer the exception; providers want behavioral health clinicians on their team. My courses demonstrate that the services that a DBH can offer are valuable and the opportunities abound. I’m learning that as a DBH, I can work to create a new norm in healthcare, one that promotes holistic care provided by a collaborative team delivering diverse services. I now view behavioral healthcare as a crucial piece of the medical care puzzle, rather than a separate entity. I can see the gaps in care that a DBH can fill and why including a DBH in treatment is critical. I am beginning to see how I will play a role in disrupting healthcare to provide quality treatment while advocating for my patients. Although I may still have to explain my role at times, I am learning that once I do, others will seek out my services. I am gaining confidence in what I bring to the medical team and am continuously expanding my knowledge of what else I can do.”
Jennifer KellyDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - July 26, 2020

“As a Social Worker, I believe my main mission includes advocating for and empowering patients. The DBH degree will allow me to fully integrate the “medical side of the house” with the “behavioral health side”. My experience working side-by-side with medical providers (PCM’s, ED docs, Hospitalists, etc…) has shown that most of them do not understand behavioral health issues nor how medical symptoms or diagnoses can effect a patients’ mental health and vice-versa. Alternatively, I have worked with a multitude of behavioral health providers who have very limited knowledge of how medical issues might affect their clients. I have often wondered how many patients I have had who were diagnosed with depression or anxiety or other DSM-V diagnosis when in reality the origin was medical. Earning a DBH will allow me to push the envelope when it comes to consulting with medical providers and promote the inclusion of “behavioral healthcare” within “healthcare” as its ALL healthcare! As Mahatma Ghandi said “be the change you wish to see in the world”; earning a DBH will enhance my ability to “change the world” – even if it’s one medical provider or one patient at a time.”
Diane Scott, MSW, LCSWDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - August 7, 2020

“My friend and I were talking about the challenges and frustrations that we face daily in our careers with the clear divide between mental health and physical health and how we wished we had the knowledge and skills to shake up healthcare and bridge the gap. She brought up researching doctorate programs and how interested she was in the DBH. My reponse was, “What on earth is a DBH?” She laughed and said it was a newer doctorate degree in behavioral health, that focused directly on integrated care and doing exactly what we were dreaming of doing….shaking up healthcare and bridging the gap and treating the person as a whole. I had a hard time believing her. It sounded too good to be true. How was there a degree out there that fit my goals and aspirations to a T without me knowing about it? I had been looking periodically throughout my 20 year journey in behavioral health for a program that resonated with me. It was here all this time? How had I missed it? I immediately spent hours scouring the internet to find any crumb of information that I could about the Doctorate of Behavioral Health and the programs associated with it. Then I hit the jackpot. I found the Cummings Graduate Institute for Behavioral Health Studies.”
Amy McConnell, LCSWDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 18, 2020

“During my tenure as a student at CGI, I wrote a book review that was published in the International Journal of Integrated Care. One of my papers became a newsletter article, a pitch for my population health class became a poster presented at a CFHA conference, a book chapter was developed based on a paper I wrote for my independent study, and I am submitting my CP project to a journal this weekend. So, everything that you write during the program is potentially publishable! You have the advantage of having faculty read and give you feedback on it before submitting it. Take risks! The worst that can happen if you submit a paper for publication is receiving a rejection letter. Well, if you don’t send it you’re already acting as if the paper had been rejected. 😉 Plus, if you receive a rejection letter, it usually comes with feedback, so you can improve your paper and send it again!”
Dr. Liliane de Aguiar-Rocha, DBH, BCBADBH Alumni, Cummings Graduate Institute for Behavioral Health Studies - October 9, 2020

“There is a substantial need for integrating care between our physical, and mental health. The gap between these domains are more so overlooked among those with developmental delays and intellectual disabilities – the very population I serve as a Behavior Analyst. Filling these gaps entails work that demands for a DBH who is competent, empathetic, and altruistic.”
Pauline Pablo, BCBADBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - November 11, 2020

“My interest in a DBH degree grew out of frustration and hope. On one hand, I grew frustrated with the quality of care my clients with intellectual and developmental disabilities were receiving. As members of a marginalized population who lack the skills to advocate for themselves, the clients I serve receive subpar medical care, mental health care, and behavioral health care. Many healthcare providers are not trained to address the unique language and cognitive challenges present when serving a person with Autism and I/DD.

On the other hand, as I learned more about the DBH program, a potential solution came into view. I believe this program will allow me to acquire the knowledge and skills to become a better advocate for my clients, and new job opportunities will open up in positions in which I will be able to make a bigger impact on a system level, thus improving quality of life for many clients. A DBH degree will command interest and respect from other healthcare professionals who are evaluating their practices and noticing areas in which they are not being effective, namely the behavioral health side of the equation. As we are learning in our first classes about the Biodyne Model, the Integrated Care Model is not widely accepted or known in the healthcare field, despite its proven track record. I believe a DBH degree provides the necessary tool to change the landscape of healthcare provision by arming my passion for this topic with knowledge and concrete strategies.”
Valeria ParejoDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - January 15, 2021

“As a Doctorate of Behavioral Health (DBH) student my vision for healthcare is to disrupt the current model, close gaps to care and create healthcare improvements. In the evolving world of healthcare I believe behavioral healthcare providers (BCP) are essential to the development of integrative healthcare. Once I obtain a DBH degree, I know I will gain a leadership role and be able to add quality to the creation of integration efforts worldwide. I know I will graduate with the essential tools I need to stand at the forefront of integrated healthcare. I want to create healthcare improvements for marginalized populations that are typically underserved or forgotten. As an individual of two minority groups; woman and African American, I am very passionate about helping reduce cultural, ethnic, social economic and geographic disparities within healthcare systems.”
Ebony WatsonDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 30, 2021

“Since beginning my studies at CGI, I have been awakened to how much I truly did not know and understand despite my specialty training in Social Work and behavioral health needs. The classes at CGI allow me to explore topics that I may not have thought to investigate and encourage me to question and think outside the “normal” delivery of behavioral health services. Services that I previously thought were quality and designed to meet the needs of special populations, I now believe to be woefully inadequate to serve the needs of the patients. Patients cannot receive the best quality, efficient, and timely care they need and deserve within institutions that are not integrated. Institutions that continue to silo and do not encourage collaboration and integration are not focused on the needs of the patient.”
Amanda BarnardDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 30, 2021

“I believe, as a DBH, I will disrupt the current healthcare systemby promotingguaranteed health care for allasa right, not a privilege.I willadvocate fora national, rather than state, licensing of providers. This will allow clinicians (medical,behavioral health, etc…) to provide care across state lines using telemedicine.Finally, the skills I have learned at Cummings Graduate Institute for Behavioral Health Studies allow me to identify healthcare delivery concerns, propose alternative interventions and cost–effective solutions and evaluate theirreturn on investment.”
Diane ScottDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - March 29, 2021

“Since entering CGI, I have more confidence in discussing the need for healthcare systems to have a population health approach to care, and to put in place “upstream” programming. I have always been proud of working in a hospital and delivering care, working as a multidisciplinary team member, and making a difference. I now realize I have been part of healthcare’s focus of “treating the sick” rather than being an influencer for preventative care.

Preventative care can be part of service delivery from a hospital system; we should not rely only on public health programs to tackle social determinants of health. COVID-19 is not only impacting mental health but also how we are delivering medical care. Could COVID-19 be an unintended force for healthcare policy change? Apostolopoulos et al. (2020) reports the complexity presented to the health care system by COVID-19 has created change that will continue in healthcare for years to come. The needed changes to delivery and access will require a policy shift in all levels of healthcare (Apostolopoulos et al., 2020).”
Billie RatliffDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - December 13, 2021

“The DBH is exactly the type of doctorate degree that I’ve been searching for. A doctorate that is clinical focused is where my interest lies. I am motivated to pursue this degree, and courses like Pathophysiology, Psychopharmacology, Neuropathophysiology, only add to that excitement. One must be motivated to complete any degree program. The Doctor of Behavioral Health fits that bill for me. In fact, I would say that I am beyond motivated.”
Arthur Williams IIIDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - July 8, 2022

“As a member of the AAPI community, I’m very familiar with the barriers to mental health services and the need to break through the glass wall of cultural stigma that prevents many from receiving potentially life–saving treatment. I was the only Asian American person in my master’s cohort, the only Asian American person in many of my clinical work settings, the only Asian American person to walk into many of the professional settings that I pushed myself to show up to. In my current practice, I’m constantly reminded by my patients of how difficult it is to find an Asian American mental health provider, though this reminder constantly informs me that more needs to be done for my community. Day after day, I read stories of Asian American people who die by suicide as a consequence of our culture’s avoidance of mental health topics. As a DBH, my biggest goal is to use my expertise in whole–person care to amplify the conversation around mental health and help my community understand that mental healthcare is not a privilege that we are not entitled to, it is a crucial part of our healthcare that will manifest differently in us than what many Western psychology or psychiatry textbooks will describe, and that our unique experience of mental health issues are valid, important, and is time to be part of the larger conversation.”
Willam ChumDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 16, 2022

“Pursuing a doctorate in behavioral health is essential in helping to transform my thinking as a healthcare provider; moving from a more traditional mindset, embracing change and a “different world view” of tools for successful client outcomes. This type of advanced study will equip me with the clinical and leadership skills to be a leader on the cutting edge of behavioral health. This type of training would make me an asset to the healthcare workplace; specifically to function effectively as a change agent for the successful outcomes of the workplace and its clients.”
Judith AllenDBH Candidate, Cummings Graduate Institute for Behavioral Health Studies - September 23, 2022 Previous Slide