PCBH groups and music festivals couldn’t be more different
experiences, right? Well, sure, most
groups don’t suggest earplugs, don’t have food trucks and usually don’t include
intoxicated “20-somethings,” but there are a few lessons music festival
promoters have learned that are pertinent to PCBH groups. Namely, setting the date, getting useful
feedback and clear practical information for attendees.

 

The biggest limitation to setting a good lineup for a music
festival: the date. Once the date is set, 95% of bands have been
eliminated thanks to the world’s consistent refusal to revolve around me. (“But I really want to see Coldplay at Coachella!”) The task of coordinating the schedules of
multiple groups of people is too much work, better to set your date and send
out as many invites as possible. For
behavioral providers in primary care, the challenge is similar, starting a
group can be a long process and success is not guaranteed.

 

My typical strategy includes posting information about the
group to medical providers and compiling a list of as many patients as
possible. Once the date is set, I send
out letters with the expectation the date will whittle the list down
considerably. If 20-25 patients express
interest, I’m doing pretty well. The
process of securing “commitments,” scheduling and reminder calls may further
dwindle the list. Once we get to the
date of the opening visit, we may arrive to find 4-5 people waiting to begin
(one of whom needs to leave after 15 minutes).

 

Thing is, this is pretty successful.
Coordinating the schedules of more than two adults can be extremely
challenging, especially without any momentum off of which we can feed to inject
energy into the process. It’s much
easier to get someone to attend a meeting that has been taking place for months
or years; the risk it will not be what they are looking for is lower with a
known entity. Selling tickets to Bonnaroo is easy, try selling tickets to
the Maha Music Festival….

 

Any music festival worth its’ salt has a twitter handle and
at least one hashtag (@govballnyc,
@ACLfestival, #youredoinggreat,
#smile) to promote the experience via social media. Often, promoters project tweets and Instagram
posts onto screens near the stages. The
audience, those on the fence about paying for a last minute ticket, and
promoters get real time feedback on what is going well (“Gogol Bordello is melting faces in That Tent
#Bonnaroo2009”) or not so well, (“The Port-a-lets look like a war crime
#ACL2012”) and respond accordingly.
While PCBH groups may not rate high enough for a hashtag, feedback
measuring outcomes is important and can inform our practice going forward. Determinations of effects will depend upon
the type of group and the information the practice believes to be most
important.

 

For example, outcomes for a group focused upon Acceptance
and Commitment Therapy for chronic pain may include patients’ subjective
reports of their pain levels, changes in narcotic medication dosages or number of
visits to the Emergency Department for treatment of out of control pain. Providers working on a mood management group
may simply choose the PHQ-9 and/or GAD-7 to determine efficacy; this is
certainly acceptable and may yield significant and actionable results. The word actionable is used intentionally in
this context.

 

Rather than simply serving
as formative and summative evaluation of the intervention, measurement may be
used to inform changes to the process, intervention or make up of the
group. Outcome measures are easiest to
track and disseminate within the electronic health record (If you find yourself
in a setting where this is possible, practice gratitude and enjoy!
#youredoinggreat). Without such tracking
capability my strategy has been to record data via my own excel file and,
although more time consuming, this works just fine.

 

Festival goers like to know what to expect, as most humans
do, and a festival’s smartphone application can facilitate or limit the flow
and organization of the event. People
need to know where to eat, how to find the bathrooms and on which stage their
bands are playing. PCBH groups, similar
to warm hand offs and initial visits with a BHC, should be described effectively
at the outset. For some clinics, group
therapy can be an effective adjunct for patients that would normally be
considered for referral to specialty mental health but lack the insurance
coverage for a successful referral. However, the expectation of many patients, as
we often see in the PCBH setting, may be reflective of their understanding of
traditional mental health. This
misunderstanding can be corrected with clear conversations regarding the nature
and duration of treatment prior to starting.

 

Over-all, the business case for group visits is clear and
the increased efficiency in primary care makes group visits a wonderful
addition to your practice. Behavioral
providers are well trained in running groups and can take the lead with the
recruitment, planning and execution of a traditional group, shared medical
appointment (SMA) or other innovative group process to meet the specific needs
of the practice. You won’t always get Desert Trip but you can certainly have fun,
make a difference and demonstrate again the value of behavioral health
providers in primary care. #smile

Corey joined the faculty at the Maine Dartmouth FMR in 2015 after serving as the director of behavioral health at MidValley Family Practice in Basalt, CO and the Lincoln Family Medicine Residency in Lincoln, NE. He completed his doctoral training at Spalding University in Louisville, KY and internship at the Wyoming State Hospital. Corey is enthusiastic about integrated behavioral health care, primary care and education. In his spare time he practices martial arts and enjoys cycling, reading, hiking, and spending time with friends.  Corey and his wife Karen are anxiously awaiting the arrival of their first child in January of 2017.