<?xml version="1.1" encoding="utf-8"?>
<article xsi:noNamespaceSchemaLocation="http://jats.nlm.nih.gov/publishing/1.1/xsd/JATS-journalpublishing1-mathml3.xsd" dtd-version="1.1" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"><front><journal-meta><journal-id journal-id-type="publisher-id">HPR</journal-id><journal-title-group><journal-title>Health Psychology Research</journal-title></journal-title-group><issn>TBA</issn><eissn>2420-8124</eissn><publisher><publisher-name>Health Psychology Research</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4081/hpr.2018.7393</article-id><article-categories><subj-group subj-group-type="heading"><subject>General</subject></subj-group></article-categories><title>The role of the psychologist in the veterans administration’s patient  aligned care team and huddle: A review, practical recommendations,  and a call to action</title><url>https://healthpr.org/journal/HPR/6/1/10.4081/hpr.2018.7393</url><author>VelezmoroRodrigo</author><pub-date pub-type="publication-year"><year>2018</year></pub-date><volume>6</volume><issue>1</issue><history><date date-type="pub"><published-time>2018-07-31</published-time></date></history><abstract>The Veterans Administration (VA)&amp;rsquo;s Patient Aligned Care Team (PACT) model has been a cornerstone of primary care in the VA healthcare system and has indicated the need for an organiza tional cultural shift towards interdisciplinary care. Most of the focus in PACT has been on the traditional providers of the medical model, with little attention focused on the role of the psychologist. This paper examines how psychologists can assist in the PACT model and, in particular, within the team VA huddle. Literature on the PACT model, mental health in PACT, and the advantages of the huddle are reviewed. Lessons learned within a large VA clinic are also discussed. Psychologists&amp;rsquo; ability to be a clinician, team builder, and system specialist is discussed and how it benefits the PACT and the huddling process. Practical recommendations are made for how to best assist during the huddle, and how to advo cate for both the huddle, and for a broader cultural shift in care.</abstract><keywords>Huddle, Interdisciplinary, Veterans Administration, Teams</keywords></article-meta></front><body/><back><ref-list><ref id="B1" content-type="article"><label>1</label><element-citation publication-type="journal"><p>1. Agha, Z., Lofgren, R. P., VanRuiswyk, J. V., &amp;amp; Layde, P. M. (2000). Are patients at Veterans Affairs medical centers sicker?: A comparative analysis of health status and medical resource use. Archives of Internal Medicine, 160(21), 3252-3257. doi: 10.1001/archinte.160.21.32522. Ashrafioun, L., Pigeon, W. R., Conner, K. R., Leong, S. H., &amp;amp; Oslin, D. W. (2016). Prevalence and correlates of suicidal ideation and suicide attempts among veterans in primary care referred for a mental health evaluation. Journal of Affective Disorders, 189, 344-350. doi: 10.1016/j.jad.2015.09.0143. Awa, W. L., Plaumann, M., &amp;amp; Walter, U. (2010). Burnout prevention: A review of intervention programs. Patient Education and Counseling, 78(2), 184-190. doi: 10.1016/j.pec.2009.04.0084. Basham, C., Denneson, L. M., Millet, L., Shen, X., Duckart, J., &amp;amp; Dobscha, S. K. (2011). Characteristics and VA health care utilization of US Veterans who completed suicide in Oregon between 2000 and 2005. Suicide and Life-Threatening Behavior, 41(3), 287-296. doi: 10.1111/j.1943-278X.2011.00028.x5. Beacham, A. O., Van Sickle, K. S., Khatri, P., Ali, M. K., Reimer, D., Farber, E. W., &amp;amp; Kaslow, N. J. (2017). Meeting evolving workforce needs: Preparing psychologists for leadership in the patient-centered medical home. The American Psychologist, 72, 1, 42-54. doi: 10.1037/a00404586. Beehler, G.P., Funderburk, J.S., King, P.R., Johnson, E.M., Lilienthal., K., Maisto, S.A., &amp;hellip; Wray, L.O. (2015). The Role and Functions of Embedded Behavioral Health Providers in VA Primary Care-Mental Health Integration: Current Evidence and Future Directions for Research [White Paper]. Available from: https://www.mirecc.va.gov/cih-visn2/Documents/Research/White%20Paper%20.pdf. Accessed: April 7, 2017.&amp;nbsp;7. Blow, F. C., Bohnert, A. S., Ilgen, M. A., Ignacio, R., McCarthy, J. F., Valenstein, M. M., &amp;amp; Knox, K. L. (2012). Suicide mortality among patients treated by the Veterans Health Administration from 2000 to 2007. American Journal of Public Health, 102(S1), S98-S104. doi: 10.2105/AJPH.2011.3004418. Bodenheimer, T. (2006). Primary care &amp;ndash; will it survive? New England Journal of Medicine, 355(9), 861-864. doi: 10.1056/NEJMp0681559. Bodenheimer, T., Chen, E., &amp;amp; Bennett, H. D. (2009). Confronting the growing burden of chronic disease: can the US health care workforce do the job? Health Affairs, 28(1), 64-74. doi: 10.1377/hlthaff.28.1.6410. Bohnert, K. M., Pfeiffer, P. N., Szymanski, B. R., &amp;amp; McCarthy, J. F. (2013). Continuation of care following an initial primary care visit with a mental health diagnosis: differences by receipt of VHA Primary Care&amp;ndash;Mental Health Integration services. General Hospital Psychiatry, 35(1), 66-70. doi: 10.1016/j.genhosppsych.2012.09.00211. Bohnert, K. M., Sripada, R. K., Mach, J., &amp;amp; McCarthy, J. F. (2016). Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patients With Positive PTSD Screens. Psychiatric Services, 67(1), 94-100. doi: 10.1176/appi.ps.20150003512. Brady, P. W., Muething, S., Kotagal, U., Ashby, M., Gallagher, R., Hall, D., ... &amp;amp; Geiser, M. (2013). Improving situation awareness to reduce unrecognized clinical deterioration and serious safety events. Pediatrics, 131(1), e298-e308. doi: 10.1542/peds.2012-136413. Brawer, P. A., Brugh, A. M., Martielli, R. P., O&amp;rsquo;Connor, S. P., Mastnak, J., Scherrer, J. F., &amp;amp; Day, T. E. (2011). Enhancing entrance into PTSD treatment for post-deployment veterans through collaborative/integrative care. Translational Behavioral Medicine, 1(4), 609-614. doi: 10.1007/s13142-011-0097-014. Carter, B. L., Ardery, G., Dawson, J. D., James, P. A., Bergus, G. R., Doucette, W. R., ... &amp;amp; Xu, Y. (2009). Physician and pharmacist collaboration to improve blood pressure control. Archives of Internal Medicine, 169(21), 1996-2002. doi: 10.1001/archinternmed.2009.35815. Cooper, R. L., &amp;amp; Meara, M. E. (2002). The organizational huddle process &amp;ndash; optimum results through collaboration. The Health Care Manager, 21(2), 12-16. doi: 10.1097/HMR.000000000000000916. Croghan, T. W., &amp;amp; Brown, J. D. (2010). Integrating mental health treatment into the patient centered-medical home (AHRQ Publication No. 10&amp;ndash;0084-EF). Rockville, MD: Agency for Healthcare Research and Quality.17. Dutka, P. (2016). The Huddle: It&amp;rsquo;s not just for football anymore. Nephrology Nursing Journal, 43(2), 161.18. Farber, E. W., Ali, M. K., Van Sickle, K. S., &amp;amp; Kaslow, N. J. (2017). Psychology in patient-centered medical homes: Reducing health disparities and promoting health equity. American Psychologist, 72(1), 28-41. doi: 10.1037/a004035819. Fisher, L., &amp;amp; Dickinson, W. P. (2014). Psychology and primary care: New collaborations for providing effective care for adults with chronic health conditions. American Psychologist, 69, 4, 355-363. doi: 10.1037/a003610120. Fogarty, C. T., &amp;amp; Schultz, S. (2010). Team huddles: the role of the primary care educator. The Clinical Teacher, 7(3), 157-160. doi: 10.1111/j.1743-498X.2010.00369.x21. Feldman, M. D., Franks, P., Duberstein, P. R., Vannoy, S., Epstein, R., &amp;amp;Kravitz, R. L. (2007). Let&amp;rsquo;s not talk about it: suicide inquiry in primary care. The Annals of Family Medicine, 5(5), 412-418. doi: 10.1370/afm.71922. Funderburk, J. S., Dobmeyer, A. C., Hunter, C. L., Walsh, C. O., &amp;amp; Maisto, S. A. (2013). Provider practices in the primary care behavioral health (PCBH) model: An initial examination in the Veterans Health Administration and United States Air Force. Families, Systems, &amp;amp; Health, 31(4), 341-353. doi: 10.1037/a003277023. Galvin, J.E., Valois, L., &amp;amp; Zweig, Y. (2014). Collaborative trans-disciplinary team approach for dementia care. Neurodegenerative Disease Management, 4(6), 455-469. doi: 10.2217/nmt.14.4724. Ghorob, A., &amp;amp; Bodenheimer, T. (2015). Building teams in primary care: A practical guide. Families, Systems, &amp;amp; Health, 33(3), 182-192. doi: 10.1037/fsh000012025. Ginzburg, K., Ein-Dor, T., &amp;amp; Solomon, Z. (2010). Comorbidity of posttraumatic stress disorder, anxiety and depression: a 20-year longitudinal study of war veterans. Journal of Affective Disorders, 123(1), 249-257. doi: 10.1016/j.jad.2009.08.00626. Gilman, S. C., Chokshi, D. A., Bowen, J. L., Rugen, K. W., &amp;amp; Cox, M. (2014). Connecting the dots: Interprofessional health education and delivery system redesign at the Veterans Health Administration. Academic Medicine, 89(8), 1113-1116. doi: 10.1097/ACM.000000000000031227. Goodrich, D. E., Kilbourne, A. M., Nord, K. M., &amp;amp; Bauer, M. S. (2013). Mental health collaborative care and its role in primary care settings. Current Psychiatry Reports, 15(8), 1-12. doi: 10.1007/s11920-013-0383-228. Grace, S. M., Rich, J., Chin, W., &amp;amp; Rodriguez, H. P. (2016). Implementing interdisciplinary teams does not necessarily improve primary care practice climate. American Journal of Medical Quality, 31(1), 5-11. doi: 10.1177/106286061455033329. Graham, R. D., Rudd, M. D., &amp;amp; Bryan, C. J. (2011). Primary care providers&amp;rsquo; views regarding assessing and treating suicidal patients. Suicide and Life-Threatening Behavior, 41(6), 614-623. doi: 10.1111/j.1943-278X.2011.00058.x30. Greene-Shortridge, T. M., Britt, T. W., &amp;amp; Castro, C. A. (2007). The stigma of mental health problems in the military. Military Medicine, 172(2), 157-161. doi: 10.1177/153476561245522731. Gulliver, A., Griffiths, K. M., &amp;amp; Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry, 10(1), 113. doi: 10.1186/1471-244X-10-11332. Gundlapalli, A. V., Redd, A., Bolton, D., Vanneman, M. E., Carter, M. E., Johnson, E., ... &amp;amp; O&amp;rsquo;toole, T. P. (2017). Patient-aligned care team engagement to connect Veterans experiencing homelessness with appropriate health care. Medical Care, 55, S104-S110. doi: 10.1097/MLR.000000000000077033. Harrod, M., Weston, L. E., Robinson, C., Tremblay, A., Greenstone, C. L., &amp;amp; Forman, J. (2016). It goes beyond good camaraderie&amp;rdquo;: A qualitative study of the process of becoming an interprofessional healthcare &amp;ldquo;teamlet.&amp;rdquo; Journal of Interprofessional Care, 30(3), 295-300. doi: 10.3109/13561820.2015.113002834. Helfrich, C. D., Sylling, P. W., Gale, R. C., Mohr, D. C., Stockdale, S. E., Joos, S., ... &amp;amp; Nelson, K. M. (2016). The facilitators and barriers associated with implementation of a patient-centered medical home in VHA. Implementation Science, 11(1), 24. doi: 10.1186/s13012-016-0386-635. Hoge, C. W., Auchterlonie, J. L., &amp;amp; Milliken, C. S. (2006). Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Jama, 295(9), 1023-1032. doi: 10.1001/jama.295.9.102336. Hunter, C. L., &amp;amp; Goodie, J. L. (2012). Behavioral health in the Department of Defense Patient-Centered Medical Home: history, finance, policy, work force development, and evaluation. Translational Behavioral Medicine, 2(3), 355-363. doi: 10.1007/s13142-012-0142-737. Hyde, P. (2008). Implementing the &amp;ldquo;Cardiac Huddle.&amp;rdquo; Critical Care Nurse, 28(2), 144-144.38. Jones, A. L., Mor, M. K., Cashy, J. P., Gordon, A. J., Haas, G. L., Schaefer, J. H., &amp;amp; Hausmann, L. R. (2016). Racial/ethnic differences in primary care experiences in patient-centered medical homes among Veterans with mental health and substance use disorders. Journal of General Internal Medicine, 31(12), 1435-1443. doi: 10.1007/s11606-016-3776-139. Kaslow, N. J., Kapoor, S., Dunn, S. E., &amp;amp; Graves, C. C. (2015). Psychologists&amp;rsquo; contributions to patient-centered medical homes. Journal of Clinical Psychology in Medical Settings, 22(4), 199-212. doi: 10.1007/s10880-015-9445-440. Kazak, A. E., Nash, J. M., Hiroto, K., &amp;amp; Kaslow, N. J. (2017). Psychologists in patient-centered medical homes (PCMHs): Roles, evidence, opportunities, and challenges. American Psychologist, 72, 1, 1-12. doi: 10.1037/a004038241. Kazdin, A. E., &amp;amp; Blase, S. L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6(1), 21-37. doi: 10.1177/174569161039352742. Kearney, L. K., Post, E. P., Pomerantz, A. S., &amp;amp; Zeiss, A. M. (2014). Applying the interprofessional patient aligned care team in the Department of Veterans Affairs: Transforming primary care. American Psychologist, 69(4), 399-408. doi: 10.1037/a003590943. Kim, L. Y., Rose, D. E., Soban, L. M., Stockdale, S. E., Meredith, L. S., Edwards, S. T., ... &amp;amp; Rubenstein, L. V. (2017). Primary care tasks associated with provider burnout: findings from a veterans health administration survey. Journal of General Internal Medicine, 1-7. doi: 10.1007/s11606-017-4188-644. Klein, S. (2011) The veteran&amp;rsquo;s health administration: implementing patient-centered medical homes in the nation&amp;rsquo;s largest integrated delivery system. The Commonwealth Fund, 1537(16), 1-23. doi: 10.1007/s11606-014-2773-5f45. Ladebue, A. C., Helfrich, C. D., Gerdes, Z. T., Fihn, S. D., Nelson, K. M., &amp;amp; Sayre, G. G. (2015). The experience of Patient Aligned Care Team (PACT) members. Health Care Management Review, 41(1), 2-10. doi: 10.1097/HMR.000000000000004846. Lancaster, G., Kolakowsky-Hayner, S., Kovacich, J., &amp;amp; Greer-Williams, N. (2015). Interdisciplinary communication and collaboration among physicians, nurses, and unlicensed assistive personnel. Journal of Nursing Scholarship, 47(3), 275-284. doi: 10.1111/jnu.1213047. Langerock, H. (1915). Professionalism: A study in professional deformation. American Journal of Sociology, 21(1), 30-44.48. Leonard, M., Graham, S., &amp;amp; Bonacum, D. (2004). The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(suppl 1), i85-i90. doi: 10.1136/qshc.2004.01003349. Lew, H. L., Tun, C., &amp;amp; Cifu, D. X. (2009). Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF/OEF veterans: polytrauma clinical triad. Journal of Rehabilitation Research and Development, 46(6), 697-702.50. Long, T., Dann, S., Wolff, M. L., &amp;amp; Brienza, R. S. (2014). Moving from silos to teamwork: integration of interprofessional trainees into a medical home model. Journal of Interprofessional Care, 28(5), 473-474. doi: 10.3109/13561820.2014.89157551. Mann, C. C., Golden, J. H., Cronk, N. J., Gale, J. K., Hogan, T., &amp;amp; Washington, K. T. (2016). Social Workers as Behavioral Health Consultants in the Primary Care Clinic. Health &amp;amp; Social Work, 41(3), 196-200. doi: 10.1093/hsw/hlw02752. McDowell, A. K., Lineberry, T. W., &amp;amp; Bostwick, J. M. (2011). Practical suicide-risk management for the busy primary care physician. Mayo Clinic, 86(8), 792-800. doi: 10.4065/mcp.2011.007653. Meredith, L. S., Hackbarth, N. S., Darling, J., Rodriguez, H. P., Stockdale, S. E., Cordasco, K. M., ... &amp;amp; Rubenstein, L. V. (2015). Emotional exhaustion in primary care during early implementation of the VA&amp;rsquo;s medical home transformation: Patient-aligned Care Team (PACT). Medical Care, 53(3), 253-260. doi: 10.1097/MLR.000000000000030354. Nelson, K. M., Helfrich, C., Sun, H., Hebert, P. L., Liu, C. F., Dolan, E., ... &amp;amp; Sanders, W. (2014). Implementation of the patient-centered medical home in the Veterans Health Administration: associations with patient satisfaction, quality of care, staff burnout, and hospital and emergency department use. JAMA internal medicine, 174(8), 1350-1358. doi: 10.1001/jamainternmed.2014.248855. Pape, G. A., Hunt, J. S., Butler, K. L., Siemienczuk, J., LeBlanc, B. H., Gillanders, W., ... &amp;amp; Bonin, K. (2011). Team-based care approach to cholesterol management in diabetes mellitus: two-year cluster randomized controlled trial. Archives of Internal Medicine, 171(16), 1480-1486. doi: 10.1001/archinternmed.2011.41756. Proia, K. K., Thota, A. B., Njie, G. J., Finnie, R. K., Hopkins, D. P., Mukhtar, Q., ... &amp;amp; Lackland, D. T. (2014). Team-based care and improved blood pressure control: a community guide systematic review. American Journal of Preventive Medicine, 47(1), 86-99. doi: 10.1016/j.amepre.2014.03.00457. Provost, S. M., Lanham, H. J., Leykum, L. K., McDaniel Jr, R. R., &amp;amp; Pugh, J. (2015). Health care huddles: Managing complexity to achieve high reliability. Health Care Management Review, 40(1), 2-12. doi: 10.1097/HMR.000000000000000958. Randall, I., Mohr, D. C., &amp;amp; Maynard, C. (2014). VHA Patient Centered Medical Home Associated With Lower Rate of Hospitalizations and Specialty Care Among Veterans With Posttraumatic Stress Disorder. Journal for Healthcare Quality, 39(3), 168-176. doi: 10.1111/jhq.1209259. Regier, D., Goldberg, I., &amp;amp; Taube, C. (1978). The de facto US mental health and addictive disorders service system. Archives of General Psychiatry, 35, 685-693.60. Rodriguez, H. P., Chen, X., Martinez, A. E., &amp;amp; Friedberg, M. W. (2016). Availability of primary care team members can improve teamwork and readiness for change. Health Care Management Review, 41(4), 286-295. doi: 10.1097/HMR.000000000000008261. Rodriguez, H. P., Meredith, L. S., Hamilton, A. B., Yano, E. M., &amp;amp; Rubenstein, L. V. (2015). Huddle up!: the adoption and use of structured team communication for VA medical home implementation. Health Care Management Review, 40(4), 286-299. doi: 10.1097/HMR.000000000000003662. Rosland, A. M., Nelson, K., Sun, H., Dolan, E. D., Maynard, C., Bryson, C., ... &amp;amp; Schectman, G. (2013). The patient-centered medical home in the Veterans Health Administration. The American Journal of Managed Care, 19(7), e263-72.63. Ryan, A. M., &amp;amp; Ployhart, R. E. (2003). Customer service behavior. In W.C. Borman, D.R., Ilgen, R.J. Klimoski (eds). Handbook of psychology: Industrial and organizational psychology, Vol. 12. (377-400). Hoboken, NJ, US: John Wiley &amp;amp; Sons, Inc.64. Setaro, J., &amp;amp; Connolly, M. (2011). Safety huddles in the PACU: when a patient self-medicates. Journal of PeriAnesthesia Nursing, 26(2), 96-102. doi: 10.1097/HMR.000000000000000965. Shunk, R., Dulay, M., Chou, C. L., Janson, S., &amp;amp; O&amp;rsquo;Brien, B. C. (2014). Huddle-coaching: a dynamic intervention for trainees and staff to support team-based care. Academic Medicine, 89(2), 244-250. doi: 10.1097/ACM.000000000000010466. Simonetti, J. A., Sylling, P. W., Nelson, K., Taylor, L., Mohr, D. C., Curtis, I., ... &amp;amp; Helfrich, C. D. (2017). Patient-Centered Medical Home Implementation and Burnout among VA Primary Care Employees. The Journal of ambulatory care management, 40(2), 158-166. doi: 10.1097/JAC.000000000000016067. Sloan, D. M., Marx, B. P., &amp;amp; Keane, T. M. (2011). Reducing the burden of mental illness in military veterans: Commentary on Kazdin and Blase (2011). Perspectives on Psychological Science, 6(5), 503-506. doi: 10.1177/174569161141699568. Solimeo, S. L., Ono, S. S., Lampman, M. A., Paez, M. B., &amp;amp; Stewart, G. L. (2015). The empowerment paradox as a central challenge to patient centered medical home implementation in the veteran&amp;rsquo;s health administration. Journal of Interprofessional Care, 29(1), 26-33. doi: 10.3109/13561820.2014.93748069. Stewart, E. E., &amp;amp; Johnson, B. C. (2007). Huddles: Improve office efficiency in mere minutes. Family Practice Management, 14(6), 27-29.70. The Joint Commission. (2012). In improving patient and worker safety: opportunities for synergy collaboration and innovation. Available from http://www.jointcommission.org/71. Torrence, N. D., Mueller, A. E., Ilem, A. A., Renn, B. N., DeSantis, B., &amp;amp; Segal, D. L. (2014). Medical provider attitudes about behavioral health consultants in integrated primary care: A preliminary study. Families, Systems, &amp;amp; Health, 32(4), 426-432. doi: 10.1037/fsh000007872. Tuepker, A., Newell, S., Nicolaidis, C., Reyes, M. E., Gonz&amp;aacute;lez-Prats, M. C., Skaperdas, E., &amp;amp; Kansagara, D. (2017). Veteran patient perspectives and experiences during implementation of a Patient-Centered Medical Home Model. Journal of Patient Experience. doi: 10.1177/237437351773160273. Un&amp;uuml;tzer, J., Schoenbaum, M., Druss, B. G., &amp;amp; Katon, W. J. (2006). Transforming mental health care at the interface with general medicine: report for the presidents commission. Psychiatric Services, 57(1), 37-47. doi: 10.1176/appi.ps.57.1.3774. Veterans Health Administration. (2008). Uniform mental health services in VA medical centers and clinics (VHA Handbook 1600.01). Washington, DC: Department of Veterans Affairs.75. VA Celebrates 70 Years of Partnering with Medical Schools (2016). Available from https://www.va.gov/opa/pressrel/press-release.cfm?id=2747</p><pub-id pub-id-type="doi"/></element-citation></ref></ref-list></back></article>
