HealthPOWER! Prevention News (Fall 2011)—Preventive Care Program HBCs 

Preventive Care Program Reports Successes—Already! HBCs at the Forefront of Patient-Aligned Care

In April 2011, the Society of Behavioral Medicine (SBM) hosted its 32nd Annual Meeting & Scientific Sessions, titled, Behavioral Medicine: Accelerating Our Impact on the Public's Health. The meeting featured the latest basic, interventional, and translational research in behavioral medicine and was attended by representatives from NCP.

Dr. Michael Goldstein, Associate Chief Consultant for Preventive Medicine, and Dr. Peg Dundon, National Program Manager for Health Behavior, attended the meeting as leaders of NCP's ongoing efforts to integrate prevention and health behavior change in VHA's primary care services. Also in attendance was Dr. Ken Jones, National Program Director for Weight Management/MOVE!^®, who played an early role in NCP's development of the VHA HBCs critical to this integration. Drs. Goldstein and Jones helped frame an SBM Annual Meeting panel discussion on promoting behavioral medicine at the local facility level.

The main focus of the discussion was NCP's new Preventive Care Program—an excellent example of how the SBM's multidisciplinary, biopsychosocial focus aligns with VHA's vision of evidence-based, patient-centered preventive care.

New Models of Care

In a committed effort to shift focus from disease management to Veteran-centered preventive care, VHA adopted the "New Models of Care" transformational initiative in 2010. In turn, NCP developed the Preventive Care Program, which is designed to ensure that Veterans receive

• Comprehensive health education and information
• Clinical preventive services
• Coaching and resources in health behavior change
• Support to help manage their health

A major goal of the Preventive Care Program is to inspire positive, life-long changes in Veterans' health behaviors—a traditionally formidable challenge. With new funding to help realize this goal, two new positions were established in each VA facility: an HPDP Program Manager and an HBC, which is described below.

How HBCs Fit In

"The role of VHA's 153 new HBCs is to close the behavioral medicine 'gap' that NCP identified in clinicians' traditional approach to Veterans' care," says Dundon. Typically, patients are told "what" they need to do, but are not always provided guidance on "how" to accomplish it. This is where HBCs come in. They are specialists in behavioral medicine, applying behavioral science knowledge and techniques to improve physical health and prevent illness within the primary care setting. Most of the HBCs are health psychologists; others are social workers or nurses with advanced training in the theory and practice of health behavior change.

As Dr. Dawn L. Edwards, Clinical Health Psychologist and HBC at the Syracuse VA Medical Center (VAMC) explains, "Increasingly, research shows that behavioral and emotional factors have a huge impact on physical health, and especially on how we care for ourselves. However, most medical providers do not receive training in this area, so they often don't incorporate it into their work with patients."

Making An Impact

But HBCs are. Only a year into the Preventive Care Program, they are successfully integrating behavioral medicine into a variety of clinician- and Veteran-oriented programs. Several HBCs attended the SBM meeting and shared the creative methods, novel programs, real progress, and measureable dividends that they've created in the field. In addition to Drs. Lea Lavish and Joanne Taylor, three HBCs presented examples of their success at the local level.

Restructuring for Success

At the Harry S. Truman Memorial Veterans' Hospital (Columbia, Missouri), Dr. Autumn Keefer focused her efforts on improving a high-priority, high-profile program: smoking cessation. She reworked the program by relocating it to a newly created Prevention Program in primary care and restructuring required and optional activities for participants. She did this by

• Learning key staff members' needs and issues
• Taking on new leadership roles
• Developing multi-disciplinary teams co-located in primary care
• Creating marketing materials for providers and patients

Incorporating social media, non-traditional communications, and MI techniques also has helped the smoking cessation program realize impressive initial results: the quit rate increased to 62 percent after the first 7 weeks of implementation and substantial savings in travel costs were realized at her facility.

Health Coaching

Dr. Autumn Braddock felt that health coach was a role tailor-made for a member of the primary care team. At the VA Greater Los Angeles HCS, she has begun training clinicians to coach and support patients emotionally and behaviorally. Using a patient-centered collaborative process, these clinicians help Veterans create health goals and plans based on their individual values, needs, and motivations. Ultimately, Braddock envisions HBCs playing a multi-faceted role that includes

• Provider-extender
• Champion of patient-centered strategies
• Facilitator who connects patients to education, resources, and services
• Consult-providing clinician who carries a patient caseload and delivers behavioral medicine and preventive clinical services
• Trainer of staff and new health coaches

Taking It to the Next Level

Dr. Amanda Lienau Purnell already had a strong behavioral medicine component in place at the St. Louis VAMC. But she knew that she could enhance the facility's excellent Veteran care through increasing staff support. She used the HBC position to

• Provide more intensive clinical training
• Develop a Health Promotion "Grand Rounds"
• Create scripts to encourage patients' self-management and program use
• Distribute monthly prevention messages

On-the-spot clinical assistance was provided by integrating behavioral medicine specialty providers in selected programs, providing on-site wellness clinics, and developing a cadre of peer educators. Lienau Purnell also augmented her facility's offerings, adding new patient orientation and healthy living programs, and increasing weight management and smoking cessation services.

An Excellent Investment

After little over a year, the Preventive Care Program's impact on Veteran care at the local level has been tangible and far-reaching. VHA's investment in HBCs is paying off in terms of the development of new patient-centered programs that deliver effective, evidence-based interventions that are changing Veterans' health behaviors for the better. Much success has been realized in a short period of time, but there is more to come.

During concluding remarks at the SBM meeting, Dr. Goldstein outlined the established and expanding roles that HBCs will play in three general categories: direct clinical services; staff training, coaching, and support; and developing and implementing facility-level preventive activities and programs. "HBCs will be force-multipliers and agents of cultural change in VHA's transformation at the local level," he said, "and they've already made great strides in advancing patient-centered care and Veteran health."

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