PopHealth Week with Teri Bourdeau, Ph.D., the Vice President of Training and Development for PracticeWise LLC
Gregg Masters 00:07 This episode of PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand narrative alive both on the ground and in the virtual space for major trade shows, conferences and innovation summits via our signature pop-up studio. Connect with us at www.PopUpStudio. productions Welcome everyone. I’m Gregg Masters, Managing Director of Health Innovation Media the publisher of ACOwatch.com and your PopHealth Week co-host with my partner, co-founder Fred Goldstein, President of Accountable Health, LLC, a Jacksonville, Florida-based consulting firm. Our guest on today’s broadcast is Terry Bordeau, Ph.D., the Vice President of Training and Development for PracticeWise LLC whose mission is to advanced how evidence and information are used to improve the lives of children and families. Dr. Bourdeau serves on the PracticeWise executive management, professional development and services and product development teams. She received her BA in Psychology and her MA and PhD in clinical psychology from the University of Tulsa, she completed a psychology internship in the Department of Child and Adolescent Psychiatry at Vanderbilt University Medical School, and a pediatric and clinical psychology postdoctoral fellowship at the University of Oklahoma Health Sciences Center. Dr. Bourdeau was an associate professor of Behavioral Sciences at the Oklahoma State University Center for Health Sciences and also engaged in private practice prior to assuming her current position with PracticeWise. So Fred, over to you help us get to know Dr. Bourdeau and what she’s up to at PracticeWise.
Fred Goldstein 01:59 Thank you so much, Greg. And Teri welcome to PopHealth Week.
Teri Bourdeau 02:02 Thanks, Fred. Great to be here.
Fred Goldstein 02:04 Yeah, it’s a pleasure to have you on very excited about today’s show talk about mental health and important issue for myself and friends and others in this field. So give us a little bit of your background, Teri, and also a little bit about PracticeWise.
Teri Bourdeau 02:15 Sure. I’m clinical psychologist, so got my doctorate in Oklahoma, spent a lot of time in Oklahoma and worked primarily with youth and adolescents. Children also worked with adults, older adults. During my career. So private practice, faculty at the University have served on different boards, part of the Oklahoma Psychological Association president, their chair of the board of examiners, psychologists. So we’ve been on the Medical Advisory Committee of the Oklahoma Health Care Authority, you know, Medicaid provider for the use. So done a lot of different things, a lot of public speaking about obesity and health related issues, because my primary interest was really that interdisciplinary care, integration with primary care and worked with a lot of youth with medical conditions.
Fred Goldstein 02:59 And a little bit about PracticeWise, how you ended up there and what they do and your role.
Teri Bourdeau 03:04 Yeah, PracticeWise. So I was a student and one of the founders lab when I was an undergrad, and also as a graduate student. And he founded a company, he and his colleague, Bruce Arpita, where they recognize the importance of evidence based practice, as many do, just like medicine, we should expect evidence based practice for children, right. So they recognized that providers could not be trained in all of the evidence based practices. And so they created a way for you to get access to all of that kind of like an up to date medicine for folks that understand the medical kind of literature. And I became interested as a consultant basically, to them. And they invited me to come out to Florida, where operations are centralized. And it was a, you know, hard to offer to refuse to come out to Barrier Reef Island in Florida, because I’m getting to now work with providers all over the country, and really all over the world, we have users of their products and services all over the world.
Fred Goldstein 04:03 So this whole concept of bringing evidence based practice, whether it’s in the medical side, the mental health, behavioral side, is is critical. How do you manage to do that? Obviously, there’s a lot going on all the time, a lot of expanding evidence, how do you do that?
Teri Bourdeau 04:19 Yeah, that’s a really good question. Actually. They were really innovative, honestly, and the mental health field for children, I believe adults will get here. But they really took all of that research and all of those articles as peer-reviewed journal articles on evidence-based treatments for youth in 11, target areas for zero to 18 and coded it down to smaller parts, such that clinicians and providers could from their office from their home office and go right into the database and do a search for anxiety eight-year-old female and see which treatments have been demonstrated to be the most effective. So they coded them not just for the parts, but also what level of effectiveness, you have access to 1000s, you know, 1000’s of protocols of evidence-based practice and those common parts.
Fred Goldstein 05:12 So given that there’s obviously all these articles you have available, this is the evidence for this area that how do you make it into a system where somebody can then implement that into their practice?
Teri Bourdeau 05:24 Yeah, so you’re right, like you have the information. Now, what do I do with it? Practice wise, we have lots of different tools. So we have, we have created practice guides, such that we can teach providers how to do those common parts of those treatments like relaxation, cognitive for anxiety, cognitive, for depression, psychoeducation, any variety of those kinds of elements, right, goal setting, monitoring, self monitoring. So we’ve created practice guides, which are basically two page how to do it. And then we also train them on how to do those, we train them on how to use that database, we train them how to organize their practices based on that evidence, and also all of the things they learned in graduate school. They’re important, all the things that are very unique and tailored to a youth on how to consider diversity as a part of treatment. Where does it fit in? How do I consider adapting process and content? So we really teach them how to think about the youth that’s in their office and really use those evidence basis to treat them. And then we teach them how to do those practices. And we also teach them Fred how to track their progress, which is so important in this process is I’ve got a good plan. It’s based on good evidence, but am I tracking it to see if it’s working? Because if it’s not working, then it’s not a great plan, right? Or perhaps I’m not doing it in the way that it was intended to be done.
Fred Goldstein 06:49 So you’ve added that outcomes measurement piece to the broader system?
Teri Bourdeau 06:54 Absolutely. Yeah. And we see that is really vital and critical to the success of treatment, because I can have a really good plan. And if I don’t check in to see how it’s working. It won’t matter if I delivered it beautifully if the youth is not less anxious, and I don’t want to wait six months to assess them to see if my anxiety treatment plan is working. Right. So we providers how to do that regularly, frequently, and in a way that provides feedback as they’re engaged in treatment.
Fred Goldstein 07:24 We’ve seen on the medical side that you look at a certain condition, say diabetes, and you see a fairly substantial number of providers, not necessarily practicing according to evidence based guidelines. How does that? Or how good or bad is that in the mental health area?
Teri Bourdeau 07:41 That’s a really good question. We definitely find that in the mental health area. And that the type of treatment and how it’s implemented varies a great deal, where when we’re in areas where there have been initiatives taken to introduce evidence based practice to try to standardize to some extent, I think you see the uptake and the implementation of those evidence based practices higher than in areas where there aren’t initiatives, there aren’t policies, you know, there aren’t procedures in place to make that happen. That’s one thing I would say. And that it depends on training programs and getting this into those training programs and educating students in you know, the multiple social science disciplines, right? How to do this while they’re in school. So they come out knowing how to use evidence to guide care.
Fred Goldstein 08:32 And these providers who are out there using the system. Have you been able to document better results from that? Or have there been, studies on that?
Teri Bourdeau 08:42 Yeah. So there, there are some articles, there are some studies, we had a very large initiative out in LA County, which is perhaps the largest or one of the largest right counties in the nation, and probably serve as many youths in that county as anywhere, where in LA County, they were required to do evidence based practice for youth. And MAP was one of the practices that was or models, I should say, that was on the list of approved practices. And so there has been an article about that, in particular, as well as other articles that have demonstrated not only positive outcomes, but also provider satisfaction, which is one of the challenges, right is getting providers to be satisfied with what they’re doing. Because some providers say if they’re over scripted, if they’re over manualized, there’s no longer them in the therapy room, you know, with you. And MAP really gives them that it gives them the ability to be flexible.
Fred Goldstein 09:43 And could you explain to our audience what MAP is?
Teri Bourdeau 09:46 Oh, sure.Yeah, good question. Like a map. It’s, you know, this thing I follow to get from point A to point B in our world, that’s called Managing Adapting Practice. And it really just is all of the tools that I described about the database. There’s practice guides there’s coordination models, those resources, that clinical dashboard or that tracking tool that helps us monitor the practices we’re using to help us make those decisions.
Fred Goldstein 10:12 You talked about provider satisfaction. And one of the areas we’re seeing now is this whole impact of COVID on everybody, how is it impacting the field of mental health and in particular with children?
Teri Bourdeau 10:27 Wow, so its interesting, I’ve been watching a lot of things, I follow a lot of different news sources. And that’s one of the things I would say is it’s almost information overload, that’s part of what our model tries to help people do is detect signal from noise. So I have to do that myself when I’m out there. But the surveys really have that looked at COVID, initially, were definitely mental health rates of anxiety rate of depression went up. And that wasn’t just for youth or children. That’s also for transitional age youth, which would be like 18 to 25. I’ve even seen rates up to 36. And surprisingly, they didn’t go up quite as much for adults or older adults who might be more vulnerable. So that was a pretty interesting finding. So they went up, when I was looking at surveys that have been put out by multiple sources, recently, because of course, now we’re looking at it, how many months later, it looks like that some of those rates are starting to come back down, which actually speaks to the resilience of people, right, that we have this initial thing that changes our lives, it could seem semi traumatic, you know, economic, changed our lives, economically, social distancing, isolation, rates of abuse, for folks that are home now, where domestic violence was already high, but now you’re stuck at home with perpetrators. But what we’re seeing is some of those rates, it looks like in the surveys are coming back down, but not completely down to where it was before. And it wasn’t zero before, doubt that COVID is going, has had an effect. And it’s probably going to have a somewhat lasting effect. But I have to emphasize that there is some resilience we see, especially in children, and especially for caregivers who are managing well.
Fred Goldstein 12:09 And you we talk a lot about obviously the children that people experiencing this, but as you mentioned in the call we had beforehand, everybody’s touched by this. So
Teri Bourdeau 12:19 Absolutely
Fred Goldstein 12:19 like where do you go? How is it impacting therapists and their work?
Teri Bourdeau 12:2 Yeah, that, you know, I really appreciate that question, because I meet with providers weekly, right now on consultation calls. So I’m getting to see this from the lens of all over the country, you know, big city rural areas, and it’s avoiding no one. So I would say everybody I’m talking to is Zoomed out, tired of being online, or some of the providers especially like school-based providers, they are finding that they’re spending time doing things they don’t typically do at the start of a year. They’re having to help get kids on camera, because kids aren’t showing up to school on Zoom. So I see that as disruptive behavior, right? If they’re not showing up, or is it a caregiver issue? Or is it an accessibility issue with computers. So when you ask how it’s affecting providers, it’s changing the nature of what they do, at least in the short term, because their job description, and in some ways, their role has changed a bit with the teams.
Gregg Masters 13:27 And if you’re just tuning in, you’re listening to PopHealth Week. Our guest is Dr. Teri Bourdeau Vice President of training and development for Florida based PracticeWise, we discuss the impact of COVID-19 on the nation’s mental health with an emphasis on youth and their families.
Fred Goldstein 13:45 And how has this move? You talked about Zoom fatigue and all those kinds of issues? How has this move to I don’t necessarily have my therapy session face to face in the in the office moving into an online perspective? Have you seen any influence of that?
Teri Bourdeau 14:02 Yes, actually, you know, there’s the challenges with that, right. I mean, it’s very different to talk to you, Fred, you know, over the radio, as opposed to if we were sitting down and having a meal together or sharing a cup of coffee on so I definitely think that changes the nature of the relationship. But I will say that some of the positive is, many providers are reporting that caregivers are now more engaged in part because they’re home with these youth. So they don’t have to take time off to work to come to a session. They don’t have to try to fit it into their schedule. So while there are the challenges of getting families engaged, there are also some benefits to that. And I should know that there is the potential for disparity, though, to increase when you have the technology, you know, challenges for some families that just don’t have access to the Wi-Fi. And the computers that run smoothly.
Fred Goldstein 14:52 Yes, there’s technology gaps that we’re seeing across the spectrum in terms of COVID-19 and the pandemic and how its impact those who don’t have access to the resources, or their communities have been redlined from internet connection perspective and things like that. Obviously, that’s a major point. Is there any approaches that you would have to do? And I’m asking this as a lay person differently in terms of approaching somebody with a counseling session, telehealth wise versus face to face? Are the things you extra can learn or can’t quite figure out? Because of that type of modality?
Teri Bourdeau 15:27 For sure, I would say that there are different considerations you have to make. The evidence is pretty robust that you can do therapy quite successfully by telephone. We’ve been doing it by telephone for many years by telehealth video conferencing. So you certainly can do it successfully. There are a couple things that have to be kept in mind. Well, probably many, but engagement is probably slightly different. If you’ve never fully engaged with someone in person, and now you’re online, it’s a brand new connection. But there are a lot of folks that are digital natives, you know, they were born on computer and a lot of our kids like the screen and and are able to adapt to that quite well. Technology gaps and shifts and disconnects. And, you know, some of the technical difficulties, I would say is a slight barrier at times, because that can be pretty disengaging, you’re trying to share very openly, you know about what’s going on in your life, and then it you know, the Wi-Fi goes down right in the middle of you talking about that, and you’re trying to reconnect. Um, so certainly that can be challenging. But overall, I would say many of the practices and we’ve been doing some webinars on that, at PracticeWise, lots of folks have been wonderfully generous all over the nation and world about putting out free videos about how to do it, and how to bring telehealth whether it’s activity selection for depression, relaxation, and in some ways, honestly, to be creative. Let’s get some apps out for relaxation. How can we use those together online? Maybe more than we have in the past?
Fred Goldstein 16:54 And I would imagine to that, because everyone’s stuck in the house or in the in the apartment or wherever they might be that yes, the issue is the parents can be there as well and not have to drive them to an appointment or take off time potentially from work. But also, I would think there would might be some issues around confidentiality, and trying to find a place where you can feel comfortable and maybe away from the other people in your in your location.
Teri Bourdeau 17:16 Yeah, there’s no doubt about that. Actually, it’s a double-edged sword because you want them to have the confidentiality, you also as a therapist, I think about so many adolescents I saw who were potentially suicidal. And I certainly might be concerned about being on a session having this confidential, we’re talking about distressing things. And do I have, you know, all of the ethical considerations made you know, legalities? Do I have the parent within, you know, contact don’t have a cell phone? I know, some providers have had some concerns right, about doing some of that therapy, you know, telephonically or by video conference. But overall, there, lots of folks are doing work arounds and working that through?
Fred Goldstein 17:59 How is the interaction been I know, over time, there sort of was for a while maybe still this split between the medical side of psychiatry and, and the counseling and therapy side associated with psychology and social workers and others? How is that become integrated better, perhaps to in terms of children and treatment for them those that might require medications versus straight therapy?
Teri Bourdeau 18:22 You know, I think it depends on training programs, and perhaps people’s perceptions and perspectives. But there’s zero doubt that, um, the literature is pretty robust for, you know, cognitive behavioral therapy, interpersonal therapies, many types of psychosocial treatments and interventions that have been demonstrated to be effective. So I think the medical community doesn’t overlook that. And I think they do value, Hey, I don’t want to just prescribe you something. When I know there are these really great tools that could work maybe in absence of medicine, or in addition to it. Um, you were talking about diabetes, I’m going to go It makes me think about, you know, youth who are experienced, you know, have Type One Diabetes for an example. And absolutely, that’s health behavior, right, and regulating that, but how much do their moods and emotions impact their ability to take their insulin? You know, with their food and to manage that? Well. So I would say that the medical profession, my experience has been that folks are pretty interested, enthusiastic. Now. I think it’s a matter of getting payers to value mental health, treatment, and the importance of that as being integral to physical health.
Fred Goldstein 19:33 Yeah, it’s something that Greg and I have talked about for a while Terry’s the whole funding schemes throughout health care, etc. Obviously, in the mental health arena. It’s been underfunded for years, we get the Mental Health Parity Act in and now we can at least have a push to try and get equal funding. I think your concept is you talk about it. Ultimately, it needs to be an integrated approach. You think about that type one diabetes patients seeing their physician for their diabetes, well, a lot of the impact of their success or failure with that may have to do with some mental health issues and how you work together to help that person. Correct?
Teri Bourdeau 20:08 Yes, absolutely. And one of the things that, you know, Fred, you said is, you know, I would often have you said mental health issues, which makes me think about some of the youth that would be sent to me by their endocrinologist, you know, their diabetes doctor, and say, I’m not, there’s nothing wrong with me mentally, you know, I’m fine. I’m like, of course, you are. And at the same time, anybody would find it challenging to have not had diabetes for 12 years of your life, and then to be diagnosed with something where now every time you put a piece of food in your mouth, you have to consider Do I have to take insulin, and how much insulin and then I have to be like this master mathematician, you know, to try to calculate how many carbs are in my food, you know, how much protein how much physical activity am I going to get later. So I think that’s the other piece of it is really destigmatizing support psychological support, mental health supports, and mental-emotional well being as being just absolutely critical for physical well being, when we can get over that people will just, you know, there’ll be should be a psychologist or mental health professional, probably in every clinic,
Fred Goldstein 21:10 right. And we talked about that, from a primary care practice perspective, is integrating in psychiatrists, psychologists, and other mental health professionals into the practice to provide that full continuum of services. Because what you’re giving people are tools, and other resources that they can then use to be better able to manage their conditions, their well being their overall health. So that whole integration seems to be critical.
Teri Bourdeau 21:34 Yeah. And you made a point that I used to actually make to some of the young people I saw is I would emphasize that diabetes meant that it got health behavior on their radar early, and that, frankly, of some people would get health behavior on their radar earlier, they could establish healthier habits and have less challenge with eating things that were less healthy, but my body and my metabolism could manage that, right. So I say to them, many of you will be healthier because you have had to manage that it has not been an option. It’s been life or death for you. But you’re focused on it now and empowered. And really watching those youth come into my office, not liking this diagnosis, but learning how to manage it well and live well. And be amazing athletes and artists and students and educators has just been fantastic.
Fred Goldstein 22:22 Yeah, now you’re speaking my language if if we can get early health behaviors in place, we can push back the incidence of these chronic conditions, and hopefully, let people live healthier for a much longer period of time.
Teri Bourdeau 22:36 Yeah, an ounce of prevention is worth a pound of cure. How many times have I said, you know, all high functioning people are walking around using effective like cognitive behavioral tools? You probably don’t know the names for them.
Fred Goldstein 22:48 Where do you see this going now, in terms of the distribution of evidence-based practice, and people begin to pick it up? Obviously, there’s still room for growth in all the areas? Are you seeing more people beginning to reach out and say, How can I get help around this? I’ve been out of my Ph. D. program for 10 years. I gotta get back, you know, things change so rapidly. Are you seeing that kind of a transition in the mental health field? Or is it always been? We know, we need to keep up with this stuff?
Teri Bourdeau 23:13 Yeah. So that’s interesting. You say, we talked about this a lot. I think, yes, providers know that evidence is important. And I think when they see it being effective for their colleagues who are using those skills with other people, and they say, wow, I did exposure with a youth who had anxiety and it was like magic, you know, it just works so well. Um, clearly, you want to be a provider who’s well versed in evidence-based practice. Um, I also think it’s probably like anything, once we get out of graduate training at times, we’re like, man, I studied my whole life, I know what I need to know. So I wouldn’t say everybody’s a lifelong learner in that regard. Some people actually do feel like what they learned is working quite well. And frankly, maybe they are using evidence-based practice without going back and kind of verifying that they are. But I do think that folks, it’s on their radar. And it certainly I think the media can help us in that regard, getting the word out that it’s important. And I think when families come in asking for it, and asking, Are you trained in cognitive behavioral therapy? Are you trained in exposure for anxiety? Are you trained in interpersonal therapy? I do think providers then are very interested. I’m sure they’re giving their clients the best care
Fred Goldstein 24:34 with everything that’s going on with COVID-19 right now, and the kids out of school, or some are partially in school, the resources, what would you recommend, maybe one or two things we should be doing to ensure we maximize their opportunities to succeed over the long run?
Teri Bourdeau 24:53 You know, it’s one or two, but one comes to mind a lot. And you’ve already heard me talk about it a little bit, and I would say that’s the Behavioral Activation getting up and get moving, we’re just moving around a whole lot less. And we know inactivity can be both a cause and effect of depression. So for those who were depressed before, it’s certainly not helping for those who weren’t depressed before, you know, there’s the potential for it to cause them to be depressed just because you’re sitting around a great deal. So one thing is, you know, I can’t emphasize enough just increasing movement, getting up getting away, taking those breaks walking. And I often say it doesn’t have to be, you don’t use the term exercise. Although that would be beautiful, wonderful to get the heart rate up for 20 to 30 minutes, I’m just moving more is going to be particularly helpful. The other thing is monitoring. I think just being aware as those people being aware of our own self self monitoring, like monitoring our own mood, our own behaviors, our own activities, and what’s bringing us pleasure and what’s not and how we’re feeling and then monitoring, you know, our young, you know, our young people around us, how are they doing? And are there things that we can change in the environment, perhaps that would help them feel better and improve their mood and they’re functioning academically, socially, occupationally?
Fred Goldstein 26:16 Well, that’s fantastic. And I think the studies are beginning to bear out in terms of COVID, that outdoor activities are inherently safer than indoor, obviously, you still need to look at social distancing, and spacing. But we can get outside and walk around and do those kinds of activities, which as you point out, are so helpful, Terry, we’re coming up on October, it’s Mental Health Awareness Month. Are you doing anything special at PracticeWise,
Teri Bourdeau 26:37 Fred, we try to post as often as we can about mental health awareness. And we’ll be doing that on our Facebook and I will be writing a blog on LinkedIn, or a little post, just to talk a little bit about COVID. And the impact it’s had on youth and families. So if you go to www.practicewise.com. You can get more information about that and our other webinars there,
Fred Goldstein 27:03 Teri, I really want to thank you for coming on PopHealth week this week. You’ve been fantastic a great guests with fantastic information.
Teri Bourdeau 27:09 Thanks so much, Fred, really fun to be here. Appreciate you and all that you do.
Fred Goldstein 27:12 It’s our pleasure. And I’ll send it back to you, Greg.
Gregg Masters 27:16 And thank you, Fred. That is the last word on today’s broadcast. I want to thank our guest Dr. Teri Bourdeau, Vice President of Training and Development for PracticeWise, for her time and generous insights today during this Mental Health Awareness Month. For more information on Dr. Bourdeau or PracticeWise’s work, go to www.practicewise.com. For PopHealth Week, my colleague Fred Goldstein and Health Innovation Media. This is Greg Masters saying please stay safe everyone we are in this together and we will only get through this together; if we toe the line on social distancing, proper hygiene and by all means, do wear those masks when in public. Bye now.
SUMMARY KEYWORDS
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