During 2024, Northwestern Medicine added more than 50 primary care clinics to its established Collaborative Behavioral Health Program (CBHP), embedding psychiatric care within primary care.

Clinics using a collaborative care model have reported improved treatment outcomes for psychiatric conditions such as depression and medical comorbidities, including hypertension and diabetes. Despite its promise, model uptake remains limited across health care systems. Early feedback suggests this is partly due to screening and referral burden on primary care providers.

This poster team have been examining variability in implementation to find common barriers, and facilitators, to screening and referral to collaborative care within primary care aimed at improving pathways to psychiatric treatment. “Knowledge of the barriers and facilitators to psychiatric screening and referral in primary care will support development of new strategies to increase primary care engagement in CoCM and support scaling the model,” they say. “Findings from this study will aid other health systems seeking to implement CoCM.”

Dr. Lauzon: The Collaborative Care Model (CoCM) has a robust, well-established evidence base as an effective model of psychiatric care delivery in primary care settings. However, even in health care systems in which collaborative care implementation is supported by leadership, one common implementation challenge is variable uptake and buy-in among different primary care providers (PCPs). The authors of this study have capitalized on variability of implementation across a large regional health system to learn more about real-world barriers and facilitators of CoCM adoption, through qualitative interviews with PCPs who are high utilizers versus low utilizers of collaborative care services. Understanding provider- and clinic-level factors that influence adoption of the model can help the collaborative care psychiatrist (and other CoCM team members) to more effectively partner with their primary care colleagues.

 

Glucagon-like peptide-1 (GLP-1) receptor agonists are widely used for type 2 diabetes and obesity due to their efficacy in glycemic control and weight reduction. However, concerns about potential neuropsychiatric effects have arisen, as GLP-1 receptors are found in brain regions linked to mood regulation.

 

Hospital workplace violence has negative impacts including lower patient safety, severe injury including death, burnout, and increased turnover. The Brøset Violence Checklist (BVC) and Behavioral Emergency Response Team (BERT) have been shown to improve outcomes for staff and patients. This poster team propose a violence-prevention model based on the integration of these interventions, creating both a proactive and reactive psychiatry consultation, and an interdisciplinary approach to hospital safety.

At Tufts Medical Center, a pilot was conducted using the BVC to assess risk of violence from patients. The study showed restraint use decreased 17.6% from baseline mean and calls to public safety decreased 60% from baseline mean. Qualitative results suggested nurses felt safer and better equipped to care for agitated patients. The BVC has since been implemented across the medical center.

A secondary needs assessment was completed to identify patients not captured within the BVC. The proposed intervention was behavioral codes responded to by the BERT which includes the primary team, C- L Psychiatry, public safety, and nursing leadership. It also triggers a C-L Psychiatry consult for continued evaluation. “We will describe the integration of these interventions and how the proactive and reactive consult model creates an environment of safety,” say the team.

 

The poster team present six foreign body ingestion (FBI) cases that motivated the creation of a new interdisciplinary hospital-wide protocol to improve patient safety and collaboration. The protocol highlights the role of the C-L psychiatrist.

Key elements include removal of loose objects from the patient room; presence of a care companion and public safety at arm’s length from the patient; elopement precautions; finger-food only diet; chart flagging for automatic notification on presentation to the hospital; and psychiatric education of involved teams.

“Caring for patients with FBI is demanding and stressful work for clinicians and staff,” say the team. “We developed a comprehensive protocol for managing patients with FBI that can be adapted by other hospitals to enhance safety and collaboration.”

 

Studies show that patients with opioid use disorder (OUD) are at elevated risk of discharge against medical advice (AMA), which in turn increases risk for poor clinical outcomes. This poster team hypothesizes that various factors, including delays in identifying OUD and management of opioid withdrawal, contribute to AMA discharge in OUD patients.

“Our findings reinforce the importance of identification of OUD and comorbid substance use disorders in hospital settings, prompt confirmation of methadone doses for patients enrolled in methadone programs, and management of opioid withdrawal,” say the team. “It additionally highlights potential gaps in education and confidence in managing OUD in non-psychiatric providers as C-L Psychiatry consultation increased the likelihood of both opioid and non-opioid based treatment.

“Proper management of OUD in hospitalized patients, such as preventing interruption of methadone-based treatment, can reduce risk for AMA discharge.”

 

Historical exclusion of pregnant women in clinical trials has led to a persistent lack of data on the safety of psychotropic medications in pregnancy (Liu, 2016). This gap has led to an overabundance of caution, misinformation, and continued reliance on outdated or anecdotal sources. Despite robust evidence that untreated perinatal mental illness poses greater risks than appropriately managed psychotropic use, public and provider misconceptions persist, underlying potential educational gaps in physicians’ training (Fawcett, 2019).

This study investigates resources that patients and physicians rely on, identifies knowledge gaps, and underscores the urgent need for improved, evidence-based perinatal mental health education and interdisciplinary collaboration.

“Despite increasing evidence supporting the safety of many psychotropic medications during pregnancy, uncertainty persists among providers—particularly regarding where to find reliable, up-to-date information,” say the poster team. “Challenges in identifying reliable resources, and reliance on informal consultations suggests that many clinicians lack confidence in the tools currently available to them. Promoting specialized training, such as an ACGME-accredited women’s mental health fellowship, and establishing interdisciplinary collaboration to support decision-making for perinatal psychotropic regimens would provide structured pathways for improving provider knowledge, clinical confidence, and ultimately, patient outcomes.”