Program Spotlight: Doctor of Behavioral Health program at Arizona State University
an interview with Nicholas Cummings, PhD, ScD (photo), and Ronald O’Donnell, PhD
A lifestyle change manifests itself in active decisions: from diet and exercise to giving up smoking. But at the crux of Lifestyle medicine is a psychological and behavioral understanding of what it takes to encourage a patient to achieve true, lasting change, moving beyond the surface of "do this, not that". Physicians, however, may struggle to motivate their patients to make better lifestyle choices, or even to simply visit a therapist who can.
This is why the new Doctor of Behavioral Health program at Arizona State University promises to radically change the way we approach lifestyle modification in the clinical setting.
Dr. Nicholas Cummings, President of the Cummings Foundation for Behavioral Health and former president of the American Psychological Association, had long been troubled by the difficulty of getting a clinical patient with psychological or behavioral issues to a psychologist trained to directly address lifestyle problems. Dr. Cummings states that this issue did not result from physicians reluctant to refer their patients, but rather a reluctance on the patient’s part to follow through with a visit. Going across town to visit a psychologist may simply be too inconvenient for a patient, Dr. Cummings explains, or the patient may be wary of the stigma associated with visiting a therapist. An integrated, clinical approach to behavioral health, Dr. Cummings realized, was the only clear solution.
The Doctor of Behavioral Health Program (DBH), founded in 2008, is a new doctoral degree. “This is definitely the first program of its kind and nothing else has come close,” Dr. Cummings states. The program seeks master’s-level clinicians with seven or more years of experience and focuses on giving them not only an education in evidence-based therapy skills, but also an understanding of medical terminology and the predominate illnesses seen in primary care practice. Students are also educated in business practices with classes that focus on health care economics and entrepreneurship, so graduates can respond to a medical field that is swiftly changing.
The program replaces the traditional internship with a practicum-based experience. Students spend sixteen hours a week on-site until they have completed 400 hours. The students make themselves essential wherever they are placed, allowing physicians to allocate more of their own time to more lucrative procedures as they are supervised by the program. Dr. Cummings states: "There are now reimbursement codes for seeing a patient in the medical setting when the patient came in for ostensibly a physical illness." Furthermore, the students provide their services at low internship salaries.
The ultimate goal for DBH graduates is to make themselves a seamless part of a patient’s medical care by working side by side with physicians. If a DBH graduate is practicing in the same medical facility as other physicians, those physicians can simply walk their patients to the behavioral therapist’s office -- an infinitely more direct approach than leaving them with a referral. This is something Dr. Cummings calls “the hallway hand-off” and is a crucial part of simplifying patient access to behavioral care.
The other hurdle DBH graduates overcome is stigma. By making behavioral care a normal and routine part of a medical visit, physicians remove the misconception that seeing a therapist is embarrassing and shameful. Furthermore, the visits are brief -- around fifteen minutes -- and targeted. DBH students are trained to give patients behavioral strategies for improving lifestyle and also the motivation to do so, but in a way that is compatible with the high-speed medical world.
A Highly Successful Program
The success of the DBH program has, according to its director, Dr. Ronald O’Donnell, “Exceeded our expectations across the board.” During the first year of the program, ASU planned to accept only twenty students maximum and expected that only fifteen would go through the program, but they received so many qualified applicants that they took on 54 students. And the DBH program shows no signs of slowing down. Within the next few years, Dr. O’Donnell predicts the program may be hosting more than 100 students. Even the Chinese government has expressed a strong interest in the program, and the DBH program is currently working out a way to train teachers in China to instruct their students in behavioral therapy.
These graduates have had enormous success integrating into the medical field. While a small hand full of DBH graduates have set up their own private practices, the majority have found positions in clinics, private practices, and hospitals. Graduates have been found invaluable, particularly to primary care providers, who may struggle to motivate their patients to make lifestyle changes, and pediatricians, who want to emphasize healthy behaviors among children as a preventive medicine strategy. It is no wonder that other universities are eager to host their own DBH programs, and Dr. O’Donnell believes that this may happen within the next couple years.
A New Kind of Healthcare
The potential benefits of having a health care system that places an emphasis on behavior modification cannot be trivialized. Dr. Cummings states that patients receiving behavioral care, “get attention for psychological problems and don’t have to rely as predominately on medication.” The DBH program is an astounding and progressive step toward a health care system that places equal emphasis on both medical and lifestyle changes, and challenges patients to take an active role in their health.
Marc Braman, ACLM Past President notes: "With this new kind of professional that is so skilled with the heart of Lifestyle Medicine entering the healthcare arena, it will be exciting to see how they become an important part of Lifestyle Medicine specialty practice."
article by Diana Cater