The UCSF Psychiatric Assessment and Brief Intervention (PABI) Program—What Have We Learned So Far?

The Psychiatric Assessment and Brief Intervention (PABI) program combines psychiatric evaluations and medication management with individual psychotherapy, delivered concurrently in 3 months or less, as described in an article recently published in ThePrimary Care Companion for CNS Disorders. PABI increases the access of patients referred by University of California, San Francisco (UCSF) Health primary care providers (PCPs) to the UCSF outpatient psychiatry clinic. The goal is that patients return to their PCPs after 3 months once their symptoms have improved. Initially, we were not sure whether this program would be of interest to patients or we could accomplish any meaningful therapeutic goals in such a short time. For those of us trained in long-term psychodynamic psychotherapy (including me), 3 months seemed jarringly short. On the other hand, there was such a need for patients to be seen that any initiative appeared to have a chance of success.

Since PABI was a novel program, we were careful to collect data and document outcomes from the start to help us understand what was and wasn’t working. We developed a patient log containing important data beginning with the first patient. The log helps us track our patients’ progress through PABI at any given time and reminds us of the expected end dates, which in turn guides our therapeutic efforts. Using one of the collaborative care model principles, “treatment-to-target,” we strive to achieve certain goals, such as reducing GAD-7 or PHQ-9 scores and, in some cases, improving the management of medical illnesses (for example, by adhering to a patient’s diabetes medication regimen as prescribed by their PCP).

Each PABI patient has 2 psychiatric diagnoses, on average, in addition to at least 1 medical condition. No two patients are alike. We have seen very interesting patients, which makes our work even more rewarding. Because most patients are referred by PCPs or other UCSF Health specialists after several medication trials have failed, these individuals usually present a diagnostic or management dilemma. If the complexity of the presenting problem exceeds the type of pathology routinely managed by PCPs, patients will remain in the UCSF psychiatry clinic for longer-term treatment after completing the PABI program cycle.

PABI operates with a small interprofessional team (1 psychologist and 2 part-time psychiatrists) that communicates closely through weekly huddles and team meetings. We also have periodic calls with the behavioral health navigator who processes primary care referrals. For the PABI model to work, active patients need to be paired with active providers. Our patients learn about PABI’s expectations (ie, frequent appointments, homework for therapy) prior to entering the program; they also know that the treatment cycle will end in 3 months. In our experience, this finite duration has helped increase patient engagement and motivation for change. Our article reports significant improvement in clinical outcomes (as measured by GAD-7 and PHQ-9 score reductions from baseline to endpoint). We have received wonderful compliments from patients and colleagues. The best compliment I heard was, “PABI performs magic in 3 months.” Of course, we all know it’s not magic, and it will be important to gather formal feedback from patients and referring providers. We have not yet done this in a systematic way, although we are hoping to do so in the near future.

So, what have we learned so far? This brief split-treatment model works. The active ingredients are the patients’ deep desire to get better, experienced clinicians working together, and a whole lot of communication.

Financial disclosure:Dr Seritan has no relevant personal financial relationships to report.