ADAPT Level One Detailed Course Outline - Training for Clinicians …kresserinstitute.com/wp-content/uploads/ADAPT-Level-One... · 2018-09-20 · ADAPT Level One Detailed Course Outline

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ADAPT Level One Detailed Course Outline

I. ADAPT FOUNDATIONSA. WelcomeB. Course overview

1. Course overview and learning objectivesa) Clinician handout: Learning Objectives

2. Learning theory: why course is structured how it is3. How to get the most out of the course

a) Time commitmentb) Study tipsc) Getting support

C. The Future of Medicine1. The epidemic of modern disease2. A new approach to medicine

a) Recognizes exposome and epigenetics as primary drivers of disease

b) Embraces an evolutionary/ancestral perspectivec) Applies a functional medicine approach to care

3. How functional and conventional medicine differa) Patient handout: Functional vs. Conventional Medicine

4. The ADAPT functional medicine systems modelD. Patient Care

1. Where do you start? Where do you go from there?a) Clinician handout: FM Systems Model and the “Order of Things”

2. How do you layer and structure the treatment?a) Clinician infographic: Structuring a Treatment

II. OPTIMIZING THE EXPOSOMEA. Introduction and overviewB. Nutrition

1. Introduction2. Starting clients on Paleo

a) Three options:(1) 30-Day Reset(2) 14-Four with 2-week on-ramp

b) What if your clients won’t go Paleo?

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(1) Common objections—and solutions(a) Patient handout: Resources for Getting Started(b) Patient handout: Healthy Living on a Budget

(2) Paleo for vegetarians(a) Patient handout: Paleo for Vegetarians

(3) The 3 most important changesc) The Paleo Reset diet

(1) Patient handout: Paleo Reset Guidelines3. Diet/lifestyle protocols for particular needs

a) The importance of personalizationb) Macronutrient ratios

(1) Patient handout: Macronutrient Targets(2) Patient handout: Monitoring Ketones(3) Patient handout: Blood Sugar Tracking Form

c) Meal frequency and timingd) Intermittent fasting e) Carbohydrate backloading f) Athletes: protein, post-workout meals, carbs

(1) Patient handout: Paleo for Athletesg) Women: hormones, carbs, other tips

(1) Patient handout: Paleo for Womenh) Paleo pitfalls and solutions i) Case studies j) Homework: Case assignments

4. How to customize diet/lifestyle for common health conditionsa) Introduction b) Weight loss

(1) Patient handout: Six Strategies for Successful Weight Loss(2) Case study

c) High cholesterol and heart disease (1) Patient handout: High Cholesterol and Heart Disease(2) Case study(3) Homework: Case Assignments

d) High blood pressure (1) Patient handout: 10 Tips for Lowering Your Blood Pressure

Naturally(2) Case study

e) GERD, IBS, IBD, and other digestive problems (1) Patient handout: Digestive Problems(2) Case study

f) Anxiety, depression, and cognitive disorders (1) Patient handout: Boost Your Mood Without Medications


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(2) Case study(3) Homework: Case Assignments

g) Diabetes and other blood sugar disorders (1) Patient handout: Diet and Lifestyle Recommendations for

Blood Sugar Disorders(2) Case study

h) Thyroid disorders (1) Patient handout: Diet and Lifestyle Changes for Good

Thyroid Health(2) Case study

i) Autoimmune disorders (1) Patient handout: Diet and Lifestyle Recommendations for

Autoimmune Disorders(2) Case study

j) HPA Axis dysregulation (1) Patient handout: Diet and Lifestyle Recommendations for

HPA-D(2) Case study(3) Homework: Case Assignments

k) Acne, eczema, psoriasis, and other skin conditions (1) Patient handout: Diet and Lifestyle Changes for Healthy

Skin(2) Case study

l) Fertility, pregnancy, and breastfeeding (1) Patient handout: Diet and Lifestyle Changes for Fertility,

Pregnancy and Breastfeeding(2) Case study(3) Homework: Case assignments

C. Basic supplementation1. Introduction 2. Maintenance supplementation

a) Vitamin A (1) Food sources(2) Recommended supplements

b) Vitamin D (1) Food sources(2) UV exposure(3) Recommended supplements

c) Magnesium (1) Food sources(2) Recommended supplements

d) Vitamin K2


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(1) Food sources(2) Recommended supplements

e) Vitamin C (1) Food sources(2) Recommended supplements

f) Iodine (1) Food sources(2) Recommended supplements

g) Patient handout: Food Sources of Key Nutrients3. Nutrients to be cautious of supplementing with

a) Ironb) Calciumc) Vitamin E (alpha-tocopherol)d) Beta-carotenee) Folic acid

4. Summary of supplement recommendations a) Patient handout: Maintenance Supplementation

D. Lifestyle1. Introduction 2. Physical activity

a) Introduction b) Core concepts

(1) Physical activity-disease connection (2) Move like your ancestors (3) Overtraining

(a) Patient handout: Are You Overtraining?c) Recommendations

(1) SWAP (2) Apps, tools and resources (3) Patient handout: SWAP Your Way to Health

d) Homework: Case assignments3. Sleep


(1) Sleep-disease connection (2) The role of artificial light (3) Determining how much sleep you need (4) Sleep quality: factors that interfere, improving

c) Basic recommendations (1) Sleep hygiene(2) Sleep nutrition(3) Light control


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(4) Movement(5) Apps, tools and resources(6) Patient handout: Sleep More Deeply

d) Homework: Case assignments4. Stress management


(1) Stress-disease connection(2) Definition of stress(3) HPA axis dysregulation(4) Benefits of stress management

c) Basic recommendations (1) Reduce stress you experience(2) Manage stress you can’t avoid(3) Tips for getting started with stress management(4) Apps, tools and resources(5) Patient handout: Manage Your Stress

d) Homework: Case assignments5. Environmental toxins


(1) Toxins-disease connection(2) Most harmful toxins and where to find them

c) Basic recommendations (1) Minimizing toxic exposure(2) Supporting natural detoxification systems(3) Apps, tools and resources(4) Patient handout: Living Clean and Green

d) Homework: Case assignmentsE. Additional resources

1. Introduction 2. Hardware tools (e.g. Fitbit, iWatch, Withings scale, etc.)

a) Patient handout: Tools for Getting Healthy3. Websites and apps

a) Food/diet trackingb) Physical activityc) Sleepd) Stress management/meditatione) Behavior changef) Food/productsg) Patient handout: Apps for Getting Healthy

4. 14Four


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a) 14Four overviewb) 14Four affiliate program

III. GUTA. Introduction and overview B. Basic physiology

1. Review of digestive tract anatomy and physiology 2. Microbiome in health and disease 3. The role of the gut barrier

C. Pathology 1. Risk factors 2. Difference between syndrome/symptom and pathology 3. Pathologies

a) Hypochlorhydria and impaired bile/enzyme production b) SIBO

(1) Patient handout: Understanding SIBO(2) Clinician handout: SIBO test options

c) Infections d) Dysbiosis and fungal overgrowth e) Food intolerancesf) Intestinal permeability g) Autoimmunity

D. Diagnosis1. Identifying and working with food intolerances

a) Introduction (part of slide presentation)b) Is food intolerance testing legitimate? c) Signs and symptoms d) Recommended labs

(1) Cyrex Array 3 (a) Case studies(b) Homework: Case assignments(c) Clinician handout: Array 3 Interpretation Guide(d) Clinician handout: Interpretation of Antibodies

Against Wheat, Gluten and Enzyme Antigens(2) Cyrex Array 4

(a) Case studies(b) Homework: Case assignments(c) Clinician handout: Array 4 Interpretation Guide(d) Patient handout: Preparing for Array 4

(3) Cyrex Array 10 (a) Case studies


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(b) Homework: Case assignments(c) Clinician handout: Array 10 Interpretation Guide(d) Patient handout: Preparing for Array 10

e) Elimination/provocationf) Follow-up testing

2. Gut pathologiesa) DD CSAP + BioHealth 401H

(1) Case studies(2) Homework: Case assignments(3) Clinician handout: CSAP Interpretation Guide(4) Patient handout: Preparing for the CSAP

b) NCNM SIBO Breath (1) Case studies(2) Homework: Case assignments(3) Clinician handout: SIBO Breath Interpretation Guide(4) Patient handout: Preparing for SIBO Breath

c) Genova Organix Dysbiosis(1) Case studies(2) Homework: Case assignments(3) Clinician handout: Organix Dysbiosis Interpretation Guide(4) Patient handout: Preparing for Organix Dysbiosis

d) Cyrex Array 2 (1) Case studies(2) Clinician handout: Array 2 Interpretation Guide(3) Patient handout: Preparing for Array 2

e) Doctor’s Data Intestinal Permeability Assessment(1) Case studies(2) Clinician handout: IPA Interpretation Guide(3) Patient handout: Preparing for Intestinal Permeability

Assessmentf) uBiome and American Gut

(1) Pros and cons (2) Clinical relevance

E. Treatment protocols1. General considerations

a) Two stages of treating the gut (1) Remove(2) Rebuild

b) General guidelines and tips for antimicrobial protocols 2. SIBO

a) Dietb) Antimicrobials


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c) Prokineticsd) Other supplementse) 3-stage SIBO protocolf) Patient handout: Anti-Microbial Protocolsg) Clinician handout: SIBO Treatment – Durationh) Clinician handout: Prescription Medications for SIBO Treatmenti) Clinician handout: Pediatric SIBO and Gut Dysbiosis Treatment

Protocolsj) Clinician handout: Elemental Diet

3. Dysbiosis and fungal overgrowtha) Dietb) Antimicrobialsc) Other supplementsd) Clinician handout: Botanical Protocol for Dysbiosis

4. Parasites & H. pyloria) Dietb) Antiparasiticsc) Other supplementsd) Clinician handout: H. Pylori Botanical Treatment

5. Low stomach acid/GERDa) Dietb) Supplementsc) Other considerationsd) Clinician Handout: GERD Treatment Summary

6. IBD/IBS-Da) Dietb) Supplementsc) Medicationsd) Patient handout: Paleo Low-FODMAP Diete) Patient handout: GAPS Dietf) Patient Handout: How to Manage Your Stressg) Clinician Handout: IBD Remission and Maintenance Treatment

7. IBS-C/constipationa) Dietb) Supplementsc) Other considerationsd) Clinician Handout: Probiotics and Gut Symptom Treatment

8. Leaky guta) Dietb) Supplementsc) Other considerationsd) Clinician handout: Gut Barrier Interventions


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F. Probiotics and prebiotics 1. Fermented foods 2. Fermentable fiber 3. Commercial products 4. Patient handout: Fermented Foods Guide5. Patient handout: Rebuilding a Healthy Gut

G. Lifestyle and behavior 1. Stress management2. Mindful eating 3. Meal timing and frequency4. Clinician handout: Gut Lifestyle & Behavior Recommendations

H. Advanced treatments 1. Probiotic and prebiotic implants 2. Fecal transplants

I. Bringing it all together 1. Case studies 2. Homework: Case assignments

J. Wrap-up

IV. HPA AXIS DYSREGULATION (HPA-D)A. Introduction B. Basic physiology

1. HPA axis and Adrenomedullary Hormone System (AHS)2. Stress hormones and hormone metabolism

C. Etiology 1. 4 categories of HPA axis stressors2. Diet and lifestyle factors 3. Caffeine, steroids, and other drugs

D. HPA-D vs. “Adrenal Fatigue” 1. Does Adrenal Fatigue exist?2. Problems with the 3-stage model3. How to discuss HPA-D with clients and other medical professionals

a) Patient handout: What is HPA Axis Dysregulation?E. Pathology

1. Allostatic load and depletion of metabolic reserve2. Genomics, epigenetics and HPA-D3. Conditions related to HPA-D

F. Diagnosis 1. Categories of assessment

a) Signs, symptoms & history(1) HPA-D is clinical diagnosis


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b) Lab tests: “allostatic load battery”: what to measure?(1) Cortisol(2) DHEA(3) Cortisol awakening response(4) Cortisol: DHEA ratio(5) Optional: aldosterone, melatonin, ACTH, inflammatory

markersc) Assessment tools for perceived stress

(1) Patient handout: Perceived Stress Scale(2) Patient handout: Holmes and Rahe Stress Scale

2. Comparison of available testsa) Serum vs. saliva vs. urine vs. hairb) Saliva vs. DUTCH testc) Recommended test protocol

G. DUTCH Adrenal Profile 1. PH Adrenal Profile2. Case studies / specific patterns of dysfunction3. Clinician Handout: Adrenal Profile Interpretation Guide

H. Treatment of HPA-D1. Diet

a) Macronutrients (1) Protein (timing, total amount)(2) Carbs (timing, total amount)

b) Meal frequency and timing c) Specific nutrients d) Patient handout: Diet for HPA-D

2. Behavior and lifestyle a) Light exposure b) Exercise c) Stress management d) Patient handout: HPA-D Behavior and Lifestyle Strategies

3. Adjunctive therapies a) Acupunctureb) Massagec) MBCT

4. Supplemental nutrients, botanicals & hormones a) Basic nutrients b) Adaptogens and licorice c) Glandulars d) Hormones

5. Building a protocol a) High free and total cortisol


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b) Low free and total cortisol c) Disrupted diurnal rhythm / high nighttime cortisold) High free cortisol with low totale) Low free cortisol with high totalf) Impaired cortisol metabolismg) Low/high DHEAh) Low melatonini) Clinician handout: HPA-D Protocol Matrixj) Homework: Case assignments

I. Bringing it all together1. Case studies 2. Homework: Case assignments

J. Wrap-up

V. FUNCTIONAL BLOOD CHEMISTRY A. Introduction and overview B. Blood chemistry basics

1. Principles of functional blood chemistry 2. Functional vs. conventional ranges

a) Clinician handout: Functional Blood Chemistry Rangesb) Clinician handout: Functional Blood Chemistry Template

3. Recommended panel a) Clinician handout: Professional Co-op “Case Review Panel”

4. Options for ordering the panel5. Where to find additional info

C. Blood chemistry patterns 1. Blood sugar imbalances

a) Hyperglycemia / MetSyn(1) Case studies(2) Additional markers

(a) Clinician handout: Post-Meal Blood Sugar Template(b) Patient handout: Post-Meal Blood Sugar Testing

Instructions(3) Treatment

(a) Patient handout: Intermittent Fasting(b) Patient handout: The Potato Hack Diet(c) Patient handout: Protein-Sparing Modified Fast

Guidelinesb) Hypoglycemia / reactive hypoglycemia

(1) Case studies(2) Additional markers(3) Treatment


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(a) Clinician handout: Interpretation of Hypoglycemia Follow-up Tests

2. Nutrient imbalancesa) Iron deficiency


(a) Patient handout: Iron Repletion Protocol(b) Clinician handout: Functional Ranges for Iron

Markersb) Iron overload


(a) Patient handout: Iron Reduction Protocol(b) Patient handout: FeGGT Score Questionnaire(c) Clinician handout: FeGGT Score Assessment(d) Patient handout: How to Determine HFE Status

c) B12 deficiency(1) Case studies(2) Additional markers(3) Treatment

(a) Patient handout: B12 Repletion Protocold) Vitamin D imbalance


(a) Patient handout: Optimizing Vitamin D Levelse) Zinc-copper imbalance


(a) Patient handout: Optimizing Copper and Zinc Levels

f) Magnesium deficiency(1) Case studies(2) Additional markers(3) Treatment

3. Thyroid imbalancesa) Thyroid hypofunction

(1) Case studies(2) Additional markers


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(3) Treatment(a) Clinician handout: THEA Score Assessment(b) Patient handout: THEA Score Questionnaire(c) Patient handout: Dietary Nutrients for Thyroid

Healthb) Thyroid hyperfunction


(a) Clinician handout: Finding Low Thyrotropin Level4. Other blood chemistry patterns

a) Impaired kidney function(1) Case studies(2) Additional markers(3) Treatment

b) Other metabolic patterns (dehydration, gout, edema, changes in muscle mass)


c) Impaired liver function(1) Case studies(2) Additional markers(3) Treatment

d) Impaired gallbladder function(1) Case studies(2) Additional markers(3) Treatment

e) Anemia (iron deficiency)(1) Case studies(2) Additional markers(3) Treatment(4) Clinician handout: ACD and IDA Iron Marker Comparison

f) Anemia (B12/folate/B6 deficiency)(1) Case studies(2) Additional markers(3) Treatment

g) Anemia (of chronic disease)(1) Case studies(2) Additional markers(3) Treatment

h) Dyslipidemia


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i) Chronic infection & immune dysregulation(1) Case studies(2) Additional markers(3) Treatment

j) Impaired methylation(1) Case studies (2) Additional markers(3) Treatment

(a) Patient handout: Methylation Nutrients and FoodsD. Bringing it all together

1. Full case studies with blood panels and history 2. Case assignments3. Clinician manual: Functional Blood Chemistry Interpretation Guide

E. Wrap-up VI. Case Reviews

A. Introduction and overview B. Full case studies C. Full case assignmentsD. Final thoughts

VII. PRACTICE MANAGEMENTA. Healthcare business models

1. Distributed/virtual practice 2. The Case Review process

a) Patient handout: What is a Case Review?3. Patient flow

a) Initial Consult b) Case Review appointmentc) Follow-ups

B. Operations and procedures1. Staffing

a) Key staff positions and roles(1) Start-up(2) Growth(3) Clinician handout: CCFM organization chart

2. Onboarding new clientsa) Introduction b) Overview of steps


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c) Initial application & follow-up d) Email autoresponder e) Scheduling the Initial Consult

(1) Clinician Handout: Authorization for Services(2) Clinician Handout: Chart Prep Case Reviews(3) Clinician Handout: Chart Prep Initial Consults(4) Clinician Handout: Create BC Reports(5) Clinician Handout: Create Superbills(6) Clinician Handout: Estimate Additions(7) Clinician Handout: Estimate Approvals(8) Clinician Handout: Estimate Modifications(9) Clinician Handout: Lab Ordering Procedures(10)Clinician Handout: Onboarding AR Outline(11)Clinician Handout: Onboarding Case Review Clinician(12)Clinician Handout: Onboarding Case Review Follow-up Call(13)Clinician Handout: Onboarding Case Review Follow-up(14)Clinician Handout: Onboarding EHR Registration(15)Clinician Handout: Onboarding from Initial Consult through Case

Review(16)Clinician Handout: Onboarding Initial Consult Follow-up Call(17)Clinician Handout: Onboarding Initial Consult Follow-up(18)Clinician Handout: Onboarding Initial Consult for Clinician(19)Clinician Handout: Onboarding Initial Inquiry Follow-Up(20)Clinician Handout: Onboarding Process Registration Form(21)Clinician Handout: Onboarding Schedule Initial Consult Follow Up(22)Clinician Handout: Onboarding Schedule Initial Consult(23)Clinician Handout: Onboarding through Booking Initial Consult(24)Clinician Handout: Outline of NP Onboarding Procedure(25)Clinician Handout: Patient Guide(26)Clinician Handout: Process Appointment Encounter Case

Reviews(27)Clinician Handout: Process Appointment Encounter Initial

Consults(28)Clinician Handout: Schedule CR(29)Clinician Handout: Send Messages(30)Clinician Handout: Tag Questionnaires(31)Clinician Handout: Update CC Info(32)Clinician Handout: Upload Lab Results into the EHR(33)Clinician Handout: Using Ring Central

3. Utilizing allied providers to improve care and increase revenue1. Why use allied providers?


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2. The role of various allied providers: health coaches/nutritionists, nurse practitioners/physician assistants

3. Incorporating allied providers into the case review model4. Additional ways to utilize allied providers to improve patient care5. Scope of practice considerations for licensed clinicians and allied providers

4. The Initial Consulta) Overview b) Key points to cover

(1) Clinician handout: Initial Consult Scriptc) Follow-up

(1) Sending intake paperwork, lab requisitions, and kits(2) Scheduling the Case Review

d) Clinician handout: Patient Guide & Informed Consente) Working procedure: Initial Consultf) Clinician handout: Initial Consult Overview and Tips

5. The Case Reviewa) Overview b) New patient intake

(1) Chief complaints (2) Body systems assessment (3) Diet survey and one-day diary (4) History (5) Supplement and medication list (6) Case Review questionnaire (7) Patient handout: Case Review Questionnaire(8) Patient handout: Dietary Habits Questionnaire(9) Patient handout: Environmental Exposure Survey(10)Patient handout: Food Survey(11)Patient handout: Metabolic Assessment Form

c) The Report of Findings(1) Clinician Handout: Report of Findings Template

d) How to structure the appointment e) Managing expectations for treatment f) Follow-up

(1) Delivering the Report of Findings(2) Delivering patient instructions

g) Working procedure: Case Review6. Follow-up appointments

a) Overviewb) Pre-appointment questionnaire: tracking progress over timec) How to structure the appointmentd) Follow-up


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e) Working procedure: Follow-up Appointmentsf) Patient handout: Follow-Up Appointment Questionnaire

7. Processing patient chartsa) Processing initial consult appointments

(1) Overview of steps(2) Preparing invoice and getting patient approval(3) Ordering supplements(4) Ordering labs(5) Delivering clinician instructions and handouts(6) Billing(7) Working procedure: Processing Patient Charts

b) Processing case review appointmentsc) Processing existing patient appointments

8. Billing, insurance and reimbursementa) Relevant issues for functional medicine practiceb) Billing policies for cash practicesc) ICD-10 diagnosis codes d) Clinician handout: Registration and Agreement Form Example

9. Patient communicationa) Providing first-class service while protecting your timeb) Phone vs. electronic communicationc) Patient communication policy and procedures

(1) Clinician handout: Patient Communication Policy Example(2) Clinician handout: Privacy Policy Example

C. Back-end systems1. EHR and Accounting

a) Overview b) Accounting

(1) Quickbooks introductionc) EHR

(1) Using the EHR(a) Process Appt Encounters - Lab Ordering(b) Navigate the PPQ - Quest & Comm for Clinicians (2 parts)(c) Create, Manage, and Use Chart Parts(d) Send Medical Records(e) Order Supplements(f) Order Prescriptions(g) Create BC reports(h) Add CPT Options to the Database(i) Add Supplements to the Database(j) Patient handout: How to Use Your Patient Portal

2. Legal / Phone/ File management


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3. Schedulinga) Overview b) Case review and initial consult appointmentsc) Existing patient appointments

4. Collaboration & Video conferencinga) Basecampb) Teamweekc) Perch.cod) Clinician handout: Hosting a Zoom Webinare) Clinician handout: Webinar Best Practices

5. Getting help 6. Documentation (Work The System)


Documents

ADAPT Level One Detailed Course Outline - Training for Clinicians …kresserinstitute.com/wp-content/uploads/ADAPT-Level-One... · 2018-09-20 · ADAPT Level One Detailed Course Outline