ABOUT CFHA

The Collaborative Family Healthcare Association (CFHA) promotes a comprehensive and cost-effective model of healthcare delivery that integrates mind and body, individual and family, patients, providers and communities. CFHA achieves this mission through education, training, partnering, consultation, research and advocacy.

Goals:

• Develop the knowledge base of collaborative family healthcare;
• Present and advocate for the collaborative family healthcare perspective locally, nationally and internationally;
• Develop programs, initiatives, educational opportunities and projects that enable students, providers, educators, legislators, communities and healthcare organizations to acquire knowledge, skills, relational competencies and experience applying collaborative family healthcare;
• Create partnerships that will strengthen the links between education, research, service and policy in the delivery of collaborative family healthcare.

As the 1992 presidential campaign moved into high gear, it was evident to all that a major change in healthcare delivery was imminent. The compartmentalized, fee-for-service delivery system in place was cumbersome, inefficiently protective of privileged sectors of the healthcare profession, unable to respond to the complex needs of disadvantaged populations, and plagued with intolerable costs. Most new designs focused on cost control by limiting access and redesigning benefit packages.

In March of 1993, fifteen colleagues from the fields of family medicine and family therapy met to develop a better healthcare paradigm. This model aimed to address current pressing clinical as well as economic problems. The group considered this urgent question: No matter how financed, what should a thoroughly modern healthcare delivery system look like at the clinical level?

It was agreed that a truly contemporary system would thoroughly integrate the expertise of biomedical and psychosocial providers and include family and community as key elements in the practice model. This became their design goal.

Naming their vision the "collaborative family healthcare model", they formed an organization to bring together those interested in the approach. In July of 1995 a National Conference was held in Washington, DC that was well attended and received glowing reviews. The Collaborative Family Healthcare Coalition was up and running.

The collaborative family healthcare model envisions seamless collaboration between psychosocial, biomedical, nursing, and other healthcare providers, and views patient, family, community, and provider systems as equal participants in the healthcare process. This approach is a radical departure from conventional "diagnose and refer" models and is distinctly different from the usual managed care approaches. It recognizes that clinical events always occur at biological, psychological and social levels, and that patient, family, and community represent a single ecosystem. By adding the essential ingredients of psychological and family care at the front end, and continuously throughout the healthcare process, and by coordinating and integrating the hard-won expertise of these and other healthcare professions, the wasteful use of repeated diagnostic procedures is minimized, as are costly sub-specialty referrals. It is a profoundly ethical approach that conserves resources for all participants: patients and their families, clinical providers, administrative and financial entities.

As population-based healthcare increases, it is less possible to tailor delivery systems to a hypothetical standard population. Racism, diversity, and cultural sensitivity, are front line and bottom line issues in the design of delivery systems. For example, the healthcare system as it stands now has not been able to stem the worsening of the overall health of African Americans. Failure to tailor delivery systems to the particular communities they are constructed to serve, will become even more costly as the healthcare system undertakes responsibility for the health of all as opposed to the sickness of some. Among the principles guiding the organization are the following:

1. All clinical events always occur at biological, psychological and social levels.
2. At the extremes, presentation may be simple and single level (accidental laceration, viral URI,) or complex and multi-level (self laceration, AIDS infection.)
3. Mixed and ambiguous presentations are commonplace. (50% of primary care presentations are without demonstrable tissue pathology.)
4. Financing shifts, from fee-for-service to capitation, shift the economic interest of the healthcare industry from service delivery to prevention.
5. The increased complexity of treatment protocols puts a greater premium on integration of the multiple healthcare disciplines involved in the care of a patient.
6. Numerous factors associated with the advances of biomedicine implicate ever-increasing involvement of families in healthcare. Among these are complex chemotherapy protocols, heroic interventions such as bone marrow transplant, or family stressors such as the survival of newborns at risk for chronic disabling conditions.
7. Reduction in duration of inpatient hospital stay as a cost control measure also increases burdens on family.
8. Increasing awareness of the ethical dimensions of healthcare (prenatal decisions, end of life decisions, DNR orders) inevitably involve families.
9. Advances in diagnostic capability (molecular medicine) lead to complex ethical and life pattern decisions. For example, diagnosis of an untreatable condition might pose a question of whether to initiate or terminate a pregnancy.
10. There is increased awareness of family systems relevance to lifestyle health-related activities (smoking, other addictions, accidents, suicide.)
11. There are many studies indicating a relationship between adhering to biomedical treatment (non-compliance) and family and other psychosocial factors.