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INTRA-Disciplinary Care: Can Mental Health Professionals Work Together in Primary Care?

Posted By Jennifer Hodgson , Thursday, December 01, 2011
Updated: Thursday, December 01, 2011
The burgeoning success of integrated care brings with it a complicated by-product. The diverse range of behavioral and mental health professionals are stepping up to the plate. Many of these professionals, trained under the "old guard” as competitors in the market, are now tasked to re-align in the context of a new paradigm. The following represents insights from a year-long conversation (tongue in cheek) between two friends and colleagues, one a clinical psychologist and the other a medical family therapist who are in search of a model of intra-disciplinary collaboration.

Dr. Jodi Polaha, Most Awesome Clinical Psychologist (and humble too):

Last fall, I sat through an uncomfortable board meeting. I was charged to work with a Clinical Social Worker, Licensed Practicing Counselor, a Counseling Psychologist, and a Licensed Nurse Practitioner to develop an integrated care training program as part of a rural workforce development project. Whose students could provide treatments in behavioral medicine? Whose students could help develop programming? Whose students understood research well enough to do program evaluation? "Ours!” I said, smiling.

So did the other professionals in the room.

"NOT!” I shouted in my mind. I tried to keep my facial expressions in check, but it was hard. Everyone knows social workers help people get food stamps and find support groups, right? Everyone knows our counseling friends deal mostly with life-adjustment issues, right? And everyone knows that clinical psychologists are superheroes, trained in the scientist-practitioner model, who REALLY CAN do everything…RIGHT?

I was challenged by this conversation, and recognized my long-held, inaccurate stereotypes of other mental health disciplines, including my own. Still, some questions made me itch: Can mental health professionals from various training backgrounds work harmoniously in integrated care? If so, could their roles be interchangeable? Should they be?

I took my questions to Dr. Jennifer Hodgson. Who would know better than the president of CFHA? Granted, she is a marriage and family therapist (or medical family therapist as she calls herself these days), so she lacks the finely-honed analytical skills of a clinical psychologist. She can pick out a cute suit, though, so I felt it was worth a try.

Dr. Jennifer Hodgson, Supreme Marriage and Family Therapist:

First, I would like to say, when Jodi Polaha approached me with questions about intra-disciplinary collaboration, I had to hide my confusion. Why would a clinical psychologist be concerned about this? Don’t they mainly do testing and inpatient work with serious and persistent mental illness? Isn’t their training mainly in one specific area of health or mental health? What are they doing in primary care? I would not want a foot specialist operating on my eye, after all! How does she figure she is a team player with the likes of medical family therapy, who, we all know, leads the field in advancing integrated care! I know what is going to happen, she just wants psychologists to take over the leadership of this integrated care movement. Arguably, they do have Medicare in their back pockets, but so do social workers. Does that mean though that they are better integrated care clinicians?

There are so many inaccuracies in how different mental health disciplines are trained that perpetuate the ideas that others are less well trained simply because of their degree. Why can’t a social worker, pastoral counselor, professional counselor, or family therapist (had to get my field in there somehow) run an integrated care service with a blend of professions present? Of course we can work harmoniously Jodi, but we first have to be willing to be vulnerable and willing to learn from one another in the field.

I have gotten to a place where I just want all mental health disciplines to stop figuring out who is best based on degree and to start taking classes together, training in the field together, and promoting policy for parity together. We would be even better together…if only we knew how to share the space. It is the old adage of those who have power want to hang on to it and those who want it are working hard to get it. I tell my students that there is plenty of room in the sandbox so no need to throw sand to create space.

Most healthcare professionals just want someone who can do the job and cannot understand why some mental health providers cannot work together easily. I go back to how people were trained, Jodi, and I believe strongly that we can be retrained to learn models of integration that embrace multiple disciplines in the same location. We can share the work, divide the responsibilities, and promote one another’s strengths. We can embrace hiring someone not because of the degree, but because he or she meets the patient population’s needs and has the core competencies (to be determined) to provide integrated care services.

It starts at the training level and I believe CFHA is the place where we can drop our labels and learn the core competencies needed for the work. I know my calling is to train the next generation to behave differently, but it starts with me and sometimes I struggle with it too. I want to understand why we cannot just drop the entitlements...but as a systems thinker I know that change happens slowly, thoughtfully, and organically (with a smidge of encouragement from associations like CFHA).

Dr. Jodi Polaha

It’s funny, in spite of my reaction to that board meeting last year, this year in Philadelphia, I had so many positive interactions with professionals from so many varied disciplines. In that forward-thinking environment, Jennifer, it was truly effortless to meet the spirit of your ambition for all of us. I learned from social workers, public policy people, and physicians. I exchanged cards with a school psychologist from Florida, with similar research interests to my own. The energy in this mixed group was incredibly engaging and specific credentials, training history, and even experience seemed to fade away. In another week, I am off to a clinical psychology conference and, reflecting back, I feel I was more among "my people” at CFHA than I will be there.

It occurs to me that the mental health professionals involved in integrated care have so deftly cast off the old guard notions about the 50-minute session, the cozy psychotherapy room, and even the term "mental health.” I’d like to see your vision become a reality, Jennifer. Perhaps, the stereotypes and competitive dispositions will be the next to go.

Jennifer Hodgson, PhD, is a licensed Marriage and Family Therapist, Associate Professor in the Departments of Child Development and Family Relations and Family Medicine at East Carolina University, and outgoing President of CFHA. She has over 18 years clinical experience and has served on numerous boards and committees related to healthcare and mental health care issues. She is co-author to the first doctoral program in medical family therapy in the nation.

Jodi Polaha, Ph.D. is an Associate Professor in the Department of Psychology at East Tennessee State University where her primary professional interest is research, training, and workforce development in rural integrated practice. In addition to her work, she spends lots of time with her husband and two young boys swimming, biking, and hiking in the surrounding mountains.

The view expressed in the blogs and comments should be understood as the personal opinions of the author and do not necessarily reflect the opinions and views of the Collaborative Family Healthcare Association (CFHA). No information on this blog will be understood as official. CFHA offers this blog site for individuals to express their personal and professional opinions regarding their own independent activities and interests.

Tags:  CFHA  family medicine  family therapy  Philadelphia 

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Comments on this post...

Randall Reitz says...
Posted Tuesday, December 06, 2011
You 2 present a challenge for the rest of us. In considering the spectrum of mental health specialties, the question that comes to my mind is whether we want all types of clinicians to bring the same universal skill set to primary care (as you seem to recommend) or whether it is preferable to have a diverse team with some shared competencies and some specialty skill sets? Should we all be generalists like primary care physicians or should we stratify by guild?
Permalink to this Comment }

Peter Y. Fifield says...
Posted Thursday, December 08, 2011
Is the value of a clinician based on their ability to connect with patient or a function of the theory behind how they connect with the patient?
Permalink to this Comment }

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