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10 Steps for Establishing a New Role in Collaborative Care: A Guide for Trainees

Posted By Amber Landers, Wednesday, July 02, 2014
Being a trainee in mental health primary care integration is exciting, cutting-edge, and innovative, but not easy. Primary care mental health integration is a new frontier compared to other modes of clinical intervention. Because of this, there are few established models for how to prepare trainees for inter-professional interactions within primary care settings.

As trainees we’ve spent much time learning various theories, assessment measures, and therapeutic techniques. We have much to offer in clinical consultation and intervention, but when placed in a new role, new system, or new setting it can be difficult to feel like an expert in anything. We may come across challenges in figuring out how to carve out a role as well as understanding the roles that already exist in a particular clinic. In addition, each clinic and healthcare system that we navigate is likely to be different, thus requiring constant adjustment despite previous experiences or training.
When I began as the new child psychology fellow in primary care I was excited to have the freedom to carve out a position and draw from my previous experiences and training; however there was no blueprint for how to establish my role in an unfamiliar clinic with professionals from different disciplines. I felt awkward, uneasy, and questioned whether I was useful, or just in the way. I learned that establishing a welcome presence is an important step to building collaborations in a new setting and creating opportunities to articulate my potential role. It is an important first step that is rarely talked about explicitly and can feel very uncomfortable to stumble through.

I offer 10 practical steps from the perspective of a trainee and based on my experiences working in three different primary care clinics over the course of my training. I do not focus on the clinical skills, knowledge base or required training for primary care mental health integration, instead I offer some basic tips about introducing oneself to a new setting to establish a role that may be new to you and/or new to others. These are beginning steps to help establish familiarity with a new space, build allies, and feel comfortable in a new role.

1. Introduce yourself - Introduce yourself to anyone who you may encounter on a regular basis and anyone that will listen. This includes administrative staff, interpreters, physicians, nurses, medical assistants, other mental health professionals on site, cleaning crew, and mail deliverers. Include your name, title and role. This can be difficult if your role is not yet clearly defined. If that is the case, (as it was for me) introduce what you hope to learn and how you hope to be useful. Be friendly and greet everyone as you enter and leave in order to become a familiar face. Familiarity is an important precursor to warm-fuzzy feelings.

2. Be/appear confident and professional - You may not feel confident, but you do have something to offer. Temper confidence with professionalism and humility. You will at first be inviting yourself into someone else’s space. Be respectful of that, while being confident that you belong.

3. Name drop - Make connections through existing connections. Mention supervisors, colleagues, or other providers that you know in common.

4. Shadow - Shadowing is important to help you get a sense of specific clinic culture, flow, and style of providers.

5. Ask questions - Do not be afraid to ask questions. Ask about the clinic and existing roles there. Ask questions to providers, medical assistants, nurses, and front desk staff. Find out about workflow, screening tools, protocols and patient demographics.

6. Share ideas - Sharing ideas and getting feedback is helpful to sustaining relationships and developing buy-in for your role. State new ideas as tentative and include providers in the process as much as is appropriate and desired by the providers. Get feedback and ask how they see a particular idea playing out in their clinic. They may add to your idea, help implement it, and/or offer a different perspective.

7. Be a squatter - Space can be hard to come by. Hang out in space identified for you and in shared space. Become a usual and expected part of the environment. Many of my clinic questions were answered and my “curb-side” consults conducted while standing around in the shared work area.

8. Stay visible - Keep office doors open if you’re not working on confidential work, say hi and bye to providers and front desk staff as you enter and leave the building. Share your schedule and be visible on a regular basis.

9. Speak up - Expect the atmosphere to be busy. Physicians, nurses, and medical assistants will be coming and going, walking around, sitting at computers, moving from one space to another. You may always feel that you are interrupting something important when you have a question or offer an observation, but don’t be afraid to speak up.

10. Connect with other behavioral health professionals in primary care - It can be lonely, especially if you are the only mental health person on site. Connect with others at your clinic, within your healthcare system, or within other groups or organizations. Attend meetings and conferences to network and to learn about other’s experiences.

These are steps to help build allies and feel comfortable in a new role Establishing a role for yourself in a new setting requires flexibility and perseverance. Humility, humor, confidence, and professionalism when entering a new space will also help form relationships in order meet goals to assess needs, offer new ideas, and offer new services.

I recognize that not all experiences are the same, and I offer what was surprising and useful to me in developing collaborations and becoming part of a healthcare team. After 6 months of stumbling and 3 months of settling, I currently offer consultation during well-child visits at a community hospital and feel like part of the clinic team. The providers and staff are welcoming, and I feel like I have something useful to offer. 

Amber Landers is post-doctoral fellow in pediatric primary care and behavioral health at Cambridge Health Alliance/Harvard Medical School where she also completed her APA-approved clinical psychology internship. She received her PhD in Clinical Psychology at Purdue University and obtained her BA (summa cum laude) in Psychology and Sociology from the University of California-Riverside. Her doctoral dissertation examined the effects of stress and parent-teacher communication on the psychological adjustment of ethnic minority elementary school children. Currently she works in primary care behavioral health integration at CHA providing consultation and brief intervention during pediatric well-child visits. In addition, she conducts developmental assessments and outpatient psychotherapy, and offers mental health and developmental consultation to the Early Years Project in Cambridge, MA

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