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Integrated Care Thought-Leader Series: Larry Fricks

Posted By Cheryl Holt, Thursday, November 21, 2013

(This blog post is a reprint of a piece by Cheryl Holt on September 18th, 2013. Click here for the original post. Reprinted with permission)

"When you look at people holistically and start valuing their mind-body resiliency, I think there is a level of excitement, and better outcomes.”

September is Recovery Month. This year’s theme is Join the Voices for Recovery: Together on Pathways to Wellness. It is very fitting that Larry Fricks is our featured Integrated Care Thought Leader this month, as he is one of the nation’s greatest leaders in peer-led services, wellness, and recovery. An amazing individual who has devoted his life to helping others, Mr. Fricks was gracious enough to his insights into the importance of whole health wellness and resiliency and the vital role of engaging with people who have the lived-experience to provide support through the process. He offered insight into the role that a whole health approach plays in improving health outcomes and managing wellness. Drawing from his own experiences, Mr. Fricks identified many factors that contribute to a person’s recovery process. Acknowledging that factors such as race, socioeconomic status, and personal support system play a crucial role: "I don’t think you can underestimate what social determinants do to break somebody down.


Larry Fricks is Director of the Appalachian Consulting Group and Deputy Director of the SAMHSA-HRSA Center for Integrated Health Solutions. For 13 years he served as Georgia’s Director of the Office of Consumer Relations and Recovery in the Division of Mental Health, Developmental Disabilities and Addictive Diseases. A founder of the Georgia Mental Health Consumer Network and Georgia’s Peer Specialist Training and Certification, he has a journalism degree from the University of Georgia and has won numerous journalism awards. He is a recipient of the American Association for World Health Award and the Lifetime Achievement Voice Award from the Substance Abuse and Mental Health Services Administration for the development and adoption of multiple innovative, community recovery-oriented programs and services. Mr. Fricks’s recovery story and life’s work to support the recovery of others was published by HarperCollins in the New York Time’s best-selling book Strong at the Broken Places by Richard M. Cohen. (Click here for video of Mr. Fricks’s interview on the Today Show.) He is also the creator of the Whole Health Action Management (WHAM) training, a best practice model which strengthens the peer workforce’s role in healthcare delivery.

From Peer Support to Whole Health and Resiliency

I first met Mr. Fricks in 2000 in Rockford, Illinois. He was the keynote speaker at the Consumer Family Forum, addressing a group who receive behavioral health services, their families, and behavioral health professionals from across the state. His passion resonated among the 300+ attendees as he shared his personal recovery story, urging others to believe that recovery is possible. I vividly recall (and have frequently shared with others) a very moving story that he shared about an initiative that has grown to be The Gardens at Saint Elizabeths: A National Memorial of Recovered Dignity, honoring the hundreds of thousands of people who died and were buried in unmarked graves on the grounds of psychiatric hospitals…and were forgotten:

Larry Fricks: Their graves were decimated and desecrated and they have no markers and people didn’t care about maintaining their graves. They walked the Earth and they had a life. Mothers, husbands and wives, children. They had wonderful things happen, and they saw miracles, and they had heartbreak, and you’re just honoring that experience. I just really believe that the Memorial is drawing people that I never expected to draw…very inspiring.

Through the years, Mr. Fricks has traveled from state to state, providing inspiration to so many, sharing his vision, and leading the way to transforming the way behavioral health organizations provide services. He led the national initiative to include peer-led services as a core feature, and is now working with states to embed Peer Support Specialists and Family Peer Specialists in integrated healthcare efforts as well. He currently divides his time between his work with the Appalachian Consulting Group based in Georgia, and his work in Washington, DC, as Deputy Director with the SAMHSA-HRSA Center for Integrated Health Solutions which has included testifying at Congressional Hearings on Mental Health.

Larry Fricks: We now know that things like a social network and service to others are huge health and resiliency factors. People who are in service to others tend to be healthier and they tend to live longer. Also they tend to be more resilient toward relapse or illness. So my life striving to be in service to others to strengthen their health and maybe strengthen their skills in recovery has had the benefit of strengthening my own recovery.

While his earlier work has focused on the role of Peer Support in the recovery process, Mr. Fricks’s work has broadened the focus to include a whole health approach. With startling reports that people with serious behavioral health conditions are dying decades earlier on average than the general population, he led a team at the SAMHSA-HRSA Center for Integrated Health Solutions to create a training called Whole Health Action Management (WHAM) that is designed to address this disparity though self-management supported by peers. Mr. Fricks has great praise for the effort in Georgia to develop Peer Support, Wellness, and Respite Centers that are reducing hospitalizations.

Larry Fricks: Let me tell you about what excites me. Georgia has three of these Peer Support, Wellness, and Respite Centers and they’re going to open two more. I’m very excited about what’s going on in those centers. Basically, if you feel early warning signs of your illness, or your addiction, you can go to one of these peer respite centers where you have your own bedroom and you can stay up to seven nights, chill out, and you’re surrounded by peers trained holistically to support your wellness. I think it’s really cutting the need for more intense crisis services and hospitalizations. So I had a chance to actually pull a shift in one of them, I answered the warm line and experienced what it was like to provide healing support by simply listening, or maybe just ask a few questions for deeper reflection like we are trained to do. These peer support wellness centers are returning us to whole health. Removing some of the stigma, giving us a sense of owning our recovery and being proactive, and really engaging peer support to be successful. Georgia is leading the nation. With three we had more than any state, and with five we’ll really be out in front.

What’s next on the horizon?

Larry Fricks: I’m really excited about epigenetics. On April 2 of this year, Time magazine had a cover story on curing cancer, and this whole science on epigenetics basically says DNA does not have the last say. There are mind-body resiliency factors and there’s more and more research on epigenetics. "Epi” means over and the epi is the cell structure over your genome, over the DNA. And what they’re saying here is: Things that you do, like what you eat and managing stress to stay well, it determine which genes switch on and switch off. And so being aware of this thing, if you look at the WHAM training, we include ten health and resiliency factors which we got from Dr. Greg Fricchione who used to run Mrs. Carter’s Mental Health Program [at the Carter Center], and now he’s director of the Benson-Henry Institute for Mind Body Medicine. These prevention doctors are big on something called the Relaxation Response, and so we’re looking at the things you can do to switch on and switch off gene markers; and they can impact the next generation.

And in parting:

Larry Fricks: I’m aware that there are just people and things that happen in your life that, if you’re open to it, you work on staying connected and having faith, your life can experience great meaning and purpose.

Dr. Martin Luther King, Jr. said "We’re all bound in a mutual destiny and I’m not all I can be until you’re all you can be, and you’re not all you can be until I’m all I can be.” We should be about connection. We should be about cooperation, and there’s a spiritual power to that, and when you’re open to it, positive things just seem to happen. And you’re inspired by it.

Sometimes you want to shake your head and say, "Oh my gosh, why don’t I have more faith?


Cheryl Holt, MA, CEO of Behavioral Health Integration Consulting, LLC, is an advocate for the integration of behavioral and primary healthcare for whole-person health and assists organizations in adopting a whole-health focus. She is active in social media promoting integrated care, behavioral health policy, and global mental health. She blogs regularly via the Behavioral Health Integration blog and manages LinkedIn's Behavioral Health Integration group and the Behavioral Health Integration page on Facebook. You can follow her on Twitter: @cherylholt, @BHPCIntegration, and @WorldMentalHlth

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Teach Us How to Innovate! Graduate Students’ Impressions from Their First CFHA Conference

Posted By Jodi Polaha, Thursday, November 7, 2013

(This post is the second in a two-part series of blog posts following up on the 2013 CFHA Annual Conference. Click here for the first post.)

Taking students to the CFHA annual conference is, in my 7th year, a kind of ritual. I start in April, selling our first year students on the mission match for CFHA and ETSU’s doctoral program. Over the summer, I badger our Chair for department funds to cover student travel and badger the students to apply for CFHA scholarships. In the fall, when we begin to meet weekly for my course, "Primary Care Psychology 1,” I strategically note the contributions of CFHA members in this advancing field. Mid-semester, we finalize our plans and attend the conference. And then I worry about them. Will they learn? Have fun? Think it was worthwhile? I take them out to dinner, introduce them to people, and offer to share a cab to the airport.

It’s a lot to take on. At some point I find myself asking "Why am I doing this?”

Over the years, I’ve generated plenty of satisfying answers to this question, but this year Dannel and Katelyn stopped me in my tracks with a new one. Their thoughts, in sum, were:

Yes, they met lots of great people and even the authors of some class readings.
Yes, they heard someone (besides me) talk convincingly about the burgeoning opportunities in integrated care.
Yes, they saw the data that supports integrated care models.
Yes, they felt there were ample opportunities to exchange ideas.

It was all the best stuff of any great conference. "But,” they wondered aloud, "how do we learn how to innovate? Everyone keeps talking about it. We want to know how to do it.”

Instinctively, my students’ interest in learning how to disrupt status quo made me glow. That the CFHA conference effectively conveyed the value of disrupting status quo is a new and singular reason for taking them along, no matter the work involved, the badgering, and the logistics.

Their question is also a challenge to me as an educator. Should I teach my students to innovate? And, if so, how?

Choosing to teach my students to innovate means I’m betting that "innovating” will be a marketable skill in the health care workforce of the future. Will it? As an educator in this ever-changing landscape, I am faced with a curious objective: to prepare providers with skills for tasks, roles, and milieus yet unknown. In his oft-cited TED talk,Sir Ken Robinson, a leading expert on innovation and human resources makes the same case regarding the education of our children:

I have a big interest in education, and I think we all do, we have a huge vested interest in it, partly because it’s education that’s meant to take us into this future that we can’t grasp. If you think of it, children starting school this year will be retiring in 2065. Nobody has a clue, despite all the expertise ….{ }, what the world will look like in five years’ time. And yet we’re meant to be educating them for it. So the unpredictability, I think, is extraordinary.

Student reflections on the need for new skills (to innovate!) are always a sign to me that my target has moved. Educators like me and even CFHA as an organization have to be sensitive to feedback about that moving target. My students and many others are beginning to come to the conference convinced of the concept, armed with the supporting data (sometimes from their own dissertations!), and with a business plan, job offer, and grant in hand. Our students are graduating from programs where they take interdisciplinary courses, watch integrated practices in action, start up their own integrated practices, and conduct studies evaluating integrated care. The unpredictability of how these skills and experiences will play out IS extraordinary. To do this job right, we educators will need to be reconnoitering, reallocating, and re-aiming for new training targets every step of the way.
"Innovating” will be a marketable skill in the health care workforce of the future
As a testimony, my syllabus for my Primary Care Psychology 1 Class changes every semester. Last year, I added a week on Dissemination and Implementation Science. This year I added a week on Ethics in Primary Care. Next year: "Innovating” thanks to Dannel and Katie. As the "integrated care” concept has taken off, I’ve had email requests for my syllabus, which I am happy to share, but perhaps it should contain a disclaimer or, better yet, an expiration date.

In its "educator role,” CFHA has to make its best predictions about what data, models, and skills will be needed in the future; a tall order in the context of this dynamic health care landscape. Those predictions can be based on policy, practice, research, and student input. They can’t pay much, if anything, and may not have great content-related expertise to add to the meeting, but they are worth the effort. Students’ fresh eyes and personal stake in training for the future workforce bring a valued contribution and one we need to integrate. Personally, I am looking forward to doing it all again next year.

Dr. Polaha would like to thank her students, Dannel Petgrave and Katelyn Todaro, for their input on this blog post.


Jodi Polaha, PhD, 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.

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Disruption. Movement. Beauty.

Posted By Lauren DeCaporale-Ryan, Thursday, October 31, 2013

(This post is the first in a two-part series of blog posts following up on the 2013 CFHA Annual Conference. Be sure to return next week for the second post.)

Disruption. Movement.Beauty.

Everyday I find myself using metaphors in my clinical work and role as an educator. Just days after my return from Denver, still actively reflecting on all I had learned and the ideas generated, a patient reminded me of the power of metaphor. He reflected on his artistic work, and said "To be successful at writing, you must do so collaboratively. You must create inspiration. If you work together, you will find beauty and you will move things forward.” This statement, on the heels of messages about disruption, reminded me so much of the work that we are all trying to do.


Disruption:

In one of the final sessions, Drs. Colleen Fogarty and Larry Mauksch (co-editors of Families, Systems, & Health) led a discussion on scholarship and peer reviewed publication. As part of their presentation, they encouraged the group to consider what gaps existed in the collaborative literature. The room generated a substantive list, which included the dissemination of information about how integrative and collaborative work had been applied to specific clinical areas. I left the conversation feeling inspired, with a desire to write more about my experiences and hope that all of you left the conference with similar aspirations in mind. Each of you is doing something creative each day, whether as a clinician or a teacher. Find ways to share this work, to demonstrate to others it is possible to have a collaborative vision and to make it happen. Tell your story.Write or present about the models of disruption that you are using in your everyday life. Not sure how? Start by finding a mentor or just sitting down and writing

Movement:

Disruption and dissemination can also occur through sharing what we know in the classroom, practicums, and other learning environments. Many students, trainees, and early career professionals participated in a pre-conference workshop focused on Career Innovation. They were encouraged to consider how they can be the next generation of pioneers, with well-established speakers reflecting on their own experiences in integration. Though we know there are often barriers to this work, trainees learned how some of these have already been overcome. Many have since remarked that they left excited to try new things, to implement new ideas, and to help create energy in their unique settings. Movement is created and maintained when we teach others and continue to learn ourselves. How can you create movement? Who can you teach? And who can help you grow and learn?

Beauty:

Seven presenters kicked off this year’s conference PechaKucha presentations. Though they each spoke of disruption, these presentations also provoked thoughts of movement and hope for beauty. We were reminded of the importance of righting wrongs, approaching each patient as unique, and acknowledging that they have families, histories, and stories that are naturally a part of their care.  Laura Sudano reminded us that "transparency empowers” and Dr. Toby Long encouraged us to "foster hope.” These messages articulated that even in the face of challenges and barriers, there is beauty and positivity. We have a chance to create wonder and hope everyday.  

And so I ask you: What will you do in the weeks (and yes, years) ahead to create disruption, movement, and beauty


Lauren DeCaporale-Ryan, PhD is a Family Geropsychologist and Senior Instructor in the Departments of Psychiatry, Medicine & Surgery at the University of Rochester Medical Center. She completed her graduate training in clinical psychology with specialization in geropsychology at the University of Missouri-St. Louis, and most recently completed a two-year fellowship in primary care psychology with specialization in geriatrics and internal medicine at the University of Rochester Medical Center. Her clinical work is focused on providing care to older adults and the chronically ill, and she provides coaching on patient-family centered communication skills to residents and faculty. 

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October 1st, Healthcare, and You?

Posted By Benjamin Miller, Monday, September 30, 2013

Health Insurance Exchanges will likely bring more patients to the doors of all providers


Depending on what radio talk show you listen to or what news talk shows you watch, tomorrow, October 1st, is either going to be a smashing success bringing help to millions or a cataclysmic failure bringing death and destruction. Yes, I am referring to the health insurance exchanges.

Before we dive into those weeds, let me back up just a few feet and discuss how we got here.

Health care is broken.

Healthcare is expensive.

Healthcare doesn’t give us the outcomeswe should get for what we pay.

Many people do not have any access to health insurance and medical care.

Some of you may recall a small piece of legislation that was passed into law called the Patient-Protection and Affordable Care Act. This law was intended to fix many of the problems highlighted above. There are quite a few moving pieces in PPACA, and it is important to understand the law as a whole before breaking it down into the specifics around implementation (and the impact that will have on mental health and primary care, which I will not do here). There are many substantial overviews that can be found online that explain PPACA in detail (e.g. Waits et al.). I encourage those of you who do not about the law to read through this document as there is everything you would want to know about "ACOs”, "PCMH”, and other fun and exciting acronyms.

A few more small details.

It is important to also remember that many of the provisions of PPACA are on the public side (CMS – Medicare and Medicaid). Take for example Medicaid expansion using the state I live in and CFHA will land in next week. In Colorado, there will be Medicaid expansion starting January 2014. Of course, other states have not gone the same route as Colorado leaving local and state politics to decide what will and will not happen with expansion.

Back to the exchanges.

Health insurance exchanges are going to have an impact on everyone
Health insurance exchanges are going to have an impact on all healthcare folks in all types of practices. In Colorado, for the approximately 800k uninsured, there is going to be an option for them to gain access to health insurance. Recently, the Colorado Division of Insurance announced the rates of the plans (including those on the exchange). You can find that info here(and it gives you a good idea as to which plan may be chosen by those who have not had insurance before). Also, you can find out more about the exchange in general here. The point is that there will be an influx of new patients looking for providers who can help them with their problems.

Ironically, patients most likely to benefit from the exchanges starting tomorrow are those often least aware.

So, the exchanges will likely bring more patients to the doors of all providers (and remember, mental health parity was in the ACA, too).

What will happen tomorrow? Well, it is expected that "most federally run exchanges will offer more plans, lower premiums than expectedone HHS report shows. Those states that are setting up exchanges on their own (e.g. Colorado), we will have to see their impact starting tomorrow.

Bottom line: Having more people covered (with choices) is likely to help get people the care they need. Do health exchanges fix healthcare? No, but they do solve a problem that is so pervasive in our country – they help connect those with no insurance to a plan they can afford that will cover them.

Some progress is better than no progress.


Dr. Miller is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. He leads the Agency for Healthcare Research and Quality’s Academy for Integrating Behavioral and Primary Care project as well as the Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) project in Colorado and Oregon. He is the co-creator of the National Research Network’s Collaborative Care Research Network and is the past President of the Collaborative Family Healthcare Association. He is the section editor for Health and Policy for Families, Systems and Health and reviews for several academic journals. Dr. Miller is a technical expert panelist on the Agency for Healthcare Research and Quality Innovations Exchange and on the International Advisory Board of the British Journal of General Practice. Dr. Miller’s research interests include models of integrating mental health and primary care, health behavior interventions, primary care practice redesign, using practice-based research networks to advance whole person healthcare, and healthcare policy.

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Integrated Care Thought Leader Series: Benjamin Druss, MD, MHP

Posted By Cheryl Holt, Thursday, September 26, 2013

(This blog post is a reprint of a piece by Cheryl Holt from August 6th, 2013. Click here for the original post. Reprinted with permission)

"That’s the next direction that [organizations] need to go, bringing substance abuse back into the discussion. We need to go past just the integration of primary care and mental health care to a more Whole Person Care."

It has been my pleasure to talk with Dr. Benjamin Druss for this edition of the Integrated Care Thought Leader Series. Having had the privilege to work with Dr. Druss on various integrated care projects over the past few years, I have come to respect not only his keen insight into what’s needed beyond the horizon for the care of people with behavioral health disorders, but the compassion and dedication he brings. His humility and brilliance are evident upon introduction; he’s a true visionary. Dr. Druss, my mentor and my friend, has provided inspiration to me in my work and outlook on the world of healthcare, integration, and beyond.

Dr. Druss, world-renown researcher in health policy, has made a significant contribution to healthcare and the integration of behavioral health and physical health. He has impacted the lives of many individuals as a result. As the first Rosalynn Carter Chair in Mental Health, Dr. Druss is working to build linkages between mental health, general medical health, and public health. He works closely with Carter Center Mental Health Program, where he is a member of the Mental Health Task Force and Journalism Task Force. He has been a member of two Institute of Medicine Committees, and has served as an expert consultant to government agencies including the Substance Abuse and Mental Health Services Administration, the Centers for Disease Control, and the Assistant Secretary for Planning and Evaluation. He serves as professor at Rollins School of Health Policy and Management at Emory University.

Dr. Druss’s research focuses on improving physical health and healthcare among persons with serious mental disorders. He has published more than 100 peer‐reviewed articles on this and related topics, including the first randomized trial of an intervention to improve medical care in this population in 2001. His research is funded by grants from the National Institute of Mental Health and the Agency for Healthcare Quality and Research, and he serves as a standing member of an NIMH study section. He has received a number of national awards for his work.

Dr. Druss, Dr. Silke von Esenwein, and their colleagues at Emory University are currently conducting an exciting NIMH research trial, The Health Outcomes Management and Evaluation (HOME) Study. As described on the website: There is an urgent need to develop practical, sustainable approaches to improving medical care for persons treated in community mental health settings, this study will test a novel approach for improving mental health consumers based on a partnership model between a Community Mental Health Center and a Community Health Center. When this study is completed, it will provide a model for a medical home for persons with severe mental illness that is clinically robust, and organizationally and financially sustainable.

Dr. Druss received his bachelor’s degree from Swarthmore College in 1985, earned his medical degree from New York University in 1989 and later his master’s in public health from Yale University in 1995. He is also board certified in psychiatry. He trained as a resident in general internal medicine at Rhode Island Hospital and in psychiatry at Yale University School of Medicine. Click here for more information about Dr. Benjamin Druss.

Advancement in integrated care through the years

Dr. Druss was one of the first to address the physical health concerns among people with serious mental illness and substance use disorders, particularly among the public sector populations in urban regions. During our discussion on integrated care, he addressed areas of change over the past 18 years that has had the greatest impact on the advancement of healthcare for people with serious mental illness. He described the world of Health Information Technology as a frontier that, over the past 10 years, has resulted in changing policies and procedures in healthcare. These changes have had significant impact on the ability for healthcare organizations to share information, resulting in improved care for patients.

Dr. Druss advises that the next stage needed for healthcare is to begin "broadly looking at other social determinants of health.” The focus should be on an approach to healthcare that is person-centered. The concept of addressing population health and creating a system of care will be a more effective approach to improving health outcomes moving forward. He recommends that substance abuse must be brought back into the discussion, and to go past just the concept of integration of physical health and mental health, toward a more "whole person care” approach.

What do you foresee for the field as we move forward?

Dr. Druss: Clearly there’s going to be major changes in how care is delivered. I think there’s a lot of opportunity moving forward with new public sector models, Medicaid, patients with medical homes, and also the promise of new technologies moving forward as well.

I’m very optimistic; I think things will certainly be very different five years from now. We’re in a period where things are evolving very quickly and we don’t know exactly what the world will look like, but I think we can say that things will look different—and that things will look better.

Research has to change as well. I’m mostly a researcher and lot of what we’ve been doing is slow-paced. The slow-paced process by which we develop a model, and then test it over a five year period. You apply for a grant and then you test it for five years, then it’s another two years before it’s published. So we’re going to have to be looking for more ways for understanding data and evaluating programs. I think the new technologies will help, their more wide-spread availability will help. Just as the health system needs to change—and is changing—health research is going to need to change as well.

The funding agencies still are gradually coming to that point. NIMH has a new program that they are looking to fund that looks at natural experiments out in the community. So I think that’s the sort of research that we’re going to need to see more of in the coming years—good, careful, thoughtful evaluations of some of the demonstration projects going on out in the community.

What barriers to integration to you currently see?

Dr. Druss: I’d say that a lot of community mental health centers are still on this part of the learning curve in terms of learning about integration, such as how potential partner organizations work, [such as] Federally Qualified Health Centers. [CMHC’s] often lack information technology infrastructure that makes it easier to do the work. There are some places, some community clinics, and other organizations that are out in front on these issues, that are early adopters, and there’s some that are trying to figure it out and hopefully will learn from the experience of those organizations that are further ahead.

Thank you, Dr. Druss, for your dedication to improving the health and quality of life of so many who live with serious behavioral health conditions. Click here for a list of research projects and publications by Dr. Druss.

Be sure to check back soon for our next Thought Leader, Larry Fricks, pioneer in the Peer Support movement.


Cheryl Holt, MA, CEO of Behavioral Health Integration Consulting, LLC, is an advocate for the integration of behavioral and primary healthcare for whole-person health and assists organizations in adopting a whole-health focus. She is active in social media promoting integrated care, behavioral health policy, and global mental health. She blogs regularly via the Behavioral Health Integration blog and manages LinkedIn's Behavioral Health Integration group and the Behavioral Health Integration page on Facebook. You can follow her on Twitter: @cherylholt, @BHPCIntegration, and @WorldMentalHlth

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My Experience Mentoring Behavioral Science Faculty: Getting Back Much More Than I Gave

Posted By Kathryn Fraser, Thursday, September 12, 2013

"The mediocre teacher tells. The good teacher explains. The superior teacher demonstrates. The great teacher inspires.”

- William Arthur Ward

I honestly never imagined how rewarding it would be to help others who are starting out on their path as behavioral medicine faculty. In my own experience as a new behavioral science faculty member, I was sometimes ignored, criticized, and questioned straight to my face about my knowledge and my credibility. Fortunately, a series of very supportive program directors and fellow faculty helped me through some tough times and helped me find my voice. I often imagined what it might be like for new behavioral scientists who felt less than supported in their jobs.

My experience being a small-group mentor in the Behavioral Science/Family Systems Educator Fellowship (BFEF) was truly magical. My co-mentor and I were both focused on fostering an environment of growth and encouragement—we wanted to help the fellows to spread their wings and also feel well grounded in this unique field. Advising the fellows on teaching activities was only a small part of what we did. The bigger tasks were teaching them about self-care, helping them develop a strong professional identity as behavioral faculty, and helping them set professional boundaries. It is easy to feel like you are on the periphery since behavioral science is often considered by residents to be a small part of what they really need to learn. We try to help the fellows understand that their contributions are crucial to one of the cornerstones of family medicine—the physician-patient relationship.
We wanted to help the fellows feel well grounded

The mentoring we received from the leaders of the BFEF was phenomenal. At planning meetings I felt like I was part of a think tank helping to pave the way for the future of behavioral science. This group helped bring out the best in me as a teacher and a mentor. Their support, warmth, and kindness made them excellent role models for the small-group mentors as we attempted to provide a safe, effective growing space for our up and coming fellows.

Perhaps the most important life lesson I got from this experience was how to develop my skills as a leader in medical education. As residency faculty, we must see ourselves as leaders and role models for our residents. As behavioral science faculty, we must embrace the leadership role we have in our own particular niche, which helps provide the building blocks of the communication and relationships skills so necessary for family physicians. 

If you get the opportunity to mentor folks who are early in their career, take it. There is no greater gift as a teacher than to have the feeling of inspiring others, except perhaps inspiring others to also be an inspiration to their own students.


Dr. Kathryn Fraser is a licensed psychologist and Behavioral Medicine Coordinator in the Halifax Health Family Medicine Residency Program, Daytona Beach, Florida.  Her professional interests include anxiety and stress management, the physician/patient relationship, women’s issues in psychotherapy, and cultural competency in health care.  In her free time she enjoys yoga, cooking, reading, and spending time with her family and dog at Florida’s state parks and beaches.
(This piece was originally posted on the Society of Teachers of Family Medicine blog. Reprinted here with permission)

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2013 CFHA Conference - Early Registration Ends Soon!

Posted By Colorado Conference Co-Chairs, Wednesday, September 11, 2013


Our conference aims to disrupt the status quo at all levels

Early bird registration ends this Friday, September 13th. Click here to register today!
 

A stressed single mother sees her physician, therapist, and case manager at the same time

= Disruption x 1.

A physician provides a warm hand-off of a couple who just lost their child

= Disruption x 2.

A first group medical appointment for pediatric obesity attracts 5 families

= Disruption x 15.

A family doctor is embedded into a community mental health center

= Disruption x 1,000.

A charitable foundation launches a state-level integration initiative              

= Disruption x 100,000.

A national insurance company introduces advanced payment for PCMH clinics          

= Disruption x 10,000,000.

We collaborators are disrupting the status quo of healthcare every day.  Sometimes disruption occurs through an intimate conversation in an exam room.  Other times disruption occurs in the halls of power in congress and corporations.  Our conference aims to disrupt the status quo at all levels:

  • Some of you seek clinical skills to practice one patient or family at a time.  You will find those skills.

  • Some of you seek operational insights to overcome obstacles facing your healthcare system.  We have convened the experts you need.

  • Some of you seek financial models to sustain integration in your clinic or community.  We have answers from communities just like yours.

A lot has changed in the five years since Colorado first hosted the CFHA conference.  At a state level, integrated care has advanced from a smattering of clinics to a coordinated, statewide standard.  At the national level, we have advanced from a radical voice from the wilderness to finally catching the attention of the highest level decision makers.  This year’s conference will champion the disruptions we’ve caused and provide you with the tools and knowledge to alter the status quo where you live and practice.

In addition, we’ve planned a lot of Colorado-style fun and networking.  From beer-tasting, to bus trips to Boulder, to speed mentoring, we aim to please. 

Thanks for joining us, and have a great conference!

Colorado Conference Co-Chairs 

Amy Davis

Laurie Ivey

Ben Miller

Sam Monson

Randall Reitz

Laura Sudano 

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The Great Debate

Posted By Benjamin Miller, Thursday, September 5, 2013


This is the third post in a series of "blasts from the past". These classic posts will highlight issues that are just too important to collect dust in the archives. The series will be off and on for the next several weeks. Enjoy!

(This piece was originally posted on September 21, 2012)

Changing healthcare requires an ability to gracefully navigate between competing interests and ideologies. Depending on "where you sit,” what type of change you want may be different than what your neighbor wants. Change is relative, and aims, goals, and objectives are often dependent on who you are professionally and who you work for. Integrating care, specifically behavioral health and primary care, brings out some of the best and worst of this "where you sit” phenomenon.

To this end, CFHA will host a presidential-style debate for the Friday plenary at our October 4-6 conference in Austin. We will grapple with the question: "Will collaborative care be a mainstream healthcare model within a decade?" To get you excited for this event, our blog today presents the opening statements of our 4 debaters. As the moderator for the plenary session it will be my job to engage these leaders and hear all sides of the argument. Who will win this debate? Whose side will come out on top? That decision is up to you, dear reader.

Randall Reitz

Randall Reitz PhD
is CFHA's Director of Social Media and the the Director of Behavioral Sciences at the St Mary's Family Medicine Residency in Grand Junction, CO.

Collaborative care is still a gangly, pre-pubescent David amongst the Goliaths of healthcare. We lack the scale, strength, and resources of the major industry players. That being said we are on the precipice of something great. Within the next decade the clinical, operational, and financial aspects of collaborative care converge to push our model into the mainstream of healthcare:

  • Clinical:We now have empirical evidence published in top scientific journals that demonstrates the proven effectiveness of collaborative care in terms that even the most hardened insurance executive or corrupt government official could not deny.

  • Operational: The simple reality is that we have experienced exponential growth in the adoption of collaborative care operations at all levels of the American healthcare system. We have already conquered the public sector and are within a decade of conquering the entire system.

  • Financial:Our research and policy advocacy has already won the hearts and minds of policy makers. The teeter-totter of policy and payment is already reaching the tipping point at which the laws, regulations, and reimbursement standards will align to insist on financially sustaining collaborative care as a wholly necessary, fully-funded, and central feature of American healthcare.

Paul Simmons

Paul Simmons MD is a faculty physician at St. Mary’s Family Medicine Residency Program in Grand Junction, Colorado. He enjoys Apple products, black coffee, fountain pens and eponyms.


In this group of true believers, I have the honor of standing boldly as the lone skeptic who has not yet drunk of the collaborative care Kool-Aid. There are several reasons that collaborative care will not, unlike flying cars, be mainstream by 2022.

  • First, the collaborative care clan cites supposedly supportive studies that are flawed, biased and not generalizable to the real world. The evidence-based emperor has no clothes.

  • Second, collaborative care will not be able to overcome its own vagueness and impassioned, but unfocused, hand-waving. If advocates cannot clearly and rigorously define what they’re advocating, passion fails to persuade.

  • Third, the fevered dream of collaborative care will be exposed to the harsh, bright light of financial and payment system realities.

Despite these hard truths, I can hardly hope to persuade the diehards who have pledged their lives and fortunes to the cult of collaboration. Disillusionment is difficult, but we should always prefer reality to the pipe-dream of wishful thinking.


AJ Jayabarathan

Ajantha Jayabarathan MD
20 years of practice in primary care, 10 years of working on television and radio, 8 years of association with the Canadian National working group on shared mental health care, 16 years of raising a family while living in Nova Scotia, Canada, inform my opinions of how health care is evolving in 2012.


Yes and No… so states my reading of the tea leaves of time.

In ten years’ time, if Obamacare is actualized in the United States of America, integration of mental and physical health through collaborative, co-located mental and physical health services will become the mainstream model of care. If the injection of funds and faith into this model of care is thwarted by the politics of 2012, the rate of uptake of this model will be slower and the United States might well be left ten years behind as health care evolves because of this model in the rest of the world.

Meanwhile, in Canada, Australia, New Zealand and the United Kingdom, this model of care has already seeded fertile health care fields and is growing in strength, outcomes and diversity. Coupled with the parallel explosions of the information age via the internet, virtual social networks via social media and electronic management of health care it has steadily gained momentum …..and is now unstoppable.


Eduardo Sanchez

Eduardo Sanchez MD is
Vice President and Chief Medical Officer, BlueCross/Blue Shield-Texas

Opining as a health plan chief medical officer, I believe that the health system will have evolved to a collaborative care model by 2022. The direct and indirect medical costs associated with behavioral health, when it is not recognized and not well managed, can no longer be ignored.

Employers and health plans are beginning to appreciate that better employee health status correlates with higher productivity and an upside bottom line and that medical costs decrease and, more significantly, workplace productivity improves when behavioral health is appropriately and "collaboratively” managed. As a result, employers (whether they are corporate America, small business owners, government, and non-governmental organizations) and health plans across the United States will join health care providers and patients to accelerate the realization of a competent, considerate, culturally-relevant, compassionate, collaborative health system.

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Requiem for Family Medicine

Posted By Paul D. Simmons, Thursday, August 29, 2013


This is the second post in a series of "blasts from the past". These classic posts will highlight issues that are just too important to collect dust in the archives. The series will be off and on for the next several weeks. Enjoy!

(This piece was originally posted on August 2nd, 2012)

Family medicine is a young specialty, a mere forty-three years old (1). Unfortunately, family medicine will be extinct before it reaches its 70th birthday if current trends continue and—although I write as a family physician who educates family medicine residents and loves the idea and ideals of family medicine, I say—this might not be a bad thing. Several forces, both from within and external to family medicine, are conspiring to make us irrelevant, unnecessary and obsolete. We’ve all seen the Match Day trends (2). Each year until 2010, fewer medical students pursued training and careers in family medicine, and the slight increases over the last few years are largely attributable to more family medicine residency positions available. We cannot fill our available positions with US graduates. Many of those who match in family medicine are trained in a shrinking spectrum of skills. Many new graduates quickly jettison any broader skills they may have had in the name of work-life balance (3). Across the country, specialists and insurers implicitly or explicitly argue that family physicians cannot and should not be doing surgical (or non-surgical) obstetrics, endoscopy, minor surgery, ICU care or hospital medicine (4). We are often complicit in this effort to minimize our domain of practice, again in the interest of lifestyle or avoiding liability.

As our skills and practice scope are diminishing, a wave of mid-level practitioners (i.e., physician assistants and family nurse practitioners) are moving into primary care medicine (5,6,7). They share many of our same skills, are able to prescribe and order just as we are in a growing number of states, and are paid less. Most of these so-called "physician extenders” do excellent work and are viewed as equivalent to physicians by many patients. It is inevitable that health systems, policy-makers and third-party payers will soon realize—with dollar signs in their eyes—that these practitioners are inexpensive physician substitutes rather than physician "extenders.” All of the skills, more empathy and a similar scope of practice without the egos or paychecks of physicians.
Paul D. Simmons
Our support for the Patient-Centered Medical Home (PCMH) model, while predicated on admirable ideals, could easily be speeding our demise.

Sadly, family physicians are ill-equipped to resist our own demise because we lack a clear sense of what, exactly, it is we do. Not only does the public have little sense of how a "family doctor” differs from an old-fashioned "GP” or an internist, many of us have a difficult time explaining the distinction apart from defensively sputtering, "We’re a specialty, too!” Family medicine, some say, takes care of 90% of medical problems that present in the outpatient setting. Of course, so do internists (for adults), pediatricians (for children), and emergency physicians (for everyone). Family medicine, some say, provides continuity of care over the lifespan. Perhaps thirty years ago this was true. Now, however, vanishingly few family physicians will spend a career in the same location, taking care of the same population.

Even more troubling, however, is a deeper sense of inadequacy within the family physician’s psyche. Yes, I take care of adults, but can I really do so as well as an internist? Yes, I take care of children, but can I really do so as well as a pediatrician? I may deliver babies, but can I really provide the same quality of care as an obstetrician? If the reader balks at these questions, consider: if your wife were to experience a pregnancy complication, and you had the option, would you ask for an obstetrician or a family physician? If your child was suddenly struck with serious illness, would you bring her to a pediatrician or a family physician? We claim we are "equal” to our specialty colleagues—yet when serious or complex illness strikes those we love, we may find we have been playing doctor and we want a Real Doctor to step in to save us. Do patients sense this as well?

The larger medical world certainly seems to have detected our impotence. Family physicians exert minimal or no influence in determining our own payment structure, nor are our protests taken seriously. The Accreditation Council of Graduate Medical Education (ACGME) frequently ignores or delays our specialty’s recommendations or intentions (8). The AMA/Specialty Society Relative Value Scale Update Committee (RUC) continues to perpetuate an unjust payment model despite our protests (9). Family physicians are not the doctors that come to mind when patients think of disease-detecting, mystery-solving "experts” at the Mayo Clinic or Cleveland Clinic, nor do many tertiary- and quaternary-care institutions see a significant role for us in their delivery of medical care. Our medical journals are of comedically dubious quality, and we seem to be best at publishing, if anything, within the review article genre (10).

Family physicians exert minimal or no influence, ... nor are our protests taken seriouslyOur support for the Patient-Centered Medical Home (PCMH) model, for example, while predicated on admirable ideals, could easily be speeding our demise. The PCMH model rests on the idea of team-based care, where many of the functions previously carried out by physicians are delegated to nurses, medical assistants and case managers. This is intended to free up the physician to deal with the "hard” cases for which we are best suited. The problem is: we are not best-suited. The endocrinologist is best-suited to deal with the complicated, uncontrolled diabetic patient that cannot be brought under control by the nurse practitioner’s efforts. Similarly, the cardiologist is best-suited to deal with the refractory hypertensive; the gastroenterologist with the complicated hepatitis C patient. The family physician, in the PCMH model, is an unnecessary (and expensive) middle-man who has very little to add to the best management efforts of a high-functioning team operating with evidence-based protocols and guidelines. Inevitably, someone in authority will realize this cost-saving, simplifying fact.

Our support for the Patient-Centered Medical Home (PCMH) model, for example, while predicated on admirable ideals, could easily be speeding our demise. The PCMH model rests on the idea of team-based care, where many of the functions previously carried out by physicians are delegated to nurses, medical assistants and case managers. This is intended to free up the physician to deal with the "hard” cases for which we are best suited. The problem is: we are not best-suited. The endocrinologist is best-suited to deal with the complicated, uncontrolled diabetic patient that cannot be brought under control by the nurse practitioner’s efforts. Similarly, the cardiologist is best-suited to deal with the refractory hypertensive; the gastroenterologist with the complicated hepatitis C patient. The family physician, in the PCMH model, is an unnecessary (and expensive) middle-man who has very little to add to the best management efforts of a high-functioning team operating with evidence-based protocols and guidelines. Inevitably, someone in authority will realize this cost-saving, simplifying fact.

While our specialty shrinks and delegates itself out of existence, some of us take refuge in the ridiculous romanticism of "biopsychosocial” or "patient-centered” or "holistic” flag-waving—as if patients would rather have sympathetic hand-holding than competent, efficient, expert medical care. That’s all fine, of course. We’re generally nice people. But while we’re spending our collective efforts on patient focus groups, learning acupuncture, satisfaction surveys, lifestyle balancing acts and "restoring the mystery” to medicine, our colleagues in internal medicine, pediatrics, obstetrics, critical care, surgery and emergency medicine are taking care of actual seriously sick people and showing that they can do a better job of it than we can. Perhaps we should step aside and let them get back to work.

REFERENCES:

1. Piscano, NJ. (n.d.) History of the Specialty. From American Board of Family Medicine website. Retrieved from https://www.theabfm.org/about/history.aspx.

2. Porter, S. (2012) Family Medicine Match Rates Increase Slightly. AAFP News Now, American Academy of Family Physicians. Retrieved from http://www.aafp.org/online/en/home/publications/news/news-now/education-professional-development/20120316matchresults.html.

3. Kotmire S. (2012) Shrinking Scope of Practice Raises Questions About Future of Family Medicine Training. Leader Voices Blog, American Academy of Family Physicians. Retrieved from http://blogs.aafp.org/cfr/leadervoices/entry/shrinking_scope_of_practice_raises.

4. Should Colorectal Surgeons and Family Doctors Perform Colonoscopy? (2012). Gastroenterology.com, retrieved from http://www.gastroenterology.com/featured/should-colorectal-surgeons-and-family-doctors-perform-colonoscopy.

5. Rough G. (2009). For many, a nurse practitioner is the doctor. Arizona Republic. Retrieved from http://www.azcentral.com/news/articles/2009/02/21/20090221nursepractitioners0220.html.

6. Horrocks S, Anderson E, Salisbury C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal 324: 819-23. Summary retrieved at http://apps.who.int/rhl/effective_practice_and_organizing_care/SUPPORT_Task_shifiting.pdf.

7. Flanagan L. (1998). Nurse practitioners: growing competition for family physicians?Family Practice Management 5(9): 34-43. Retrieved from http://www.aafp.org/fpm/1998/1000/p34.html.

8. Wood J. (2012). Changing training standards for maternity care. Leader Voices Blog, American Academy of Family Physicians. Retrieved from http://blogs.aafp.org/cfr/leadervoices/entry/changing_training_standards_for_maternity.

9. AAFP Opts to Remain in the RUC (2012). AAFP News Now, American Academy of Family Physicians. Retrieved from http://www.aafp.org/online/en/home/publications/news/news-now/inside-aafp/20120313rucdecision.html.

10. Van Driel L, Maier M, De Maeseneer. (2007). Measuring the impact of family medicine research: scientific citations or societal impact? Family Practice(2007) 24 (5): 401-402. Retrieved from http://fampra.oxfordjournals.org/content/24/5/401.full.

 

Paul D. Simmons, MD FAAFP, is Extremely Junior Faculty at St. Mary's Family Medicine Residency in Grand Junction, Colorado where he serves mainly as a negative example for malleable trainees. He practiced family medicine, including obstetrics and endoscopy, for several years in rural eastern Colorado and Wisconsin before joining St. Mary's. His interests include antique Jungian archetypewriters, obscure eponymous diseases, superhero movies, Sherlock Holmes and misanthropy.

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Integrated Care Thought Leader Series: Alexander “Sandy” Blount, EdD

Posted By Cheryl Holt, Thursday, August 22, 2013

(This blog post is a reprint of a piece by Cheryl Holt from July 9th, 2013. Click here for the original post)

"It’s very hard to do integrated care and still think of mental health and physical health.”

Welcome to the first in the Integrated Care Thought Leader Series. This series will focus on the forward-thinking individuals who have had the foresight to envision possibilities in the healthcare industry's future. I'm pleased to begin the series with a man who has been instrumental in advancing integrated healthcare.

Alexander Blount, EdD, better known to most as "Sandy," has played a very important role in bringing the integration of behavioral health and primary healthcare to its current prominent focus within the healthcare industry. Dr. Blount is credited with coining the term integrated primary care in his 1994 publication, "Toward a System of Integrated Primary Care," Blount A, Bayona J. Family Systems Medicine, 1994;12:171-182.

He currently serves as Professor of Clinical Family Medicine and Psychiatry at the University of Massachusetts Medical School in Worcester, MA and Director of Behavioral Science in the Department of Family Medicine and Community Health.  He teaches resident physicians the psychosocial skills of primary care practice and founded the post-doctoral Fellowship in Clinical Health Psychology in Primary Care.  He was previously Director of the Family Center of the Berkshires in Pittsfield, MA and a faculty member at the Ackerman Institute for the Family in New York. He has more than thirty-seven years experience as a therapist, teacher of physicians and therapists, administrator and lecturer in the US and abroad.  He is a member of the National Integration Academy Council and has had a leadership role in state and national efforts developing healthcare policy.  His books include Integrated Primary Care: The Future of Medical and Mental Health Collaboration published by W. W. Norton and Knowledge Acquisition, written with James Brule', published by McGraw-Hill.  Click here for more information about Dr. Blount.


It’s an honor to talk with Dr. Blount about the integration of behavioral health and primary care. Yes, he admits that he is optimistic about the direction in which the field is moving! His enthusiasm is almost palpable, with a freshness that belies the number of years he has devoted to the advancement of this revolutionary approach to healthcare. It’s apparent that this enthusiasm easily holds the attention of the students he teaches at UMASS.

Dr. Blount is a visionary whose diligent efforts and perseverance have made great strides toward bringing attention to the widespread failure to address the individual patient as a whole. He graciously agreed to provide insights for Behavioral Health Integration Blog:

What do you see as being the greatest barriers for successful integration of behavioral health and primary care services?

Dr. Blount: I see two things:

First are the barriers that have always been there: regulatory barriers that are built on the idea that mental health and medical services have to be kept separate, financial barriers that only pay fee for service and define services as what is delivered in specialty mental health, and cultural barriers on the part of both medical and mental health people that make working together difficult without some cultural broker who can make the connections and translations necessary.  These have been our problems historically, and happily with the ACA and the PCMH movement, these are reducing.

We will need a four-fold increase over 2010 levels in behavioral health clinicians
The second area is the barriers caused by our own success.  Because integrated care is becoming more possible and is proving itself, there is pressure to start programs in settings where there is little understanding of what it entails and little time and resources to prepare for the change.  People are getting put into integrated programs or co-located, who aren’t trained for it and didn’t pick it. They don’t know what to do. They go in and do specialty mental health. They do what they’ve been trained to do…and it doesn’t work. Then administrators, who may have been skeptical initially, thought this was a fad, see this failure and think "oh yeah, I was right,” it was more inconvenient than useful. We felt we had to develop a training program at UMass Medical School available to these folks to prevent just this form of failure.

Also because there is sometimes a faddishness about integration, you get some administrators who become "true believers” who really don’t know how to do this. They see a presentation,  and they say this is what we are going to do–and they start it without any depth of understanding. It’s sort of the administrative version of the clinician that doesn’t work. We need clinicians who are fully oriented to integrated primary care and leaders who are aware of the difficulties of making these changes and who can develop the buy-in from the whole practice. Integrated pilot programs are often funded on three year cycles.  Places like the DIAMOND Project in Minnesota, where they’ve had some real time to make it work, say that it’s more like a five year cycle from beginning to fully transformed practice.  I fear that federal and private funders will think it will happen faster than it does and will turn away.

Another barrier to our success is the workforce crisis we are facing.  All of the government projections of what will be needed for behavioral health workforce, when compared to the number of people who are being trained, say we will have a terrible deficit, and those projections were made without any calculation of the workforce that has proved to be needed in mature integrated settings.  When word gets out that we will need a four-fold increase over 2010 levels in behavioral health clinicians in Federally Qualified Health Centers alone, not to mention the rest of the health system, the true magnitude of the problem will become clearer.

What excites you about the field today?

Dr. BlountOne, is absolutely the transition in payment models that may make a great leap forward happen. Essentially those models let us implement the clinical routines of integrated care. Up to now the payment models have dictated routines that weren’t very integrated.  Paying for health, rather than for services allows us to deliver evidence based care by the clinician best able to do it at the point that it is most sensible and acceptable to the patient.   Having it actually knitted into the flow of care makes a big difference.

And the other thing that I see happening is a transformation in how we conceptualize mind and body, illness and health.   It’s very hard to do integrated care and still think of "mental health” and "physical health”. The categories just begin to break down because they don’t describe the way people present. They don’t describe how problems form over the years. We’ve had science now for a good while on the plasticity of brain and the way that experience changes the brain and the brain changes experience. The current science even describes the way that experience changes what genes are expressed at various points in a person’s development.  In other words, the science of the brain has been there but the way of thinking in our day-to-day clinical lives has not because we have been enacting models build on conceptions of separate domains.  As we enact integrated clinical routines, we will begin to think differently.  We create the likelihood that the science of the brain will be mirrored in the unity of our conceptions about people and how we try to help them.
As we enact integrated clinical routines, we will begin to think differently

So I think, at least in the places that are more developed, the places that integrated care gets to be mature, you begin to see different forms of conceptualization and hopefully we’ll be documenting those, writing about those, helping to pull others along. There aren’t many places where integrated care is really mature. The places that are mature are very different in numerous ways that don’t initially seem to be connected to integration. The question of "isn’t integration interesting, how do we work on it?” just goes away and the questions are about new ways of helping patients, new groups of patients we can understand better, and new ways of involving patients on their care teams.  How we involve people in their own care, how we get past the doctor as leader and authority to doctor and the team as teachers and facilitators, that’s really the next piece. And when that is going well, I think that integrated care will sort of already be there.

Will you look into your crystal ball for us and tell us what you foresee in the future for integration?

Dr. Blount:  Let’s imagine that we get it right in terms of mature programming, mature routines of integration as far as our workforce allows.  Then we begin to be able to think about health and illness differently, and the whole set of concepts, the models that we have of understanding health and illness and how to influence those begin to move. I foresee the time when there’s a foundation of mature integrated care that we will be looking at great leaps forward in theory or great research leaps forward with greater understanding of what and how we should be researching. That’s one optimistic thing.

And when I look in my crystal ball I think we are going to have states that begin to have whole-state programs that are starting to be implemented and organized so that we can begin to look at the impact of integration on a really big scale.

Thanks so much to Dr. Blount for sharing his insights in the premiere of the Integrated Care Thought Leader series!

Check back soon for a conversation on integrated care with Benjamin Druss, MD, MPH, Rosalynn Carter Mental Health Chair and Department of Health Policy and Management Professor at Emory University.


Cheryl Holt, MA, CEO of Behavioral Health Integration Consulting, LLC, is an advocate for the integration of behavioral and primary healthcare for whole-person health and assists organizations in adopting a whole-health focus. She is active in social media promoting integrated care, behavioral health policy, and global mental health. She blogs regularly via the Behavioral Health Integration blog and manages LinkedIn's Behavioral Health Integration group and the Behavioral Health Integration page on Facebook. You can follow her on Twitter: @cherylholt, @BHPCIntegration, and @WorldMentalHlth

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Contact Us

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info@CFHA.net

What We Do

CFHA is a member-based, 501(c)(3) non-profit organization dedicated to making integrated behavioral and physical health the standard of care nationally. CFHA achieves this by organizing the integrated care community, providing expert technical assistance and producing educational content.