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Collaboration is Personal Too: Speaking of Microblogging

Posted By Gonzalo Bacigalupe, Thursday, February 3, 2011
Updated: Friday, June 10, 2011

Microblogging, writing and immediate publishing of brief entries (i.e., 140 characters in Twitter), has been personally a compelling draw for several years. With almost 12,000 entries in my @bacigalupe account and about 2,000 in an academic project (@healthglobal), it is legitimate to ask the question of why a busy researcher and clinician would want to spend time almost everyday in such a medium. One way for me to describe its power is in its ability to continuously experiment collaboration in what seems a purely virtual environment; one in which the conversations are happening as if it were in real time. For me though, these conversations are an experiment with the artificial dichotomy of the real and virtual dissolving.

The ongoing sharing with about 6,000 individuals and institutions has been for the most part friendly, fun, intelligent, and thought-provoking: A true learning experience. I have met individuals from all over the world, old and young, unilingual and multilingual, the majority sharing some similar interests although from very different points of view. This social technology has brought together many streams of interests, personal, professional, and scholarly and often with gems (those #ff one would want everyone to follow) that seem to integrate them all. For the most part, these are people I had never met before but in planned, and at times surprising ways, found them next to me at a conference, a restaurant, or other venue.

What has been so rich is also the network of conversations that started in the public arena and have continued via direct email. In some cases, those conversations became the source of shared projects, i.e., a panel at the American Psychological Association. One of the richest aspects is the interdisciplinary nature of those participating. Folks I would have taken a defensive to, or even rejected their stance, if I had been exchanging ideas face-to-face have now become a way of expanding my view; of making collaboration possible across divides.

This exercise at collaborating in conversation, in what amounts to hundreds of conversations, has included discussions about politics and public policy, healthcare (a lot) and public health, education, ethics in research, psychology, and much more. One of the most fascinating weekly dialogues in which the medium has mirrored part of the content (a weekly discussion about healthcare and social media or #hcsm) was the initial stimulus to writing a scholarly paper on the subject of the potential role of social media in collaborative health care (soon to be published in Family, Systems, and Health).

During times of disasters, for example, the earthquakes in Haiti and my native Chile, these conversations took a different turn, they became a way of supporting those in the middle of the crisis and sharing useful and reliable resources with those trying to help the survivors in the field. And two upcoming papers (one in Family Process) explore how social technologies transform the immigrant family experience as geographical and time distances are reduced with the fast adoption of cell phones and cheap web-conferencing calls.

What happens with microblogging, similar to conversations with friends or good colleagues, is that the activity is truly participant-driven. Twitter exchanges are not about the technology we are using but about who is participating. Like conversations with friends or colleagues, in Twitter the best of a listening and transparent stance occurs if those who are in conversation (as Followers or as Following) are honest, interesting, and respectful. What distinguishes this virtual conversation from those around a real table is the possibility of having a much more diverse group of participants sharing their thoughts; the walls are much more permeable and barriers to entry are minimally guarded.

Like solid friendships, it takes time to "get Twitter.” It takes time and energy to foster good relationships via the web, like it does face-to-face. What is different though is the potential for a rich and continuous selective form of absorbing the wealth of information that comes to us or we directly seek. Like friendships, it may be that the group of followers and the ones you follow reflect a parochial reflection of my own interests, political leanings, and professional biases. That may be the case but despite these potential limitations, I am thankful for the ways in which microblogging has enriched my professional, scholarly, and personal life.

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Promoting Diversity in Membership: Growing the CFHA While Broadening its Constituency

Posted By Jennifer Hodgson, Thursday, January 27, 2011
Updated: Thursday, June 2, 2011

This blog is not filled with grandiose rhetoric. You will neither find state-of-the-art statistics nor endearing stories about collaborative successes. Rather this blog is designed to challenge the face of CFHA and establish tangible solutions to help us move forward. It is an exciting time to be a member of CFHA as our association is gaining national attention for our grassroots work. CFHA’s annual conferences and pre-conference summits have stimulated important discussions and actions at each sponsoring state’s policy, payment, and community levels.

They have also resulted in an expansion of our membership base, hiring of staff, and increase in conference attendance. The key to success for any organization though is not accepting what it is but aiming for what it can become.Membership has always been the heartbeat to CFHA but until recently we have focused more on collaboration between the behavioral and medical specialties only. It is important and timely that we examine our diversity not only in discipline but also with regard to culture and geographic representation. We have been strong in the medical and behavioral health disciplines, particularly with family medicine physicians, marriage (couple) and family therapists, medical family therapists, and psychologists.

We have some representation from internal medicine, pediatrics, social work, counseling, pharmacy, psychiatric nursing, dental, nursing, and healthcare administration. However, many disciplines are missing from this list and are important to include and recruit to join CFHA. While some may be underrepresented (even those mentioned above), others are absent and need to be a part of our growing association. Which ones come to mind for you? How do you believe we can successfully invite them to become part of CFHA?

Diversity within CFHA does not just need to happen in discipline, but also in race, ethnic origin, and sex as well. While we are actively working on statistics regarding our current CFHA composition, attending the annual conferences gives a fairly accurate depiction of where we are not as strong. Again, it is critical that we work hard to grow the association so that it mirrors the populations we serve and represent. What ideas you do have? What are your thoughts about how we can grow and diversify our membership?

Lastly, we have a lot to learn from our international collaborators. Although we have drawn some presenters and attendees from other countries, this is one area of our outreach that is in need of additional focus. The challenge for many of our overseas colleagues is the expense of coming to the United States for a conference. Our limited budget precludes offering scholarships for international attendees. However, we need to think outside of the box for ways to engage groups who value collaboration as we do and who have learned how to study it, initiate it, and create policy for it. What international groups are you aware of that we need to begin to engage in active discussions?

In CFHA there is no need for guilds but there is a need for fair representation across all of the variables addressed above in this blog. I hope you will join me in celebrating our growth and accepting this challenge of diversifying our membership.

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The Relevancy of Relevance--Collaborative Care's Search for Maturity

Posted By Ben Miller, Thursday, January 20, 2011
Updated: Friday, May 27, 2011

In the spirit and tradition of Albert Camus, let us take a moment and dwell in the absurd. Now for you philosophy majors out there, I am not going to attempt to do justice to true absurdist philosophy, but rather take great liberties and address the field of collaborative care. Camus believed that life was absurd in that human’s constantly seek meaning from life, but have difficulty finding it. Collaborative care as a field continues to search for meaning. The ultimate question is where can the field find that meaning and is it possible to obtain this meaning?

It has been shown for some time that integrating mental health into the larger medical arena leads to better outcomes. While research of this type initially began in specialty medical settings, it has more recently expanded into the general healthcare arena, primary care. As where most people receive their healthcare, primary care identifies more mental health, treats more mental health, and arguably has the most to do with what happens "next” with mental health than the mental health system. Still, in the face of these facts, there remains difficulty integrating mental health providers into primary care to "streamline” and "defragment” how we as a healthcare system treat mental health. This fundamentally is a policy issue, and one that has not been tackled.

As I have recently charged the field to do more work in the policy domain for collaborative care (see upcoming Families, Systems & Health issue), I will not do so here; however, I want to make the point that much discussion and effort for collaborative care should continue to include policy whenever possible.

So conceptually, most agree that by integrating we are doing a great service to patients who would benefit from these services. We have some research, wonderful stories, and passionate leaders, but we do not have a firm standing in the healthcare system whereby our efforts are discussed as often as other "left out” aspects of healthcare such as prevention, quality measures and enhanced/modified payment schemes. So how relevant is collaborative care? How mature is the field? I will argue that there needs to be a tri-fold process that occurs to lead collaborative care down a road of increased relevancy and maturity especially as it relates to policy.

  1. Disruptive Innovation: Each new integration effort, started, studied and written up should do so under the auspices that the content can disrupt the status quo and attempt to address second order change. Papers simply rehashing what we know may not be that helpful for moving collaborative care forward; no more reviews of how great integration is – we have plenty of these. We need disruptive research and innovation that can move the "needle” for collaborative care.
  2. Policy Briefs: Sites interested and actively engaged in integration should become experts on how to write up one-page policy briefs. While stories have a powerful impact on policy, concise one page policy briefs that highlight an issue on integration with data (qualitative or quantitative) can be an even more powerful and persuasive argument for policy makers. One-page policy briefs, as difficult as they are to write, and write well, will be a distinguishing characteristic of a mature field where newly learned information begins to be included in the national dialogue on healthcare (for example of excellent one pagers see here). Additionally, policy briefs can accomplish the goal of getting the community talking about an issue germane to collaborative healthcare and bring the field more closely together.
  3. Seeing the Big Picture: Representing an ideal, a whole (field/movement), rather than a specific part (my model) means that rapid infusion of the collaborative care message into policy may be more likely as fewer barriers will be in place filtering the message. Policies advocating for comprehensive collaborative healthcare can be inclusive. Since there is much we still need to know about what strategies work for integration, it is premature to promote a "standard approach” to integration. However, by grounding our argument in the inseparability of mental from physical, we can discuss the cost of separating mental and physical, the problem with access to mental health, and providers desire to have onsite mental health, we can start to address the "big picture” not simply another workaround.

So you see, collaborative care has a way to go before we can increase our stage presence on the national healthcare stage. We can get there faster if we begin to consider how to mature our field by more comprehensively studying our disruptive integration efforts, writing up smart, concise policy briefs on said efforts, and recognize collaborative care’s role in the larger healthcare system.

Is it possible to find our "meaning” as a field or will we continue to search for meaning without ever finding it? Addressing policy head on is a proactive way to find our meaning for collaborative care. Because really, the last thing any of us want is for collaborative care to be a "stranger” in national healthcare debates.

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CFHA--A Foundation Perspective

Posted By Mary Jo Dike, Thursday, January 13, 2011
Updated: Friday, June 10, 2011

In 2008, I was tasked with taking over and breathing new life into the Foundation’s initiative on "Integrating Mental Health and Medical Services”. The initiative began several years earlier and was developed as a result of hearing Kentuckians tell us that we need increased access to health care for underserved and rural communities and that services should be delivered in a less fragmented way. I’m not a health care expert, "I have an MBA”, I thought. "How am I going to go about this?”

My first move was to ask a friend and colleague, Dr. Nancy G. Moore, Executive Director for Governance Affairs at APA. She said, "You need to talk to Ben Miller” – end of sentence. Ben who? Okay, so I email Ben Miller and two seconds later I had a response and thus, new life was breathed into the Foundation’s initiative.

Ben conferred with me on this initiative and spent time listening to the issues faced by Foundation grantees – The Foundation funded primary care and community mental health center demonstration sites in Kentucky working to integrate mental health and medical services. We learned that these sites shared many of the same challenges experienced by sites across the country. Ben started opening doors to resources, people and information; providing me and Foundation grantees with opportunities for training, technical assistance and guidance on tackling regulatory and policy barriers.

The biggest door he opened for me and the Foundation was to the Collaborative Family Health Care Association. Whew, that name is a mouthful. It’s almost as long as Foundation for a Healthy Kentucky. I was grateful to learn everyone calls it "CFHA”. I attended my first CFHA conference in 2008 in Colorado. It was instant – love at first site – everything I could ever want to know about integrating health care services was contained within this "small but mighty” organization.

I remember the first session I attended – it was a "Pre-Con” with Dr. Wayne Katon on "Evolving Models of Collaborative Care” – WOW, what a way to start a conference! My awareness and knowledge of the fundamentals, research and models of collaborative care went from zero to sixty in 3 days.

In the months following, I began funneling what I learned to our grantees and other key stakeholders in Kentucky. The Foundation began sponsoring tracks on integrated care at health care professional meetings in Kentucky; provided the Certificate Program in Primary Care Behavioral Health to Foundation grantees; and formed an Integrated Care Action Team (ICAT) to identify and seek to address regulatory and policy barriers to integrating services.

Because CFHA and its network of members had been such a tremendous resource for me, it was a no-brainer when I learned that hosting the 2010 CFHA Annual Conference in Louisville might be an option – I jumped on it and quickly identified Kentucky-based leadership to chair and serve on the planning committee. My colleagues (Drs. Baretta Casey and Sheila Schuster) were delighted when the Board voted to hold their conference in Louisville, and we immediately got to work as the 2010 Annual Conference Co-Chairs.

From the Foundation’s perspective this was a wonderful opportunity to bring the definitive organization for collaborative and integrated care to Kentucky. For Foundation grantees and others in Kentucky who are working on advancing these models of care, having local access to this conference was a tremendous technical assistance and networking opportunity.

As you can see from the 2010 Conference Report on the CFHA website, the conference was a tremendous success, 60 of the 355 registrants were Kentucky health professionals and students. CFHA membership increased from 3 to 25 active members from Kentucky. What is even more exciting, participants in the conference came from 37 states and 5 countries creating a dynamic learning and networking event.

By becoming involved in CFHA, the Foundation has facilitated linkages in Kentucky to a national network of learning, sharing and moving towards "a comprehensive and cost-effective model of healthcare delivery that integrates mind and body, individual and family, patients, providers and communities.”

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V-Forming Healthcare Through Collaboration

Posted By Ajantha "AJ"Jayabarathan, Wednesday, January 5, 2011
Updated: Thursday, June 2, 2011

2011 finds Healthcare in the throes of transformational change, locally and globally. In some Canadian provinces, such as Prince Edward Island, change has been as gradual as tectonic plates forming the earth’s crust but, Alberta, has known the volcanic eruption of change, destroying what was created before, while organizations and people struggle to survive the onslaught and the aftermath.

Remarkably, the issues plaguing the US, Canada and UK, have common themes, despite their differing approaches to healthcare and distinctly varied philosophies and values:

  • Emergency room overcrowding
  • Poor access to care
  • Disjointed silos of care
  • Escalating costs
  • Aging populations
  • Dissatisfaction with pharmacologically based algorithmic care
  • Separation of mind, body & spirit in the application of the medical model
  • Impact of ignoring social determinants of health
  • Caregiver & provider burnout
  • Challenges, risks & benefits linked with the use of the Internet and medical technology.

But 2011 finds me working as a doctor, healer, teacher and guide within a renewed context of self managed health and wellness. What transformed me and my practice in the last two decades?

The first influence was working collaboratively with patients, families and an inter-disciplinary mix of physician & non-physician providers. The second influence relates to the development of a robust electronic interface within my practice. Lastly, the freeing exchange of knowledge, enabled by the Internet, has broken down walls that once separated doctors, patients and other providers of care.

Many people working in interdisciplinary teams believe they are working collaboratively. I would like to challenge this view using the perspective gained from observing Canada Geese. "Lessons from Geese” has found worldwide circulation since it was written in 1972 by Dr. Robert McNeish, a biology teacher and student of nature from Baltimore. A combination of aerodynamic benefits and enhanced ability to communicate are thought to be reasons why geese fly in V-formation. They also fly is columns and clusters and V-formation flying occurs less than 25% of the time. Below are a few Facts, Lessons and Reflections comparing the collaborative nature of Geese to that of healthcare providers.

Fact: As each goose flaps its wings it creates an "uplift" for the birds that follow. By flying in a V-formation, the whole flock adds 72% greater flying range than if each bird flew alone.

Lesson: People who share a common direction and sense of community can get where they are going quicker and easier because they are traveling on the thrust of another.

Reflections: How often do you work as part of a team with others? Do you consider "patients” and "family members” as members of your team?

Fact:When a goose falls out of formation, it suddenly feels the drag and resistance of flying alone. It quickly moves back into formation to take advantage of the lifting power of the bird immediately in front of it.

Lesson: If we have as much sense as a goose we stay in formation with those headed where we want to go. We are willing to accept their help and give our help to others.

Reflections: Do you lift others with your energy? Do you allow yourself to be lifted by another’s energy?

Fact: When the lead goose tires, it rotates back into the formation and another goose flies to the point position.

Lesson: It pays to take turns doing the hard tasks and sharing leadership. As with geese, people are interdependent on each other's skills, capabilities, and unique arrangements of gifts, talents, and resources.

Reflections: Does your ego get in the way of recognizing what you need to learn from the experiences of others? Can you balance the needs of the flock and your personal ambitions?

Fact: The geese flying formation honk to encourage those up front to keep up their speed.

Lesson: We need to make sure our honking is encouraging. In groups where there is encouragement, the production is greater. The power of encouragement (to stand by one's heart or core values and encourage the heart and core of others) is the quality of honking we seek.

Reflection: Do you recognize when you seek to compete rather than collaborate? Are you secure enough, empowered enough, to give another what they need from you?

Fact: When a goose gets sick or wounded, two geese drop out of formation and follow it down to help and protect it. They stay with it until it dies or is able to fly again, then join another formation or catch up with the flock.

Lesson: If we emulated geese, we would stand by each other in difficult times as well as when we are strong.

Reflections: How much can you give up for another? Today? Tomorrow? In a lifetime? Is the path to your goal linear and rigid? How much change can you tolerate and how flexible are you?

Fact: Geese fly south for the winter in the Northern Hemisphere.

Lesson: It is a reminder to take a break from the cold of winter and take a vacation to some place warm & sunny to rejuvenate ourselves.

Reflections: How well are you? How happy? How content? Are you alive? Are you engaged in your life? When did you last replenish your reservoir?

Fact: The larger flocks of geese usually inhabit areas where eating geese is more popular whereas when there are smaller flocks of geese flying, there is usually smaller demand for geese, to be consumed as food.

Lesson: Larger groups of humans may not always be as effective as smaller groups that can maneuver quickly in life and business without being eaten up by the competition.

Reflections: Is your "team” effective in affecting change that is meaningful? Is your team in "touch” with the real world? How responsive is your team?

These points of reflection are intended to evoke an inner dialogue about "collaborating” with others; physicians, non-physicians, patients, clients, families, caregivers, politicians, policy makers, administrators, students, and those in institutions that are linked with "health care”. As the winds of change blow and the currents of transformation threaten us, V-forming our disciplines through true collaboration appears to be the path of least resistance and best direction. Honk, if you agree!

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Two Steps Forward, One Step Back

Posted By Ben Miller, Tuesday, August 3, 2010
Updated: Thursday, June 2, 2011

In the current redesign of healthcare, there is precious little time for meetings to discuss what should be done next. The convening of various healthcare stakeholders to Baltimore, Maryland for the URAC/HAYES Paul Wellstone Mental Health Parity Stakeholders Conference was a unique opportunity for dialogue to occur around the future of mental health. This meeting was timely and precise in its attempt to examine the impact of mental health parity on current healthcare legislation, clinical practice, and payment strategies. There were three main points that emerged from the meeting that I will briefly address.

First, there appears to be growing sentiment that mental health parity is an important step for mental health treatment, but remains insufficient. Mental health parity law is in direct response to the fragmentation of the healthcare system. From an insurance perspective, parity brings mental health on an equal footing with medical benefits. This is a positive step for individuals in the community who need access to mental health services, but have previously been unable to access due to insurance barriers. However, it is important to note that just because insurance barriers have decreased does not mean more people will access mental health services. For example, we know that the majority of the public receives their mental health care in primary care, and that when referred to outpatient mental health, they often do not go. This may not change just because one has insurance to pay for services.

Second, within the redesign of primary care in the patient-centered medical home (PCMH), there is an increased opportunity to make the case that mental health and substance use must be included. While many know of the inseparability of mental health from primary care, this point still needs to be made every time the PCMH is discussed. The integration of mental health providers into the PCMH is one possibility for primary care’s redesign; however, mental health needs to constantly be at the table of discussions on the PCMH for this to happen. While this is just one future for mental health, acting now and acting fast is key to success as the fluidity of primary care’s redesign will not stay this way long.

Third, more research is needed to support the importance of mental health in the larger healthcare system. Without enhancing the evidentiary support for mental health and psychological treatment in medical settings, recommendations will be anecdotal and possibly ineffective. A golden opportunity could be missed. At a point in our nation’s history where we are looking to "bend the cost curve” and provide higher quality more effective and efficient care, our arguments should be grounded in science. There are many examples of this type of research happening now throughout the country. Mental health providers interested in the future of their field should consider using similar measures, tracking similar outcomes, and sharing this data so a stronger "business case” can be made for integration. Yes, there is a robust literature base on psychological treatments for medical conditions, but they have predominately been disease specific and limited in generalizability. We need more effectiveness trials that look at the heterogeneity seen in our healthcare settings.

There are rare opportunities in healthcare where systems can be profoundly impacted by their redesign. This may be one of those times. While mental health parity brought a group together in Baltimore, the passage of the bill itself was more confirmation of how far we still have to go. Dichotomizing mental health from physical health is a false separation. Two systems have developed from our inability to treat the whole person. Will healthcare providers of all ilks be able to rise to this momentous occasion and define itself in a new system? Will we be able to know what our future looks like and actively work towards this point? As I outlined above, there are many opportunities for mental health to become a major player in healthcare. Are we willing to take the risk? Are we willing to innovate? The choice is entirely up to us; but make no mistake, if we do not move, and move now, we will be left behind fighting for another version of parity in 10 years.

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Collaboration Haiku

Posted By Randall Reitz, Tuesday, July 27, 2010
Updated: Thursday, May 26, 2011

As the CFHA Conference in Louisville fast approaches, the collaborators of the world are abuzz with creative energy. What better way to channel that enthusiasm than by writing a short Japanese poem? You loved haiku in 4th grade, now that you've finished grad school, you are a Haiku MASTER.

This link will take you to a brief video synopsis of how to write haiku. Traditional haiku maintains a very tight formulation of 17 syllables, 3 lines, 1 season, and the creative juxtaposition of 2 disparate images. As with all things American, new world haiku tend to be more free-form and include the profane with the natural. For example, a favorite website of mine boasts over 19,000 haiku dedicated to spam, including this gem:

Post-SPAM catharsis:

Peptic acid and pink chunks

Floor-mount Pollock piece

Please take a minute to add your own haiku about collaborative care or your aspirations for the upcoming Louisville conference. I'll get us started with:

Reform the system

Discover self among peers


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Medical Family Therapy: Integration Into Healthcare

Posted By Jennifer Hodgson and Tai Mendenhall, Monday, July 26, 2010
Updated: Thursday, June 2, 2011

Medical Family Therapy (MedFT) is inspired by many people from several different professions. It has made a nest under the umbrella of Family Therapy by nature of its attention to the family unit, systems thinking, and relational foci. However, when it comes to practicing MedFT, numerous professions embrace and apply its concepts. My intent in this piece is to briefly introduce two core concepts (of many) that form MedFT’s foundation and articulate how they represent an asset(s) to healthcare.

Foundational Concept #1: Relationally-Minded. Medical Family Therapists, while generally viewed by others as professionals who are skilled at providing family therapy in medical settings, they see their role in a considerably broader frame. They work systemically with individuals, couples, parent-child subsystems, and can facilitate health behavior groups across a variety of mental health and physical health conditions and illnesses. Their work with relationships also extends out to the providers within the healthcare team and across the healthcare system. At times this looks like comforting a nurse who just lost her mother, sitting with a NICU resident who lost a baby in his care, calming down a physician who just found out that her patient is selling his pain medication at the local high school, or spending time figuring out how the clinical administrator can delicately reassign offices to accommodate a new hire. They see situations as having systemic impacts and help patients and providers to solve difficult relational issues. Where some may find comfort in working exclusively with the individual and see the support persons around the patient as data gathering assets, MedFTs believe that the more people in the room with the patient while the intervention is happening, the faster the change and greater likelihood of its sustainability.

Foundational Concept #2: Integrated/Collaborate Care Advocacy. Medical Family Therapists are trained to provide integrated and/or collaborative care in primary, secondary, and tertiary care settings. They recognize that without integration of care, patients will continue to fall in between the cracks of the healthcare system. MedFTs are trained to know and understand the culture(s) of medicine and have tremendous respect for it. They respect the ethical and reimbursement challenges that exist when integrating care and work to construct models that combine providers’ ideas into one shared treatment plan. They find the patient and family unit (as defined by the patient) to be critical partners in that process. You will also find MedFTs at the table drafting policy, designing models of integrated collaborative care, and running behavioral health components within healthcare settings. They are change-agents that help medical systems to thoughtfully integrate services in a manner(s) that pays simultaneous attention to the overlapping views and interests of the clinical-, operational-, and financial- worlds of healthcare.

It is through the advancing of these concepts (again, among others) that Medical Family Therapy is defined. Today there are several certificate and degree-granting programs in MedFT across the master’s and doctoral levels; within these programs the amount of education given regarding relational interventions and integrated collaborative care may vary, but these areas are consistently an important part of the curricula. This is important to note because not all family therapists, psychologists, social workers, or counselors who do family work are trained to do MedFT, and not all MedFTs are trained family therapists. And while MedFTs are not being defined as a independent profession currently, recent research shows that they are headed in that direction.

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Who's the Boss of Me?

Posted By Peter Fifield, Wednesday, July 21, 2010
Updated: Thursday, June 2, 2011

Good Question. A few weeks back my almost three year old son and I were looking at a poster of the 8 planets. After reviewing the names together it was his turn to try solo. He began with the sun then to the subsequent planets--pointing to each one he said "Mercury, Venus, Earf, Mars, Jupatewr, Saturn, Myanus, and Neptewn”. I offered him encouragement for his job well done and of course just one correction…”Isn’t it Uranus” I asked him with a slight grin. "No it’s mine Papa!” he insisted. At that point I could not help but appreciate what ownership he had of his body. Later, I asked my wife "At what point do we lose that ownership”?

It is hard to deny that many social psychology concepts have great significance regarding our health. Three different yet somewhat related topics come to mind. Diffusion of Responsibility, The Bystander Effect and Social Loafing—all of which basically state, the more people whom are involved in a situation, the less likely anyone will take responsibility for the outcomes of that situation. Usually a population greater than 10 is needed to see these social phenomena at work. I can’t help but speculate that maybe there is a direct connection between these concepts and the state of our health care conundrum. Has our society created a nanny-istic health system that has become so protective of its patrons it has reached a point of harm?

Why do I have to look out for my own health? Why should I do it when someone else will? Due to many driving factors we have managed to medicalize most chief complaints presented in the primary care setting. Complimenting these sometimes "every day” medicalizations are a salvo of pills; a synthesized solution for the infirm. It is no wonder why the US is last in healthcare, we are trying to fix things that aren’t fixable or even broken--they are to some degree, just normal. My challenge as behavioral health provider is to empower people to be healthier but I continue to ask myself "Who am I to think I have the power to give back to them in the first place?

So this leads to the pressing question of how do we make this happen? How do we get people to become more possessive of their own heath and stop relying so much on medical intervention? How do we not only shift but balance our philosophical approach so people see their health as their responsibility not someone else’s? How do we as health care providers promote patient autonomy? Concepts such as collaborative patient centered healthcare, and the use of social media options as well as new medical technologies such as EMR’s "Health Apps ” for smartphones and other Health Information Technologies can make this job easier but there has to be more.

How did we end up creating this society based on health nannying…a sort of protectionist approach that conversely demotes the need for personal discretion and accountability? Maybe through the medicalization of our lives we adopted a social loafing perspective of ourselves; or maybe it is a case of learned helplessness. Either way we should adopt a new healthcare mantra like "I’m the boss of me”. I’m not sure when it happened but somewhere down the line we have managed to give someone else the power over our wellbeing. We have to work on taking it back. We have to somehow create a balanced healthcare delivery system where public and private sponsored healthcare options create a conduit that facilitates access to quality and evidence based care and simultaneously creates a venue where people have personal autonomy and accountability to themselves.

Typically when I find fault in a process I try not to opine unless I have a few potential solutions. Who do we blame for this mess: the medical model, the mere existence of health insurance, the need for a listed cause of death on death certificates or the drug companies—maybe all of the above? I’m at a loss here, possibly due to the magnitude and complexity of it all. That being said, this topic is too important, to forego a comment this time around even though I have no proposed solutions. Ultimately we have to ask: How do we shift the healthcare paradigm and truly allow people to be accountable for their health. Then we have to ask, "what do we do” if they don’t want it.

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Can Social Technologies Help a Healthcare Professional Organization?

Posted By Gonzalo Bacigalupe, Tuesday, February 23, 2010
Updated: Friday, June 10, 2011

Julia, an active board member of a health care professional organization, noticed my recent twitter activity, such as:

Paternalism, participation & partnership: the evolution of patient centeredness in the consultation> <> #cfha

What physicians should discuss with families in relation to brain-activity? <> @NEJM

WashingtonPost: Experts Defining Mental Disorders Are Linked to Drug Firms> <> #dsm5

Financial Ties between DSM Panel Members & Pharmaceutical Industry #dsm5 (referee article) <>

Are people who sell Dickens novels depression enablers? #dsm5 generalized fail disorder <> @Adisson89 @helio_girl

Doctors need to EDUCATE THEMSELVES about complex ethical issues; they drop the ball with #BlackPatients on this all the time

What physicians should discuss with families in relation to brain-activity? <>

#behavioralhealth: Listening is good in #primarycare #cfha blog <> @miller7 @eastcoastkid01

Harvard Vanguard offers shared appointments. Great idea: meet w/your MD & other patients for 90 minutes #hcsmeu

Julia was intrigued by the possibilities that Twitter and other social technologies could offer to the organization in which she is a board member. How could these technologies help us in doing our work? Our members are located all over the world and some of us meet annually during a three days conference at some hotel. Sound familiar? After a few email exchanges and recognizing the difficulty at having a good discussion in which we could talk about what the question meant and the complexities involved in drafting some strategic plan related to social media, we set up a phone conversation to brainstorm.

For this organization, I suggested, the initial goals may be to set up a virtual office to archive the organizational memory of this professional association. At the moment, the documents are probably filed at various offices of former and present board members. Members could archive the organization documents at a secure server but could also just upload them to a GoogleDocs account. The same set-up would allow various members of the board or committees to work on shared documents rather than getting confused with email attachments. Having the documents in a server could allow the organization to share them with everyone or a selected group.

How about a Wiki? I ask. With a wiki, board members could upload and download documents and at the same time display them. The wiki would also allow members to have threaded discussions. In the later case, the group could use the freely available wikis or pay a small sum and have a wiki that could be shaped according to their own identity. These two simple technologies are so easy to use and it is amazing how many organizations or groups seem either unaware or a bit resistant to use them.

A second goal would be to strengthen the ability to maintain transparent communication between and among the board and the general membership. For that, I suggested that the organization webpage could add a simple WordPress blog. The blog could be open to everyone arriving to the website or it could be password protected. If the board was worried that the entries could be not appropriate for a professional organization, it would be very easy to just set it up so that a board or various board members approve the publication of the comments. Like wikis, setting up a blog is a fairly straightforward procedure and it can become a terrific vehicle to share something and then engage all comers in the dialogue.

When we arrived to the issue of Twitter, we talked a lot about the hash tags. Like the ones some of us use to identify an entry that may be of interest to CFHA members. In this case #cfha <> , creating a hash tag and "owning it" via What the Hashtag?! <> By creating a hash tag, anyone could enter into a dialogue that it is relevant to the organization without requiring all members to follow each other's tweets directly. Hash tags also help groups to generate discussions.

During the conversation, Julia asked me about Facebook. Would Facebook help us network? My response was less positive when discussing Facebook. I have found that at least two important issues emerge when thinking about Facebook in relation to professional organizations.

One, a lot of professionals are concerned about the issue of privacy. If they have an account, they think that joining a group will mean that everyone in the organization will know about their private lives. It is not the case but it is hard to explain and the concern is persistent, in part because of fear and in part because Facebook made some bad decisions in this regard at various points of its evolution. There are other concerns, for many, Facebook is still a mystery, despite the tremendous growth, many join and then they don't have a clue of how to manage it or even login back again.

And two, if one is able to overcome these hurdles, I have found that Facebook groups are for the most part not very active. The problem is that members of groups are not able to know if new information is being shared unless they visit the group. Therefore, groups grow but then they become sort of a static shared webpage rather than an interesting and evolving dialogue among peers.

My advice to Julia was to try LinkedIn and to motivate a few members to join twitter and begin using it to discuss issues of interest. LinkedIn is popular among those trying to get a consultation gig or are looking for a job. For an organization though, LinkedIn offers the ability to organize groups and the interface is less distracting. For the adventurous, I told Julia, setting up a Ning social network group for her organization would be a great way of consolidating the features we discussed. But Ning will require a larger commitment and it may not be as compelling to her core membership.What are your professional association social networking needs?

Have you started thinking about moving some of the annual activities into a virtual platform?

Will these social technologies generate more interest in becoming a member of your organization?

Or, the contrary, people will ask themselves, why do I have to pay for membership in this organization if we can just organize via the digital technologies?

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Contact Us

P. O. Box 23980,
Rochester, New York
14692-3980 USA

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.