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A Vision for Families, Systems, and Health

Posted By Sandy Blount, Thursday, September 3, 2009
Updated: Thursday, June 9, 2011

From its earliest days as Family Systems Medicine, under Don Bloch, its founding Editor, this journal has occupied a unique position in the landscape of healthcare journals. Rather than carving out a new, more specialized area, it has been placed at the confluence of health and mental health, the individual and the family, personal and population approaches. Under Susan McDaniel and Tom Campbell, the editorial team that renamed Families, Systems, & Health (FSH) and guided it for twelve years, it has been brought to the high level of influence and stability that it enjoys today. Its title promises, and the journal has delivered, a balance of types of articles from its nexus at the role of relationship in health.

The change that I see that is most important to FSH is in the environment. FSH is just beginning to cease being ahead of its time. Some of the people central to the developing life of the journal have also been important in the transition that has created the current flowering of collaborative care. The forces that are driving this flowering are much larger than the group of us who have been supportive of FSH. These forces have created a renewed need for a multidisciplinary journal that can address practice and theory in addition to education and research. The "systems” in the title can refer to systems of healthcare delivery in addition to systems of human interaction.

The service model of the Medical Home has provided a locus for primary care providers, insurance companies, and government health authorities to come together to provide better care at lower cost. Exactly how that model will develop will be discussed in the literature for some time. The "patient centered medical home,” the "collaborative healthcare home,” the "family medical home” and probably others, will need to be vetted in print. FSH is an excellent venue for this sort of systems discussion.

FSH is or should be the first journal for collaborative practice, for research on the influence of the family in health and illness, for family interventions in health and illness, and for systems thinking as it applies to health and illness. For people doing research whose primary academic commitment is with a particular discipline, such as health psychology, behavioral medicine, marriage and family therapy, family medicine, internal medicine, pediatrics, or medical specialties, we can be the locus for articles about collaborative practice. For the field as a whole, we should be the journal for rigorous descriptions of the reciprocal evolution of the routines of practice, the delineation of social roles in service delivery, and models of phenomena underlying collaborative healthcare.

Gregory Bateson said that being able to rigorously articulate patterns that connect seemingly disparate domains of phenomena must certainly be a non-trivial accomplishment. I cannot improve on that idea as a reason for intellectual endeavor. We need to be much better at articulating the patterns that connect different domains if we are to be able to think better about phenomena like "mind” and "body” that we have dichotomized so thoroughly. In what other field does common parlance, such as "that child is a pain in the neck,” carry a more sophisticated synthesis of physical and behavioral experience than the language professionals usually deliver? Producing a journal that regularly offers clear articulations from many domains of relationship and occasionally offers a new articulation of the patterns that connect across domains is the first goal the new editorial team has set itself. The second is making FSH an accepted and well-used outlet in the worlds of medicine, mental health and systems thought.

As an approach to both goals, we want to broaden the readership and the contributors to FSH by making the journal accessible to authors who do their scholarly writing in Spanish. To this end, Gonzalo Bacigalupe has joined as Associate Editor. We will be inviting leading scholars from the Spanish speaking world to join us as reviewers. We want to be able to take a manuscript in Spanish from submission, through all the steps in the editing process to an accepted final form before it is translated. To be a true "agora” for ideas and science, we want to encourage submissions from authors in English and Spanish that have not contributed in the past. We hope to set the bar for publication high, and to take steps to help new authors meet the standard.

To this end, FSH will now be archived in Medline making its contents more accessible to scholars in medical disciplines.

If anyone is interested in reviewing manuscripts for CFHA, please send a CV, your contact information and a list of key words that describe the subject areas in which you want to review to Alexander.Blount@umassmemorial.org.

What do you think would make this a better journal for CFHA members?

What aspects or departments of the journal in the past should we be sure to maintain?

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The Conference Will Be Personal This Year

Posted By JoEllen Patterson, Wednesday, September 2, 2009
Updated: Thursday, June 9, 2011

My Mother is dying and my family is grieving. My 82 year old Mother has terminal cancer. Her oncologist called the aggressive radiation and chemotherapy that she receives, "palliative treatment.” I’m not sure my parents understand that "palliative” is code for "no hope” nor does my family understand that the cancer treatments will accelerate her decline into dementia. I know that my Mother’s doctors care about her but still…my family grieves and seeks understanding.

This year, as the 2009 Collaborative Family Healthcare Meeting arrives, I am thinking about my family and why I became interested in CFHA many years ago at Wingspread:

    An organization that promotes comprehensive biopsychosocial care. An interdisciplinary group of health professionals committed to creating a more holistic model of care. Healthcare professionals who pay attention to patients’ mental health needs, not just their physical needs. Physicians and therapists who recognize the critical role of family members in supporting family members’ health.

These components of the shared vision that inspired the creation of CFHA have new meaning as the United States urgently debates how healthcare should be delivered and who should pay. What will be included in the medical home? How does globalization affect healthcare delivery in the United States and around the world? What supports and procedures do families need as they care for their ill or dying members? These are a few of the questions that I look forward to discussing at the conference in San Diego this year. While I always have a professional interest in the stimulating debates that occur at CFHA, I anticipate that this year, I will be thinking about my own family and hoping that my CFHA colleagues continue to search for new ways to deliver cost effective, comprehensive, humanistic care.

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Citizens of the Healthcare Home: A Conept and Plan for a Pilot

Posted By Bill Doherty, Monday, August 31, 2009
Updated: Wednesday, June 1, 2011

Basic Idea: The health care home idea, which now focuses on changing the way professionals serve consumers, can create pathways for consumers to become citizens of a health care home community. This citizenship has two levels: personal and family responsibility for one’s own health care in relationship with the professional team, and opportunities for leadership within the health care home community.

Goal: improved health outcomes for people connected to health care homes through stronger personal and collective ownership of their own health care

The Provider Pressure Point: Primary care needs a new practice model or it will continue to erode, and the health care home idea will not reach far enough if it does not transform how patients are engaged in their health care.

What the Citizen Health Care Model Offers: For a decade we have been developing a grass roots, organic, democratic way to involve people in tackling health care challenges in their communities. Up till now, Citizen Health Care projects have focused on specific issues such as diabetes, smoking, and depression. But this community organizing process can be adapted to the development of citizenship in a health care home community.

What a Citizen Project in a Health Care Home Might Look Like:Every patient/family would be invited to take out "citizenship papers" in the clinic, based on the framework develop by the leadership group. At the personal/family level, this might mean orientation sessions and an explicit social contract laying out expectations between citizen patients and the professionals in the clinic. The idea is to forge a more intentional approach to one’s health care and one’s relationships with providers. Patients and families who do not take out citizenship papers will continue to receive the same health care services, just as the children of non-PTA parents receive the same teaching as children of PTA parents. However, citizen patients are likely to benefit from deeper involvement with the health care home via special communications, community gatherings, and more collaborative relationships with providers.

The Pilot:A large primary care clinic has volunteered to form a leadership team of professionals and citizen patients with leadership abilities to co-create a "constitution” for its health care home community and embark on the process of implementing it. I will lead the process over the next year as part of my work in the new Citizen Professional Center (www.CitizenProfessional.org.).

The Bold Vision:The health care system can only be saved by we the people working democratically on personal and collective responsibility for the health of all. Deep citizen involvement at the grass roots level of health care can produce leaders to become part of the larger policy development.

ENGAGING PATIENTS AND COMMUNITIES IN HEALTH CARE


The level of the task and the manner of engagement


The Personal task

(The "I”)

The Clinic and Community task

(The "we”)

The larger societal task

(The "all of us”)

Traditional medical / consumer model

· The professional as expert provider and teacher

· The patient as receptive consumer and learner

· Education / outreach: professionals teach and intervene, patients / community members learn and change

· Advice / input: professionals learn from patients/community members in selected areas, patients / community members provide useful consumer feedback

· Professionals educate public officials and payers on policy issues

· Professionals advocate to public officials and payers

Well-suited for

Minor and major acute problems, trauma, surgical emergencies

Routine prevention and self-care; provider-initiated changes such as new prevention or practice guidelines;

Delivering an organized professional opinion on policy issues such as access and reimbursement

Not so well-suited for

Prevention, self-care, family care giving, chronic illnesses, uncertain diagnoses and treatment options, end of life

Health behaviors that are difficult to change; cultural differences; areas where patients don’t have access to enough information to give useful feedback to the clinic

Engaging the public in changing the culture and practice of personal and professionally-delivered health care





Citizen Health Care model

· The professional as competent, collaborative provider and partner

· The patient/family as partner and responsible agent of own health

· Citizen professionals and citizen patients co-create "constitutional framework” for patient and community involvement in the health care practice / home

· Agreed-upon practices to foster citizen patient engagement at the personal level

· Opportunities for patients to become citizens and leaders in their health care community

· Citizen professionals and citizen patient leaders (who emerge from the local level) educate and advocate with public official and payers

· Citizen professionals and citizen patient leaders engage the larger public in solving health care problems

Well-suited for

Any area where active patient/family self-responsibility and engagement are important

Clinics that desire deep engagement and community building with their own clinics, and want to focus health challenges that frustrate providers and concern patients and communities

Engaging "we the people” in systemic and personal change; creating policies that build community capacity for health

Not so well-suited for

When patient/family are not able or willing to actively engage

Clinics focused on survival or confident in the traditional model; patients and community disengaged from the clinic

The technical dimensions of policy implementation


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Collaborative Care Needs a Theme Song

Posted By Randall Reitz, Monday, August 31, 2009
Updated: Thursday, May 26, 2011

Music amplifies and animates our experience. Who can think of Rocky without hearing the theme song Gonna Fly Now? Tom Cruise and Kelly McGillis’ horizontal silhouettes from Top Gun will forever excite my mind with Take My Breathe Away beat-beating in the background. An Irish rock band provided healing to my American heart after 9/11.

Most couples can identify "their” song—a song that stirred their emotions during limerence or that was powerfully present during a "DTR” moment in their coupling (reference the boombox scene in Say Anything).

Similarly, music provides a context and a narrative to the political, cultural, and philosophical movements of our time. People who made it through the hippy era (and ended up as the founding fathers and mothers of the collaborative care movement—you know who you are) have a number of anthems from the era: Blowin’ in the Wind, Love the One You’re With, Turn Turn Turn. The feminist and gay pride movements both embrace "We are Family”. Lee Greenwood’s retirement comfort is made possible by the revival of "Proud to be an American” whenever our courageous soldiers defend us in war.

And, of course, recent political campaigns have linked themselves to music. Can you name which candidates used which songs?

1. Barack Obama                       A. You and I

2. John McCain                          B. Signed, Sealed, Delivered

3. Sarah Palin                            C. You Can Call Me Al

4. Al Gore                                    D. Barricuda

5. Bill Clinton                              E. Don't Stop

6. Hillary Clinton                         F. Take a Chance on Me

The denizens of collaborative care world don’t have a theme song. Perhaps someone who was present at the first CFHA conference in 1995 in Washington DC can tell me if a song crystallized the moment for them, but I’m not aware of it.

This is to our detriment. We need a rallying cry to blast at our national conferences, to boost our steps as we scurry between exam rooms, to wail over beer when healthcare reform evaporates in the August heat, and to chant in the boardrooms of the powerful interests. Unfortunately, I can’t say that the perfect song has come to mind yet, so I’m asking for your recommendations.

In the absence of a serious option, here are a few tongue-in-cheek suggestions:

Vanilla Ice’s Ice, Ice Baby, the only song to successfully incorporate the word collaborate in it’s lyrics ("Stop, Collaborate, and Listen!")

My kids suggest that if we’d just replace the word "Wonderpets” with "Collaborate” in their favorite cartoon’s theme song, we’d have a great possibility that embodies our underdog spirit ("What’s gonna work? Teamwork! Collaborate! Collaborate! We're on our way, To help a friend and save the day. We're not too big and we're not too tough, but when we work together we've got the right stuff. Go, collaborate, yeah!”)

And, of course, you can never go wrong with John Lennon ("You may say that I'm a dreamer, but I'm not the only one. I hope someday you'll join us and the world will be as one.”)

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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.