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Mental Health: Come Out, Come Out Wherever You Are!

Posted By Ben Miller, Friday, September 11, 2009
Updated: Wednesday, June 1, 2011

As the health reform debate rages, so many numbers, names, and "theories" are thrown around, we have to ask ourselves the question: "where is mental health"? You see, being a mental health professional committed to seeing the divide between mental health and physical health erased, I want to know that the next version of health "care" comprehensively addresses the needs of the whole person. So, I always make sure to try and see where mental health sits within any discussion on healthcare. To this end, I follow blogs, check certain websites, read bills, etc. to get a better sense if the artificial divide between systems will be erased.

My findings: mental health is not part of the larger health reform discussion (that I can see) - if we are talking HEALTH REFORM, shouldn't we include all aspects of health?

Now, here me on this one, I know the mental health community is actively engaged in advocacy around parity, but is this sufficient?

Watching the President's speech to Congress two nights ago, I kept wanting to hear something about mental health - that is too much to hope for. I follow Twitter to see what other thought leaders (yes, they are on Twitter) have to say on #healthreform (a Twitter technique), etc. I see brilliant articles, discussions, ideas, but none include mental health. Being a Twitter amateur, I try to push for integrating mental health into the discussion as often as possible, but this is not going to get the message that now is the time to end the separate histories of mental and physical health and defragment healthcare. Still, I try and use any and all any means necessary to bring attention to this issue. If you are feeling adventurous, you can follow me on Twitter - miller7

Am I off base here?


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Thank You Mentor, Thank You Collaborator

Posted By Randall Reitz, Wednesday, September 9, 2009
Updated: Thursday, May 26, 2011

Some names in our field naturally go together: Mac Baird and Bill Doherty, Donald Bloch and Nathan Ackerman, Susan McDaniel and Thomas Campbell. By its name and nature, collaborative care is a team sport. Without our collaborators, integrated care services are as effective as one hand clapping.

Similarly, wherever we are in our careers, we owe much of our success to the assistance of mentors who have helped us along the way. Mentors are our key advocates and personal champions. They point us in the right direction and stick with us along our professional path. They have sufficient hope to bring out our best and sufficient compassion to help us overcome our worst.

I would like to thank two treasured mentors.

Larry Mauksch took me under his wing back in 2000. I was fortunate to complete my PhD internship at Marillac Clinic shortly after Larry had completed a year-long sabbatical during which he established Marillac’s collaborative care program. My internship was funded through a 5-year RWJ grant Larry had co-authored. During my years there, Larry returned to Grand Junction yearly to offer training and conduct research. My first published research was with him as a first author, and my early professional presentations included him as co-presenter. On multiple occasions I’ve slept in his home and eaten at his table. I’ve called him for advice before each major decision of my career. He personally nominated me when I was invited to join CFHA’s board. Thank you, Larry, for your loving wisdom and prescient vision.

Steve Hurd was my 2nd supervisor at Marillac Clinic. I’m pleased to have played a role in his conversion to the collaborative care model. He was a dream supervisor who provided direction, required accountability, and advocated for my promotion. Steve was always very tolerant of my pet projects and clinical distractions. When I became the Executive Director of a Marillac-like clinic in Frisco, CO his phone number was #1 on my speed-dial and he never lacked time to work me through issues. He consoled me in South Bend when Notre Dame beat BYU and I consoled him in Provo when BYU returned the favor the following year. He is the godfather of my eldest daughter. Thank you, Steve, for your warmth, caring, and abiding support.

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Coyote Medicine

Posted By Peter Fifield, Monday, September 7, 2009
Updated: Thursday, June 9, 2011

Although I have owned the book for years, I most recently rediscovered and read Coyote Medicine a book by Lewis Mehl-Madrona, M.D., Ph.D. What a fantastic read. To my pleasant surprise, just yesterday, I found out that the author will be presenting at the CFHA conference in San Diego CA this October 2009.

The following link http://www.healing-arts.org/mehl-madrona/mmbook.htm provides a description of Dr. Mehl-Madrona’s book as follows:

A Stanford-trained physician, who gave up the promise of a lucrative private practice to embrace the Native American healing arts of his ancestors, describes his continuing efforts to integrate both ancient and modern medicine.

Dr. Mehl-Madrona’s attempts to shake things up in the medical world are similar to the concept of Integrated Care; shifting a medical paradigm from traditional approaches to something new. Providing integrated care is partially about addressing the mind body connection in order to provide comprehensive care to our patients. A unique characteristic of Lewis Mehl-Madrona’s approaches is that he practices a combination of modern technology based medicine coupled with spiritual precepts from his Native American heritage.

Mehl-Madrona’s approach not only addresses the mind/body connection he also adds a spiritual component to his medicine. Cultural sensitivity and relativity are very important concepts when treating patients. Spiritual healers range from Curanderos and Houngans, to Priests and Rabbis. These practitioners use the person’s faith and belief systems to address the presenting medical issue. Preparing for a Native American "sweat lodge” can take a significant amount of effort but there are more subtle, realistic and practical approaches that could be attempted even in our offices.

What sort of faith, spiritual or cultural based approaches have you seen used, have you used in your practice or heard of in other practices regarding behavioral health. Please share your thoughts on what you think constitutes "hokey” and why. When does a certain faith/religious or cultural approach violate your office policy?

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Using Direct Observation for Team Development and Collaborative Training

Posted By Larry Mauksch, Sunday, September 6, 2009
Updated: Thursday, June 9, 2011

A great way to flounder or fail in system change is to avoid relationship development between team members. When we examine efforts to integrate collaborative designs, relationship development is often given short shrift or completely overlooked. For example, the recently published initial evaluation results from the medical home National Demonstration Project found team function suffered (Nutting et al, Ann Fam Med 2009;7:254-260). One way to build teamwork is to use direct observation of day-to-day practice. I have been experimenting with this strategy for 15 years and below I will share some experiences.

Since we began the mental health internship in collaborative care within our Family Medicine Residency in 1996, the first month for the new intern is spent shadowing residents and faculty. Observing helps the intern learn about the challenges of family practice and it spawns many new relationships. Our residents and medical students observe one another regularly as well.

In 1998 I was invited to spend a year training providers, serving patients and designing a system of care in an indigent primary care clinic. During the first half of the year I regularly observed the primary care providers, teaching them interview and primary care psychotherapy skills and forming relationships. My behavioral health practice grew rapidly. A few years before I arrived a local agency had placed a counselor in the clinic. Six months later the counselor was withdrawn due to lack of referrals despite being in a clinic where 50% of the patients had one or more mental disorders. Looking back, it appears that little was done to create relationships with this new team member.

In my work with health care organizations to train primary care teams to be more efficient and effective in communication with patients, a standard portion of training is peer observation. When the lack of team coordination between medical assistants and physicians became a common theme, I began asking physicians how often they had observed their medical assistants or if medical assistants had observed them. The answer was almost always the same—team observation had never occurred. I began having these dyads observe one another and discuss how to increase the quality and efficiency of patient flow. These primary care dyads or "teamlets” (see Bodenheimer, Ann Fam Med, 2007, 5:547-461) immediately began dissecting day-to-day processes to improve systems of care.

Collaboration is hard won without adequate relationship development. One way of forming relationships is to curiously watch each other provide patient care. It takes time. Trainees need to be sensitive to how feedback is delivered and remember that watching someone else promotes observation of one’s self.

Many of you have other strategies to promote team development or perhaps use similar approaches. What experiences have you had where team development went really well or stumbled?

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Advancing the Evidence for Collaborative Care

Posted By Ben Miller, Saturday, September 5, 2009
Updated: Wednesday, June 1, 2011

The case for integrating mental health services into primary care has been made. We know that primary care, the largest platform for healthcare delivery in the United States, remains the de facto mental health system. There is evidence to support combining mental health and primary care services to more comprehensively address the construct of health (mental and physical), but when making a business/policy case for such integration there is less evidence for what works and what models or elements of models should be incorporated to reach the desired health outcomes.

A recent systematic review (Butler, et al., 2008) pointed out that it is often difficult to tease apart the success of integrating mental health into primary care from the attention that a specific disease is receiving. Of the 33 studies examined, 26 focused primarily on depression. If depression were the only mental health condition we treated in primary care, we may have more answers, but it is not as patients bring complexity co-mingled with co-morbidity.

To this end, the Collaborative Care Research Network (CCRN) was created to expand the evidentiary support for mental health in primary care and to enhance the understanding of what works using a practice-based research network (PBRN) structure. To date, 40 practices have enrolled. The team developed a position paper arguing for a collaborative care PBRN and sent it to the Agency for Healthcare Research and Quality (AHRQ), after which we were advised to immediately submit a grant application as they had certain dollars that needed to be spent this fiscal year. We were also advised to keep an eye on the AHRQ website if the President's stimulus package was approved as there would be initiatives of interest.

Dr. CJ Peeks reminds us of the famous Peter Drucker quote: "In business and elsewhere, nothing ever happens except when created by a monomaniac on a mission." And monomaniacs we (CCRN) are. Even so, we are systems folks who are observing what Harry Goolishian said was the first rule of working in systems--keep the conversation going; hence this communication and blog. For more information on the CCRN, please visit www.aafp.org/nrn/ccrn

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Just Another Day at the Office

Posted By Jennifer Hodgson, Friday, September 4, 2009
Updated: Wednesday, June 1, 2011

Sitting in my office at the Family Medicine Center and checking my desktop is something that I try to do before clinic really gets busy. I always preach to my Medical Family Therapy students that they have got to be visible to be used by primary care providers. This day was different. Being in my office was the trick. One of the doctors who uses our service on occasion raced into my office at 8 a.m. and closed the door behind him, even before my purse hit the floor.

"I need your help with this patient, Betty. She is in bad shape.”

As he spoke, I immediately recognized this patient from a clinical case presentation done the previous week.

"She is going to hear this morning that at the age of 25 and with 3 children that she was being diagnosed with HIV/AIDS. We would like for you to see her.”

She was a very sick woman being cared for by a newly turned senior resident and fresh from orientation intern. Everyone was worried because they were not sure how she would handle the news. Her affect had reportedly been pretty flat since her admission. Her hesitancy to get the HIV test to begin with marked for her team a presence of awareness and denial. I sat back in my chair thinking about who was really my patient here and then it dawned on me, the entire system was my patient. So, I started rapid fire paging and checked in with the senior (who was dealing with the recent death of a loved one), the intern and the medical student who had done a great deal of the interviewing up to this point. I also paged the Infectious Disease (ID) resident who gave her the news and who admitted to not sticking around long after giving it to her. I wanted to know what she had been told, how the team was managing this very complicated case, and how each person thought I could be helpful to her and/or to them.

I waited a few hours after the ID resident spoke to her so as to eliminate the "pounce effect.” Prior to my visitation, I stopped to check in with her nurse, who remarked that Betty’s affect remained flat but who commented that her Family Medicine service had been exceptional. She was impressed with how our Family Medicine team was caring for her. Noting things such as: taking time to answer her questions, not racing out of the room, touching her hand, and functioning as a team.

Upon approaching Betty, she laid still, enveloped by her white hospital cotton blanket and staring blankly at a monitor. I introduced myself again, having been introduced to her the day prior by one of her team physicians. She said she did not want to talk that day because she was getting a painful IV treatment for an infection so I agreed to return the next day. She initially did not want to talk this day either, but kept responding to brief joining questions. I felt the ambivalence and when asked again if I could stay with her for just a few minutes, she said yes.

With no chairs close by, I squatted close enough to make eye contact. Standing just did not feel respectful. We spoke about her kids, her understanding that this was a chronic illness if she followed her treatment, and her support system. She noted the support of her pastor and offered a past history of depression that she knew was at risk of returning, especially with this news. She noted that ironically she came to the hospital with belly pain and flu-like symptoms and now would be leaving with a powerful label and a chronic illness.

She talked about how she would tell her mother and her mother’s probable response (one of strength and love). She was not sure yet how she would tell her children and began to withdraw slowly at that point. She disappeared emotionally when thinking about talking with her partner of 2 years. It was suspected by the ID residents that she contracted the virus 1-2 years ago. She ended our session with an admission of anger, still remaining blunted in her affect. She would not go into detail about her anger but in many ways she did not need to as it appeared the anger was directed toward herself at that moment.

I entered the room a professional wanting to offer my assistance and left the room a mother painfully aware of the precious moments in life. I could see where my team needed support. They saw what I saw in this patient, themselves. Most of them are young, some are parents, one grieving the loss of a loved one herself, and all recognizing how Betty’s life had changed dramatically that day when she heard the news of her chronic illness.

Tomorrow, after a long weekend, I will return to see her again. I will also check in on the Family Medicine team who is providing her care. The amazing thing to me about Family Medicine providers is that they are often criticized for not being specialized enough in one aspect of medicine but actually they are….they are masters of systems and are skilled at diagnosing, treating, and referring to specialists when needed. They have a genuine interest in incorporating me as a Medical Family Therapist because I too share a similar approach to care. In this job I am vulnerable to the same highs and lows that my fellow primary care providers experience each day. This case is reflective of just another day in the life of this Medical Family Therapist. I look forward to sharing more and hearing back from you about cases that left their mark on you as well.

++ All identifying information has been changed to protect the confidentiality of this patient and the providers who cared for her.

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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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Contact Us

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