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INTRA-Disciplinary Care: Can Mental Health Professionals Work Together in Primary Care?

Posted By Jennifer Hodgson , Thursday, December 1, 2011
Updated: Thursday, December 1, 2011
The burgeoning success of integrated care brings with it a complicated by-product. The diverse range of behavioral and mental health professionals are stepping up to the plate. Many of these professionals, trained under the "old guard” as competitors in the market, are now tasked to re-align in the context of a new paradigm. The following represents insights from a year-long conversation (tongue in cheek) between two friends and colleagues, one a clinical psychologist and the other a medical family therapist who are in search of a model of intra-disciplinary collaboration.

Dr. Jodi Polaha, Most Awesome Clinical Psychologist (and humble too):

Last fall, I sat through an uncomfortable board meeting. I was charged to work with a Clinical Social Worker, Licensed Practicing Counselor, a Counseling Psychologist, and a Licensed Nurse Practitioner to develop an integrated care training program as part of a rural workforce development project. Whose students could provide treatments in behavioral medicine? Whose students could help develop programming? Whose students understood research well enough to do program evaluation? "Ours!” I said, smiling.

So did the other professionals in the room.

"NOT!” I shouted in my mind. I tried to keep my facial expressions in check, but it was hard. Everyone knows social workers help people get food stamps and find support groups, right? Everyone knows our counseling friends deal mostly with life-adjustment issues, right? And everyone knows that clinical psychologists are superheroes, trained in the scientist-practitioner model, who REALLY CAN do everything…RIGHT?

I was challenged by this conversation, and recognized my long-held, inaccurate stereotypes of other mental health disciplines, including my own. Still, some questions made me itch: Can mental health professionals from various training backgrounds work harmoniously in integrated care? If so, could their roles be interchangeable? Should they be?

I took my questions to Dr. Jennifer Hodgson. Who would know better than the president of CFHA? Granted, she is a marriage and family therapist (or medical family therapist as she calls herself these days), so she lacks the finely-honed analytical skills of a clinical psychologist. She can pick out a cute suit, though, so I felt it was worth a try.

Dr. Jennifer Hodgson, Supreme Marriage and Family Therapist:

First, I would like to say, when Jodi Polaha approached me with questions about intra-disciplinary collaboration, I had to hide my confusion. Why would a clinical psychologist be concerned about this? Don’t they mainly do testing and inpatient work with serious and persistent mental illness? Isn’t their training mainly in one specific area of health or mental health? What are they doing in primary care? I would not want a foot specialist operating on my eye, after all! How does she figure she is a team player with the likes of medical family therapy, who, we all know, leads the field in advancing integrated care! I know what is going to happen, she just wants psychologists to take over the leadership of this integrated care movement. Arguably, they do have Medicare in their back pockets, but so do social workers. Does that mean though that they are better integrated care clinicians?

There are so many inaccuracies in how different mental health disciplines are trained that perpetuate the ideas that others are less well trained simply because of their degree. Why can’t a social worker, pastoral counselor, professional counselor, or family therapist (had to get my field in there somehow) run an integrated care service with a blend of professions present? Of course we can work harmoniously Jodi, but we first have to be willing to be vulnerable and willing to learn from one another in the field.

I have gotten to a place where I just want all mental health disciplines to stop figuring out who is best based on degree and to start taking classes together, training in the field together, and promoting policy for parity together. We would be even better together…if only we knew how to share the space. It is the old adage of those who have power want to hang on to it and those who want it are working hard to get it. I tell my students that there is plenty of room in the sandbox so no need to throw sand to create space.

Most healthcare professionals just want someone who can do the job and cannot understand why some mental health providers cannot work together easily. I go back to how people were trained, Jodi, and I believe strongly that we can be retrained to learn models of integration that embrace multiple disciplines in the same location. We can share the work, divide the responsibilities, and promote one another’s strengths. We can embrace hiring someone not because of the degree, but because he or she meets the patient population’s needs and has the core competencies (to be determined) to provide integrated care services.

It starts at the training level and I believe CFHA is the place where we can drop our labels and learn the core competencies needed for the work. I know my calling is to train the next generation to behave differently, but it starts with me and sometimes I struggle with it too. I want to understand why we cannot just drop the entitlements...but as a systems thinker I know that change happens slowly, thoughtfully, and organically (with a smidge of encouragement from associations like CFHA).

Dr. Jodi Polaha

It’s funny, in spite of my reaction to that board meeting last year, this year in Philadelphia, I had so many positive interactions with professionals from so many varied disciplines. In that forward-thinking environment, Jennifer, it was truly effortless to meet the spirit of your ambition for all of us. I learned from social workers, public policy people, and physicians. I exchanged cards with a school psychologist from Florida, with similar research interests to my own. The energy in this mixed group was incredibly engaging and specific credentials, training history, and even experience seemed to fade away. In another week, I am off to a clinical psychology conference and, reflecting back, I feel I was more among "my people” at CFHA than I will be there.

It occurs to me that the mental health professionals involved in integrated care have so deftly cast off the old guard notions about the 50-minute session, the cozy psychotherapy room, and even the term "mental health.” I’d like to see your vision become a reality, Jennifer. Perhaps, the stereotypes and competitive dispositions will be the next to go.


Jennifer Hodgson, PhD, is a licensed Marriage and Family Therapist, Associate Professor in the Departments of Child Development and Family Relations and Family Medicine at East Carolina University, and outgoing President of CFHA. She has over 18 years clinical experience and has served on numerous boards and committees related to healthcare and mental health care issues. She is co-author to the first doctoral program in medical family therapy in the nation.


Jodi Polaha, Ph.D. is an Associate Professor in the Department of Psychology at East Tennessee State University where her primary professional interest is research, training, and workforce development in rural integrated practice. In addition to her work, she spends lots of time with her husband and two young boys swimming, biking, and hiking in the surrounding mountains.


The view expressed in the blogs and comments should be understood as the personal opinions of the author and do not necessarily reflect the opinions and views of the Collaborative Family Healthcare Association (CFHA). No information on this blog will be understood as official. CFHA offers this blog site for individuals to express their personal and professional opinions regarding their own independent activities and interests.


Tags:  CFHA  family medicine  family therapy  Philadelphia 

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CFHA in Philadelphia: A Field Trip for ETSU Doctoral Students in Clinical Psychology

Posted By Jodi Polaha, Wednesday, November 23, 2011
As a school girl, I always loved going on field trips, what kid doesn’t? What I know now is that it is just as fun, and maybe even more so, to guide one.

A few weeks ago, I took five students from East Tennessee State University (ETSU) to Philadelphia to see the Collaborative Family Healthcare Association in action. The students are in their second year in our doctoral program in clinical psychology, which has an emphasis on rural, integrated care. This semester, the students are taking my course, Primary Care Psychology; devoted to learning the language of contemporary healthcare, understanding the rationale and research behind integrated care, and evaluating models for its administration. Overall, the conference was a great way to bring to life the great potential and actual effects of their "book learning.” In particular, I was pleased to see that the content was not redundant with classroom-based knowledge, but advanced what they have learned. And, it was exciting for them to have employers asking, "When will you be finished?” with a position in integrated care in mind!

I thought blog readers might like to hear from these up-and-coming professionals themselves, so I asked them, "What impressed you most about the conference?”

Laura Maphis
I chose to earn my Ph.D. in psychology at ETSU, because I was hoping to learn how to "do” integrated care. What I have learned so far is that there is no instruction manual for "doing” integrated care, that it is a pioneering endeavor, and that the more I learn, the more questions I have. For instance, how are we going to do this in primary care when primary care has its own unique problems (e.g., fewer physicians seeking generalist careers)? How are we going to do this with multiple insurance/coverage barriers? How are we going to do this with little legislative support? As a graduate student new to the integrated care frontier, I felt the excitement of this "frontier” enhanced by the vastness of it (so many questions!), as well as the isolation of having only a small minority of U.S. care providers on-board. I am super impressed with how the 2011 CFHA conference was able to give shape and form to this vastness by honing treatments for specific disorders, treatment modalities, issues inherent in working with special populations, ethical concerns, billing and reimbursement considerations, cultural considerations, issues at the provider level, and education and research as they pertain to integrated care. Moreover, the collaborative nature of the CFHA conference made me feel, if only for a few days, part of a majority. As a result, I feel more capable of navigating this frontier in the future, and know that I will be in good company.

Sheri Nsamenang
My trip to CFHA happened right when I needed better shape to my career aspirations. Aside from the things I learned from listening to talks by renowned leaders in the field, the mentoring opportunity, the friendliness and the willingness of conference attendants to discuss the practicality of collaborative care, I was inspired by the informative research presentations at the poster sessions. While I have increasingly become conversant with the clinical practice of collaborative care, I have been less familiar with conducting research in primary care settings. As I visited various researchers and learned about their projects, I was exposed to a plethora of research topics, ideas, and designs. Although I did not necessarily leave the conference with an idea to research, I left with ideas on how I could design studies, examine interventions, and how to examine non-conventional data such as patient charts in a primary care setting. Off additional importance, I left feeling that there was an audience for primary care research. A highlight moment for me as I walked from one poster to the next, was meeting researchers from Japan. As an international student, this encounter made me realize that, CFHA was an association I could rely on in the future if I were practicing collaborative care somewhere in Africa.

Alishia Foster
At this conference, the model I had become accustomed to reading about had taken on new life. I felt I was part of a dynamic process of change and that the struggles of integrated care are also my own struggles. For example, sustainability was a prominent topic, and I found myself debating with my fellow students over pitching integrated care to insurance companies, the use of H&B codes, as well as the reality of current dependence on grant funding for many programs. Amidst the brainstorming over those few days and after, I felt that we are the generation rising up to follow in the footsteps of those we’ve read about such as Strosahl and Blount and be the innovators for a changing age of health care. The conference was an enlightening and encouraging experience, reassuring me that I am on the right track!

Jamie Tedder
What impressed me most about the conference was the "boots on the ground” mentality that was such a pervasive theme across so many of the sessions. It was exciting to hear about various integrated care research and projects that are having an impact and helping people in the here and now. I felt like I could easily take the information I gathered at the conference and immediately apply it to my own clinical and research experiences. During the First-Timer’s Orientation, CFHA’s outgoing president Jennifer Hodgson made the remark that CFHA is where she feels rejuvenated professionally and I certainly now echo that statement. The new perspective I gained from the conference has completely reshaped how I view my current program of research as well as the direction I would like to see my professional career take in the future. This grad student has definitely been inspired to lace up my boots and hit the ground running!

Jenny Barnes
Of the many impressive aspects of this conference experience, I would like to address the outstanding sense of community. It was such a great feeling to engage with like-minded up-and-comers and professionals who are truly committed to high quality care. Though the different healthcare disciplines may have their differences, one would never know from observing the interactions at this conference. It can be easy to think only in terms of one’s own "bubble,” so it was refreshing to see that the push for collaborative care is happening nationwide, and not just on paper, but in real, boots-on-the-ground applications. As well, the passion at this conference was palpable, and speaking of passion, I could not think of a better way to kick off the conference than with Dr. Brenner’s opening plenary session! Overall, this conference was a great learning experience and I’m glad we made the trip from east Tennessee. This is a conference I definitely plan to attend in the future as I stay abreast of the newest innovations in integrated care.

In closing, it’s worth mentioning that I am grateful to CFHA, who provided a scholarship to each student to defray the registration cost. I am also grateful to my Department Chair, Dr. Wally Dixon, who provided funds to cover transportation and hotel costs. Without this support the field trip wouldn’t have been possible… and that would have been a real loss for the students considering all they gained at the conference in Philadelphia … not to mention the cheesesteaks!


     Left to right:                                                            
     Sheri Laura, Jamie, Jenny and Alishia

The view expressed in the blogs and comments should be understood as the personal opinions of the author and do not necessarily reflect the opinions and views of the Collaborative Family Healthcare Association (CFHA). No information on this blog will be understood as official. CFHA offers this blog site for individuals to express their personal and professional opinions regarding their own independent activities and interests.



Tags:  CFHA  collaboration  ETSU  Philadelphia 

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