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Measures for Measure

Posted By Barry J. Jacobs, Friday, November 18, 2011
How do you know when your product is a smash success? The regulators show up to anoint you with accreditation standards to establish order in your industry and to separate the sketchy posers from the rigorous real McCoys. So it is with collaborative family healthcare. It is apparent to governmental agents and leaders of various healthcare disciplines that some form of integrated care will be part of emerging practice models and the rush is now on to set standards for our field.

The American Psychological Association is assembling a multidisciplinary group to devise competencies for psychologists working in collaborative primary care settings. The SAMSHA-HRSA Center for Integrated Healthcare Solutions (CIHS), run by the National Council for Community Behavioral Healthcare, has just put out a brief but far-reaching report—really a framework to spur and direct future action--entitled "”Primary and Behavioral Healthcare Integration—Guiding Principles for Workforce Development.” Here’s the link.

The CIHS report, written by a stellar committee that included CFHA stalwarts Sandy Blount and Ben Miller, contains several components of pertinence to Medical Family Therapy educators:

  • It calls for the training of a collaborative workforce steeped in the principles of the recovery movement, especially patient, family and community self-determination. The report’s number one core goal (of 7 cited) is "Expand the role of consumers and their families to participate, direct, or accept responsibility for their own care.” It promulgates the establishment of competencies and curricula to foster the sharing of integrated care treatment decision-making with consumers and family members.
  • It seeks the implementation of evidence-based training through a so-called "Learning Home on Integration” that will "link individuals to sequenced educational opportunities that are reinforced through supervision.”
  • It proposes devising a "Faculty Forum on Integration” to identify best educational practices and resources.
  • It calls for the development of core competencies in integrated care tailored to general healthcare, mental healthcare and peer support. Core curricula would also be developed and disseminated to foster integrated care practices for specific, highly impacted communities.

In spirit, this report is respectful of families, trying to level the playing field among healthcare professionals, patients and relatives in their sometimes testy, sometimes tender collaborative partnerships. However, there is nothing here on training competent integrated care practitioners in the critical skills of how to effectively engage family members in medical exam rooms and other settings, nor how to study their reactions, facilitate their growth or clinically intervene with them when necessary. Family-centered care here is an aspiration, not a fully delineated set of techniques as yet.

That’s where we come in. We teach our trainees just those clinical skills to help family members gain a sense of agency in the midst of medical crises and to draw strength through communing with others in similar straits. We have experientially-based training methodologies that instill self-awareness and self-efficacy. We have systems expertise to fine-tune the group dynamics of the emerging integrated healthcare team.

So how do we join the ongoing conversations at CIHS (and other standard-bearing entities)? I suppose we could heavily lobby Sandy and Ben. Better yet, we should make our knowledge more visible to the federal agencies and healthcare organizations that will be regulating the integrated healthcare of tomorrow. That will take educational and clinical research. And speechifying. And good PR.

What are your thoughts about how to influence the future?

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Comments on this post...

Randall Reitz says...
Posted Friday, November 18, 2011
Barry, Thanks for pulling together these family strands. I wasn't aware of many of these recent publications. I share your concern that collaborative care is often FINO (family in name only).

I had been feeling the same way about the CFHA conference in recent years, but had an entirely different experience at this year's conference in Philadelphia. I think it was largely due to your efforts (with a tip of the hat to Jennifer Hodgson). I was bedazzled with the richness of systemic sessions that presented a bevy of fresh ideas.

I think this type of professional activity (or to use your term "speechifying") is key to keeping systemic care at the forefront of collaborative care.
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Jennifer Hodgson says...
Posted Sunday, November 20, 2011
Despite the strong evidence that family involvement in heathcare has positive benefits for patientsand other family members, we tend to treat family as if they are largely in the way, a risk factor to be studied, not embraced. Intuitively, we know family matters but families are messy, complex, and much harder to control in a room than one patient. It takes special skills to be a provider in a room of people and have interactional conversations that are therapeutic in intent. For this reason, I think "family" has been slower to catch on and some are reluctant to embrace the idea of changing the way we work as a healthcare system.

While exam rooms are small, and training in working systemically is not front and center for more healthcare professionals, it is a critical skill. As our population ages and family members are asked to do more and more, we need to understand family dynamics, interactional processes, and communication patterns.

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Maureen Davey says...
Posted Thursday, November 24, 2011
I agree that medical and mental health providers who actively partner with families in the healthcare system is a 'best practice' approach. I still do not fully understand why the research that supports the importance of partnering with families/parents to improve treatment adherence, retention and clinical outcomes has not translated into more transformations of current healthcare practices in the US. Perhaps it is part of that research-clinical gap in most of psychosocial research and we need to do more funded translational research. Something I would like to do with other medical family therapy clinicians/researchers/educators is to apply for NIH Support for Conferences and Scientific Meetings (R13 and U13) (http://grants.nih.gov/grants/funding/r13/) to begin talking about how to overcome this gap and do more collaborative research together.
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Randall Reitz says...
Posted Friday, November 25, 2011
Maureen, That is an excellent idea. CFHA actually applied for three years of conference funding from AHRQ in October. We'll see how we do.
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Barry J. Jacobs says...
Posted Friday, November 25, 2011
Maureen, I agree that going after big research grants by teaming several MedFT programs from around the country is a great idea. Perhaps you'll organize us into one large research group. As for the research findings that currently exist, my sense is that they are relatively few and are scattered across disparate disciplinary silos. It would take something like an IOM report to pull them together and draw attention to the family factor.
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David Seaburn says...
Posted Monday, December 05, 2011
I agree with everything that has been posted. Research is the place to start. Family research is very stenuous. Evidence that family involvement plays a positive and negative role in health is very important. Some of that research already exists, but hasn't gotten the play that it should. It's a long road. Efficacy is one thing. Effectiveness another.

Training is also critical. Cross-discipline training is key. In the 1990s there were a few HMOs that decided to try collaborative approaches. They simply put professionals from different disciplines together without much training. As you might guess, they failed. Bringing different professional cultures together is of critical importance. Having those different cultures respect each other and also value family is yet another challenge, one that has been met over the years by many of the training programs represented in this group.

I have always felt that the best argument for collaborative family healthcare is the experience of patients. Their suffering is not neatly divided into different parts. It is shared and it is experienced as a whole. treatment should reflect that.
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