Print Page | Contact Us | Your Cart | Sign In
Families and Health
Blog Home All Blogs

 

Search all posts for:   

 

Top tags: cancer  caregiving  chronic illness  collaborative care  integrated care  medical family therapy  collaboration  communication  dementia  nutrition  Parkinson's Disease  provider patient relationship  research outcomes  resident wellness  self-care 

Trauma History: ACE in the Hole or Futile Family Fact?

Posted By Randall Reitz, Tuesday, January 17, 2012
Updated: Friday, January 20, 2012

At this point in my education I am not easily awed, much less shocked. Discovering the Adverse Childhood Experience research was a shock and awe campaign to my clinical sensibilities.

For the uninitiated, the ACE study was n=17,000 research sponsored by the CDC. It looks at the effects of childhood trauma on adult health and behavior. Each research participant completed a 10-item childhood trauma screen. They also provided a thorough health and behavior history. The participants were stratified by trauma history ("ACE Score”) to assess whether it was predictive of health outcomes. Their data proved statistically significant to a degree rarely seen in the human sciences.

In each of the graphs below the numbers on the X-axis are ACE Scores (i.e. how many of the 10 traumas the person endured as a child) and the Y-axis is the percentage of participants with a particular health outcome as an adult. I apologize for the low quality of the graphs.

 

 

 

 

 

 

2 Conclusions:

  1. Negative early childhood experiences, especially those involving family members and other caregivers, have a profoundly detrimental effect on adult health.
  2. People with low ACE scores are amazingly free of these problems.

Fine.

No, that's a poor word choice. It is not fine, it's horrible.

Let's try that again, inspired from a song my kids love, but I hate: "whatever, it doesn't matter, oh well”.

No, that's not right either. It does matter. It matters deeply. BUT, as it relates to my adult patients who are already demonstrating the health sequelae of childhood traumas, I haven't been able to identify anything I can do with these data.

Knowing the fact that horrible parenting or a chaotic childhood placed the patient on a nearly inexorable path toward health destruction is diagnostic, but not therapeutic.

How do I intervene?

How do I make it better?

How do I advise my medical and nursing colleagues?

I have attempted 3 (inadequate) responses so that at least I feel like I'm not being callous:

1. Normalize their Experience: I can say: "I'm sorry, you've been through horrible experiences in your life, and unfortunately, science and my own clinical practice has shown us that these experiences help to explain many of your health problems”. This might assist the patient in piecing together a different health narrative, and the empathy that it implies might fortify our therapeutic relationship. But, I've never seen it go very far.

2. Protect the Innocent: I haven't had occasion to do so, but I've often imagined that a reasonable MedFT intervention would be to go through the ACE research with an abusive parent. These data might be the missing piece to dissuading him from passing along this horrible family legacy to his children. After all, this is exactly what we do with pre-contemplative smokers (i.e. "Were you aware that 2nd-hand smoke can cause more frequent illness, asthma episodes, and perhaps even lung cancer in your children?"). So, yes, this might help the next generation, but it doesn't turn back the clock for the abusive parent in the room who is already addled with her own health problems from her parents' abuse.

3. Educate the Clinicians: Patients who were traumatized as children are some of the least rewarding for healthcare providers. They come to the room with intractable health problems and behavior which looks like an Axis 2 diagnosis. These are the patients who quickly get labeled and often get fired from a practice. Perhaps having the patient complete an ACE screen will assist the clinician in having more compassion and in passing less judgment to the patient. If so, that would be wonderful.

OK, there might be some clinical advantage to screening for childhood traumas. However, I remain unconvinced that it is a clinically relevant tool. The ACE score should NOT be the 6th vital sign (or the 7th or 8th, or however many there are now that we therapists keep adding our soft scales to the hard science of checking patients-in). Perhaps I will continue to bust out an ACE 1-2 times per year, but it's not about to join the PHQ9, GAD7, and Vanderbilt in the pantheon of primary care screens.

There, I said it.

Now you say it:  Do you like the ACE screen? Do you use it in primary care settings? How have you made it clinically relevant?

 

Randall Reitz is the Director of Social Media for CFHA and the Behavioral Science Faculty at the St Mary's Family Medicine Residency in Grand Junction, Colorado. He studied family therapy at Brigham Young University and Indiana State University.

He is the author of CFHA's
CollaboBlog.

This post has not been tagged.

Share |
PermalinkComments (3)
 

Earning our Place at the Healthcare Table: A Call for Research in Medical Family Therapy

Posted By Tai Mendenhall, Tuesday, January 10, 2012
Anybody who listens to the radio or watches television nowadays knows that "healthcare” in this country – however it is defined – is undergoing a dynamic and messy evolution influenced by a myriad of competing interests and constituencies. One of the positive things rising out of (or perhaps enduring despite) all of the political wrangling that makes it to NPR’s "All Things Considered” or ABC’s "World News” is that the calls for integrated care are stronger now than they have ever been. Whether physicians are working with therapists to help a patient for his/her own sake or if it’s to offset forthcoming medical costs associated with a(nother) hospitalization if they do not, really doesn’t matter. What matters is that providers across a variety of disciplines are increasingly working together because, somehow, everybody wins: patients are healthier, providers are more effective, administrators are less overwhelmed, and payers’ funds are more secure.

As our training sites across different mental health fields prepare future healers to enter these complex work environments, we are seeing many of yesterday’s interdisciplinary tensions regarding who is "better” (e.g., Psychology vs. MFT vs. Social Work) change to contemporary mutual respect and valuing of our colleagues’ contributions to a whole that is more than the sum of its parts. This shift is likely, at least in part, a reflection of how we are no longer working within the comfort of private practices that are isolated (or at least insulated) from the biopsychosocial/spiritual realities of the worlds that our patients and families reside in. We are working on a common ground that is not claimed by any single mental health discipline. We are on Medicine’s turf now, wherein most of us – whether we identify personally as a "family therapist,” "psychologist,” "social worker,” or "counselor” – are seen by everyone else as a "mental health clinician,” "behavioral medicine practitioner”, or "shrink.”

Defining and Proving the Profession

Within the trenches of day-to-day practice, many would argue that our medical colleagues, patients and families, and other treatment team members do not care what discipline us mental health providers were originally trained in. And I would, in many cases, agree with them as long as key facets and processes of what I espouse to be essential to good collaborative care are advanced (e.g., biopsychosocial/spiritual sensitivity to the systemic nature of patients’/families’ presentations, active efforts to promote agency and communion). However, from the 1000-foot view of health care policy and 3rd party payer systems, the disciplinary home-base of mental health providers is in fact VERY important. Psychology, for example (with its uncompromising efforts to advance – and deep pockets to support – research, political advocacy, and lobbying for preferential coverage), has long been able to keep other mental health fields from sitting at the healthcare table and/or drawing equally from available funds for service.

As a medical family therapist, it would be easy to demonize Psychology’s efforts to establish itself so well at the head of this table (to the detriment of me, my own specialty, or professional home). However, doing so without challenging MedFT’s contribution to this imbalance would be irresponsible. For example, Tyndall’s (2010) recent review of almost two decades of literature found only 65 articles about Medical Family Therapy, almost all of which are focused on the history, development, and/or application of clinical skills and processes – i.e., NOT on the evaluation of MedFT’s effectiveness or efficacy. In my opinion, we must compare this paucity of published work to the hundreds (if not thousands) of articles that highlight interventions housed within Psychology – or even Social Work – and ask, "Where are the MedFT researchers?”, "What are they doing?” and/or "Who do you think HMOs and other health systems are more likely to pay for, given the available evidence?”

To be sure, it important for all mental health disciplines involved in the evolution of collaborative and integrated healthcare to work hard to produce solid empirical evidence to survive. For MedFT per se, I believe that the first thing we must do toward this goal is to establish and settle-upon what it is we do and how this overlaps with and is distinct from other types of care. Extant literature regarding our efforts to date is very messy in this regard (e.g., defining MedFT inconsistently from one article to the next), and this makes it difficult for researchers to take ensuing steps to assess which components or processes of MedFT contribute to desired outcomes, and/or to evaluate and compare MedFT approaches to standard care alone and other collaborative models.

Drawing from the foundational work of McDaniel, Hepworth, and Doherty (1992), along with writings by Lindville, Hertlein, and Prouty-Lyness (2007) and Tyndall (2010), key components of what MedFT looks like on-the-ground are now coming together. They include: a) a theoretical foundation in MFT and systems theory; 2) biopsychosocial / spiritual sensitivity in care; 3) targeted efforts to empower patients’/families’ active participation and influence in care (i.e., "agency”); 4) purposeful supporting of and attention to emotional connections between patients and family members and other important persons within their immediate social systems (i.e., "communion”), and 5) interdisciplinary collaboration within the contexts of a larger care team and supporting organizational structure.

Asking the Right Questions

Okay, there’s our baseline definition. Now we have to get to work. We must advance research that documents MedFT’s applications/variations from this baseline characterization, and its processes within different teams oriented to different patient and family presentations. Across Peek’s (2008) three worlds of health care, we must evaluate MedFT across clinical, operational, and financial arenas. We can do this through qualitative methods that tap patients’, families’, providers’, and/or administrators’ experiences across different care types and clinical procedures. We can do this through quantitative methods that compare and track disease-related outcomes, cost offset data, and/or inter-member functioning and satisfaction in care teams. We can do this through mixed-methods approaches that simultaneously capture the richness of participants’ experiences alongside objective measures of beneficent change. Wherever we choose to start, and whatever we choose to do, we will be advancing MedFT – because at the present time our specialty is so novel that there are more "gaps” in what we know than there are empirically supported areas of what we do.

I am not advocating that we set out to "prove” MedFT’s universal superiority over any other discipline, nor have I ever found inter-departmental squabbling over whose field or approach is "best” to be very helpful as it relates to clinical work. I believe that graduate students within any discipline do better when they are exposed to each other’s fields and learn how their own and other’s respective efforts contribute to a larger mosaic of high quality and effective care. Just as there are some tasks in which a hammer is more appropriate than a screwdriver (and visa versa), there will be some scenarios in which MedFT is a better fit than a straightforward psychological assessment or intervention (and visa versa). But in order for MedFT to have a stable place at the healthcare table, it (we) must catch-up and establish our right and our worth be there.

And so, let’s get started. Now.



References

Lindville, D., Hertlein, K. & Prouty-Lyness, A. (2007). Medical family therapy: Reflecting on the necessity of collaborative healthcare research. Families, Systems and Health, 25, 85-97.

McDaniel, S., Hepworth, J., & Doherty, W. (1992). Medical family therapy: A biopsychosocial approach to families with health problems. New York: Basic Books.

Peek, C. (2008). Planning care in the clinical, operational, and financial worlds. In R.

Kessler & D. Stafford (Eds.), Collaborative medicine case studies (pp. 25–38). New York: Springer.

Tyndall, L. (2010). Medical family therapy: Conceptual clarification and consensus for an emerging profession. Unpublished doctoral dissertation. East Carolina University.


Tai Mendenhall

Tai Mendenhall is an Assistant Professor at the University of Minnesota (UMN) in the Department of Family Medicine and Community Health, the Associate Director of the UMN’s Citizen Professional Center, and the co-Director of mental health teams within the UMN’s Academic Health Center. He holds an adjunct faculty position in the UMN's Department of Family Social Science and mentors doctoral students who are completing the UMN’s Preparing Future Faculty series in college-level teaching. Dr. Mendenhall’s principal investigative interests center on the use and application of community-based participatory research (CBPR) methods targeting chronic illnesses in minority- and under-served patient and family populations.


This post has not been tagged.

Share |
PermalinkComments (0)
 

Real-Time MedFT Case Consultation: What Would You Do Next Week?

Posted By Randall Reitz, Tuesday, January 3, 2012

Fall 2011

Natalia and Norberto* attended my clinic's diabetes group medical appointment for the first time. They are both immigrants from a Spanish-speaking country who reside in a small town in western Colorado. Natalia has very limited English ability and Norberto knows just enough English to speak for her and to correct the interpreter. Both of them are 5'3” tall. His BMI is 41; hers is 55. Both have diabetes, chronic pain, and numerous other chronic conditions that are caused by or exacerbated by their weights

The topic for the group appointment was "sexual health with diabetes” and the patients were asked to submit anonymous questions to a panel that included a family physician, a family therapist (me), and a resident physician. Despite the promises of confidentiality, few patients submitted questions. We received a question about Viagra, a question about female Viagra alternatives, and a question about how diabetes can affect sexual performance. Natalia submitted a very detailed question which roughly translated to "My husband is now unable to ever have sex with me. He cannot maintain an erection. I am sexually unfulfilled and am not sure what I can do. What do you recommend?”

The panel attempted to maintain confidentiality with this question, but about 1 minute into the discussion Natalia interjected to clarify her question. Norberto then provided a rejoinder, and the couple started a sexual repartee in front of the group. The panelists redirected the discussion, but failed to fully respond to the question.

At the end of the group all participants set a self-management goal for themselves, which they report out to everyone. When it was Natalia's turn, Norberto stated that she needed to drink less soda. Natalia clarified that she only drinks 1-2 diet sodas per day. Norberto stated that it was at least 3-4. Their dialogue continued for about 5 minutes at which point Natalia stated "Why aren't you more worried about your 4-5 beers per night and less worried about my diet soda?” Norberto didn't respond and a silence fell over the room.

Four Months Later

I was precepting residents as they come out of exam rooms and report on their cases. A first year resident was seeing Natalia (and Norberto) so I joined the presentation along with the attending physician. The resident informed us that Natalia has end-stage renal failure and has been referred to hospice. As I knew the couple and have reasonably good medical Spanish I was asked to interpret for the last portion of the visit. The goal was to clarify what the couple understood and to answer any questions they might have.

After greeting the patients and explaining my role, I assumed my customary interpreter's position, slightly behind and to one side of the patient. The resident asked Natalia if she understood why she had received a visit from a hospice social worker. Natalia stated that when the person first came she didn't know she was going to die. She was in her home with Norberto and their adult children when she was told that she would probably only live for 6 to 12 months. At first she was shocked and everyone started crying. In the 2-3 weeks since then she has come to greatly appreciate hospice's home-based care. She credits them with helping to manager her pain and for being very responsive to her calls. She is very pleased to be receiving her care in-home and hopes not to leave.

During our visit Natalia and Norberto reprised their previous interaction of speaking over and contradicting each other. At one point he called her a "masoquista” and she often struggled to speak with the resident, as her husband continued over her. She reported that she has been sleepwalking and he has installed an alarm on their bedroom door so he will know if she is at-risk during a sleepwalking spell.

The resident seeing the patient that day was due to invite a patient or family to "Psych Day”. So, I suggested that she invite Natalia, Norberto, and their children to come. I will attend this visit along with a 2nd resident. I will assist with the patient's care and the 2nd resident will observe and provide feedback.

Now

If you had 45 minutes to work with a family in this setting, what would you want to accomplish? How would you focus the discussion?

Have you ever provided a family conference such as this? If so, what was the outcome?

 

*The patients' names and identifying information have been changed. Additionally, the content of this blog post was approved by my hospital's risk management department and the patients provided verbal consent to have it published online.

 


Randall Reitz is the Director of Social Media for CFHA and the Behavioral Science Faculty at the St Mary's Family Medicine Residency in Grand Junction, Colorado. He studied family therapy at Brigham Young University and Indiana State University.

He is the author of CFHA's
CollaboBlog.



 

This post has not been tagged.

Share |
PermalinkComments (3)
 

Money, Money, Money, Money

Posted By Barry J. Jacobs, Tuesday, January 3, 2012

Happy New Year and welcome to a once-in-a-decade opportunity to promote the growth of Medical Family Therapy. On January 1, new Medicare rules for hospital payments took effect and are a veritable game-changer.

In the past, if a 70-year-old man was admitted to a hospital with, say, a COPD exacerbation, he'd be pumped full of steroids and given breathing treatments for 3 days and then sent home; the hospital would be paid by Medicare for those 3 days of intensive care. If, once home, the guy started smoking heavily again and then suffered another COPD exacerbation a week later, he'd be readmitted to the hospital—jocularly called a "bounce-back”--and the hospital would again be paid by Medicare for another 3 days of care. The guy could keep going in and out of the hospital and the hospital could keep reaping the profits from its ultimately futile treatments for up to 100 days a year that the gentleman was hospitalized.

No longer. Under the new regulations, hospitals will not be paid by Medicare for patient re-admissions within 30 days of hospital discharge. That means the hospital will be paid for the first admission for our 70-year-old smoker but for none of the re-admissions thereafter if the guy bounces back too quickly. In other words, hospitals will have to eat the cost of the care it provides—the steroids, the breathing treatments, the food, the linens, etc.--during those bounce-backs. Medicare will no longer incentivize hospitals to provide inadequate care that doesn't keep patients out of hospitals.

This has spooked hospital administrators. Nearly every VP of Clinical Integration in the country is now scrambling to find ways to decrease hospital bounce-backs and thereby save their institutions money. They are looking at "care transitions”—i.e., how to make sure patients follow up with their primary care doctors, get the proper medications, and receive necessary home-based services. They are also turning their attention to something we know is obvious—the conditions in patients' home environments that affect their health.

Here's MedFT's golden opportunity. We have the know-how and techniques to understand the impact that patients' family members have, for example, on treatment compliance and to foster good health habits to keep patients ensconced at home.

For instance, please take a look at this presentation by Carol Levine, MA, a MacArthur Award-winning ethicist, director of the Families and Health Care Project of the United Hospital Fund of New York, and a major figure in the family caregiving movement (as well as a former CFHA conference plenary speaker)-- http://www.uhfnyc.org/publications/880807?tr=y&auid=10030107. The presentation, given during October 2011 at the National Health Policy Forum in Washington, DC, has a simple premise: If we better support all family caregivers in their work with chronically ill patients, then they will keep those patients from being re-hospitalied.

Then consider combining this approach with that of the "hot spotter” or "super-utilizer” emphasis propoundeded by Jeff Brenner, MD, a family physician and plenary speaker at the CFHA Philadelphia conference in 2011. Dr. Brenner has been highly successful using data to identify those patients within Camden, NJ who have the highest health cost expenditures and then lowering their hospital and emergency room usage by providing them with team-based primary care instead. For an eloquent description of Dr. Brenner's work, see this New Yorker magazine profile--http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande

At the Crozer-Keystone Health System in suburban Philadelphia where I work, we are now trying to decrease hospital bounce-backs by using a "super-utilizer” approach that focuses on family factors. For example, we identified a brittle diabetic man who was hospitalized 20 times in 12 months for diabetic complications, creating hospital bills in excess of $500,000. What simple method worked to decrease his rate of hospital re-admissions? We engaged the man's wife and convinced her to provide greater supervision for his diabetic regimen. To cite another example, a middle-aged, somaticizing woman who was frequently hospitalized for syncope ran up hospital and ER bills of over $700,000 over a 5-year period. What changed this pattern for her? We engaged her husband to help us convince the patient that her symptoms were more stress-related than neurologically based.

Money always talks. Under the new Medicare rules, hospitals will quickly get out of the revolving-door, bounce-back business. Working effectively with patients' families will be the key. We hold that key.

 

Barry J. Jacobs, Psy.D. is a clinical psychologist, family therapist and the author of the book, The Emotional Survival Guide for Caregivers—Looking After Yourself and Your Family While Helping an Aging Parent. He is the Director of Behavioral Sciences for the Crozer-Keystone Family Medicine Residency Program in Springrfield, PA and has had adjunct faculty positions with the Temple University School of Medicine, University of Pennsylvania School of Nursing and the Institute for Clinical Psychology of Widener University. He is on the board of directors of the Collaborative Family Healthcare Association. He lives with his wife and two children in Swarthmore, PA and maintains a website—www.emotionalsurvivalguide.com.

This post has not been tagged.

Share |
PermalinkComments (11)
 

Learning How to Live in Somebody Else’s Medical Home

Posted By Maureen Davey, Wednesday, December 21, 2011

Our masters students at Drexel's Couple and Family Therapy Department who have done internships in medical settings (e.g., HIV, oncology, and primary care) often experience culture shock when they first begin their placements. As a supervisor, I have normalized this initial culture shock because I believe that learning about the medical culture is like moving to another country where the language and customs are different. I remind students that they will eventually become more familiar with the medical language and concerns of physicians and will learn how to collaborate and consult about patient care and family issues.

As a program we make sure our interns are placed in collaborative medical settings, where they are able to ask questions and to learn from medical providers and where medical providers are open to learning about family-centered care. Our students often rely on physicians to make referrals to them so as a supervisor I help students learn how to translate the medical concerns of physicians, for example medical compliance and treatment retention, into a psychosocial or family problem that they can work on collaboratively with the provider and with the patient and his/her family. I believe that family-centered care occurs when two cultures learn from each other, allowing medical providers and family therapists to collaborate, partner and work together in order to provide more holistic and family-centered healthcare.

Initially most interns have felt out of place or like they do not fit into the medical setting. Although our students have found it is much easier when another family therapy intern was placed at the medical clinic before them, it is still an adjustment and culture shock regarding the pace of care (e.g., learning how to do 10-15 minute therapy sessions vs the typical 50 minutes), medical language and terminology, and hierarchical medical model. Again, I remind my interns that fitting in will take some time and will improve as they begin to collaborate on shared cases with medical providers.

However, my students have also shared that they struggle with the differences in approaches to care and techniques. Physicians tend to focus on short-term goals, focusing on very specific problems or tasks (e.g., taking medications as prescribed) but also tend to follow their patients over several appointments. Family therapy interns often feel they need to do more lengthy sessions with families. Although this can be helpful, patients in medical clinics have become impatient and some refused family therapy unless it can be integrated into their regular health care at the clinic. I think this is the biggest challenge for beginning medical family therapists and for me as a supervisor. I would like to hear about other strategies that can help trainees learn how to do effective shorter-term therapy in medical settings.

In general, I am also curious about what has worked or not worked for other faculty, supervisors and providers to help interns and family therapists find a place in the medical home?

 

Maureen Davey Maureen Davey, PhD LMFT is an Assistant Professor in the Couple and Family Therapy Department of Drexel University.  She is a member of CFHA.

This post has not been tagged.

Share |
PermalinkComments (0)
 

Growing MedFT and Growing Pains

Posted By Randall Reitz, Monday, December 12, 2011
Updated: Monday, December 12, 2011

I had the great fortune of having Wendy Watson as my doctoral chair at BYU. She and her Canadian colleagues formulated Systemic Belief Therapy. SBT was one of the first family therapy approaches specifically targeted to medical family therapy (although the Canadian nurse triumvirate just cringed at my MedFT reference).

SBT was a great fit with my other favorite postmodern approaches: narrative therapy and solution-focused therapy. Coming out of grad school I thought these models were sufficient for everything I would see in medical clinics. As a post-modern therapist I was:

  • Opposed to psychopathology (that’s not encopresis or schizophrenia, it’s sneaky poo and the in-the-corner lifestyle);
  • Skeptical of psychotropicmedication;
  • Hyper-sensitive to physician privilege and the power of the gaze in "La Clinique”;
  • Convinced that behaviorism was inhumane.

My internship quickly disabused me of these assumptions. Now 11 years later I still follow many of the post-modern assumptions and I teach residents solution-focused therapy. However my day-to-day therapy would make Skinner smile and I model motivational interviewing and CBT for my residents.

All is not lost, however, I am still acutely aware of the influence of families and am often successful at turning individual referrals into systemic interventions. I still draw genograms for my new patients, but haven’t yet figured out how to integrate them into the EMR.

My guess is that my experience is not unique among medical family therapists—especially among MedFTs who were trained before MedFT existed. In some ways family therapy is a perfect fit for medical settings and in some ways it is severely lacking.

Please take a minute and add your thoughts about the family therapy models that caught your fancy in training and on how you’ve had to either adapt them or abandon them to fit within the medical culture. What other models of therapy do you find most helpful?



Randall Reitz is the out-going Executive Director of CFHA and the Behavioral Science Faculty at the St Mary's Family Medicine Residency in Grand Junction, Colorado.  He family therapy at Brigham Young University and Indiana State University.

He is the author of CFHA's CollaboBlog.


This post has not been tagged.

Share |
PermalinkComments (5)
 

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?

This post has not been tagged.

Share |
PermalinkComments (6)
 
Page 19 of 19
 |<   <<   <  14  |  15  |  16  |  17  |  18  |  19

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.