Jennifer Hodgson: "My Fantasy Football Healthcare Team"

Brilliant. Simply brilliant, Jennifer. Thank you for this fascinating and challenging post. Isn't it funny that this all boils down to working in teams and collaborating with other professionals who maybe don't look like you, talk like you, or perform the same function as you but all work towards the same goal of helping patients?

If only my residency Integrated Team were functioning as well as my residency Fantasy Football team (In 1st place going into Week 6).

At my first integrated site the original team consisted of 3 MFT's.  This made sense at the time because it allowed for consistency in training, treatment model, and supervision requirments.  Additionally, at this time the collaborative care movement was dominated by MFT programs.  However, our homogenous team also struggled with similar deficiencies in skill set.  That is, we were all great systems thinkers and collaborators, but we lacked education and clinical experience in psychopathology, psychopharmaceuticals, and cognitive-behavioral therapy.  Similarly, we were geared up to treat the entire system, but 90% of our referrals were for individual patients seeking treatment for depression and anxiety.

We were able to address many of these issues by getting crash-course training in areas of concern and by educating medical staff about how best to work with the entire family system.  However, real progress came as we diversified our team.  Our second supervisor was a psychologist from a community mental health center, we replaced another MFT with an addictions counselor, and we added an LCSW.  I continued to carry the flag for MFT's.  This seemed to be a much better fit for our clinicians' and patients' needs.

The one caveat about this idyllic picture is that we were working as employees in a safety net clinic that exclusively served the low-income uninsured.  There was no profit or billing advantage for us to jostle over.

I have been extremely interested and trying to devote myself as much as possible in learning about collaborative health.  I have been searching for graduate programs that would make me an essentail member of this collaborative team we have going on.  Its extremely difficult!  What route would make me the best professional?  I think the blog answers my question.  No single route will create the best Psychologist, unless there is a degree that requires every subfeild in psychology is studied and expected to be an expert...impossible.   In my short life I have realized that we can read all the books and go to school for 6-10 years, we'll still fall short somewhere.  I think we learn the best when we are actually out there experiencing and seeing what works and doesnt.  Just my thoughts...

I think I would feel comfortable throwing down with the following line-up.  The offensive line would consist of one DO/MD, and a few ARNP's while the defensive squad would be made up of a PhD MedFT/Clinical Psychologist, an addictions counselor, a licensed clinical mental health counselors and an MSW that could play the role of therapist and/or other social worker duties.  As well, a care coordinator and maybe a psych ARNP in special teams.  All members would have some level of cross training/in-service education regarding the others duties/skills in order to make the team as flexible and adaptable as possible. 

Tattiana,  I think you  stated it perfectly with "we learn the best when we are actually out there experiencing...".  Books are valuable as is the knowledge you gain by doing; finding that balance is the key.  My fantasy football training course would be based on a graduate program with a  "Behavioral Therapist" track with a focus on creating a "generalist" practitioner.  Classes such as Anatomy and Physiology as well as Pathology and a basic nursing or EMT class mixed with the typical mental health counselor classes might make for a good start. 

This is exactly what I had hoped we would generate in this type of a discussion. I would like to add a PharmD to our team. Also, front staff (check in specialist and scheduler) and admin support (medical director and admin assistant).

Tattiana, I would encourage mental health professionals/students to enter into medical settings with training and understanding in the infrastructure, language, and basic treatments common to the areas of medicine/dentistry that one wants to enter into for a career/training. Students and professionals should know where and how to look up information about medical illnesses, disabilities, medication, etc.  I refer to CJ Peek's 3 world view and strongly believe that clinicians need to have understanding in each of these areas to be successful. I have seen players placed on the field without knowing what the function of their position is or how to communicate with the other players on the team. Experience is a great teacher but I would also endorse preparation as a key to success. I would strongly encourage students like Tattiana to explore graduate programs that have more than one class that would prepare them for health care practice, as well as, programs that have a strong clinical training process (masters) and research/supervisory training curriculum (doctoral) that help students to prepare for this type of employment.

 I would have to say that yourpassion for what you do is vividly shown in all of your lectures Dr Hodgson. I have always been a huge supporter of integrating the medical field hand by hand with the mental health field. It seems thought that the Journey will have to be like a battle at times to make many other practitioner feel for what it means to provide this source of care , and as you said , for them to be convinced that it takes someone who is well trained in this field to do the kind of profession that you do everyday. As one of your students, I was amazed to the amount of training that we are getting to be well skilled in the field of collaborative care. I would have to say that it must feel so rewarding over and over to help patients and sometimes some of their families to overcome some difficult emotional, relational, so as for spiritual struggles that accompany any physical illness, whether a chronic illness or even an cute one.