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Neftali Serrano

Integrated Care: A Critical Strategy for Chronic Illness, Prevention, and Pediatric Health

Apr 22, 2025
RE: Talking Points for CFHA Members Engaging Policymakers, Medicaid Leaders, and Local Officials Integrated care—the coordination of medical and behavioral health within primary and specialty settings—is a key solution to […]

Integrated Care: A Critical Strategy for Chronic Illness, Prevention, and Pediatric Health

by Neftali Serrano

RE: Talking Points for CFHA Members Engaging Policymakers, Medicaid Leaders, and Local Officials

Integrated care—the coordination of medical and behavioral health within primary and specialty settings—is a key solution to the most pressing health issues of our time. It is also perfectly aligned with the vision of Make America Healthy Again (MAHA): the root causes of chronic disease, promoting wellness, and protecting our children and adolescents.

Why Integrated Care Supports the MAHA Platform

Chronic Illness Root-Cause Care

Integrated care treats chronic conditions like diabetes, heart disease, and chronic pain by pairing medical management with behavioral support (e.g., stress reduction, adherence strategies, lifestyle change). It reduces over-reliance on pharmaceuticals and increases patient agency.1

Pediatric Health and Early Intervention

Behavioral health integration in pediatric settings helps children and families address anxiety, trauma, developmental delays, and family stress—before these become lifelong conditions.2

Prevention and Health Autonomy

Integrated care empowers patients through early intervention, behavior change support, and shared decision-making. It helps prevent escalation of mental health and physical conditions through timely, personalized support.3

Policy Recommendations for State and Federal Leaders

  1. Fund Integrated Care Teams in Primary & Pediatric Clinics
    • 1.1. Allocate Medicaid and federal resources to support embedded behavioral health in routine medical care settings including models such as PCBH and CoCM.
  2. Build the Workforce for Community-Based, Whole-Person Care
    • 2.1.Invest in training Behavioral Health Consultants, care managers, consulting psychiatrists, peer support specialists and community health workers specifically for primary care and prevention-focused roles.
  3. Enable Same-Day, Behavioral Health Support
    • 3.1.Reform payment and regulation to support brief, evidence-based interventions for mental health and substance use—especially in early stages and for populations with poor access to care.
  4. Incentivize Measurement-Based Preventive Care
    • 4.1.Promote simple, scalable technology tools to track behavioral health symptoms like we do medical labs—ensuring progress, accountability, and patient-centered planning.

What’s at Stake

  • 60% of U.S. adults have a chronic illness
  • Pediatric behavioral health crises are escalating
  • Substance use deaths and anxiety diagnoses continue to rise

Footnotes

  1. https://pubmed.ncbi.nlm.nih.gov/21190455/ ↩︎
  2. https://pubmed.ncbi.nlm.nih.gov/34807644/ ↩︎
  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC8412979/

    Photo by Andy Feliciotti on Unsplash ↩︎

CFHA Board Response To Federal Executive Actions

Mar 12, 2025
RE: When it feels like our backs are against the wall. To: Our Members & The Larger Healthcare Workforce Over the last several weeks …  We at CFHA want to […]

CFHA Board Response To Federal Executive Actions

by Neftali Serrano

RE: When it feels like our backs are against the wall.

To: Our Members & The Larger Healthcare Workforce


Over the last several weeks … 

  • If you have been worried or deeply concerned by federal policy changes that impact the healthcare workforce,
  • If you have been directly or indirectly affected by executive orders, funding changes, or the darkness of the national rhetoric,
  • If you are a member of a community that is a prime target for policies that threaten your safety and dignity,
  • If the status of your ability to stay in this country is in question,

We at CFHA want to share with you: you are not alone. 

Our members across the country are directly impacted or work in communities deeply impacted by the series of executive orders that have disrupted millions of lives. The truth is, many of us, depending on our social, economic, and/or racial status in American society, have been here before and carry the legacy of communities bruised by political meanness, subhuman rhetoric, and undignified policies.

We believe that the dis-ease and unexplainable lament we feel—emotions that are necessary and appropriate—stems from the loss of our individual and collective ability to do the work of equity with intention, visibility, and support. A significant dimension of this real loss is the ability to explicitly do what we deeply value and the fear that arises with the loss of things we cannot get back. We also lament the loss of trust and the pain we feel as we witness the erosion of the gains in equity built through deep vulnerability, especially by people of color who bore the weight of such work.

There are also real losses of funding and human capital that have accompanied these federal directives and those that still lie ahead in the federal budget process. While we stake no political claim as a not-for-profit, we do call out the obvious: healthcare and the healthcare workforce are not the enemies of good governance and we should not be targeted as the cause of macro-economically related financial circumstances.

We will do what we have always done – integrate ourselves in locations where our people are and hold space for each other. Here are some of the concrete things we can do together: 

  • We will schedule community conversations to hold space for connection and to be present with our dis-ease and lament. Look for calendar invites. We look forward to seeing you.
  • Ask your SIGs to convene, share, and hold space. Reach out to the Board of Directors if you need someone to be present or facilitate. 
  • We will curate targeted podcast episodes to share new strategies and learnings. 
  • We will remember our past – the conditions our beloved women and men endured to give us the values and freedoms we have today and to remind ourselves that we have overcome before.
  • We will continue to gather intelligence from around the country and share what we have learned.
  • We will partner with like-minded organizations to promote sustained workforce funding and protections.
  • We will keep reminding you and ourselves to care for ourselves and each other. 

We have been intentional in the use of the word, lament. Drawing from ancient traditions, lament is more than just sadness, rather it is necessary to help us unfreeze from our natural response to traumatic environments. As all of you know, the issue is not that these rough-edged emotions are present but rather our refusal to feel them. Lament reminds us to feel so that we can find clarity to act. We issue this memorandum as a first-step of many and look forward to our continued partnership towards healthcare that integrates physical and behavioral health seamlessly. 

With equity, peace, and resistance in mind, 

Jason Herndon, President

Monica Harrison, Treasurer

Deepu George, Immediate Past President

The CFHA Executive Committee on behalf of the Board of Directors

Photo by Mulyadi on Unsplash

Dr. Don Bloch, a key founder of CFHA.

CFHA Luminaries Reflect On Whether The Vision For Integrated Care Has Been Realized

Aug 21, 2024
By Joellen Patterson, PhD, LMFT The foundation of this small project was a curiosity about whether, and if so to what extent, Don Bloch’s (physician, key founder of the Collaborative […]

CFHA Luminaries Reflect On Whether The Vision For Integrated Care Has Been Realized

by Neftali Serrano

Dr. Don Bloch, a key founder of CFHA.

By Joellen Patterson, PhD, LMFT

The foundation of this small project was a curiosity about whether, and if so to what extent, Don Bloch’s (physician, key founder of the Collaborative Family Healthcare Association) ideals for integrated care as voiced at Wingspread (first CFHA meeting) have been realized in the world of integrated care today. C.J. Peek wrote an article nearly ten years ago about where integrated care stood in respect to Bloch’s ideals at that point in time, and this short paper is meant be a near 10-year follow-up to Peek’s work (Peek, 2015). This project was motivated by the ongoing selection process for a new Families, Systems, and Health (FSH) editor, in the hopes that a reflection of where integrated care was, where it stands now, and where it may would help inform the selection committee. (Since the inception of the project those editors have now been selected.)

From December 27, 2022 to January 27, 2023, the following people were interviewed about the state of integrated care, especially in comparison to its original formulation as presented at the 1994 Wingspread conference: Dr. C.J. Peek, Dr. Susan McDaniel, Larry Mauksch, Dr. John Rolland, Dr. Gene Kallenberg, Dr. Bill Doherty, and Dr. Mac Baird. These individuals were asked about successes of integrated care, current roadblocks to increased adoption and implementation of integrated care, the role of the family, and thoughts and ideas of future direction for FSH. Though many of the interviewees prefaced their answers by stating they had moved on from working in integrated care in the last ten or twenty years, nearly all still had insights about the successes and areas of growth for the field and for FSH. 

Don Bloch’s vision as visualized by C.J. Peek (Peek, 2015)

Interview Findings

All interviewees agreed that integrated care has made progress in the last 20-30 years. Some interviewees thought of this progress as more widespread acceptance of the importance of integrated care, while others pointed to the increased number of practices instituting (their own version of) integrated care. At the same time, interviewees were quick to point out roadblocks. One of the two primary roadblocks for increased adoption and implementation of integrated care is the lack of conducive financial payment systems. McDaniel sees the fee-for-service model as inhibiting further growth of integrated care and implementation of its central tenets. This was Peek’s opinion too, as he expressed that payment systems are still anchored in the mind-body split. At the same time, he notes that several sites have been able to take advantage of alternative payment schemes like shared savings and pay-for-performance, though these are still workarounds. The second primary roadblock expressed among interviewees is the “how to” of implementation, about which there still isn’t enough research. See below for more commentary on this.

Roadblocks for increased adoption and implementation of integrated care

  • Existing payment models (e.g. fee-for-service) do not support high levels of integration 
  • Need more evidence (RCTs, or other studies with comparison groups) supporting effectiveness of integrated care
  • Lack of unified conceptual definition of integrated care
  • Mind-body division still prevails as dominant healthcare view
  • Lack of manualized implementation strategies
  • Lack of involvement of family

One of Bloch’s original visions for healthcare was that it would incorporate both the individual and the family. All interviewees agreed that the family is still not involved or utilized in integrated care. There were a variety of reasons posited for this idea. One was that there is no financial system (e.g. reimbursement) in place that rewards any involvement with the family. This problem is compounded by the public’s lack of awareness of why including the family might be beneficial, especially when many primary care appointments are preventative. Peek noted that one way in which family is involved is through healthcare systems’ involvement of communities, of which families are the primary unit of care. 

Another part of Bloch’s vision was the balance between the mind and the body. While most interviewees still lamented healthcare’s stuck place in this split, there were some ideas about how insight into this faux-duality may be shifting. Peek mentioned that research about chronic illness, ACEs, health behavior changes, and depression as a “foreground” issue have all encouraged the medical field to see the mind and body as intermixed. Mauksch thinks, too, that that increased insight into the epidemiology of mental health issues have made integration more logical, as such epidemiology sees the mental and physical colliding. Despite these at least conceptual advancements into the shallow nature of the mind-body split, the dualism still dominates business models and inhibits further integrated care adoption. 

A third part of Bloch’s vision was about the importance of striking a balance between generalists and specialists. Not many interviewees commented about this, but the ones who did agreed that there was there are still too much emphasis/reliance on specialists. At the same time, Rolland thought that it makes a lot of sense for families to be involved in specialty clinics because, presumably, the person is already sick. 

In addition to being asked about Bloch’s original vision, interviewees were asked about CFHA, the role of research in supporting integrated care, and FSH. There was consensus among the interviewees about the unbalanced nature of CFHA’s member (physicians and behavioral health providers) makeup. There are various reasons for this. For one, as Mauksch put it, it’s never been that balanced. Another reason in Mauksch’s eyes is that physicians have less time and are faster moving than BHPs, and often don’t have the same research and academic training as do some BHPs. Third, many (if not most) physicians still don’t have the incentive to incorporate integrated care into their clinics because of their clinics’ clinical leadership and administration.

A number of interviewees had suggestions about research needed to advance integrated care.  These suggestions fell mainly into two categories: proving the utility of integrated care and explaining the “how-to” implementation of integrated care. Many people advocated for the need for more studies with comparison groups illustrating the effectiveness of integrated care. Regarding the second point, many interviewees expressed the need for studies about how to “fit everything together” for an integrated care setting, including business model, delivery model, and education and training. In addition to these two main points, there were rumblings among several interviewees about how there isn’t even agreement in the research about what integrated care looks like (e.g. a singular model).

Some interviewees had thoughts about FSH and what types of articles it should publish. Rolland for example, thought the journal needs more conceptual papers (and fewer data-driven articles), needs to be more multi-disciplinary, and needs to refocus on how to make integrated care truly systemic. Mauksch had somewhat different ideas and expressed the negative consequences of contributors conflating the collaborative care approach and the PCBH approach, stating that PCBH does not have nearly the same strength of evidence as does the collaborative care approach. Kallenberg also had ideas for the journal and stated that there are too many special interest articles and one-off articles reviewing how integrated care was implemented at a single site. He suggested that the journal needs more papers about measuring the effects of integrated care, papers examining integrated care operational difficulties, and articles that target primary care physicians more in an attempt to realize the importance of integrated care. Thoughts and suggestions for FSH can be summarized by the following list:

Suggestions for FSH

  • The journal needs fewer “one-off” studies about case successes
  • The journal needs more rigorous studies involving comparison groups proving effectiveness of integrated care
  • The journal needs more articles addressing workflow, training, and operational issues
  • The journal needs to have articles that better attract physicians
  • The journal needs more conceptual papers (Rolland)

Conclusion

In summary, while the field of integrated care continues to make advances, it still faces external impediments, like financial payment systems rooted in the mind-body split, as well as internal difficulties, like lack of a “one-size-fits-all,” or even a “one-size-fits-most” approach for implementation. Nevertheless, there is more support for the idea of integration and its potential benefits for patients, healthcare systems’ pocketbooks, and providers. It is an open question in what capacity FSH will propel integrated care going forward. Will it focus on disseminating rigorous research to further prove the efficacy of integrated care? Will it provide more manualized approaches for non-integrated healthcare systems to move toward integration? Will it be a platform for conceptual and experimental inquiry into how integrated care may look? 

February, 2023

References

Peek, C. J. (2015). Don Bloch’s vision for collaborative family health care: progress and next steps. Families, Systems & Health, 33(2), 86.

JoEllen Patterson, PhD, LMFT, is Professor in the Marital and Family Therapy Program at the University of San Diego. She is also Associate Clinical Professor of Family Medicine, Global Health, and Psychiatry at the University of California, San Diego, School of Medicine.

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Why Texas?

Aug 5, 2024
Do We Engage Or Protest States With Regressive Healthcare Policies? As the CEO of the Collaborative Family Healthcare Association (CFHA), I want to address a topic that has been on […]

Why Texas?

by Neftali Serrano

Do We Engage Or Protest States With Regressive Healthcare Policies?

As the CEO of the Collaborative Family Healthcare Association (CFHA), I want to address a topic that has been on many of our minds: our decision to host conferences in states with regressive policies related to healthcare for women and other justice issues that impact healthcare professionals and the patients we serve.

To begin, I’ll state at the outset that our decisions are made with careful consideration and a conscious stance of engagement rather than absent protest. And, we don’t pretend to have all the right answers. We, meaning the CFHA board and staff, together with member leaders, come together and make the best decision possible for each situation. So, here are some of the reasons why we chose Texas as location for our upcoming conference.

A Stance of Engagement

Our decision to hold conferences in states with controversial policies is not an endorsement of those policies. Rather, it reflects our commitment to engagement. We believe in the power of dialogue and the importance of being present in these regions. By choosing to engage, we aim to foster discussions, share knowledge, and provide support to our members who are directly impacted by these policies. On balance, we asked ourselves whether being present and engaged was more efficacious than protesting via our absence and it was hard to see protest winning over presence.

Supporting Our Members in All States

We have members across the country, including in states with regressive healthcare policies. Abandoning these states would mean abandoning our members who live and work there. These dedicated professionals rely on CFHA for support, resources, and community. We cannot turn our backs on them during challenging times. Instead, we choose to stand with them, offering our support and ensuring they know they are not alone. This is especially true for Texas where some of our most ardent members, including our President, hail from. These teams are caring for women as they struggle with reproductive issues. They are caring for migrants as they struggle with immigration issues. They are caring for LGBTQ+ populations as they struggle to find support. It does not feel right to abandon those care teams.

Because They Asked

We host conferences in areas that members ask us to host conferences, and our San Antonio conference came to be as a result of an application put forth by a group in the southwest Texas region, much the same way our last conference was held in Phoenix, AZ as a result of an Arizona-based group. The planning committee, which hails from that region, is excited to show off their state and the many ways they have overcome barriers to care, including political barriers. This is crucial not just for Texas but for care teams coming from other states with regressive policies to have exemplars and encouragement that you can still provide quality, team-based care in difficult political environments.

A Long-Term Perspective

The issues we face in healthcare are complex and multifaceted. They will not be resolved overnight, and we cannot afford to ignore red-leaning states for decades to come. Change is a long-term process, and we must remain engaged and active in all regions to drive progress. By being present and vocal, we can contribute to meaningful change over time. In other words, we don’t see these issues resolving quickly and thus a decision to protest by avoiding red-leaning states could essentially mean 10 or more years of absence from these states.

Fostering Dialogue and Support

Our conferences are more than just events; they are opportunities for connection, learning, and growth. They provide a platform to discuss pressing issues, share best practices, and support one another. In states where healthcare policies are regressive, our conferences become even more critical as they offer a space for care teams to come together, find solidarity, and develop strategies to navigate the challenges they face. We have opportunities to have these discussions in San Antonio. And we have created a virtual Community Conversation in September ahead of the conference to ensure that we are primed to play an active role in supporting our Texas-based care teams.

Respecting Different Approaches

I want to acknowledge and respect that some may choose protest as their form of engagement. Protest is a powerful tool for change, and those who choose this path have our respect and support. However, given our relatively small size and purchasing power, CFHA believes that our greatest impact comes from being present and actively engaged.

I want to emphasize that our choice to host conferences in all states is driven by a commitment to our members and the belief that engagement is a powerful catalyst for change. We will continue to stand by our members, support their work, and foster dialogue, no matter where they are located. I’m sure some of you disagree with our stance and some may even choose not to come to the conference as a result of its location. I get it. These are tricky times around the dinner table. We just hope we can still be at the dinner table and continue the conversation.

Photo by Aarón Blanco Tejedor on Unsplash