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Defining Good-Enough: An Amateur’s Reflections on Integrating Care

Posted By Rachel L. Hughes, Monday, November 23, 2015


Would you believe that I’m starting my second year as a Medical Family Therapy (MedFT) doctoral student and the first time I heard of MedFT was a little over two years ago?  During my very first practicum class, a second year doctoral student enthusiastically recounted some of her experiences as a medical family therapy volunteer in the Health Resource Center (HRC), a free community clinic managed by medical students.  I immediately volunteered hoping to get my first taste of what medical family therapy meant. 

Knowing little more about integrated health care than the name, I dove headfirst into a collaborative experience with medical students also trying to learn about integrated health.  When I first started volunteering, the HRC was set up with medical care, optometry, physical therapy, nutrition, and mental health services (clinical psychology and medical family therapy), sharing little but a location amongst them.  Now, MedFT is a part of lead student professional planning meetings, preceptor meetings before clinics, and an active voice in the future direction of the HRC.  Getting to this point was not an organic, natural, or even comfortable process to start but was well worth the blood, sweat, and tears put into it.

What Wasn’t Working   


·         Mental health professionals were pigeonholed, specifically with social work at this site.  Medical family therapy volunteers had defined their home as in the social work office because 1) the social worker was an amazingly kind woman and 2) medical students looked at the volunteers as though they had three heads when attempting interaction.


·         Different screening forms were used with different mental health professionals.  Because psychology and medical family therapy alternated weekends at the HRC, the medical students in charge of the intake paperwork at the clinic had to switch between sets of mental health screening forms (and really struggled with remembering which forms for which professionals).


·         The lead medical students in charge of the clinic could barely recognize the medical family therapy volunteers, let alone describe the span of services provided.  Most bruising to my new professional ego was the fact that I would enter the clinic week after week, check in with the lead medical student of the day, and be met with a blank, unrecognizing face.


What Has Changed For the Better


The increase in integration was not because of the singular effort of medical family therapy, which would have been near impossible since the clinic was first and foremost a medical clinic.  Because the medical student leads pass the torch to new leads every March, being involved from the very beginning with the new leads really helped increase the buy-in to MedFT services.


·         Increasing proximity to medical students.  Instead of limiting location to the social work office, MedFT volunteers make more noticeable appearances by attending preceptor meetings and giving elevator speeches reminding medical students of the services offered.  In lulls at the clinic, MedFT volunteers often socialize with the medical students, checking in on how the medical students and patients are doing.  Social conversations have often opened the door for medical students to ask more in depth questions about MedFT services.


·         Collaboration of mental health services to create a shared intake form.  To reduce the confusion of front desk volunteers, psychology and medical family therapy has reevaluated the efficiency of two discrete forms and were able to work together and create a shared screening form that was effective for both services.


·         Welcoming the new leads and efficiently disseminating information about medical family therapy services.  You catch more flies with honey than vinegar.  This was also true in the integration process.  Being friendly and sociable with the leads allowed for receptive ears when speedily describing the services medical family therapy volunteers could offer.  Focusing on how medical family therapy were also invested in the physical health of the patients at the clinic even further increased receptivity of the leads.


·         Creation of an interdisciplinary "lead” board.  To address the lack of communication between different services, a group of lead students from each profession in the Health Resource Center was established.  The board communicates about difficulties in disseminating services, brainstorms about ideas that might increase collaboration, and shares in the successes of the Health Resource Center.


What Might Not Change (and That’s Okay!)

·         Lack of direct referrals from the medical students.  As lovely as it would be to have an eager medical student walk up and say, "I think I have a patient that could benefit from your services,” this is probably a lofty goal at best and unrealistic.  Since medical student turnover at the clinic is so high (few students come for more than two weeks a semester) and the current structure of the clinic does not allow for unplanned MedFT visits, the focus of intervention has and will continue to be with the lead medical students that are at the HRC regularly.


·         Cohabitation of medical family therapy and psychology.  Even though both groups of volunteers offer different services, the space in the clinic is so limited that an office exclusively for one set of mental health volunteers is not guaranteed.  To make both services accessible to the community, medical family therapy and psychology collaborate on scheduling and alternate weekends in the clinic.


Despite being a complete novice in the field of collaborative care, I have seen (and advocate for) a huge shift towards greater integration at the Health Resource Center in a single year.  I have learned to celebrate the successes and not to sweat the things that didn’t turn out exactly how we were hoping.  Not every healthcare system is meant to be fully collaborative because certain parameters (e.g., high employee turnover or space constraints) simply will not allow for it, but level of collaboration is not necessarily a measure of effectiveness.  Mental health and medical professionals should not be discouraged by imperfect collaboration.  Take it from a total amateur, the smallest changes can make a world of difference in how we practice together.


  Rachel L. Hughes, MA, PLMFT is a medical family therapy doctoral student at Saint Louis University.  She received her MA from Appalachian State University in Marriage and Family Therapy and graduate certificates in expressive arts therapy and addictions counseling.  Her current research interests are medical outcomes of foster children, utilizing play therapy in medical settings, and adverse childhood experiences. 

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