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Invite Someone New to the Room

Posted By Randall Reitz, Tuesday, February 5, 2013

Disrupting Status Quo

 

It was a privilege to have Dr. Wendy Watson as my doctoral chair at BYU. My dissertation research implemented her Systemic Belief Therapy with families with a child with diabetes. During the clinical practicum that supported the research she shared dozens of wisdom bits—some about therapy, some about humanity, others about life. The one that has stuck with me is: "When feeling stuck, invite someone new to the room.”

As I understood it at the time, this axiom had 2 applications in the therapeutic environment: if a clinician is stuck with an individual patient, either the patient should invite a loved one or the clinician should invite a professional colleague. Wendy Watson is one of many founding mothers and fathers of collaborative family healthcare. Our movement and our association (CFHA) have grown considerably from the days when we could speak truth in axioms but lacked the sustainable clinical models and research base to justify our inchoate truths to the broader healthcare system.

Reflecting on the wisdom of inviting someone new to the room, I would suggest that the science and practice of bringing a professional colleague into the room has blossomed while the family half of the equation has been somewhat overlooked. That is, most of our best integrated care systems our experts in collaboration (i.e. integrating primary care and behavioral health), but far fewer are experts in family (i.e. health interventions that harness the power of non-clinical relationships).

As is implied in CFHA’s name, I believe the annual conference of the Collaborative Family Healthcare Association is the best example of a convening that champions both collaboration and family. As a Chair of CFHA’s 2013 conference, I would like to issue you a personal invitation to present your best ideas at this year’s conference. The conference Request for Proposals is open from now until March 15th. The conference will be October 10th-12th at Colorado’s gorgeous Omni Interlocken Resort, midway between Denver and Boulder.

This year’s conference theme, "Disrupting Status Quo”, evokes Wendy’s approach to getting unstuck in the clinical environment. We disrupt paralysis each time we invite someone new to the exam room or to the conference workshop room:

  • If you’ve never attended CFHA before, your ideas and professional contacts will be the disruptive influence.
  • If you’re a regular attendee, consider inviting a new co-presenter to bring forward a revolutionary idea that will ripple through the healthcare system.
  • Or, if you are feeling stuck in the growth of collaboration in your clinical setting, consider inviting a workplace colleague to the room so that he or she can catch the vision and develop into a champion in your setting.

Whether a first time attendee or a regular conference-goer who is inviting someone new, please be assured that your disruptive presence is welcome in our room. Please upload your best idea to the conference website today.


Randall Reitz
Randall Reitz, PhD, LMFT is the Director of Behavioral Sciences at
St. Mary's Family Medicine Residency in Grand Junction, CO. He is also a chair of the 2013 CFHA Conference in Denver. When not scheming to disrupt status quo he can usually be found uploading pictures of his children to facebook.



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Hot Air Balloons, New Friends, and Collaboration

Posted By Matthew P. Martin, Wednesday, January 30, 2013


 

 


This post is the fifth and
final in an ongoing series
about patient- and
family-centered care.







 

My first and only time in a hot air balloon was in Gallup, New Mexico. I lived in the Land of Enchantment for two years after my freshmen year in college. One year in December I decided to attend the Red Rock Balloon Rally that is held every year outside Gallup. A friend of mine discovered that volunteers who helped set up the balloons could be given a ride by the owners of the balloon. We quickly signed up and I soon found myself riding in a woven wicker basket several hundred feet in the air.

My entire perspective changed once I reached such a high altitude. I could see the tops of the beautiful red rock formations and the countless sage brushes surrounding them. At one point we silently floated above a herd of horses that calmly munched on desert grass. They never looked up. Beyond the horses I could see miles and miles of New Mexico scenery including the city with buildings and homes, interstate highway 40 with cars and trucks, and almost the entire canyon with various flora and fauna.

Once we landed, I helped fold the giant envelope ("balloon”) which consisted of large nylon panels sewn together. The basket, which seemed so light in the air, was now heavy and unwieldy. With everyone working together, we managed to place it back in the trailer hitched to a large truck. At this point, I realized that my perspective had returned to normal and yet felt different at the same time. I had experienced an amazing aerial view of the gorgeous desert landscape and now I was back to my normal 5’7” altitude. But in my mind’s eye I could picture how everything seemed to be connected together and how small I was compared to it all. My perception of the world had changed.

When you can see the forest for the trees you get the big picture

I have had similar "high altitude” experiences since then, and, no, they did not involve mind-altering substances (I know that’s what you were thinking! Who needs drugs when you have systems theory?). The first time I learned about systems theory in graduate school is one experience that comes to mind. Also, putting together this blog series has been another one. When you can see the forest for the trees you get the big picture; you notice the interconnectedness of everything around you. That can be an exciting and humbling sensation all at the same time. Learning about how strong and large of a movement patient- and family-centered care has become in recent years has been both enlightening and daunting to me. How exciting it is to discover new allies who advocate for patient and family welfare! How formidable it must feel to implement such impressive change at a large hospital! To end this series, I want to share just a few thoughts I have had since interviewing Rachel, Bonnie, Licia, and Joana.

PATIENT ADVISORS

Patient Advisors play a significant role in the model of patient- and family-centered care (PFCC) that the Institute of Patient- and Family-Centered Care (IPFCC) supports. I cannot think of a more effective way to promote patient and family voices than to include them in patient care, new employee training and orientation, and planning committees, to name a few. What this strategy suggests is that non-hierarchical, collaborative relationships facilitate optimal care and that both patients and health professionals can bring their own expertise to the table. New communication technology will continue to improve this collaboration between patients/families and physicians (Click here for an example).

Patient Advisors seem to create a culture of "we/together” as opposed to "me/them” and this change can happen on all service levels (housekeepers, nurses, physicians, administration, etc.) such that patients and families really feel like stakeholders in a hospital system. The great thing is that it seems the inclusion of Patient Advisors comes at little to no cost and may even lead to cost savings (reducing medical errors, increasing recovery time, improving discharge experience, and perhaps even reducing number of re-admissions). Although there are probably shortcomings to this approach, none really come to mind right now. As Rachel Biblow-Leone from Philadelphia says in the first post, "Family-centered care can seem like common sense, but we know common sense is not always commonly practiced”.

CHANGE

That quote brings me to my second thought. How does one elicit such important change on both an interprofessional level (one on one) as well as on a large, system-wide level? The ladies I interviewed all seemed to agree that it is easy for health professionals to feel defensive when they are asked to collaborate more with patients and families. That is part of human nature especially when a person is satisfied with the status quo (homeostasis anyone?). I even asked myself these questions: How collaborative am I? How often do I empower patients and families in their own health care? How can I encourage my colleagues to practice PFCC?

It seems then to me that implementing change requires a certain degree of humility because you are inviting people to see their work a different way, to be willing to succeed and fail together in figuring out what improved care looks like at your organization. In addition, leadership is integral as well. Licia Berry-Berard at Darmouth told me how she and other like-minded colleagues implemented change on a small scale and then worked hard to help others, including hospital leaders, catch the vision. Bonnie Nicholas at Thunder Bay told me that change began at the top with the CEO and the Chief Nursing Executive calling for a new care model. In both examples, change was ultimately effective because hospital leaders became involved. Change can start from the bottom or the top, but eventually leaders must catch the vision of PFCC for organization-wide change to happen. Otherwise, change stays local and restrained.

STORIES

I am not a narrative therapist but I do believe in the power of stories, metaphors, and analogies because they are basic tools for learning and expression. Stories have been around nearly as long as human beings have been and they are integral to our collective wisdom, history, and sense of humanity. I was impressed to hear how integral stories became in creating a new culture of care at these hospitals. The stories told by patients and family members resonate with hospital leaders and bring a perspective that statistical data cannot replicate. How do we use stories in our clinical or educational responsibilities? How can we pair stories with strong strategic initiatives and outcomes?

PRIMARY CARE

Finally, I wonder how PFCC works in primary care. The goal of this series was to highlight hospitals that provide PFCC but I am left wondering what would this model look like in primary care? Most of my experience has been in primary care and I am passionate about the roles that primary care physicians and behavioral health providers play as frontline health professionals. Although the IPFCC model may look a little different in primary care, I imagine that the principles would remain the same: patients and families should be partners in their own care; families are essential to the health and recovery of patients (Click here for a link). In fact, the Patient-Centered Medical Home model is a model that is designed to facilitate patient-provider collaboration in primary care, implement behavioral healthcare and care management, and involve patients and families in quality improvement. It would be interesting to see how these models compare with each other.

In the end, it is encouraging to find new friends in the movement to put patients and family members front and center in healthcare. It also amazing to reach a new "high altitude”, to see the incredible change that others are making in this field, and to recognize that we are partners together in making change (parallel processes, isomorphism anyone?). I guess you don’t always need a hot air balloon to see the big picture.



Matt Martin is a licensed marriage and family therapist and is currently working as a post-doctoral fellow with the Chicago Center for Family Health and the Illinois Masonic Family Practice Residency Program. He received a master’s degree in Marriage and Family Therapy from Brigham Young University and just recently a doctoral degree in Medical Family Therapy from East Carolina University. His interests include integrated primary care, behavioral health, and family medicine residency education.

 

 

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Institute for Patient- And Family-Centered Care

Posted By Matthew P. Martin, Tuesday, January 22, 2013



 

 


This post is the fourth
in an ongoing series.
In this post we highlight a professional organization
that specializes in patient-
and family-centered care






 


Joanna Kaufman is a woman with stories. When she visits hospitals and other healthcare organizations across the country or answers numerous phone calls and emails sent to her employer, she will often illustrate her meaning with narratives and examples. Some stories depict good endings and others not so good endings. But they all communicate one message: patients and families should be at the center of their own medical care. This message has been championed for the last twenty years by Joanna’s employer, the Institute for Patient- And Family-Centered Care (IPFCC), a not-for-profit organization that offers consultation, training, and technical assistance to hospitals, clinical practices, educational institutions, architecture firms, community organizations, and government agencies. Although they work with a plethora of groups, they are absolute experts in patient- and family-centered care (PFCC).

IPFCC was started in 1992 by Bev Johnson, the current president and CEO, who has received national recognition and several awards for her work. Joanna, who is a nurse by training, and Bev actually crossed paths back in the early 1980s when they both received grants from the Surgeon General on projects related to PFCC. Their paths crossed again over the years until 2006 when Joanna decided to leave the nursing field and found a job as the information specialist at IPFCC. She is responsible for the website content, writes a monthly newsletter, trains nurses and physicians in PFCC, and responds to all inquiries sent to the Institute. Altogether, there are 11 women who work at the Institute which Joanna describes as an organization that is "tiny but with great representation”.

When training others in PFCC, Joanna shares many of the experiences and anecdotes she and her colleagues have collected over the years. For example, when designing a new section of the hospital at the Medical College of Georgia, an architect met with several former patients and family members to decide how best to meet the needs of patients at the hospital. They suggested to the architect that he design all the tables, chairs, and desks to accommodate the height of the many patients with spinal cord injuries who would use them. 

In another example, patients and family members were invited to come to a hospital to take photographs of all the signs in the hospital that were hard to read or understand. This group took many pictures, created a photo demonstration of all the pictures, and presented it to the hospital CEO who then asked the group to redesign all the signs and messages they had found confusing. Joanna likes this story because it’s a great example of how hospital leaders can close the gap between medical/hospital culture and patient culture.

Sometimes the biggest challenge for Joanna and her colleagues is to help nurses and physicians catch the vision for PFCC. When meeting with hospitals across the country, Joanna and her colleagues will often request that patients from those very medical centers attend training meetings so that providers can hear the good and the not-so-good stories of their very own patients. Some providers, though, will say to Joanna "But then patients will hear and see our dirty laundry!” Her reply: "They already know your dirty laundry. When a medication is forgotten or when a physician fails to identify himself appropriately, the patient sees this”.


"Patients have a perspective that we can’t have” says Joanna. "I am a nurse and I have a certain mindset that I was trained to have. Even as much as I think I know their perspective I don’t. I have a bias … When you sit down at the table [with a patient or family], the conversation changes because then you get my perspective, their perspective, and our perspective together”.

Joanna shares a story in which a hospital in the Baltimore Washington corridor decided to open ICU visiting hours to loved ones that patients could choose, including gay and lesbian partners. Although the chief nursing officer (CNO) believed this was an important step, many nurses disagreed and resisted the change. So, the CNO created a committee of nurses and volunteers that met together bimonthly for a year. They also held town meetings and invited patients and families invested in the issue to attend. During this time, nurses voiced their concerns about what they imagined would happen if the visitation policy was changed. The CNO often replied "Yes, but how would you feel if this was your loved one?” During that year, not one committee member missed a meeting and eventually the policy change was made and accepted.

For those who want to learn more about the IPFCC, Joanna suggests checking out the Institute’s website which offers an enormous amount of information, hospital profiles, videos, testimonials, and learning materials. The videos alone cover topics ranging from bedside rounds to cultural competency to health information technology. Joanna also encourages those who are curious about PFCC to attend one of the Institute’s conferences. The next conference is slated for April 15-18th in Annapolis, Maryland. "I promise you that you will be amazed” says Joanna.



Matt Martin is a licensed marriage and family therapist and is currently working as a post-doctoral fellow with the Chicago Center for Family Health and the Illinois Masonic Family Practice Residency Program. He received a master’s degree in Marriage and Family Therapy from Brigham Young University and just recently a doctoral degree in Medical Family Therapy from East Carolina University. His interests include integrated primary care, behavioral health, and family medicine residency education.

 

 

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Dartmouth-Hitchcock Medical Center

Posted By Matthew P. Martin, Tuesday, January 15, 2013



 

 


This post is the third
in an ongoing series
highlighting hospitals
across the United
States that offer
family-centered care.







 

A young man walks into a hospital room where a patient lies on the bed waiting for breakfast. The bright sunlight streaming through the large window shows that it’s morning time. The young man walks over to the bed and smiling at the patient says "Hi, I’m Brian and I work as part of the housekeeping staff here. I will be taking care of your room during your hospital stay. Is there anything I should know right now about your room?” The patient blinks in surprise and looks up at the young man. The patient thinks for a while and then replies "Well, I guess you could clean up the spill I made last night. I dropped my juice on the floor.”

Brian nods his head in acknowledgement and then goes about locating and cleaning the sticky pool of juice. Once done he continues his cleaning routine by emptying the trash and cleaning the bathroom. Before he leaves, the young man asks the patient "Is there anything else I can help with?” The patient thinks again and then says "My two sisters are coming today. Can you make sure that there is an extra chair in here?” Brian nods his head, smiles, and then leaves.

Although the above scene is fictional, it is very likely a scene that could take place at Dartmouth-Hitchcock Medical Center (DHMC) in New Hampshire. Patient- and family-centered care (PFCC) is not just a passing slogan at DHMC; it’s a culture they are working towards that will inform almost every level of care and service there. Most recently there is an initiative to train housekeepers about patient family centered care principles and empower them as part of the team. They are trained to introduce themselves to patients and ask for feedback on their service. Patients and family members are being given, an opportunity to help providers and hospital leaders understand how they can improve the hospital service and experience.



Licia Berry-Berard, MSW, LICSW, the Manager of PFCC at DHMC, first learned about PFCC when she attended a conference held by presenters from the Institute of Patient- and Family-Centered Care. She and other colleagues at DHMC who were in attendance became very excited about what they heard and returned to work with a commitment and a vision to further this model of care. Although some PFCC was already being practiced in pediatrics and palliative care, Licia and colleagues wanted to make PFCC an organization-wide reality.

They joined forces with other like-minded colleagues, formed the Steering Committee which included patients and families, and began holding meetings and forums to share the principles of PFCC and create a vision for what patient partnership could mean. Patients, who were handpicked because of their hospital experiences and their ability to share and connect with others, attended these meetings, some of which were held early in the morning before the regular work day started.


Over time, the word spread. "It was a lot of work” says Licia. "We knocked on many doors … and took every opportunity to find colleagues who were willing to include patients in their committees and projects”. The work paid off as hospital leaders became aware of how patients and families were involved and how valuable their input could be. "We were given the sanction to move forward with PFCC in a working model which meant educating 10,000 people about the principles of PFCC and what this model of care means and looks like”. 

She states that the biggest challenge in training has been helping staff to understand that PFCC is not just introducing yourself, explaining your role at the hospital and being nice and inclusive at the bedside. It is about empowering patients and family members, including them in decision-making processes, allowing them to push back with questions and respectful disagreement, and inviting them to create new ideas and services at the hospital.

Initially, Licia, her colleagues, and patient family volunteers moved this change forward even on top of their normal responsibilities. Today, she has given up her clinical work and now works full time with a core team, including Linda C. Wilkinson, Coordinator and Jon Huntington, MD Director. They have a team, comprised of staff and patient family advisors who help to hold the institution accountable to the mission of PFCC, supporting movement and decrease in barriers. Licia works alongside several other colleagues and more than 120 Patient Family Advisors who are involved in numerous key strategic committees, interviewing patients about their hospital experience, grant writing projects, simulation training of nurses, and even interviewing job candidates.

Licia shares a story about talking with a colleague who was expressing appreciation for the role that Patient Family Advisors had played in designing a new hospital building. He then wondered out loud how he might involve the Advisors in finding nurses for a new service project. Licia extemporaneously said "Why not give them an active role in the interview process?” Her colleague replied "Can we do that?” She replied, "Why not?” That anecdote is a sample of the boldness and commitment that Licia and her colleagues have demonstrated in bringing about change at DHMC.



Matt Martin is a licensed marriage and family therapist and is currently working as a post-doctoral fellow with the Chicago Center for Family Health and the Illinois Masonic Family Practice Residency Program. He received a master’s degree in Marriage and Family Therapy from Brigham Young University and just recently a doctoral degree in Medical Family Therapy from East Carolina University. His interests include integrated primary care, behavioral health, and family medicine residency education.

 

 

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Thunder Bay Regional Health Centre

Posted By Matthew P. Martin, Wednesday, January 9, 2013



 

 


This post is the second
in an ongoing series
highlighting hospitals
across the United
States that offer
family-centered care.


 

Imagine being asked to find and integrate a new care model for a 375-bed state-of-the-art acute care facility in northwestern Ontario, Canada. Now, imagine that your catchment area of 250,000 patients is equivalent in size to the country of France. Such an endeavor would be overwhelming for most. However, like most major initiatives, change begins with capable leadership and forward vision. Both of these elements are integral to the story of how Thunder Bay Regional Health Sciences Centre (TBRHSC) became a model of multi-disciplinary teamwork, integrated teaching and research, and patient- and family-centered care (PFCC).

In 2006, the chief executive officer of TBRHSC tasked the vice present and chief nursing executive, Dr. Rhonda Ellacott, to find and integrate a new care model for patients and families at TBRHSC. After months of researching different models of care, Dr. Ellacott and other hospital leaders decided to base their care model on the Medical College of Georgia’s PFCC model of care. This is where Bonnie Nicholas, PFCC lead and patient advocate at TBRHSC, comes into the story. "This was a change of culture and philosophy” says Bonnie, who had worked at TBRHSC before and was brought back to help implement the care model. "We brought together all the stakeholders in the hospital system to create a new model of care”.

Bonnie had previously been involved in helping patients and families waiting for organ transplants before returning to TBRHSC. "I was exposed to the power of the story and saw how the stories of patients and families moved even the most hardened staff members to change”. One of Bonnie’s first ideas was to hold a "Visioning Retreat” in which all staff members participated in providing input. From this input, corporate strategies were created. For example, as part of the new care model, staff members were required to state their NOD (name, occupation, do) every time they met a patient and family member for the first time. "We found that most problems were happening around communication” states Bonnie. Staff members began listening more and paying attention to the needs of patients and families.


Another corporate strategy was to engage patients and families in the development of new initiatives the hospital. Some of the fruit of this joint effort includes televisitation (audio and video communication between patients and loved ones when barriers created by circumstance, geography, and weather are present), pediatric family tours of operation rooms, transportation of children through the hospital on Radio Flyer wagons, and a new visitation policy. "We changed our visiting hours. Now there are no restrictions on care partners visiting, whoever that may be”.

Patient advisors play a major role at the hospital. These are volunteer patient and family advisors who serve on committees and councils in the hospital. New policies and projects must be approved by these advisors. Says Bonnie, "They can be any age; we have patient and family advisors who are as young as eight years old and as old as 83. They’re involved in everything we do.” When asked how many committees and councils patient advisors have served on, Bonnie stated "Patient advisors are in our DNA. I stopped counting after 400”.

Thunder Bay

Advisors also play a role in helping new professionals orient to the culture and expectations at TBRHSC. There are even learning modules and tests available for staff members who wish to certify in patient- and family-centered care at the hospital. In fact, all new hospital staff members are required to agree and commit to the care model before they begin working at the hospital.

Input and stories from patients and families play a big role at TBRHSC. And the outcome data shows that hospital leaders are on the right track. Within 18 months of implementing the PFCC model, patient satisfaction increased on average by 12% along several dimensions (care-access, information sharing, education, physical comfort, emotional support, continuity, and transition). Provider satisfaction was also shown to increase as well. Says Bonnie: "It’s critical to making improvements in patient satisfaction. Who knows best about their own health and satisfaction than the patients and families themselves?”

 


Matt Martin is a licensed marriage and family therapist and is currently working as a post-doctoral fellow with the Chicago Center for Family Health and the Illinois Masonic Family Practice Residency Program. He received a master’s degree in Marriage and Family Therapy from Brigham Young University and just recently a doctoral degree in Medical Family Therapy from East Carolina University. His interests include integrated primary care, behavioral health, and family medicine residency education.

 

 

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The Children's Hospital of Philadelphia

Posted By Matthew P. Martin, Wednesday, January 2, 2013
Updated: Tuesday, January 1, 2013



 
 
 
This post is the first
in an ongoing series
highlighting hospitals
across the United
States that offer
family-centered care.



Numerous hospitals, community medical centers, and policy groups are recognizing the importance of collaborating with patients and families to improve safety, quality, and treatment outcomes.  For some organizations, family- and patient-centered care has long been a part of the organization’s culture and approach to health care.  The Children’s Hospital of Philadelphia (CHOP) has consistently been ranked by U.S. News & World Report, Child Magazine, and other organizations as the best hospital for children in the United States. Those awards are the result of the hospital’s top notch clinical programs and clinicians as well as their commitment to involving patients and families as integral partners in the care process as much as possible. 

According to the Director of Family Relations at CHOP, Rachel Biblow-Leone, MSW, LCSW, family centered care (FCC) is not just a "box to check off, it’s how we do what we do”.  Since 1994, CHOP leaders have worked hard to create a culture that makes family-centered care a priority.  Indeed, when hiring new professional staff, hospital leaders seek professionals who consider it a privilege to collaborate and communicate with patients and their families.  Family Consultants (family members of past patients who are paid staff members) even participate in the hiring process and orientation of new hospital professionals.  The first touch point during orientation is with a Family Consultant who shares a personal story with new hires that illustrates the standard of care at CHOP.  

Family Consultants, who play an invaluable role at CHOP, also help families navigate the complex healthcare system by offering a personal perspective and by communicating patient and family needs to nurses and physicians. They also serve on a large number of hospital committees and planning projects.  Other FCC initiatives, among many, include: the Family Advisory Council, a multidisciplinary group consisting of hospital professionals and family members with a wide range of backgrounds and diseases who offer input on hospital projects, programs, and policy development; family resource centers, which provide families a place for information, rest, support, and other resources; the Youth Advisory Council, a group that provides the child and teen patient perspective for hospital projects; and Family Partners who are credentialed volunteers who work alongside Family Consultants. 

Quality improvement, especially patient safety, is an ongoing goal for CHOP and patients and families play an important role in improving hospital services.  In fact, preliminary data has shown that family members were instrumental in reporting over 90 "catches” of patient safety events in real-time situations to staff who listened and responded (e.g., questioning medication that looks different before it is given to a patient to prevent a potential medication error). "This is a clear sign that when working with families, as partners, we are better able to deliver safer and higher quality care because there is mutual trust and encouragement for everyone to speak up for safety” says Rachel. Tip sheets are given to families that detail common safety concerns and strategies for communicating these concerns to hospital staff.  

During bedside rounds, family members are consistently included to help physicians and nurses identify potential problems.  Including families during bedside rounds also helps hospital staff to measure the amount and accuracy of information that family members have about patients’ condition and treatment. Although some have argued this model increases the length of time for rounds, the reality is that bedside rounds allow physicians to answer the questions and concerns of family members, which can save time in the long run and improve the hospital discharge process.

 "Family-centered care can seem like common sense, but we know common sense is not always commonly practiced.” says Rachel. CHOP maintains their commitment to keeping patients and families at the center of everything they do.  They also continue to set an inspiring example to other organizations looking to offer family-centered care. As Rachel concludes so well, "this is the right work to be doing. We have the same goals. We want to be more effective, more accountable, and provide greater health outcomes.  We want to see a better approach to well-being and achieve the optimal state of health”.  



Matt Martin is a licensed marriage and family therapist and is currently working as a post-doctoral fellow with the Chicago Center for Family Health and the Illinois Masonic Family Practice Residency Program. He received a master’s degree in Marriage and Family Therapy from Brigham Young University and just recently a doctoral degree in Medical Family Therapy from East Carolina University. His interests include integrated primary care, behavioral health, and family medicine residency education.



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The New Generation of Behavioral Health Providers

Posted By Melissa Lewis, Tuesday, December 18, 2012


New Faculty Forum

Melissa Lewis's blog is the last post in a month-long series from recent graduates in their first semester of a faculty or junior faculty position.


Please read the previous posts.


1. Dear student of behavioral health,

Congratulations on your pursuit to build a healthier world for all of us one client, couple, family or community at a time! You are being trained in the classroom, in the clinic, in local agencies, and for some of you in medical settings. As I reflect on my training as a marriage and family therapist (MFT) compared to the training that is currently needed, I envision a new direction for behavioral healthcare based on our understanding of what health and healing now are. When I was trained as an MFT utilizing systems theory consisted of addressing behavioral health from an ecological and not a linear, reductionistic way. In practice this meant utilizing MFT theories and addressing problems within the relationship(s) and it ended there (see diagram to the right).

Engel's Systems Levels

 Today, things look very different. Addressing psychosocial symptoms alone and within the confines of the behavioral health clinic solely have been shown to not only be inadequate for client outcomes, but also is an extremely limited use of systems theory (Craven & Bland, 2006). Now we know that pain and fatigue associated with chronic illnesses, for example, have a strong effect on mood, relationships, and parenting (Lin, Lai & Ward, 2003; White, White & Fox, 2009).

With the clear understanding of the dynamic nature of biological, psychological, social and spiritual (BPSS) effects on health outcomes, our systems of care must reflect these patterns. For instance, cold handoffs (i.e., referrals without introduction) not only result in a lack of needed patient services but represent an old way of understanding health; experts in separate realms of health (Craven & Bland, 2006). While the BPSS components of our health system interact, so must our health systems. Students must learn the models and techniques of collaboration so that they can conduct a warm hand-off, understand the medical system, interact confidently with medical providers, and assess and treat using their expertise as well as that of their medical provider and the patients simultaneously.

Further, integrated careis quickly becoming strengths-based care, patient-focused care (equitable and culturally competent), collaborative care, cost-effective care, and evidenced based care which are the pillars of the Institute of Medicine aims. The behavioral health skills needed to work in this system look much different than the skills that were needed in the previous system of healthcare 20 years ago and will continue to change in the coming years. The way health research is being conducted is a sign of what is to come.

For instance, Cutrona and colleagues (2003) have discovered that neighborhood level effects (i.e., safety, financial status, racism) are related to individual health, as well as relational outcomes. The work of Karen Matthews and colleagues (2003) has shed light on the process of cardiovascular health and its link to early childhood psychosocial traumas. Both in utero and early childhood biopsychosocial traumas are linked to worsened mother-child relationships, reduced cognitive and verbal development, and even increased risks for obesity, diabetes, and heart disease later in life (Hart & Risley,1995; Shonkoff & Phillips, 2000; Kaati, Bygren, Pembrey, & Sjöström , 2007; Gluckman, Hanson, Cooper, & Thornburg 2008; Boynton-Jarrett, Ryan, Berkman, & Wright, 2008).

 The implications of this kind of epigenetic work will be astounding for our field and will demand that in the next 20 years, behavioral healthcare providers are aware of and can treat the devastating effects of adverse childhood events, historical traumas, and current micro and macro traumas (BPSS). We will not only be asked to treat those affected by these events but also create programs to prevent these events from happening. This, I believe, will require all behavioral healthcare providers to lower themselves from an expert hierarchical position (i.e., dictating treatment protocol) and learn to work with broader systems (i.e, communities) in a more equitable and empowering way to improve individual as well as larger health systems (see Doherty & Mendenhall, 2006). Given the popularity and success of community based participatory research in empowering communities to use their local knowledge and resources to improve health and standards of living, behavioral healthcare providers will soon be required to learn these research and clinical techniques as the new standard of care for health promotion, prevention, and treatment.

 This is an exciting time in healthcare with amazing possibilities for positive changes in the healthcare system. Good luck in your journey in becoming a collaborative and integrated behavioral healthcare provider!

 Sincerely,

 An MFT professor 1

 

2. Dear MFT professor,

 As an MFT student, I feel that I need MedFT training because the medical care system affords us with a unique opportunity to serve our clients. Specifically, we can collaborate with professionals within the medical system and bring a fresh systemic perspective which will hopefully produce better client outcomes. Nonetheless, I am excited and a bit nervous about learning integrated care! While I feel competent in the theoretical and clinical components of my MFT program, I am still nervous about working as a MedFT in this local hospital system in my upcoming internship.

 As system thinkers, I know that each system is unique in so far as it has a power structure, roles, and almost unconscious rules that govern the systems. In MFT we know about the impact of trangenerational thinking. In the Medft world, I do not know the historical structures and systems of a hospital system. Who is a resident? Who is an attending? What does a short white lab coat mean opposed to a longer one? What is a charge nurse and what is an RN, BSN, or LPN? Is a DO really a doctor and what does social work do? I will be thrust into a system not knowing how it works; I wish I knew ahead of time so I can be as effective of an MFT as possible.

 We know that the system of a medical care facility is different than a clinic. We may only see a client once, twice or maybe three times due to HMOs and PPOs. How does the therapist "do” therapy in such a short about of time? If I can only see them twice, do I still do a genogram? Can I do structural therapy in one session?

 Lastly, do I need to learn anatomy and physiology, especially neurology? I worry when my clients discuss stage three cancer I will not know if it is worse that stage one. What if my client is on medications for their illness, does that affect their psychological health?

 I know this is asking a lot, and I hate to be a bother. I entered this field with a strong desire to serve my clients through a relational lens in a medical setting and can’t wait to get started!

 

Thank you for your time,

An MFT (aspiring MedFT) Graduate Student2

 

3. Dear future students, clinicians and professors of behavior health,

I am a doctoral student at University of Akron who has worked and interned in several integrated and non-integrated care sites and would like to tell you a little bit about my experiences. Specifically, my internship experiences at St. Thomas Hospital and Akron Children’s Hospital in Akron, Ohio has grown my understanding of healthcare immensely. In these training positions, behavioral health providers are required to collaborate with other healthcare providers to support the patient’s specific needs. This opportunity to work alongside professionals who are stronger in the medical/biological aspects of treatment allows for a more holistic treatment approach for me. It has been very beneficial to learn to collaborate with those outside of my scope of training because it has significantly broadened my understanding of healthcare. This would not have been possible in a traditional MFT internship.

Part of my experience as an intern has opened my eyes to healthcare costs, reimbursement, and healthcare policy. I have learned that it is important to provide care that is empirically supported for cost effectiveness and I am fortunate to have been trained in an area that is becoming increasingly more supported. It is important to understand cost effectiveness and offset of integrated care treatment, as well as the importance of tracking and measuring biopsychosocial health markers to specialize and improve patient care.

Training that provides a foundation for this increased knowledge and collaboration will provide a more enhanced training experience that will equip individuals in the Marriage and Family Therapy field to work within the medical and hospital setting. My training has allowed me to encourage the integrated team to not look past the family system and, instead, provide support and structure for the families. This has been very fulfilling as an MFT in a medical setting as I learn my place in the medical system.

I have noticed an observable difference in the engagement of the family in behavioral health services in behavioral health versus hospital settings. I have found that within the medical setting there is a decrease in stigma around behavioral health talk giving me more of an opportunity to address psychosocial stressors and coping mechanisms. While at first I was unsure about how family therapists can fit into the medical model, instead I learned that this is exactly where we need to be!

Sincerely,

An MFT Student 3

 

¹ Melissa Lewis is a Visiting Professor at University of Akron in the MFT program. She is a licensed Marriage and Family Therapist and an approved AAMFT Supervisor. She received her Master's degree at Arizona State University (MFT) in 2007 and her PhD from East Carolina University (MedFT) in 2012. Her research area broadly encompasses the relationship between stress response and BPSS outcomes. Specifically, she studies the stress transmission model with military couples and is also evaluating integrated care interventions aimed to reduce BPSS health symptoms in both Native American and military populations. Melissa can be contacted at mlewis@uakron.edu

² Michael Polnik is married and a proud father of three. He holds his MA in biomedical ethics from Case Western Reserve University and is pursuing his PhD in MFT from The University of Akron. Michael can be contacted at mep52@zips.uakron.edu.

³ Ryan Cook is a husband and a father to one son and has a daughter on the way. He is a licensed MFT and PCC in the state of Ohio. Ryan is in his final year in the Doctoral Counselor Education and Supervision program specializing in Marriage and Family Therapy at the University of Akron. He has experience working in a small agency where he provided family therapy to foster care and adopted families. He is currently a clinical therapist at St. Thomas Hospital and Akron Children’s Hospital’s Partial Hospitalization and Intensive Outpatient Programs. Ryan can be contacted at rmc41@zips.uakron.edu. 
Melissa Lewis

 

References

Boynton-Jarrett, R., Ryan, L. M., Berkman, L. F., & Wright, R. J. (2008). Cumulative

violence exposure and self-rated health: Longitudinal study of adolescents in the United States. Pediatrics, 122(5), 961-970. doi:10.1542/peds.2007-3063.

Craven, M.A., Bland, R. (2006). Better practices in collaborative mental health care: an

analysis of the evidence base. Canadian Journal of Psychiatry, 51 (6 Suppl 1): 7S-72S.

Doherty, W. J., & Mendenhall, T. J. (2006). Citizen health care: A model for engaging

patients, families, and communities as coproducers of health. Families, Systems, & Health, 24(3), 251-263. doi:10.1037/1091-7527.24.3.251

Gluckman, P. D., Hanson, M. A., Cooper, C., & Thornburg, K. L. (2008). Effect of in utero

and early-life conditions on adult health and disease. The New England Journal Of Medicine, 359(1), 61-73. doi:10.1056/NEJMra0708473.

Kaati G; Bygren LO; Pembrey M; Sjöström, M. (2007). Transgenerational response to

nutrition, early life circumstances and longevity. European Journal Of Human Genetics: EJHG, 15(7), 784-790.

Lin C., Lai Y.L., & Ward, S. (2003). Effect of cancer pain on performance status, mood

states, and level of hope among Taiwanese cancer patients. Journal Of Pain And Symptom Management, 25(1), 29-37.

White, C., White, M. B., & Fox, M. A. (2009). Maternal fatigue and its relationship to the

caregiving environment. Families, Systems, & Health,27(4), 325-345. doi:10.1037/a0018284.

Cutrona, C. E., Russell, D. W., Abraham, W., Gardner, K. A., Melby, J. M., Bryant, C., &

Conger, R. D. (2003). Neighborhood context and financial strain as predictors of marital interaction and marital quality in African American couples. Personal Relationships, 10(3), 389-409. doi:10.1111/1475-6811.00056.

Matthews, K.A., Salomon, K., Brady, S.S., & Allen, M.T. (2003b). Cardiovascular reactivity

to stress predicts future blood pressure in adolescence.Psychosomatic Medicine, 65, 410-415.

Risley, T. R., & Hart, B. (2006). Promoting Early Language Development. In N. F. Watt, C.

Ayoub, R. H. Bradley, J. E. Puma, W. A. LeBoeuf (Eds.) , The crisis in youth mental health: Critical issues and effective programs, Vol. 4: Early intervention programs and policies (pp. 83-88). Westport, CT US: Praeger Publishers/Greenwood Publishing Group.

Shonkoff, J. P., Phillips, D. A., National Academy of Sciences - National Research Council,

W. S., & Institute of Medicine (NAS), W. C. (NAS), Washington, DC. (2000). From Neurons to Neighborhoods: The Science of Early Childhood Development.

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Integrated Care, Residency, and PCMH: A Basic How To Start

Posted By Lisa Zak-Hunter, Wednesday, December 12, 2012
Updated: Tuesday, December 11, 2012
New Faculty Forum

Lisa ZakHunter's blog is the second post in a month-long series from recent graduates in their first semester of a faculty or junior faculty position.


Please check back
each week.


 

Since the end of June, I have been serving as behavioral science faculty within the second largest family medicine residency in the country. It is three times the size of the residency where I completed my doctoral internship-yikes! The program has been taking steps toward becoming a Patient Centered Medical Home (PCMH). What an opportune time to introduce integrated healthcare! But, how??

My original intent was to try to answer that question in this post. After some investigating, I have few answers, but more and more avenues of investigation. Simultaneously, I’ve had personal and professional experiences with colleagues that have reminded me of the struggles mental health professionals face entering the fast-paced, hierarchical world of medicine. Therefore, what I offer are starting points for new professionals to become better integrated within medical training programs as they drive toward the PCMH.

stages of change

Even though you might already be burgeoning with ideas and energy better suited for a preparation or action stage, the program may be precontemplative or contemplative.

 When You Start

  • Create your own job description: Include roles and responsibilities that are specific to your personal strengths, talents, and interests. Note what types of psychotherapy you provide, your clinical and research interests and specializations, populations you like to work with, specific ways you plan to attend to resident education, languages you speak, other skills etc. Get used to repeatedly being asked what you do, what types of concerns or diagnoses you’ll see, and different ways you can help the residents (personally and professionally). Spending time to write this down will help you answer these directly and succinctly. You can also turn this into a brief ‘advertisement’ to put at the nurses stations, resident lounge, and precepting room, complete with your business cards or contact information.
  • Get visible within the residency AND the clinic: Join committees; attend any and all faculty AND staff meetings (even if you feel out of place at both!); get to know the nursing, front desk, and management staff; hold brief one-on-one meetings with residents and faculty; volunteer to help on projects such as resident observations or meeting with residents who are struggling; be involved with interviewees; present at noon conference; host a ‘get to know the behaviorist’ luncheon; precept (even if you don’t really know how!). Sit near the preceptor so you can listen to the cases for opportunities to offer the classic "how do you think this patient’s depression is affecting his diabetes management?” or "have you screened that patient for past abuse?”. Then you can offer suggestions to the treatment plan or to meet with the patient/s during the visit. Practice being brief, to the point, and straightforward.
  • Don’t move too fast and be persistent! Take time to understand the culture of the program, how faculty and residents interact with each other and the clinical staff, and how patients are perceived. Ask, what is the residency known for? What are its strengths and what draws students to it? Within that, what has been the role of behavioral medicine? What was their vision in hiring you? How do you work within and enhance the culture while simultaneously respecting it? This will help you determine how and who to approach with your ideas. Remember than medical systems move slowly and are much more complicated than you are aware. Think in terms of 1, 3, and 5 year plans, and, metaphorically speaking, prepare to swim through molasses for a while.

Introducing Integrated Healthcare within PCMH

  • Familiarize yourself with Patient Centered Medical Home Standards: In 2011, NCQA outlined new standards for PCMH. There are also principles for medical education in the PCMH. These will help you understand both the clinical and educational aspects of PCMH that a residency will be trying to accommodate.
  • Meet the program where it’s at: Think Prochaska’s stages of change. Even though you might already be burgeoning with ideas and energy better suited for a preparation or action stage, the program may be precontemplative or contemplative. Recall the traditional role of behavioral medicine at your facility. Talk with your office manager, program director, chief residents, and faculty one on one. Learn what they have already done for PCMH and whether they want NCQA’s accreditation. The fact that PCMH encourages integrated and streamlined behavioral healthcare works in your favor!
  • Identify and include all angles and stake holders: This would include clinic operations (management, scheduling, referrals etc), faculty leaders and liaisons, patient education groups or protocols for certain diagnoses, residents, nurse practitioners or physician assistants, those in charge of your EHR system, potential collaborators in other departments (e.g., psychiatry, pharmacy) or other institutions (e.g., social work, family therapy, psychology graduate programs). Speak with them frequently and offer small bits of information on integrated care each time. Consider additional training that all staff (including yourself and other behavioral health specialists) may need to understand integrated care and how to carry it out. You may think your ideas are the best thing since sliced bread, but they (and possibly your reputation) will fall flat if you only consider your own perspective, role, and talents.
  • Get familiar with billing! It can be challenging to charge for integrated care since in some states is illegal to charge for same day service. As you think of different models of care, they must be sustainable. Management and clinic operations will be interested in fine print, so be prepared to try to give it to them! Additionally, the Current Procedural Terminology (CPT) codes (i.e., the billing codes) for psychotherapy and psychiatry are changing in 2013. Investigate Medicaid’s Health Behavior Assessment and Intervention (HBAI) codes to determine if they can be used at your site. Understand what mental health services CMS (Centers for Medicare and Medicaid Services) reimburses such as depression and substance abuse screening. Once you’re familiar with these, I suggest setting up an appointment with someone in your organization’s main business office and compliance. The last thing you want to do is begin creating or implementing a model that is non-compliant!
  • Remember this is a training program! Whatever model of integrated care gets established must dually enhance patient care AND resident education. If your role is more educational than clinical, make certain the model does not have you involved in clinical work that detracts from your teaching.
  • Determine your role. Do you want to lead or develop the entire model? Do you want to form a committee to help? Which of your stakeholders should be part of the committee?

 

Personal Sanity

  • Stay connected: Talk with your mentors, seek connections with similar providers in your community or department in your medical school, and other new professionals. In my personal experience, I’ve found I was a little sheltered in my safe little collaborative care bubble. I was aware my supervisor faced challenges with faculty and upper administration. However, I didn’t know all the details and I was never solely responsible for addressing them.
  • Be patient. Be persistent.

Overall, know that some of the struggles and suggestions for addressing them that are outlined in the seminal collaborative care and medical family therapy texts are very applicable. My ideas are reflective of where I am in the process of settling into a new community and introducing integrated care. I welcome further comments, suggestions and the opportunity to normalize experiences for others new to medicine or new to life after graduate school!

Some helpful websites:

http://www.integration.samhsa.gov/

http://www.thenationalcouncil.org/

http://www.pcpcc.net/behavioral-health

 

 
Lisa Zak-Hunter

Lisa Zak-Hunter, PhD, LMFT is behavioral science faculty with the Via Christi Family Medicine Residency and Clinical Instructor with the University of Kansas School of Medicine-Wichita ,in KS. She earned her PhD in Child and Family Development, specializing in Marriage and Family Therapy, from the University of Georgia. Her main clinical, teaching, and research interests lie in the realms of collaborative health care and increasing biopsychosocial understanding of mental and medical health conditions. She has a particular interest in adult eating disorders.




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Behavioral Healthcare in Immokalee, FL: The discovery of a beautiful culture and their strength in the midst of hardship

Posted By Molly Coates, Wednesday, December 5, 2012
Updated: Tuesday, December 4, 2012
New Faculty Forum

Molly Coates's blog is the first post in a month-long series from recent graduates in their first semester of a faculty or junior faculty position.


Please check back
each week.

 

I left the mountains of Colorado to move my family to Southwest Florida, a place I knew little about other than my fellow Coloradans’ dire warnings of the potential and looming disasters-- hurricanes, snakes in the toilet, flying roaches as large as palm fronds, alligators waiting for a misstep, and the exotic Nile monitors that run loose in the city with carnivorous desires. However, all that being said, I was ready for an adventure and the spirit of Florida State University College of Medicine was calling. 

FSU College of Medicine has a particular mission statement, one that speaks to me deeply. The college’s mission emphasizes providing primary care to Florida’s elderly, rural and other medically underserved populations and places value on the doctor-patient relationship, generalist medical care and working as part of the health care delivery team, including behavioral health. I was first attracted to and excited about the job position as providing entry into what I believe is the future of healthcare delivery, an integrated and holistic model of care.


"...exotic Nile monitors
run loose in the city with
carnivorous desires."

However, when I arrived onsite at the Immokalee Health Education Site, I became immersed in a challenge greater (and more exciting) than just starting a new job. I was mostly aware of the cultural differences I would encounter, in a theoretical and academic sense. Speaking with my colleagues on the first day of work, I received some wise advice that gave me valuable perspective and a glimpse into the reality of the population--If you ask one of your pediatric patient’s where he/she would chose to go on his/her "ideal vacation,” you just might get the "Walmart” in the next town over as a response. In context, the closest Walmart is 30 miles away and not a typical experience for our patients—imagine what you might buy! This anecdote begins to accurately depict a population whose struggles are very unique.

The medically underserved in this area consist of migrant farm workers following the Eastern route. This population has been referred to as the Nation’s Invisible Population with an estimated 1-3 million taking the annual trek. Resources are scarce to non-existent, life stressors beyond compare, and fear of deportation thriving. The cultural differences are immense and more so when considering this is a population displaced from their home country for various reasons. In Immokalee, families are hesitant to leave the township other than to travel to other migrant farm villages.

The predominant languages are Creole and Spanish, and they must learn to speak two or more languages while navigating systems (e.g., school, healthcare) delivered in their second, sometimes third, language. They have limited access to healthcare and other resources, while their healthcare needs are immense. Their children face changing schools several times a year as the family follows the harvests. Many are victims of chronic and complex trauma. Their life is hard-- listening to the multitude of complex stressors they experience and barriers to accessing resources, it is easy to feel overwhelmed.

How do I best serve my patients in Immokalee? I feel honored to bear witness to all of my patients' narratives, and I am continually reminded of the remarkable resiliencies of this group. They not only survive their hardships, but display an amazing resilience that they do not always recognize. Empathically relating to their narratives, reflecting on their strengths and suffering, and respecting the shared human experience allows me to help foster a self-image of resiliency and pride in my patients. I hope that with this knowledge, perhaps another change is being effected—one of self-efficacy, confidence, and hope as they navigate their life realities.


Molly Coates

Molly Coates, PsyD is a Postdoctoral Psychology Resident at the Florida State University College of Medicine, serving at the Immokalee Health Education Site, Isabel Collier Read Medical Campus. She works in pediatrics and women’s health. Her research interests include chronic pain management, obesity prevention, psychological assessment, and ADHD, Autism and Behavioral Disorders in children.



 

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Mentorship in Collaborative Care

Posted By Lindsey Lawson, Tuesday, November 27, 2012

If you haven’t already, be sure to take a peek at Deborah Taylor’s blog on mentorship. From someone on the receiving end, mentorship IS the cat’s meow!

When I began my clinical work at the medical center here in Loma Linda, I was surprised to discover that I would be doing co-therapy with other MedFT students and my supervisor, and in front of medical students and residents. Yikes! Previous experiences for me consisted of individual therapy sessions, and the occasional videotaped clips shown to my supervisor (which at times I’m sure inadvertently left me describing what I was hoping would happen in session rather than what actually did - I know I’m not the only one here). The idea of this new mentorship model was, to say the least, scary for me: I had visions of someone discovering that I wasn’t very confident in what I was doing and that at times I lacked direction and focus in session.

Those first few months were stressful; I remember feeling intense pressure to "perform” in front of my peers and colleagues. I was frustrated and felt that perhaps my sessions during those times didn’t reflect my actual abilities as my nerves took over and made me tentative and self-conscious. But with time and a purposeful group shift towards a more collaborative model, things began to change.

Lindsey Lawson
"Mentorship gives us space to have honest conversations about what is working and areas of growth..."

To my surprise, I discovered that working closely as co-therapists with fellow students and my supervisor was the best thing to happen to me professionally in a long time. I found myself being pushed in a safe, productive way towards being a better clinician. Conceptual ideas about how to do good therapy came to concrete life before my eyes as I watched others work and thought, ‘that’s how it’s done!’ I was able to see things modeled in session and then practice them myself within the safety net of more experienced therapists who would help me if needed.

I remember one session in particular, in which I was working closely with another doctoral student several years ahead of me. We were in a difficult spot: our patient was extremely anxious, and was making demands of staff that were impossible to meet. We’d been asked to help mediate the situation, and because I’d spent the most time with her, I was asked to lead our session.

My student mentor pulled me aside before we went into the room, and together we talked about how the session might go and what might be particularly helpful in trying to navigate this sensitive issue. As a result of our conversation, I felt confident going into the room, and the gentle coaching of my classmate paved the way for a successful interaction with our patient and several additional weeks of continued work together. Sure, I might have been able to do this on my own, but there was something about knowing that my mentor believed in me and would be there to help me should I need it that made this experience meaningful.

There are several things that have been particularly helpful for me in being the process of being mentored:

Feeling safe in my relationships with mentors. Mentorship requires a great deal of vulnerability on the part of the individual with less experience, and initially, it can feel as though you’ll never be quite "yourself” in therapy. It has helped me immensely to work with people who’ve been perceptive enough to hone in on my strengths and believe in me wholly - sometimes even before I believed in myself.

Practicing active, live co-therapy. Co-therapy does not mean that my mentor will "rescue” me whenever I am stuck. When one does step in to help guide me in a more therapeutic direction, I feel more equipped to try these skills myself in our next session. Rather than becoming a crutch, these have been empowering experiences for me.

Addressing the power differential. By its very nature, mentorship helps to level the power differential as MedFTs-in-training are allowed to see challenges and mistakes made by someone with more experience. This gives us space to have honest conversations about what is working and areas of growth, and allows me to see my mentors in more of a collaborative, rather than evaluative, role.

Mentorship may be an especially good fit for therapists in medical settings as it aligns with the traditional model of healthcare providers working in teams and may provide additional support for new therapists stepping into a setting with a unique set of rules and norms. As Deborah suggests in her previous blog, having experienced successful mentorship makes me want to "pay it forward” through developing these same times of relationships with new medical family therapists coming into the field. Who wants to join me?

 

 

Lindsey Lawson is a third-year PhD MFT student at Loma Linda University and has worked at the Loma Linda Medical Center for the past two years. Her professional interests include all things medical family therapy, as well as gender and power dynamics in couple relationships.


 

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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.