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Presentation of the 2011 Don Bloch Award
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On October 29, 2011 at the CFHA Conference in Philadelphia,

Dr Alexander Blount was awarded the Don Bloch Award,

Our association's highest honor.

Here is the text of the award presentation as read by CFHA's President Elect, Benjamin Miller:

The modern era of integrated, collaborative primary care would look very different but for the influence of Sandy Blount. In fact, one could say that we call it Integrated Primary Care largely because of Sandy. He began using this phrase years ago, decades ago—wrote about it, spoke about it, reviewed the literature in support of it, described

the essential principles of it, gave an elegant conceptual rationale for it, researched it, trained people to it, encouraged us to do it, and even to this day practices it.

He hasn’t let up. Integrated care dominates every aspect of his professional life. Very few people cleave so closely in their professional lives to the things they say they believe in as has Sandy—he is the very embodiment of integrated care. He even serves as the Editor-in-Chief of Families, Systems, & Health, the Journal of Collaborative Family Health care founded by Don Bloch; he has also served on the Board of Directors and as a President of the Collaborative Family Health care Association, this very organization.

Sandy will be remembered for these accomplishments, but his legacy is even more permanently assured by the work of his students and trainees. Many of them are here today. One can’t go anywhere in the United States and talk about collaborative care or integrated care or team-based care without hearing someone tell that they are practicing integrated care, that they were trained by Dr. Blount, that they are at least doing that right. So he is also responsible for literally creating a significant part of the active workforce engaged in integrated practice. And this is good training, too: the knowledge and skills he has taught are often the determinative factor in the success of a practice becoming integrated.

Thank you, Sandy; we are in your debt. We owe you our respect and appreciation. You have inspired and instructed us. You have made the way easier for us. You have made us better clinicians, better teachers, and better researchers. You have made the world a better place for us and especially for our patients.

You richly deserve this award.

Thank you.

Jennifer L. Hodgson, PhD, President, CFHA

Benjamin F. Miller, PsyD, President-Elect, CFHA

Frank V. deGruy, III, MD, MSFM, Immediate Past President, CFHA

Dr Alexander Blounts's remarks on accepting the Don Bloch Award at the CFHA Conference in Philadelphia:

It is impossible for me to express how honored I am to be chosen by the Board of the Collaborative Family Healthcare Association (CFHA) to receive the Don Bloch award. I have been toiling in the vineyard that Don set out for more than 20 years. Don was a founder of this organization. It was Don who created the vision of Dr. Biomedicine and Dr. Psychosocial working side by side, before there were many people in the U.S. who could imagine what that would look like. It was Don who created the journal that has been the trunk line for progress in the field, the journal that Susan McDaniel and Tom Campbell grew into what it is today. It was Don who brought me to the Ackerman Institute in 1987, and it was his passion for what we then called collaborative care that made our projects, nascent as they may have been, possible where otherwise there was no precedent or mandate.

Don’s passion is a symptom of a condition shared by the people in this room, some of the most interesting and impressive people I know. I have never for a moment regretted my association with this movement, with CFHA, and with the people who sustained both over the years.

The most important reason for the passion, for the commitment to the work, is the patients. We all have worked in the old system and watched it let people down, one after another, at great cost to all. We knew we could do better. At its outset, this movement was defined by the relationship of the professionals more than by their relationship with the patient.

At the summit meeting before the CFHA conference in Denver, a woman spoke who was a patient at a clinic with a mature program of integrated primary care. She told a tale of serious chronic illnesses, complex psychiatric diagnoses, and failed treatments. It was at once very personal and yet very common in this work. She was and is a person who made great strides in getting her life back, or perhaps in building a new one, through her work with that clinic. She insisted it was integrated care that made her recovery possible. She said (and I am quoting

from memory after three years), "It was my team, my physician, my nurse, my therapist, my psychiatrist that made the difference. I gradually came to believe that the integration of this team, the way they communicated and worked together for me, was a model for the integration that was coming about in me, the integration of the parts of my life that had previously seemed shattered and scattered.” I’ve never heard it said better.

The second reason to do this work is what we can learn in integrated settings that we cannot learn in siloed settings. My friends from the CBT world have a drawing we all use in which "behaviors” are depicted as interacting with "thoughts” which interact with "feelings” which interact with "behaviors” again, in a triangular diagram. I think you’ve all seen it. I would prefer to say that these three (feelings, thoughts, and behaviors) are different perspectives on one process. In the world of healthcare, I like to use a similar diagram, with our "model of health and illness” in one corner, the "social roles involved in care” in another, and the "routines of practice” in the delivery of care in the third. Each of these is a different perspective on what is one process. If you change any of these, you are impacting all over time. As we practice with different roles, as we invent routines of care, we create change in the whole process so that in the long run we can think about the domain of health and healthcare differently.

Let’s face it, right now we are in a period in terms of our conceptualizations about the mind and the body that seems to me to be analogous to the last days of the flat earth theory. We still talk about "physical health” and "mental health”. Our culture has the ideas of physical health and mental health instantiated in its array of government agencies, in funding streams, in training and disciplinary silos, and in the minds of many of our patients. And when we try to get past this dichotomy with different language, we have only the beginnings of a way to speak. We stammer; we can’t get started.

Could it be that in the future, in clinics where care has been integrated for 20 years, people will distinguish or conceptualize the problems and the processes of their patients very differently, despite structures like the DSM or medical coding systems designed to hold on to the dichotomy? I believe that in the integrated, team-based routines of care and in the transformation of roles in providing care being promoted by the Patient Centered Medical Home movement, we will gradually open the possibility of thinking and speaking differently about humans, their health, and their pains. It is hard to keep track of a transformation in how we distinguish phenomena.

Who is trying to document this process? How will we track the charges in categories of how we think about our patients, in how we think about health and healing? If we lower A1c, if we improve patient satisfaction, we have created an important first-order change. If we change the way we distinguish illness, health, and good care, that is a second-order change. It is slower but more durable change.

This is the research program I would like to see undertaken as we move forward. We are now in a period of congealing, of firming up, of trying to make a lexicon, a list of program elements, even, God help us, a list of competencies. While I think we need to be careful about what one of my friends calls "premature orthodoxy,” I want to honor the models that are beginning to be clear like the IMPACT model and the Behavioral Health Consultant model. They remind me of another transformative model, the Model T automobile. It was transformative in the development of the automobile and of the uniquely American culture around the automobile. No innovation on the Model T was unique to that car. To the industry, the innovation was in the process of building it, in the assembly line. To the user, its main innovation was the price and the availability. If you talk to people in the auto industry, they will tell you that the Model T was obsolete from an engineering perspective just a few of years after it came out. But because of the Model T, middle-class people could become car owners. That created a political mandate for spending on roads. It created business opportunities for the many industries that grew up around the auto. It made us a nation of drivers who, for good and for ill, are committed to the car.

The model transforms the environment which leads to demands for new models. I think the impact of the models we have now may be analogous in healthcare. They will be out of date in short order, but they are clear enough, successful enough, replicable enough, and testable enough to launch integrated care into the mainstream.

The early adopters— and everyone in this room counts as an early adopter, except a few like Don Bloch who count as pioneers and innovators— must still be active in advocating, in developing, and in proving. But as our programs run, I think we will also be changing ourselves. We may be given an opportunity to think about the phenomena we encounter in our work in new ways. I hope that in a few years we will see the lessons, the changed and integrated conceptualizations of health and humanness, which come from integrated care, popping up in disciplines far and wide.

Thank you.

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