Researchers Outline Trends in Integrated Care

By James Bradshaw, Senior Editor
November 7, 2016



medical and behavioral healthcare integrationIndianapolis – The increased integration of medical and behavioral health care is creating growing opportunities for mental health practitioners to provide therapy for medical patients and their families, two professors said at the 2016 Annual Conference of the American Association for Marriage and Family Therapy (AAMFT).

About 100 attendees were at a workshop where Jennifer Hodgson, Ph.D., LMFT, and Angela Lamson, Ph.D., LMFT, from East Carolina University’s Medical Family Therapy Research Center in Greenville, N.C., outlined opportunities and trends in medical family therapy (MedFT).

Hodgson said the separation of physical and behavioral health care dates back to the 17th Century when French philosopher René Descarte espoused a dualism that drew sharp boundaries between the mind and body.

Only recently has health care begun recognizing the mind-body connection, Hodgson said, pointing out that the World Health Organization also includes a person’s social environment, such as family, in defining wellness as “a state of complete physical, mental and social well-being and not merely the absence of illness or infirmity.”

The U.S. Surgeon General’s Report of 1979 argued for integrated care, helping to launch the emphasis on collaboration that has led to the importance it is given in the Affordable Care Act, she said.

Lamson said physicians do not bear the total blame for separating the treatment of mental and physical illnesses.

She said a 2012 survey showed that half of all American adults – roughly 117 million people – have one or more chronic health conditions, such as heart trouble or diabetes.

Still, many mental health practitioners do not ask about patients’ physical health when they present for behavioral therapy.

“How often are we asking these kinds of questions?” Lamson asked.

Although the presentation concerned research on the involvement of marriage and family therapists, much of the material related to all mental health practitioners.

Hodgson said the integration of mental health care into primary care can range from minimal to superior, which she and Lamson divide into five levels:

Level 1: A therapist in private practice accepts referrals from medical professionals on an “as needed” basis, typically collaborating only when a patient is in clinical/spiritual crisis.

Level 2: A therapist is aware of the biopsychosocial/spiritual (BPSS) framework but practices separately and only occasionally consults with medical health care colleagues.

Level 3: A therapy practice regularly seeks out consultation from medical health care providers but tends to provide traditional therapy without consistent input from them.

Level 4: Therapy is provided via both traditional and integrated care contexts with the behavioral therapists being part of collaborative rounds, team meetings or sessions with medical health care providers, typically working within an integrated primary care setting and incorporating other health care practitioners into most of their work.

Level 5: A therapist is proficient at traditional and integrated care, uses relational family therapy theories, models and intervention in diverse medical contexts and has skills to train others in family therapy and MedFT practice, research, policy and administration.

Hodgson said psychologist Alexander Blount, Ed.D., course director for the University of Massachusetts Medical School’s Center for Integrated Primary Care, defined good integrated care from the patients’ perspective: “It allows patients to feel that, for almost any problem, they have come to the right place.”

Lamson said it is the therapist’s duty to get the patient to believe that mental health is not less important than physical health and to encourage medical practitioners to increase integration with behavioral health practitioners for the good of patients.

Lamson noted one statistic greatly favoring marriage and family therapists.

She said they have a lower dropout rate of patients leaving therapy prematurely than other mental health providers – 19 percent lower than social workers, 20 percent lower than psychologists,  21 percent lower than licensed professional counselors, 27 percent lower than licensed practical nurses and 44 percent lower than MDs.

Hodgson said a great deal of distrust remains within medical circles and the behavioral therapist can expect to be challenged at times with statements such as, “You might be a really good therapist, but prove it.”

She said it is also often necessary to persuade primary care administrators that the financial benefits of including behavioral therapy will take time to materialize.

She said the Greenville research center where she and Lamson work is regularly adding to documentation of the outcome benefits integrated care provides as well as improving the lives of patients in its care, an aspect often overlooked by researchers only interested in collecting the needed information to justify a research grant.

Overall, about 1,400 attended the AAMFT conference held Sept. 15-18 at the Indiana Convention Center.

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