Competencies of Process: Toward a Relational Framework for Integrated Care
As integrated care (IC) has gained more traction within both the psychosocial and medical fields, the need to train medical family therapy students and established professionals in this care typology has increased in tandem. To address this stated need, there is a large body of literature pertaining to models of care, typologies of intervention, clinical and financial effectiveness, and now a burgeoning discussion related to the academic and practice-based competencies necessary for IC practice. While the ability of the medical family therapist as behavioral health provider (MedFT/BHP) to practice in integrated settings may rely on an understanding of population-based medicine, disease etiology, medication and psychopharmacology, as well as augmentations to patient conceptualization and practice, all of the specifics related to that care are ultimately leveraged on the relationships formed by the MedFT/BHP with their healthcare colleagues. What this means is while we have attempted to distill the gestalt of integrated care into its major practice-based parts (e.g., model development and implementation, competencies, financial viability, efficacy/effectiveness, mechanisms of activation, and marketing), we have not adequately described the competencies necessary to set the stage for these types of close working relationships: relationships that make integration, of any kind, a possibility. The following paper was written to discuss three competencies related to the relational process of integration: (a) conceptual flexibility, (b) understanding and acceptance, and (c) acknowledgment and appreciation, as well as how these competencies provide the backdrop against which integrated care, as a practice, can emerge.
KeywordsIntegrated care Medical family therapy Integration Behavioral health
- Agency for Healthcare Research, Quality. (2008). Integration of Mental Health/Substance Abuse and Primary Care No. 173. Rockville, MD: AHRQ Publications.Google Scholar
- Anderson, H., & Gehert, D. (2007). Collaborative therapy: Relationships and conversations that make a difference. New York: Routledge.Google Scholar
- Bateson, G. (1972). Steps to an ecology of mind. Northvale, NJ: Jason Aronson.Google Scholar
- Canadian Interprofessional Health Collaborative. (2010). A national interprofessional competency framework. Retrieved April 3, 2012 from http://www.cihc.ca/resources/publications.
- Doherty, W. (2007). Fixing health care: What role will therapists play? Psychotherapy Networker, 31(3), 24–60.Google Scholar
- Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.Google Scholar
- Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.Google Scholar
- Keeney, B. P. (1983). Aesthetics of change. New York, NY: The Guilford Press.Google Scholar
- Lambert, M. J. (1992). Psychotherapy outcome research: Implications for integrative and eclectic therapists. In J. C. Norcross & M. R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94–129). New York: Basic Books.Google Scholar
- Marlowe, D. (2011), Bridging conversations: Discussing the intra-professional relationship between medical family therapy and family therapy. Journal of Family Therapy. doi: 10.1111/j.1467-6427.2011.00553.x.
- Peek, C. J. (2008). Planning care in the clinical, operational, and financial worlds. In R. Kessler & D. Stafford (Eds.), Collaborative medicine case studies: Evidence in practice. New York: Springer.Google Scholar
- Peek, C. J. (2011). A collaborative care lexicon for asking practice and research development questions. In C. Mullican (Ed.), A national agenda for research in collaborative care: Papers from the collaborative care research network research development conference (pp. 25–41). Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
- Seaburn, D. B., Lorenz, A. D., Gunn, W. B., Gawinski, B. A., & Mauksch, L. B. (1993). Models of collaboration: A guide for mental health professionals working with health care practitioners. Oakland, CA: Basic Books.Google Scholar
- Shotter, R. G. (2008). Conversational realities revisited: Life, language, body and world. Chagrin Falls, OH: Taos Institute Publications.Google Scholar
- Strosahl, K. (2001). The integration of primary care and behavioral health: Type II changes in the era of managed care. In V. Follette (Ed.), Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice (pp. 45–69). San Diego, CA: Academic Press.CrossRefGoogle Scholar
- Strosahl, K. (2005). Training behavioral health and medical providers for integrated care: A core competencies approach. In W. O’Donohoe, N. Cummings, M. Byrd, & D. Henderson (Eds.), Behavioral integrative care: Treatments that work in the primary care setting. New York, NY: Brunner-Routledge.Google Scholar
- Tyndall, L., Hodgson, J., Lamson, A., White, M., & Knight, S. (2012). Medical family therapy: Charting a course in competencies. Contemporary Family Therapy. doi: 10.1007/s10591-012-9191-9.
- United States Preventative Services Taskforce. (2009). Screening for depression in adults. Retrieved July 5, 2013 from http://www.uspreventiveservicestaskforce.org/uspstf/uspsaddepr.htm.
- Valleley, R. J., Kosse, S., Schemm, A., Foster, N., Polaha, J., & Evans, J. H. (2007). Integrated primary care for children in rural communities: An examination of patient attendance at collaborative behavioral health services. Families Systems and Health, 25(3), 323–332. doi: 10.1037/1091-75220.127.116.113.CrossRefGoogle Scholar
- Watzlawick, P., Beavin-Bavelas, J., & Jackson, D. (1967). Pragmatics of human communication: A study of interactional patterns, pathologies and paradoxes. New York, NY: W. W. Norton.Google Scholar
- World Health Organization. (2008). Integrating mental health into primary care a global perspective. Geneva, Switzerland: World Health Organization.Google Scholar