Author: Lisa Tyndall

Fall Integrated Care Learning Opportunity

September 29, 2020

Many of our sites and partners were excited about the momentum of the NC Integrated Care Symposium created last year. While this year is a bit different, we want to welcome last year’s attendees and future attendees to what we have in store for this November!

In the fall of 2019, the Center of Excellence for Integrated Care partnered with Wake AHEC to deliver a symposium on integrated behavioral healthcare. Based on the attendee reviews it was a great success! North Carolina has been on the integrated, whole person care journey for quite some time and it was clear the passion among our healthcare workforce for delivering the highest quality whole person care still runs deep.

With a focus on the clinical, financial, and operational aspects of team-based care, the stage was set for the planning of next year’s symposium for 2020. The Center of Excellence of Integrated Care was already in conversation with a fellow FHLI Program, the NC Oral Health Collaborative, to examine best practices around weaving together oral health, behavioral health, and primary care. Several awesome planning committee members joined our effort, and we were chomping at the bit to knock the 2020 symposium out of the park.

Notice the past tense. Because, 2020 had different ideas.

Yes, along with our amazing planning committee members, we decided after the impact of COVID-19 became clear, that 2020 was not well-suited to re-convene a large gathering. Out of respect for the discipline-specific conferences necessary for continuing education already being offered virtually, we thought it best to just pause and really assess the need.

What we were hearing from our work with clinics was that due to the necessity of teletherapy with patients being seen in the context of their homes and families, that there was an increased need for support around family work. So, we tagged an awesome clinician, Jasmine Williams, MSW, LCSW with the Tim & Carolynn Rice Center for Child & Adolescent Health, and are once again partnering with Wake AHEC to bring you a webinar on November 18, 2020 from 12-1:30pm, entitled, “Integrating the Family: Child and Adolescent Health.”

We hope you will join us for a lively presentation and discussion in November by registering at Wake AHEC online. Hope to “see” you there! Click this link to register.

Posted in Resources, Uncategorized

Essential Understanding: What is psychotherapy?

September 25, 2020

by Amelia Muse, PhD, LMFT

Friday, September 25th is recognized as “National Psychotherapy Day” in the United States. In healthcare, we have observed that some patients, clients, and providers seem to have an aversion to the idea of psychotherapy, probably due to the stigma associated with the term or related terms. As a team of therapists working to promote behavioral health integration and whole-person care, the Center of Excellence for Integrated Care staff wanted to use today as an opportunity to promote a better understanding of psychotherapy.

The term “psychotherapy” comes from the ancient Greek word roots of “Psyche” which means breath, spirit, or soul, and “Therapeia” which means healing or medical treatment. Those root meanings are a long way from the often stigmatized vernacular term of “psycho.” Additionally, the historically popularized image of therapy — during which clients lay on a couch while a therapist proclaims hypotheses about childhood experiences and current mental illness — have contributed to a misunderstanding about the expectations and outcomes regarding psychotherapy.

What is psychotherapy?

In the context of mental health treatment, psychotherapy is often used interchangeably with the terms “therapy” and “counseling.” Though some professionals in the mental health field have highlighted distinct differences between psychotherapy and counseling, psychotherapy remains the name of the service of providing talk therapy. At COE, we advocate that there should be a common understanding of the language used to describe any therapy services, outpatient or integrated. However, we think that whichever term feels most comfortable to clients/patients and their care team is appropriate. Most important is that the client is well aware of the service they are consenting to receive.

What happens in psychotherapy?

Therapy could be beneficial to most everyone; you do not have to have a serious and persistent mental illness to benefit from therapy. Many people participate in psychotherapy to work on challenging relationships, cope with stress, adjust to new life situations, and explore self-identity.

Once you identify a therapist with whom you feel comfortable working — see this page about identifying a behavioral health provider — you will work toward developing a safe and trusting working relationship with your therapist. The therapist’s role is to help you walk through your challenges, versus the commonly held assumption about offering direct advice or making decisions for you. You and your therapist will work collaboratively to set goals, and both you and your therapist will establish boundaries about the work you will do in therapy. Sometimes therapy will primarily involve talking. Other times your therapist may introduce various activities into therapy, such as creative expression or role-playing to help practice talking through relational issues.

The COE team hopes that this discussion has helped improve awareness and understanding about psychotherapy — and provided some normalization about the therapy process — in honor of National Psychotherapy Day.

If you would like to learn more about providing whole-person care involving psychotherapy, please reach out to us!

Other resources:

Psychology Today locate a therapist.

Therapist Locator.net

Emotion Focused Therapist Locator

Posted in Mental Health Awareness, ResourcesTagged , ,

Implementation in a Flash

July 14, 2020

This edition of the COE blog is co-authored by Julie Austen, PhD, and Lisa Tyndall, PhD, LMFT. Dr. Austen is an Implementation Specialist at the Frank Porter Graham Child Development Institute at the University of North Carolina at Chapel Hill. Dr. Tyndall is a Senior Integration Specialist at the Center of Excellence for Integrated Care at the Foundation for Health Leadership & Innovation. Julie is healer who works at the systems level. With expertise and lived experience at the intersections of health psychology, integrated care, community capacity building, knowledge transfer, and minority wellness, she serves as an implementation specialist with UNC’s Frank Porter Graham Child Development Institute.

Colleagues for a decade, Julie and Lisa’s “forward together” paths crossed when they realized that integrated care cannot move forward without an intentional focus on the “how.” Now, the COE team and Julie partner together to strengthen access to evidence-based practices related to healthcare systems reform.

Implementation in a Flash

Long ago, Plato declared, “Necessity is the mother of invention.” The recent COVID-19 pandemic has birthed many new and necessary elements in America’s healthcare system. Clinics large and small have re-tooled themselves and have had to work with patients to get their needs met in new and creative ways. As the country’s experience of the pandemic has progressed, we have learned that this process was both a sprint and a marathon. While systems became creative quickly in how to do their work safely for all, now many of them have a chance to come up for air and take a look around to better understand how to sustain that work. And in fact, many are asking themselves, if this isn’t over, how do we handle a second potentially steeper wave? Where are we in this process of developing our protocols, new programs, or new workflows?

Now is the time for clinics to prepare themselves for this second potential wave by pausing to reflect on their progress, timelines, needs, and capacities. The good news is, this timeout to evaluate is actually built into the implementation science framework.

Implementation science provides a framework for best practice in how to implement an evidence-based practice, program or policy, for example implementing telehealth like so many clinics did in rapid time these past few months. Focusing on an implementation science framework can help us find our way through the complexity of change, identify where we are, and plan for what we still need to do. Researchers have identified four stages of implementation when systems are making changes: exploration, installation, initial implementation, and full implementation. Keep in mind, to arrive at full implementation of an effort, where the new initiative is fully folded into the clinic, typically takes up to 3 – 5 years! So, considering the typical timeframe for implementing changes, it would be completely understandable for clinics to feel a need to re-orient themselves for the long haul at this point in time just a few months in to any new initiatives brought on by this pandemic. It is for this reason that we turn to the implementation science to help us organize, co-create, optimize, and innovate.

Let’s look at a stage-based framework as a way of thinking about where your clinic is in a particular process. As your clinic comes up for air, we recommend identifying the stage of implementation by asking a few questions associated with each stage and then using that information to guide your next steps (Metz, Naoom, Halle, & Bartley, 2015).

Adapted from Metz, Naoom, Halle, & Bartley, 2015

Examine the table above that highlights the three core implementation elements as identified by Metz, Naoom, Halle, and Bartley (2015): implementation teams, data and feedback loops, and implementation infrastructure. Think about an initiative you may have just started or will start soon. What processes or pieces have you completed so far? What pieces do you need to circle back to? Who needs to help?

For example, if a clinic has never implemented telehealth for any of its providers, that effort likely became a necessity due to the pandemic. Now, thinking about the creation of that workflow and those clinic processes, who developed or thought through those new processes of telehealth check-in, billing for telehealth, or best practices for telehealth? Was there a team of people? Did that team represent all of the parts of the clinic that it needed to represent? Has that team continued to meet, or did the meetings get disregarded once things picked up speed? Thinking through these questions can help you see where you are and where the clinic needs to go next. Once a new initiative begins we often underestimate the amount of time it takes to successfully implement to the full implementation, this is a good time to reflect on what has already been accomplished and what steps to take next to make it “stick.” (See Metz et al. 2015).

If you look the table above and are still wondering where to begin, a great place to start is identifying needs at the community, organization, clinic, and individual patient level. From there, you’ll be able to identify what your next goals could be to help guide you towards the next activities of implementation. Interested in obtaining assistance in helping making your implementation of integrated care stick? Feel free to reach out for a consultation with our team.

References:

Bertram, Rosalyn & Blase, Karen & Fixsen, Dean. (2015). Improving Programs and Outcomes: Implementation Frameworks and Organization Change. Research on Social Work Practice. 25. 477-487. 10.1177/1049731514537687.

Metz, A., Naoom, S.F., Halle, T., & Bartley, L. (2015). An integrated stage-based framework for implementation of early childhood programs and systems (OPRE Research Brief OPRE 201548). Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

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Experiencing Integrated Care

June 26, 2020

Welcome to the Team

In this story, Ricky Caliendo, LMHC, provides a narrative that describes the experience of integrated care from a patient’s perspective. The names of the patient and doctor are fictitious.

“Another night of lost sleep,” I think to myself as the screeches of a toddler travel into my bedroom. There he is. At the foot of my bed, with that look only a mother could read. It’s time for breakfast. My stream of consciousness continues as I move through the morning routine.

“Breakfast, pack a daycare bag, project for the office, take your medication…what am I missing?…ugh, doctor’s appointment today!”

Attempts at applying eye liner and mascara at a red light should mask the lack of sleep. I adjust the rearview mirror to find my three-year-old son’s face showing intense curiosity.

“You look like a clown, mommy,” he comments through his giggles.

Children are brutally honest and, despite my exhaustion, my mouth cracks a small grin when we lock eyes through the rearview mirror. It’s time for him to go to daycare and for me to push forward.

“Coffee, doctor’s appointment, work, kid, bills, dinner, call with lawyer…” I recite to myself on the way to the doctor’s office.

As I enter my primary doctor’s office, I begin to script my conversation with him.

“Sleep, aches, lack of focus, tightness in chest, diarrhea…ugh, he is just going to think that I’m crazy.”

After checking in and nestling into the waiting area, all of a sudden I am acutely aware of the weight of my recently applied mascara that now feels like it weighs ten pounds. In the exhausting fight to keep my eyes open, I notice a new poster in the waiting room.

We have a new member of the team! Carly Johnson, LCSW, is our new behavioral health clinician and works diligently alongside our doctors to serve your whole-person health needs!

“Okay, Carly, welcome to the team,” I say sarcastically in my head. With just a moment to be still, I feel the weight of my eyes again, and began to nod off to sleep.

“PAMELA? Is there a Pamela here?” exclaims a staff member.

Waking up, embarrassingly, I pull my head up to see Carly’s picture staring at me and I gather myself for the appointment.

Blood pressure. Temperature. Medication list. Paperwork. Hold on, I know this routine. But what is this new paperwork? My medical doctor is asking me about my sleep, mood, motivation, and whether I enjoy things anymore? I complete the questionnaire and interestingly the score does seem higher rather than lower. I am curious about what the score means.

Dr. Haffner enters the exam room in his white coat and I think to myself, “How do they always keep those coats so white? I can barely keep my boy’s church clothes clean.”

Lost in my preoccupation about his coat, I look up and recognize that Dr. Haffner is awaiting an answer to a question that was completely lost in my daydreaming.

“I’m sorry Doc, but I’ve been feeling a little out of it lately,” I say in response to the unknown question. It turns out he asked the fairly typical doctor question about what has brought me in today.

I recite the symptoms list as gracefully as it has been in my head. “I did it!” I silently reassure myself.

Dr. Haffner validates my feelings about my symptoms and discusses some of the paperwork that was completed prior to him coming into the exam room. He indicates that he is concerned about my lack of sleep, low motivation, high levels of stress, and complaints about stomach aches. He reassures me that he will order some blood tests. But, while we’re waiting on those results, he wants me to meet a new member of the team. I instantly find myself nervous and excited at the same time.

A woman in her 40s, dressed in business casual attire, enters the exam room offering a big, warm smile. She introduces herself to me…although I acknowledge her name before she’s able to get it out…Carly.

Dr. Haffner and Carly explain the clinic’s approach to whole-person care, describing the connection between a patient’s medical, social-emotional and spiritual experiences, and their health. With my permission, Carly excuses Dr. Haffner and I find myself, again, sitting across from Carly feeling the weight of my eyes. This time, she is not on a poster.

Carly’s approach is a harmony of kindness, professionalism, and compassion. We have a frank conversation about my experiences being a single parent, my recent financial and workplace stress, and how my life goals that historically excited me, now felt deflated.

“It simply feels like everything I was working toward just passed me by,” I explain. “Now, here I am looking at it as if it is a distant mirage.”

Carly provides a sense of understanding and normalizes my stress. She talks about the importance of self-care, building motivation, and breaking down goals into small steps.

For the first time in a long time, I begin to see myself again…even if it’s at a distance. I used to think that I was so strong and independent, that I had to be for my boy. I thought my needs should come last. But Carly’s intervention really helps me understand the importance of taking care of myself.

I quickly realize that Carly — once just a stranger on a poster in the waiting room — is now a part of my healthcare team. She has provided me with a source of comfort and motivation. She has normalized much of my experience and encouraged me to revitalize old coping skills, such as painting, nature walks, and meditation. She has provided resources so I can explore some new strategies, as well.

After setting my follow-up appointment for two weeks, and walking out of the office, I truly feel cared for.

Thinking about past medical appointments, and how stress has impacted my day-to-day life, I think I was always looking for help from my doctor, but speaking in a code at times. It was a code that I did not know how to break. But Carly opened up a conversation that I did not necessarily think about going into the appointment, and I am so glad she did. I was beginning to crack the code. My happiness and health are intertwined and partially dependent on my self-care.

Welcome to the team, Carly.

Posted in Uncategorized

North Carolina Integrated Care Symposium 2019

June 15, 2020

Center of Excellence for Integrated Care Symposium logo

In the fall of 2019, the Foundation for Health Leadership and Innovation’s Center of Excellence for Integrated Care, in partnership with Wake AHEC, hosted the North Carolina Integrated Care Symposium 2019: Inspire, Educate, and Connect. Aiming to bring together healthcare professionals from multiple disciplines, this symposium focused on educating the over 130 attendees on clinical innovation, operational/implementation necessities, and financial shifts in the healthcare system. In addition to this focus on the three-world view (Peek, 2008), attendees were treated to a morning plenary on team-based care by Dr. Eduardo Salas of Rice University as well as a lunchtime plenary on provider burnout and self-care by Dr. Clark Gaither. Continuing education events such as this, where whole systems are brought together, are necessary to continuing shifting the paradigm to true whole person care being delivered in North Carolina.

The 2019 Symposium was made possible in part with funding provided by:

  • Community Care of Western North Carolina
  • Foundation for Health Leadership and Innovation
  • Kate B. Reynolds Charitable Trust
  • Wake AHEC

Peek, C. J. (2008). Planning care in the clinical, operational, and financial worlds. In Collaborative Medicine Case Studies (pp. 25-38). Spring New York.

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