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.
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!
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).
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.
Am I stressed, or do I have a mental health disorder?
by Ricky Caliendo, LMHC
It was 2014, a fresh box of tissues sat on the coffee table and steam dissipated into the air above a warm cup of coffee. A screech from the opening of the lobby door traveled into my office as a wave of anxiety set in. Immediately, I remembered a not-so-encouraging joke that my clinical psychology professor overused throughout one semester: “Every student should prepare a sorry card for their first patient.” Why was it that this poorly placed joke has found itself cornered into my thoughts as my first patient eagerly waits outside my office?
A professional, middle-aged man sat down across from me, looked at the box of tissues, and offered me a cunning grin. He understood that I was younger than him. Nonetheless, I sipped my coffee and started the session. After obtaining informed consent, and just about finished reviewing the laundry list of office policies, he stopped me with a distinct purpose. He said, “All I want to know is if I am just stressed out or actually going crazy?” I jokingly assured him that there is a thin line between the two. He gave a small chuckle as we both felt the ice in the room breaking. He eased back into the couch and began to disclose the recent detour his life had taken. Between a divorce, cancer diagnosis, and his mother’s deteriorating health, I thought to myself that he had a lot more resilience in him than he realized.
Through the years in practice, and navigating through diagnostic and treatment recommendations with colleagues, the answer to the question that my first patient had has changed. Although humor has sustained, with a more sincere explanation now, I would not jokingly hint toward this line between stress and mental health disorders as thin; on the contrary, the line is thick yet permeable.
Is stress common? Definitely. We all experience good stress, such as excitement, and then there is stress that challenges us. This is a normal part of life.
Do mental health disorders exist? Of course. Mental illness can mean many different symptoms and experiences, but we do have a way of capturing the range of mental illness through diagnoses.
Making a diagnosis is very important in guiding evidence-based interventions and psychopharmacology. However, the person, and their uniqueness, exists before the diagnosis. A diagnosis can blind the individual differences in patients. Understanding the person, their experience, unique stressors, and even more importantly, how they respond to those stressors, will always exceed the importance of a diagnosis.
Our body and mind have a fundamental response to uncomfortable internal or external conditions. Stress is the umbrella of responses that can occur in relation to this, although this experience is hardly uniform. And, while every human being on this earth has experienced stress, everyone has not experienced a mental health disorder. So, what is the real difference?
Rather than dissecting the 5th edition of the Diagnostic Statistical Manual of Mental Disorders and providing a quiz at the end of this blog, let’s look at this in a different way. The size of the stressor may influence the size of the response. For example, a global pandemic that creates media hysteria, economic crisis, broken routines, and social isolation is likely to create a more persistent and intensified stress response compared to running late for work and burning your toast. However, there are variables — such as genetics, traumatic occurrences, and biological influences — that can make these stress responses less predictable and proportional, and even alter the likelihood of developing a mental health condition.
Given that we have already established that everyone has experienced stress, one may imagine that there are some shared manifestations of stress. Trouble with sleep, concentration, appetite, drive and motivation toward pleasurable activities, and irritability are some common internalization responses to stress. The intermittent slam of the door or giving someone the silent treatment may be common externalized responses. These can also be signs of depression. But the severity — how it impacts your functioning — and other symptoms need to be considered before naming a mental illness. Some of the more concerning symptoms related to clinical depression may include hopelessness, trouble with memory, increased alcohol and substance use, and suicidal ideation, to just name a few more concerning experiences. Certain things like good self-care, support, and treatment, can impact the degree of permeability of the line between mental health disorders and stress.
Remember, if you’re having a bad day, or your environment is providing you with an extra stressful situation, it is normal to not be at your best. Allow yourself to have a stress response and remind yourself that this is uncomfortable, but it is normal, and there are coping techniques that can help reduce your stress. If persistent, disproportioned emotional or behavioral responses continue — with a negative influence on your quality of life, relationships, and functioning — it may be time to dig a little deeper to explore support for your mental health.
For Mental Health Awareness Month, we wanted to bring attention to this important distinction between stress and mental health disorders, and remind our partners and communities that there is help and support available for both. Connecting with a behavioral health professional — such as a counselor, psychologist, therapist, or psychiatrist — can help you determine if what you’re experiencing is stress or a mental health disorder. Additionally, your primary care provider will be able to support your whole-person health needs, including your mental health. Many primary care offices are homes to behavioral health professionals, and providers work together as a team to deliver whole-person health. You may be able to speak with a behavioral health clinician right at your primary care office!
We hope you all are staying safe at home and in the community. Take time to care for yourself and your loved ones. Feel free to explore our resources and blog posts related to Mental Health Awareness month.
Practical self care for health professionals during the COVID-19 Crisis
At the Center of Excellence for Integrated Care, the work we do allows us to collaborate and assist some of the most amazing healthcare professionals. Our appreciation for the work of these providers, clinicians, staff, and administrators grew exponentially with the onset of COVID-19 and the added responsibility and stress. Our team at COE has experience providing direct services to patients as clinicians and we know how important it is to take care of yourself. Now more than ever we are encouraging providers, clinicians, and all healthcare staff to pay attention to what they need to be able to take care of themselves.
While it may seem like extra work we know that it is critical for healthcare providers and staff to put gas in the tank so that they can stay well themselves, continue to help others, and be there for those they love. The document below is a resource and reminder to healthcare providers and staff of a variety of tools they can use to help take care of themselves. As a starting point, consider choosing one tool that sounds the most reasonable and add more strategies as you like. Thank you again for all that you do for so many.
Teletherapy is a wonderful resource for both providers and patients. Prior to COVID-19 many clinicians were dabbling in the world of teletherapy; however, now a majority of clinicians and patients are being asked to jump feet first into this virtual experience.
There are a myriad of resources on teletherapy, however, the document below highlights some of the key aspects that would be helpful during the transition.
Unprecedented, uncertain, unparalleled… just a few of the words that have been used to describe the happenings surrounding the COVID-19 virus. Even those who never struggled with worry or anxiety before have likely felt a pang of concern over these recent events. At COE we recognize that people are unique and are having different experiences and reactions to the stressors we are facing. While everyone will react differently, we want to offer a few tips and guidelines that will help lessen the negative impact and promote resiliency for you and your loved ones.
