Family therapists were integral in the foundation of the integrated care movement. Leaders such as Don Bloch, Jeri Hepworth, Bill Doherty, Susan McDaniel, Mac Baird, and Larry Mauksch wrote much of the seminal integrated care literature on Medical Family Therapy. Over the years, leaders in a variety of professional fields have worked to formalize processes for providing behavioral health services in healthcare settings. The constant evolution of the integration of psychosocial and behavioral work within healthcare settings requires re-training the current and preparing the next generation of the work-force to apply their skills and knowledge in new ways. Family therapy offers a unique set of skills to integrated behavioral healthcare models but also shares a degree of overlap with other behavioral health disciplines. To help prepare the family therapy profession for flourishing opportunities in health care settings, AAMFT convened a working group of medical family therapy and integrated behavioral health care leaders to create and publish a set of competencies for training family therapists to work in diverse healthcare settings. This team worked across small and large group formats to identify key domain areas, associated skill sets, and target indicators relevant to this work. For a thorough description of the steps traversed in this effort, and for a detailed presentation of the content produced, see American Association for Marriage and Family Therapy [AAMFT] (2018).
Core competencies for family therapists working in healthcare settings are situated in four principal areas: (a) clinical skills; (b) training and supervision; (c) healthcare management and policy; and (d) scholarship. Each of these areas are further anchored in six domains – systems, biopsychosocial/spiritual, collaboration, leadership, ethics, and diversity. The following is a summary of core competencies related to supervision/training skills.
Supervision and Training Skills
Supervisors have long known that a unique skill set is needed for family therapists to practice in medical or healthcare settings, and they have worked to adjust their supervisory proficiencies to match these needs (Edwards & Patterson, 2006; Pratt & Lamson, 2012). Additionally, as the work of family therapists in healthcare settings grows, their responsibilities and roles expand to include training and supervision of both family therapists as well as potentially other healthcare professionals such as medical providers in training and other mental health disciplines functioning within the healthcare setting Competencies for family therapy trainers and supervisors in healthcare settings, regardless of trainees’ discipline(s), continue to be anchored by the core domains of systems, biopsychosocial/spiritual, collaboration, leadership, ethics and diversity.
The foundation for family therapists providing supervision and training in healthcare settings is through systemic thinking. This lens is applied in supervision to help strengthen supervisees’ ability to see patients within their family systems and how those family dynamics and behaviors influence disease management and recovery processes. Additionally, the supervisor should be able to appropriately teach supervisees how to include the patient- and family- system as part of the healthcare team, honor the intersecting social locations of supervisees as well as apply concepts of family systems to their role as a trainer.
In training efforts, family therapists will be able to teach about the culture of healthcare from a systemic lens. For example, attention should be paid to teaching about reciprocal interactions and the impact of self-of-provider / self-of-staff on the healthcare system and team dynamics. Additionally, supervisors keep these systemic interactions of the healthcare system in mind as they facilitate opportunities for inter-professional collaboration. Lastly, it is critical that supervisors continue to see that each person in the larger system has intersecting needs and identities that require awareness and responsiveness as relationships and connections are built and nurtured.
The use of the biopsychosocial-spiritual (BPSS) framework (Engel, 1977, 1980; Wright, Watson, & Bell, 1996) is also critical for family therapists serving in a supervisory role in a healthcare setting. This framework should pervade a supervisor’s work such that they are ensuring trainees are educated in the foundation of the BPSS framework and utilizing it in their clinical work with patients, collaboration with other medical team members, administration and research endeavors. An example of a supervisor looking for evidence of the BPSS framework might be asking supervisees to think through the patient check-in and triage process and helping them evaluate if all of the areas of the framework are addressed.
Family therapists in the supervisor/trainer role will want to be sure their own collaboration skills are exemplary and serve as a role model for proactive and effective communication with team members. For example, therapists should be able to articulate and execute brief, clear communication methods (e.g., Situation, Background, Assessment, Recommendation [SBAR] http://www.ihi.org/resources/Pages/Tools/SBARToolkit.aspx) that convey assessment and therapeutic outcomes to the patient care team, and aid the supervisee in receiving and incorporating constructive feedback from team members.
Assuming a leadership role is often required of family therapists working in a healthcare setting. Supervisors in these roles are asked to train and prepare other family therapists to be competent future leaders in their healthcare systems. This leadership preparation should start with the supervisors’ identification of personal strengths and challenges and include the creation e of their own professional plans to further skill development. Supervisors should also be prepared to lead the effort in including relationally-based integrated behavioral healthcare with community partners. For example, supervisors should facilitate collaborative trainings and engagement between community partners/research teams and providers/staff from healthcare settings.
Within any type of healthcare setting, family therapists in a supervisory role must be knowledgeable of the various ethical codes of learners to conduct appropriate clinical services and research. Such familiarity could include ethics around various technologies, the conduct of research, and modeling and teaching appropriate roles with patients, families, and colleagues. The supervisor might also be called to articulate and demonstrate the scope of practice for family therapists in the healthcare setting so that they may participate in integrated care teams in a manner consistent with AAMFT’s Code of Ethics (2015).
Competencies for supervision and training culminate in an ability to educate and train learners to work with and advance practice and research benefitting diverse populations. Supervisors and trainers should provide learners with evidence-based practice, research, and culturally-sensitive measures, assessments, and interventions across clinical, research, supervision and teaching foci. Additionally, teaching supervisees/learners to be aware of patients and their families’ healthcare beliefs and cultural practices is important, insofar as these phenomena may impact many different levels of care. Most importantly, supervisors should cultivate a sense of cultural humility so that the process of awareness of and attention to diversity continues throughout the personal lives of learners.
Conclusion
Core supervision and training competencies for family therapists working in healthcare settings cut across systems-, biopsychosocial/spiritual-, collaboration-, leadership-, ethics-, and diversity- domains. Crossing primary (e.g., family medicine, pediatrics), secondary (e.g., OBGYN, emergency medicine), tertiary (e.g., hospice care, alcohol and drug treatment), and other care environments (e.g., employee assistance programs, military care systems), these skillsets are essential for the effective integration of family therapists into medically-oriented treatment and interdisciplinary care teams.
Note: As outlined in this blog’s introductory text, previous installments have highlighted clinical and scholarship competencies for family therapists in healthcare settings and a final installment will cover healthcare management and policy competencies
Read Part 1 of this series: Clinical Competencies for Family Therapists Working in Healthcare Settings
Read Part 2 of this series: Core Scholarship Competencies for Family Therapists Working in Healthcare Settings
References
American Association for Marriage and Family Therapy (2018). Competencies for family therapists working in healthcare care settings. Retrieved from www.aamft.org/healthcare
American Association for Marriage and Family Therapy (2015). Code of ethics. Retrieved from http://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx
Edwards, T., & Patterson, J. (2006). Supervising family therapy trainees in primary care medical settings: Context matters. Journal of Marital and Family Therapy, 32, 33-43 doi: 10.1111/j.1752-0606.2006.tb01586.x
Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196; 129-36.
Engel, G.L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137, 535-44. doi:10.1176/ajp.137.5.535
Pratt, K. J., & Lamson, A. L., (2012). Supervision in Behavioral Health: Implications for Students, Interns, and New Professionals. The Journal of Behavioral Health Services & Research, 39, 285-294. https://doi.org/10.1007/s11414-011-9267-6
Wright, L.M., Watson, W. L., & Bell, J. M. (1996). Beliefs: the heart of healing in families, and illness. New York, NY: Basic Books
Authors:
Lisa Tyndall, Ph.D., LMFT
Tai Mendenhall, Ph.D., LMFT
Laura Sudano, Ph.D., LMFT
Jackie Williams-Reade, Ph.D., LMFT
Stephanie Trudeau, Ph.D.
Randall Reitz, Ph.D., LMFT
Jennifer Hodgson, Ph.D., LMFT
Angela Lamson, Ph.D., LMFT