The AAMFT Blog

How to Advocate as an MFT in Healthcare Settings

Family therapists in healthcare settings can find many ways to gain competency as an advocate and work their way up to gaining competency as a policy maker or policy writer. Some of the opportunities that family therapists in healthcare settings can engage in as an advocate or as a policy maker include:

• facilitating job opportunities for family therapists in health care contexts,
• offering to deliver presentations pertaining to policies within their healthcare context or at national conferences,
• getting involved in writing policy briefs that promote families and family therapy via healthcare practice and reimbursement models,
• creating fact sheets for workplace settings or legislators that offers persuasive details on evidence that supports family therapy/family therapists, and/or
• writing policy focused journal articles and submitting them to family therapy and other healthcare journals.

While some family therapists may feel intimidated with policy and advocacy work, every voice is important and needed in order to grow the profession and ensure that family therapists have a consistent seat at the healthcare table. For a variety of examples related to health, policy briefs are consistently posted through Health Affairs  and examples of fact sheets pertaining to family therapy can be found on the AAMFT website. This is a call to action for family therapists in healthcare settings to gain competency in some way as an advocate, ambassador, champion, and/or policy maker.

Join the Family TEAM to educate legislators and other policymakers regarding marriage and family therapy and to lobby for legislative/regulatory policies that promote MFTs.

Angela Lamson, PhD, LMFT, Associate Dean for Research, East Carolina University 

 

Read the four blog posts on AAMFT's new Competencies for Family Therapists Working in Healthcare Settings

Core Clinical Competencies

Core Scholarship Competencies

Core Supervision and Training Competencies

Core Healthcare Management and Policy Competencies for Family Therapists Working in Healthcare Settings

Statement on Border Separation of Children from Parents

Marriage and family therapists are defined by an enduring dedication to professional and ethical excellence, as well as the commitment to service, advocacy, and public participation. The areas of service, advocacy, and public participation are recognized as responsibilities to the profession equal in importance to all other aspects (AAMFT Code of Ethics, Preamble).

AAMFT strives to make contributions and engage in public participation in line with our Code of Ethics. Further, in our Statement on Immigration Policy, “AAMFT is equally dedicated to holding true to the position that we assert the value and positive impact of stable, long-term, emotionally enriching relationships. We believe that society is better off when social groupings are created that allow for and support these qualities – not creates fragmentation and segmentation.”

AAMFT is aware of the zero-tolerance policy and we steadfastly believe that any forced separation of children from families works against long-term, emotionally enriching families. AAMFT stands with over 170 organizations and over 9,300 mental health professionals in signing the Stop Border Separation of Children from Parents petition. AAMFT also stands with our sister associations – American Psychological Association and the National Association of Social Workers - in denouncing the purposeful infliction of trauma resulting from separation of immigrant families.

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The American Association for Marriage and Family Therapy, Washington, D.C., is the largest national association for marriage and family therapists representing the professional interests of over 60,000 marriage and family therapists. Recognizing that relationships are fundamental to the health and well‐being of individuals, couples, families, and communities, AAMFT exists to advance the profession and the practice of marriage and family therapy. Relationships matter!

Support the Minority Fellowship Program

Calling all Minority Fellowship Program Alumni and leaders in the Marriage and Family Therapy field! We have opportunities for you to contribute to the efforts of the MFP in shaping the marriage and family therapy workforce and enhancing the field of mental health. You may apply to any of these positions listed below here!

Positions include:

Mentor Positions:

• MFP Mentors provide academic, professional and career development guidance to current AAMFT MFP Fellows.

• MFP Mentors are marriage and family therapists or other behavioral health professional volunteers.

Ad-Hoc Review Positions:

• Ad-Hoc reviewers serve as initial reviewers on eligible applications for the Doctoral (MFP-DF/DCF) and Masters (NITT-MFP-Y) Fellowships offered by the MFP.

Advisory Committee Positions:

• Professional Member positions and Public Member positions will provide programmatic and professional guidance aid in the growth and development of the AAMFT Minority Fellowship Program.
• Attend all MFP Advisory Committee (AC) meetings. There are one to two Advisory Committee Meetings annually in the DC Metro area. 
• Advisory Committee members serve as reviewers and assist in the determination of Fellows.
• These positions serve a two to three-year term. 

Volunteering for the MFP is an amazing opportunity to further the mission of expanding culturally competent mental health services to underserved populations, contribute to the growth and development of the behavioral health workforce, and gain access to members with similar interests and professional goals.

To review the volunteer position, you wish to apply for, please visit the MFP Volunteer Application Information Page.

Volunteer Applications are due Friday July 27, 2018

Core Healthcare Management and Policy Competencies for Family Therapists Working in Healthcare Settings

download the competencies here: https://www.aamft.org/healthcare

Family therapists who have chosen to pursue careers in systems of integrated care understand the need for a unique and additional skill set(s) to complement their biopsychosocial/spiritual (BPSS) and relational foundations. AAMFT convened a working group of medical family therapy and integrated care leaders to articulate and publish these skills. Previous installments of the Core Competencies for Family Therapists Working in Healthcare Settings AAMFT blog series have described  (a) Core Clinical Competencies, (b) Core Scholarship Competencies, and (c) Core Supervision and Training Competencies. This final installment will highlight beneficial skills for engaging in organizational healthcare management and policy to influence systems change.

Defining Our Role

Becoming an integral part of any system requires the design, implementation, and evaluation of each part to the whole. Mastering core competencies in the aforementioned areas of clinical skills, scholarship, and supervision and training does not necessarily lead to the systematic and purposeful inclusion of a family therapist in a healthcare setting. Accredited programs that train family therapists in traditional settings have historically lacked formal education that results in the development of skills for healthcare management and policy (e.g., preparing health policy briefs and white papers, creating sustainable business models that leads to mental health parity). This can leave many systemic and relationally trained professionals at a disadvantage when working toward integrating themselves within a healthcare setting. It is also a fair assumption to state that those who advance into the roles of healthcare management do so over time, after an acquisition of skills obtained on the job. A recent perusal of national career postings for healthcare management and/or leadership positions yielded scarcely few that specifically requested family therapists. This snapshot should not be one of lost hope; it should be one of the need for increased advocacy in order to promote the tenets of our training that make us pioneers in our endeavors. 

As family therapists take to the healthcare sector, many different versions of care delivery are taking shape all across the country. Various levels of integration can have family therapists operating as an essential nutrient source to a system, or it can leave them operating as an unnatural addition or foreign appendage. Inclusion does not assume integration. In order to avoid being fragmented and/or providing redundant services, we encourage the growth of a skill set that will allow family therapists in healthcare settings to operate at the top of their scope of practice. There are many skills that are innate to our training that can be exactly what healthcare settings are looking for. Examples of these skills include (but are not limited to): convening teams of people, aligning mission and vision with practice, health education, promotion, and advocacy, and collaboration between and within sectors of care.

Policy in the News

Recently, family therapists have had their scope of practice shaped by federal-level decisions that some may categorize as “successful” policy outcomes and “in progress” policy outcomes.  A successful policy outcome came about in February 2017 when a Texas Supreme Court ruling allowed family therapists to independently diagnose using DSM criteria. AAMFT advocated for, and invested a great deal of time resources in, influencing the resulting decision.

On the other hand, a current reality is that our field is in the midst of an in-progress policy outcome that has had prior failed attempts.  As of today, marriage and family therapists lack the ability to bill as a Medicare provider. There are three bills proposed to close this gap in order to improve access. These bills are H.R. 3032: Mental Health Access Improvement Act of 2017; H.R. 5531: Opioid Emergency Response Act; and S. 1879: Seniors Mental Health Access Improvement Act of 2017. The passing of these bills would improve access to Medicare-covered mental health benefits by recognizing state-licensed family therapists as eligible Medicare providers. With continued advocacy at local, state, and national levels, family therapists are finding opportunities to have their voices heard. Outside of (and within) healthcare settings, family therapists can be proactive and advocate for themselves and the profession by gaining skills in and executing proficiencies in the healthcare management and policy core competencies. The following table highlights a few high level skills for potential development in this growing and important arena.

Domain	Knowledge/Abilities/ Personal Characteristics	Target Indicators
Systems	1.3a Understands the management of systems integral to the provision of BPSS and relationally-oriented health care.	Applies critical research and updates regarding practice-related changes that influence BPSS and relationally oriented policies.
Biopsychosocial-spiritual	2.3a Applies the BPSS framework through a relational lens to healthcare management and policy.	Contributes to the development of local, state/regional, national, and/or global healthcare policies that advance research, training, and treatment of BPSS concerns, evidence-based approaches, and practice-based evidence.
Collaboration	3.3a Develops policies and procedures to enhance collaboration.	Advocates for and/or writes policies that promote integration of family therapists into the relevant healthcare context (e.g., submits and/or presents white papers).
		Consults with healthcare team to evaluate clinical, operational, and financial needs to enhance collaborative partnerships.
Leadership	4.3a Utilizes management and/or administrator roles in executing inter-professional collaboration and integrated behavioral healthcare models and policies that impact: (a) healthcare teams; (b) clinical, financial, and operational systems of health care; (c) psychological, behavioral, and relational practice and research for patients and families.	Articulates current rules, regulations and guidelines for primary care (e.g., value based care, financial incentives, affordable care, and public and private insurance reimbursement, and alternative payment methods).
Ethics	5.3a Advocates for the improvement of policies regarding the ethical practice of inter-professional collaboration, integrated behavioral health care, and family-centered care.	Attends to and researches the ethical impact of healthcare delivery models on patients, family/support system members, team members, community partners, and healthcare systems.
Diversity	6.3a Recognizes and mitigates the impacts of policies and laws have on diverse populations.	Advocates for policies that are inclusive and culturally informed within the healthcare system to reduce health disparities.
		Promotes policy that supports marginalized populations and reduces health disparities (e.g., tracking healthcare utilization, measuring cost-offset, determining cost-effectiveness).

 

Policy is Advocacy

Policy informs practice. It is what assists in systems functionality. Much like how individuals tend to and tweak their nutrition for optimal performance, policy (when continuously tended to and adapted) can help a system function at its optimum efficiency and effectiveness. To some, policy may be the least glamorous investment of the education into being a family therapist in a healthcare setting. We hope to change that by illuminating ones interest in policy should be synonymous with advocacy. Advocating for one’s self and our profession often means getting involved in policy change at local and/or national levels. Manners by which this can be done, are to put pen to paper. The following links offer more information about how to write health policy briefs (here and here), and white papers.

Conclusion

Engaging in organizational policy will create systemic change. Maybe your contribution will be creating a protocol for stratifying risk amongst your highest utilizing patients, or it maybe it will be your management style that elicits the voices of all employees impacted by organizational change prior to implementation. Find your own point of entry and infuse your system with those essential biopsychosocial/spiritual and relational nutrients. For the complete Healthcare Management and Policy competencies across the six domains (systems, BPSS, collaboration, leadership, ethics, and diversity) see American Association for Marriage and Family Therapy (AAMFT, 2018).

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 (2018). Core Clinical Competencies for Family Therapists Working in Healthcare Settings. Retrieved from: http://blog.aamft.org/2018/03/core-clinical-competencies-for-family-therapists-working-in-healthcare-settings.html)

American Association for Marriage and Family Therapy (2018). Core Scholarship Competencies for Family Therapists Working in Healthcare Settings. Retrieved from: http://blog.aamft.org/2018/03/core-scholarship-competencies-for-family-therapists-working-in-healthcare-settings.html)

American Association for Marriage and Family Therapy (2018). Core Supervision and Training Competencies for Family Therapists Working in Healthcare Settings. Retrieved from: http://blog.aamft.org/2018/04/core-supervision-and-training-competencies-for-family-therapists-working-in-healthcare-settings.html

Collaborative Family Healthcare Association (2018). CFHA Supports Bills Increasing Access to Behavioral Healthcare For Mental

Health and Opioid Crises. Retrieved from

https://cdn.ymaws.com/www.cfha.net/resource/resmgr/press_releases/access_expansion_bills_press.pdf

Mental Health Access Improvement Act of 2017, H.R.3032, 115th Congress (2017-2018). Retrieved from https://www.congress.gov/bill/115th-congress/house-bill/3032/related-bills

Opioid Emergency Response Act, H.R.5531, 115th Congress (2017-2018). Retrieved from https://www.congress.gov/bill/115th-congress/house-bill/5531

Seniors Mental Health Access Improvement Act of 2017, S.1879, 115th Congress (2017-2018). Retrieved from https://www.congress.gov/bill/115th-congress/senate-bill/1879

 

Authors:

Stephanie Trudeau, Ph.D., LAMFT

Laura Sudano, Ph.D., LMFT

Randall Reitz, Ph.D., LMFT

Jennifer Hodgson, Ph.D., LMFT

Tai Mendendall, Ph.D., LMFT

Jackie Williams-Reade, Ph.D., LMFT

Lisa Tyndall, Ph.D., LMFT

Angela Lamson, PhD, LMFT