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