Are you a tennis player or a football player? A look at integrated behavioral health culture.

Are you a tennis player or a football player? A look at integrated behavioral health culture.

According to good ‘ol Merriam-Webster’s dictionary (2016), culture is: the beliefs, customs, arts, etc., of a particular society, group, place, or time. Or in business: a way of thinking, behaving, or working that exists in a place or organization.

What is the culture of integrated behavioral health, and why is it important? Integration is not a new concept, but one that dates back centuries to the realization of a mind and body connection. The mind can have control of the body and can manifest illness if not properly taken care of. So how can a provider office create a culture conducive to wellness and thereby help patients strengthen the mind, body connection? The answer lies in a tennis ball or a football.

Integrated care is packaged in many forms: separate entities that rarely share information; separate entities that communicate on a semi-regular basis; close proximity providers that share referrals and information; co-located providers that share providers and meet as a team as needed; and fully integrated providers that work together as a team to improve all patient care. Not all integrated providers work as a team, they work in separate silos and may venture out to other providers for advice or to consult on a patient if the patient requires more attention. Although the separate providers may acknowledge a mind, body connection, they are treating each part separately. This is like a tennis player that is playing the game to win as an individual.

In more collaborative settings, integration is a culture or a new way of thinking and working together. The days of being an independent provider are gone and a stronger team effort has jumped into place. Think of the culture of integration like football players working hard together to win a championship; they have to trust, support, and communicate with each other in order to advance the football to the goal line. Each player has a strength and they use it for the betterment of the team. That is the culture of integration – teamwork.

There are many players in a provider office: doctors, dentists, nurses, behavioral care providers, medical/dental assistants, peer support specialists, receptionists, management, etc. – each has a strength and when they work together, they advance patient care. If a one of these players decided that they no longer wanted to operate in a team-fashion and went rogue, it would throw-off the other players and leave them scrambling to fill the gap.

So an integrated culture is one of teamwork where all are equal and motivated to help the patient receive the best care possible. Each team member communicates with the others, respects teammates abilities, asks questions, fills in gaps, and uses strengths to create a harmonious location where patients can feel secure knowing all bases are actively being covered. This culture cannot exist if providers are not on-board or maintain an autonomous attitude toward patient care.

How can an integrated culture be created? Education, trial and error, and most importantly, an open mind to change. The discussion of how to create or change a culture is a different blog all together, but feel free to share about your integrated culture and how it was created; after all, we are pioneers and can learn from each other.

 

Shared Decision Making is an Important Decision

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“Shared decision-making aims primarily to make the inevitable trade-offs between harms and benefits evident to patients.”

This past week I spent time at the National Integrated Healthcare Conference in Chandler, AZ. Not only did I attend the conference that was overflowing with a wealth of knowledge on the forefront of healthcare integration, I was a presenter. Talk about excitement and honor! I could go overboard describing the cloud I was on when I completed my presentation. However, since I can’t recreate the powerful moment, I will share the passion of my presentation on Shared Decision Making (SDM).

Many facilities, integrated or not, feel they are already providing SDM services to their patients. Maybe they are and maybe they don’t realize exactly what SDM is in its full potential. Shared Decision Making is a powerful tool that can foster patient compliance, lower healthcare costs through lowered patient visits, and increase patient/provider rapport. Sound like a win – win opportunity? It is!

Shared Decision Making is about creating a team consisting of providers and the patient; not just the providers or the patient, but both working together to create a treatment plan that accommodates the patient’s life. So the shift moves away from a traditional paternalistic model of treatment where the provider “tells” the patient what to do, to a model where the patient works in collaboration with the provider on deciding a course of action together. This collaboration is an information exchange with the patient explaining what is important in treatment based on personal feeling, preference, culture, religion, or other factors. The provider shares evidence-based information on different treatment options, even if an option is to do nothing at all, and together they create a treatment plan.

When a patient has a say in their treatment they are more likely to follow through on adherence as opposed to having no voice in their treatment. Most patients want to take an active role in their healthcare beyond just paying co-pays and premiums; they want to have control of their health. Shared Decision Making gives the patient an active role, a voice on what they are willing to do, take, or not take to maintain their healthcare options.

So how can Shared Decision Making be implemented into a healthcare setting? Much easier than one would think. Sometimes it is as easy as starting with an extra few minutes of discussing what is important to the patient regarding treatment and finding out if compliance would be adhered to if those important ideals were met. It could be as easy as finding a medication that produces the same outcome with less of a side effect, such as weight gain or insomnia. A patient will be more likely to take the medication if the side effect they are concerned with will not likely be an issue. This increase patient compliance because the patient’s needs were heard by the provider; the provider took action to help accommodate the patient’s legitimate concerns; and through teamwork, a treatment plan was created.

I could go on and on about Shared Decision Making and the positive impact on providers, patients, and integration. I could tell stories of how to use SDM in behavioral health, mental health, primary, and specialty care. And I could talk about how to start, establish, and continue SDM in facilities; but those are different topics. The take away from this message: Look for opportunities to learn from your patients, truly listen to their concerns regarding THEIR treatment, and take time to help them make decisions about healthcare – don’t do it for them or send them out your door with a bundle of information for them to make the decision on their own. Share decision making!

 

What is a Doctor of Behavioral Health?

One of the most frequent questions I receive is, “What is a Doctor of Behavioral Health?” This question comes from individuals out of the healthcare industry and within the healthcare industry, and all have a puzzled look when asking. Perhaps it is easier to answer what a Doctor of Behavioral Health is not before answering what is.

A Doctor of Behavioral Health is not a psychologist like many assume; although psychology is mixed in the education curriculum, a DBH and a psychologist have different roles in the healthcare field. A psychologist is usually a state licensed provider and utilized for mental health testing and assessments, counseling, and diagnosing. A DBH can have a terminal Masters degree in counseling, clinical social work, or marriage, family therapy and retain a state licensure; however a DBH degree is not a licesenable degree yet, and therefore cannot bill insurance without a billable Masters degree. With that said, a DBH has been trained to conduct assessments related to healthcare disorders such as anxiety and hypertension, chronic illness and depression, substance abuse and HIV, and risk taking behaviors, all provided in a medical setting.

A DBH is not a nurse or medical doctor. A DBH is a valuable working part of an individual’s healthcare team alongside the medical doctor and nurses. The DBH helps coordinate care with the team by working with the patient on behavioral needs to improve medical conditions. They can not prescribe medications or diagnose medical ailments; however they can offer suggestions on behavioral therapies that may create better patient compliance with medications and treatments.

So what can a Doctor of Behavioral Health actually do? A lot! A DBH is trained in three main areas: mental health, medical literacy, and entrepreneurship. Those three areas open many possibilities for a DBH. Healthcare is moving away from a traditional model of healthcare and into a a holistic model of healthcare where the mind and body are connected in illness and not separated. This is called integrated healthcare and it is becoming the standard due to healthcare changes like the Affordable Care Act.

The marriage of mind and body in medicine has created a specialty niche for the Doctor of Behavioral Health because of the specialized training in medical literacy and mental health. Unlike a psychologist that is mainly trained in disorders of the mind, the DBH is trained to work with disorders of the body and how the mind impacts the disorder. For example, hypertension and anxiety have been shown to have a correlation. In most instances a physician will administer medication to a patient to treat the disorder and lightly inquire about lifestyle and changes. A DBH will work with the physician and patient to discover possible causes of the anxiety and make lifestyle change recommendations to the patient to help lessen the anxiety and thus lessen the hypertension. This is created through helping the patient learn to change anxiety provoking behaviors through psychoeducation, motivational interviewing, behavior interventions, solution focused counseling, and referral if indicated.

Great teamwork in healthcare leads to great results, and there is a place for the DBH on that team. By possessing the strong foundation in the three core areas, the DBH can lead a healthcare team in integration, reverse integration, clinical patient counseling, even in teaching groups and classes about healthcare. The Doctor of Behavioral Health is an essential part of person-centered care and is the future of medicine.

This is a small insight into what a Doctor of Behavioral Health is and does. The title may be a little newer, but the concept has been around for many years – the mind and body work together. A DBH helps connect the two and is proving beneficial in patient care.