Engaging Others Can Help Overcome Barriers to Collaborative Care
Abstract
Virtually any integrated care initiative is bound to have its share of challenges, frustrations, and setbacks. In this month’s column, Glenda Wrenn, M.D., M.S.H.P., who leads the Satcher Health Leadership and Integrated Behavioral Health Care Initiative at Morehouse School of Medicine, talks about the importance of engagement, good communication, and a positive attitude when working at the interface of behavioral health and primary care. —Jürgen Unützer, M.D., M.P.H.
The Division of Behavioral Health at the Satcher Health Leadership Institute at Morehouse School of Medicine has been engaging community sites to cultivate primary care and behavioral health integration since 2011. Despite the established efficacy of integrated care in improving population health outcomes, the majority of care delivered to the most disadvantaged populations remains usual care. Eliminating health disparities and achieving mental health equity are aspirations that require a redefining of usual care.
Although the diffusion of innovation around integrated care has moved beyond innovators and early adopters in some parts of the country, pockets of excellence will need to expand at a rapid pace to meet population demands. What is needed to successfully engage highly stressed systems of care with limited resources?
In our experience working with public hospital systems, federally qualified health centers (FQHCs), and community mental health centers, we have found that the process of engagement is critical to understand how to successfully navigate the challenges that threaten system innovation. Since shifting to collaborative practice requires skillful navigation of disparate practice cultures, understanding how best to engage leaders, stakeholders, and champions and maintain the engagement of these groups is valuable. Here are some lessons that we have learned from our experiences working with community-based clinics at varying levels of engagement:
Show Your Face. In the current age of technology and virtual meetings, it’s still important to make an authentic, in-person connection. This is true in the beginning of initiatives and regularly throughout. If you are part of a team working to start an integrated care initiative, it can be tempting to skip to the end by setting up the parts of a model in search of a simple formula of success.
Engagement at multiple levels requires patience, persistence, and a willingness to repeat some processes at multiple time points. For example, having preparation meetings and a kickoff event may seem like enough, but many effective champions of integrated care are the unsung heroes that lean in to efforts after the initial excitement wears off. Listening to the barriers and showing up consistently to address them has helped us successfully engage several vocal naysayers.
Stay Encouraged. A crucible is a place where the ingredients are destroyed, stressed, and strained resulting in something new. The current stresses on health care systems of care are real, and the demands of efficiency and productivity are wearing out many primary care providers. Effective engagement recognizes these realities and transforms poor morale into hope for a future where there is “no wrong door” for treatment and care delivery occurs in environments where healing is energizing for all involved.
Such hopeless optimism is essential to move towards integrated care, as there are many expected difficulties, unexpected challenges, and sources of discouragement. Knowing one’s “signature strengths” can help you adapt when things seem stuck in place.
Build. As the tennis great Arthur Ashe once said, “Start where you are. Use what you have. Do what you can.” This mantra is one of practical action with a vision of what success looks like combined with a willingness to build with the ingredients and opportunities that are readily available. There is a preponderance of evidence demonstrating the effectiveness of integrated care in practice and measurement-based care.
Providers and systems can start building toward integrated care by using validated measures to track behavioral health outcomes in specified cohorts. Systems interested in integrated care can also use what they have (a psychiatrist, social worker, psychologist, nurse care manager) to move in the direction of an integrated care model.
A commitment toward building also requires a willingness to do what you can. This means not waiting for the perfect grant or fully funded initiative, but building strategically while being informed by the local issues of importance. Luckily, addressing mental health will make just about every medical condition better, so start where the levers of change will make the most impact where you are.
Translate. Engagement in the context of constraint requires translation to the patient, provider, family, and administrator. What does a meaningful outcome look like to a patient considering integrated care? What are the outcomes of relevance to payers and regulators? What matters most to providers and practice managers? Translating the benefits of full-scale collaborative practice into the language of these stakeholders can be a challenge, but is a worthy and necessary effort.
As a psychiatrist committed to achieving health equity, I find it rewarding to work at the interface of behavioral health and primary care creating system-level changes that result in positive seismic shifts. It is important to attend to engagement at many levels and work to create and sustain momentum despite the inevitable competing priorities, demands, and setbacks that will challenge your efforts. ■
