This is the first in a series of posts showing different perspectives on important topics. Check back in the future for more!
Hi everyone and happy 2020! As you can tell from the title of this post, today in the CFHA blog we are going to take on the age-old question “Which discipline creates the best BHC?” I hope that it highlights the strengths our varied disciplines bring to integrated care!
I asked my colleague and friend, Joan Pugh, PsyD, to join me in discussing this topic. I apologize to my Marriage and Family Therapy colleagues; we may have to do this again in the future with a volunteer from your field. Enjoy and take lightly!
Katie (LCSW): Hi Joan, thanks for joining me to talk about this controversial topic.
Joan (PsyD): No problem Katie. I love controversy!
Katie (LCSW): I recently read an awesome book edited by a psychiatrist, a psychologist and a social worker called Integrated Care: A Guide for Effective Implementation. In it, the authorsof the Behavioral Health Provider Essentials chapter created a table called “Attributes of great behavioral health provider”. Because I was thinking about writing this piece, it especially caught my eye and I selected a few of the attributes for us to discuss today.
Joan (PsyD): I like that the editors are from a variety of disciplines!
Katie (LCSW): That is a good point. It is also nice to see the attributes broken down into list format. I found myself nodding while reading it for the first time.
Joan (PsyD): Me too! I also thought the attributes you selected to discuss in the blog were interesting and possibly a bit biased toward social work.
Katie (LCSW): Social workers are not perfect. We are close though! The first attribute from the list that jumped out at me is: Willing and capable to provide care to all age groups, infants through elders. What are your thoughts on how psychology trains to this concept?
Joan (PsyD): An integral part of the education of a psychologist is honing the ability to efficiently perform clinical assessments and make accurate diagnoses and treatment recommendations for the patient, regardless of age and/or presenting problem. In a clinic setting, the patient may have either never spoken to anyone about their concerns or symptoms or, conversely, been to MANY providers in the past with minimal to no relief. We have the opportunity to present succinct clinical information to providers to assure collaborative care, and consumer friendly information for patients on how to obtain the best care for their concerns. This may be with us in-clinic or via referrals or resources given during the initial consultation.
Katie (LCSW): Nice one. I guess psychologists are also articulate!
Joan (PsyD): So true.
Katie (LCSW): A generalist framework is where social work really shines. The foundation of social work education and practice are the six social work core values spelled out in the National Association of Social Workers (NASW) code of ethics. These core values; service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence illustrate just how broadly social work aims to address human needs. We prepare to do the greatest good for the greatest number of people based on these values through coursework that orients us to systems and environments that may cause harm or good AND ways to skillfully understand and interface with their impact on individuals. This may not sound very clinical, but it turns out to be an extraordinarily powerful clinical lens. A social worker can apply this lens—I will call it a person-in-context lens—to any population in any place on earth to hone in on the salient factors affecting the presenting issue. We then bring this lens to our internships and first post-graduate jobs and, with supervision, learn to apply it to a variety of populations. Early career social work roles can be very challenging but they really help us diversify our intervention toolkits and prepare us for the broad range of issues and populations that are a part of working in a clinic setting.
Joan (PsyD): Yikes! I didn’t realize you were going to pull out that dusty old code of ethics. But, it’s a powerful argument. How about this next one though? Able to triage; understands who can be helped in primary care and who needs a different level of care
Katie (LCSW): It’s interesting because I think social workers have to be careful with this. On one hand, social work is foundationally strengths-based, so social workers always have antennae out to identify the skills and experiences that individuals bring to a given situation. We believe that most people have what it takes to create change in their lives but may just need help identifying and developing those skills as well as natural supports that may enhance or detract from this effort.
Social workers are also very aware of the barriers present to accessing specialists and higher levels of care. This is a strength of social work—we tend to be willing to attempt to provide interventions to almost anyone. This doesn’t mean that we believe it is appropriate for us to try to be all things to all people but at times it can seem that way—if we are aware that a patient isn’t going to access a specialist or more intensive care we will probably do our best to work with them. So, I think we are able to triage and deeply understand levels of care but I notice we are more apt than folks from other educational backgrounds to try to address more severe issues in the clinic.
Joan, (PsyD): A psychologist’s initial assessment is the basis for making appropriate referral and treatment recommendations. It would be a disservice to the patient to treat all symptoms and concerns in-clinic. If the patient needs a specialist or a different level of care, it is our responsibility to recommend it and support the patient in connecting to it. For example, I work in women’s healthcare and my specialty is geriatrics so every opportunity I have to encourage referrals in that area assures the patient specialty care when they attend an appointment with me. Conversely, if there is an area outside my scope of practice (e.g., addictions, eating disorders), I will refer to a different specialist or different level of care (e.g., outpatient mental health therapy, group therapy, support groups, inpatient care) to assure the patient receives the best care specific to their needs.
Katie (LCSW): Again, so articulate! I’m glad I asked you to do this with me. Matt Martin is going to tell me this is too long so we had better wrap up. Let’s end with this essential BHC quality: Believes that brief treatment is effective treatment. What do you think?
Joan, (PsyD): This is one of my favorites; I am a huge believer in brief treatment. Evidence-based practices recognize brief, solution-focused therapies as effective; psychologists are often the front line in research and standardization of these methods and interventions. Coupled with assessing the patient’s motivation for change, it is easily recognizable patient fit/appropriateness for this model. Additionally, the integrity of the model can be upheld in clinic settings using just 3-6 sessions (often less) to address a variety of presenting problems, either physical and/or mental health in origin. This often can parallel care provided by providers in a medical setting, for example, coupling a trial of an antidepressant with CBT for depression/anxiety or increasing/changing lifestyle habits when monitoring prediabetes or pre-hypertension.
Katie (LCSW): I also love this one. I find it fascinating when I run across statistics regarding the low percentage of people that end up accessing more than even two visits with a therapist. Social work is all about meeting people where they are; so being present where folks show up to access health care and providing exactly what most seem to want is a perfect fit. In addition, because social work is so strongly oriented toward the impact of an individual’s life circumstances on a given problem, we recognize that professional intervention is just a very small piece of the puzzle of wellness. Quickly orienting ourselves to a person’s biggest stressors and reaching for the most accessible and useful tool in our toolbox is what we are trained to do and we know from experience that well-timed support works and does not have to be complicated.
Joan, (PsyD): So we are out of space for today?
Katie (LCSW): It’s true—and this was fun, so I am a little sad we have to stop. We may have to do another round of this someday.
Joan, (PsyD): As long as I get to pick the attributes next time
Katie (LCSW): It sounds like you are harboring some frustration about this, Joan
Joan, (PsyD): Don’t social work me.
Katie (LCSW): Fair enough. Thanks so much for joining me!
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