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Model Interdisciplinary Collaborative Statewide (Inter-State) Projects in Integrated Medicine

By James Messina posted 12-06-2015 19:19


Model Interdisciplinary Collaborative Statewide (Inter-State) Projects in Integrated Medicine

Rationale for this Proposal:

This proposal is a result of two confluent influences:

  1. The first was the Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce (BHW) announcement of their release of their FY 2016 Funding Opportunity for the 2016 Academic Units for Primary Care Training and Enhancement program (AU-PCTE, HRSA-16-041- The RFP for this grant is on the Discussion Board in the Integrate Medicine Community as is the PDF of their PowerPoint given at their Technical Assistance Webinar). Then I attended HRSA’s Technical Assistance Webinar on Tuesday Dec 1, 2015 and got a better understanding of their objectives, priorities and how they define the needs in our country. Their program is funded from the Affordable Care Act. HRSA and BHW’s goal is to get country’s Medical System better focused to insure all underserved populations get quality physical and behavioral medical care.
  2. The second influence for this proposal came on Friday December 4, 2016, with my participating in the Michigan Mental Health Counselors Association’s Annual Conference in East Lansing, Michigan on the campus of Michigan State University. This conference brought together some phenomenal forward thinking, highly motivated and paradigm changing Clinical Mental Health Counselors and Medical Professionals to explore Integrated Medicine with a Behavioral Medicine focus.

It became clear to me that we (AMHCA Integrated Medicine Community) need to begin an aggressive Advocacy effort in our Clinical Mental Health Counseling Community. We need to engage State MHC Associations, Counselor Education Programs, Counselor Educators, Licensed Mental Health Counselors in agency and private practices, and CMHC student, interns and trainees under a single umbrella. Their focus would be on getting engaged in hands on Integrated Behavioral Medicine Treatment, training of primary care physicians in this model and then researching and disseminating of information on the benefits of this Integrated medicine with a behavioral medicine focus. The effort ought to be centered on the priorities of HRSA and BHW so that as future funding opportunities arise, the Clinical Mental Health Community would be adequately prepared to apply for such grants in the future.

A secondary motivation behind this proposal is that the Clinical Mental Health Community must become more visible in the promotion of initiatives in Integrated Behavioral Medicine. This will demonstrate to national and state leaders their commitment to serve the underserved populations in this country with a special focus on those individuals who are Medicare and Medicaid recipients. This will go a far way in the CMHC community’s advocacy efforts at lobbying for inclusion under Medicare funding.

All parties being called to get involved in this model are guaranteed that for as long as I am healthy and capable of helping I will provide technical assistance and training to make these proposed statewide and interstate wide projects become reality and achieve the goals of these projects.

It is strongly recommended that teams who are developing these Statewide or Inter-State projects utilize the HRSA RFP and PowerPoint which are on the Discussion Board of the AMHCA Integrated Medicine Community website.

Goals of Interdisciplinary Collaborative Statewide (Inter-State) Projects in Integrated Medicine with a Behavioral Medicine Focus

  1. To promote greater diversity among health professionals. Rationale: Such diversity is associated with improved quality of care for underserved populations, including racial and ethnic minorities and those from disadvantaged backgrounds.
  2. To promote not only training and recruitment of minorities in medical schools and collaborating professional training programs to work in these integrated medical settings with a Behavioral Medicine focus, but to improve their retention in these integrated medical settings. Rationale: This improves access in underserved communities to quality integrated medicine with behavioral medicine focus. It has been found that clinicians who receive training in community-based and underserved settings are more likely to practice in similar settings. Data shows that 86% of National Health Service Corps (NHSC) clinicians continue to practice in underserved areas, including rural communities, up to two years after they complete their service commitment.
  3. To promote modern care with improved outcomes and lower costs by changing service delivery to meet 21st century needs through an emphasis on quality care. Rationale: This effort encourages innovative team-based and Interprofessional approaches which will serve as a catalyst to advance changes in health professional training that are responsive to the evolving needs of the health care system. In Academic Year 2013-14, 12 of the Health Resources and Services Administration (HRSA) Behavioral Health Workforce (BHW) Programs had an Interprofessional focus. Within those programs 1,315 clinical training sites were engaged in Interprofessional team-based care. This will be accomplished by working with Medical Schools in the fields of family medicine, general internal medicine, or general pediatrics in order to strengthen the primary care workforce which will establish, maintain, or improve academic units or programs that improve clinical teaching and research.
  4. To develop a community of practice that will promote the widespread enhancement of primary care training to produce a diverse, high quality primary care workforce to care for underserved communities which include not only primary care physicians but also well trained Clinical Mental Health Counselors who are trained as Behavioral Health Consultants in these community practices. Rationale: To establish academic units to conduct systems-level research to inform primary care training, disseminate current research, evidence-based or best practices, and resources.

Proposed Collaborative Teams for Statewide (Inter-State) Projects

This effort is encouraging the formation of a team coming from six required areas:

  1. Two or more medical schools with separate accreditation in either allopathic or osteopathic medicine
  2. As many clinical settings as possible (Hospitals, Outpatient Medical Clinics and Mental Health and Substance Abuse Treatment Centers) in Medically Underserved Communities (MUC) in rural, inner city or transient population settings. That the people to be served would be from vulnerable populations such as children, older adults, homeless individuals, victims of abuse or trauma, individuals with mental health or substance-related disorders, individuals with HIV/AIDS, and individuals with disabilities, lesbian, gay, bisexual, and transgender (LGBT) populations; migrant workers and persons living below the poverty cutoffs in their communities.
  3. Collaborative Interprofessional working projects with departments from at least two of the following professions: primary care physicians, physician assistants, nurse practitioners, mental health providers (Clinical Mental Health Counselors both out of Counselor Education Training Programs and Licensed MHC’s in the community) and other allied health professionals.
  4. Any or all of the Federally Qualified Health Centers, Rural Health Clinics, Area Health Education Centers, or clinics that serve underserved populations within the state or within close multiple state boundaries.
  5. Medical Schools in these projects who work on a Primary Care Retention which focuses on the number of graduates who enter into and remain in primary care fields from these Medical Schools.
  6. Manpower Diversity, which focuses on the medical schools’ and collaborating training programs’ track record of training individuals from under-represented minority groups or from rural or disadvantaged backgrounds

Who could coordinate this collaborative effort?

An ideal coordination of this collaborative effort can be taken on by AMHCA State Chapters given that their role would be primarily advocacy and information coordination for all members of these collaborative teams. State Chapters can provide:

  1. Recruitment of the potential members of the proposed collaborative teams by working with the State’s Medical Schools, University Counselor Education Programs, Hospitals and Medical Clinics, Public and Private Agencies and licensed mental health counselors in the state
  2. A Website for the collaborative project information dissemination
  3. Webinar platforms for ongoing training of professional participants in the project
  4. Statewide Conferences on the project for Training, Dissemination of Research Results and Problem Solving for improve programming as the project progresses
  5. Publications of the project in the Chapter’s website, social media, newsletters and other publications and in the AMHCA Advocate and Mental Health Counseling Journal
  6. An oversight of the project’s direction, performance and results
  7. Publications of their efforts and call for support on the AMCHA Integrated Medicine Community and AMHCA State Chapter Community on the AMCHA Connection website.

What specific groups need to be recruited for the proposed State (Inter-State) Projects?

  1. Individual Licensed Mental Health Counselors from the state to work in the proposed Integrated Behavioral Medicine Initiative’s Clinical Settings
  2. Counselor Education Programs in the state to provide Interns and Trainees to work in the proposed Integrated Behavioral Medicine Initiative’s Clinical Settings and to conduct the research on the project and disseminate the results
  3. Medical Schools in the state who are committed to reaching out to enroll students from underserved populations and place them in the proposed Integrated Behavioral Medicine Initiative’s Clinical Settings to collaborate in the training of their medical students in this initiative and conduct the research on the project and disseminate the results
  4. Additional Training Programs (Nursing, Nurse Practitioners, Physician Assistants, Social Work, Psychology and Other Allied Health Professions) willing to provide Interns and Trainees to work in the proposed Integrated Behavioral Medicine Initiative’s Clinical Settings and to conduct the research on the project and disseminate the results
  5. Hospitals, public and private health clinics, Federally Qualified Health Centers, Rural Health Clinics, Area Health Education Centers, or clinics that serve underserved populations within the state or within close multiple state boundaries to be the locations for the delivery of the Integrated Medical Care of their patients.

Outline for Designing Proposed Integrated Behavioral Medicine Statewide (Inter-State) Collaborative Projects

  1. Title of Project
  2. Project Narrative
  3. Purpose and Need
  4. Program’s Purpose
  5. Methodology and Approaches to be utilized in the project
  6. Work plan annual outcomes for the project: Implementation, Timelines, Products to be developed, Dissemination Plan of Action
  7. Resolution of Challenges: how the collaborator will address and resolve any challengers which arise in the development and implementation of this statewide (inter-state) project
  8. Desired Impact of the Collaborative Project
  9. Evaluation and Technical Support Capacity
  10. Project Sustainability
  11. Identification of Proposed Organizations Resources, and Capabilities to be utilized in the project

Case Study of One State’s Potential Approach to This Proposal

The Michigan Mental Health Counselors Association (MMHCA) is well suited for implementation of this proposal:

What MMHCA currently has accomplished to begin development of this project:

  1. Held an Annual Conference on Integrated Medicine to inform and teach its membership about the constructs, processes, available consultant resources and current Integrative Efforts in the state. They now can begin to develop Webinars related to this project either with AMHCA’s Webinar Programming or with their own.
  2. Developed a close working relationship through its members with Sturgis Hospital System a rural hospital system in St Joseph’s County.
  3. Worked with Integrated Counseling Connections, LLC, an existing Consultation group whose purpose is to assist medical entities to move toward integrating behavioral medicine in their settings and which helped Sturgis Hospital in 2012 begin to develop integrative behavioral medicine programming in their hospital and clinics
  4. Established a working relationship with Blue Cross Blue Shield of Michigan to get their LPC’s on the 27 medical panels of BCBS.
  5. Identified individual members who have expertise and can be called upon to provide hands on consultation and training to other LPC and LLPC’s in the state to get them ready to work in Integrated Primary Care Medical Settings.

    What MMHCA needs to begin to work on before they can begin development of this project:

  1. Establish close collaborative working relationship with a minimum of two CACREP Accredited Clinical Mental Health Counseling training program within Counselor Education Programs in the state
  2. Assist Sturgis Hospital in its efforts in establishing an ACO with neighboring Hospitals in their Region who can be treatment sites for this project
  3. Establish a close collaborative relationship with a minimum of two Medical Schools in the State which would be willing to collaborate with all the identified parties in the training and clinical placement of Primary Medicine Medical Students, Interns, and Residents in the designated treatment site identified for their collaboration project
  4. Establish a close collaborative relationship to establish additional project clinical training sites, with as many Federally Qualified Health Centers, Rural Health Clinics, Area Health Education Centers, or clinics that serve underserved populations within the state or within close multiple state boundaries
  5. Establish close collaborative working relationship with a minimum of five Training Programs in nursing, mental health, physical health, and rehabilitation to coordinate the training of their professionals in Integrated Medicine with a Behavioral Health focus.

    What MMHCA needs to do immediately to work on this project

  1. Identify a Lead Coordinator
  2. Develop an Interdisciplinary Committee charged with program needs assessments; identification and recruitment of potential collaborating partners; coordination of the development of the program’s Curriculum, Research Plan, Dissemination Plan and Training and Conference Programming.
  3. Develop a coordinated social networking system to get the word out to the grassroots membership of the collaborators who have joined on to their project
  4. Disseminate ongoing news of their progress with the AMHCA Connection’s Internal Medicine Community so that members from that network can assist in their strategic planning, research and dissemination efforts.
  5. Seek out technical assistance from AMHCA’s Integrated Medicine Community to help strengthen their goals, objectives, procedures, methodology, clinical tools and review of current evidence based procedures and treatments to be utilized in such a project.

Call for Input and Expansion of this Proposal

It is imperative that if this proposal will ever see light in the states it will take a coordinated effort of all of AMHCA’s membership, State Chapters, National, Regional and State Leaders to get behind the establishment of these collaborative efforts to expand the visibility of Clinical Mental Health Counselors in the Integrated Medicine field. Please through comments let us know what is missing or unneeded in this proposal so that we can better, strengthen it and make it more realistic to be pursued in each of your states.


Jim Messina , Moderator of AMHCA’s Integrated Medicine

#Medicare #MentalHealthParity #MentalHealthReform


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