From Wingspread 1994 to CFHA 2014: What’s the same or different in the field? What does this mean going forward? C. J. Peek, PhD Professor, Dept. of Family Medicine and Community Health, University of Minnesota Medical School Macaran A. Baird, MD, MS Professor & Head, Dept. of Family Medicine and Community Health, University of Minnesota Medical School Lauren DeCaporale-Ryan, PhD Senior Instructor, Dept. of Psychiatry, Medicine and Surgery, University of Rochester Medical Center Lauren 1 Session # E4 October 18, 2014 Collaborative Family Healthcare Association 16 th Annual Conference October 16-18, 2014 Washington, DC U.S.A.

Faculty disclosure 2 We have had no relevant financial relationships during the past 12 months No conflicts of interest to disclose

3 Learning objectives At the conclusion, participants will be able to: 1.Trace the evolution of pressing issues and “next developmental steps” for the field between 1994 and Identify what has been accomplished (or well underway) and what stubborn areas remain that require attention today 3.Describe important steps that the field and CFHA can take now to move things forward, based on understanding this history. A learning assessment is required for CE credit. A question and answer period to fulfill this requirement will be conducted at the end of this presentation.

4 Overview of session 1.Snapshot 1: 1994—Wingspread founding meeting 2.Snapshot 2: 2004—CFHA meeting #6; Minnesota 3.Discuss: What’s the same or different between ? 4.Discussion: Next developmental steps for the field in 2014 –Quickly—A 2014 snapshot: what’s same or different than in 2004? –Small groups: Next developmental steps for field going forward –Synthesis 5.Reflections on these steps—what we and CFHA can do Use handout as a historical source document

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From Wingspread introduction (Don Bloch) “We now have the opportunity to change the way medicine is practiced…..fundamental dimensions: 1) generalist / specialist; 2) mind / body; 3) individual / family” 6 A cross-disciplinary conversation and organization, not just siloed conversations within guild organizations. “There was a paradigm to be promoted and the need for a non-guild organization to promote it”. (Recalled by Bill Doherty) “Radical new approach to healthcare reform... 3 premises: 1.Teams of health and mental health professionals working in concert; 2.The biological, psychological, and social aspects of treatment are given equal importance, and 3.The patient’s family is included as a crucial component of treatment.”

Purpose of this “Collaborative family healthcare project” “To create inventories of relevant persons, programs and projects, research methodologies and findings, clinical models and assessment, and training instruments......to be collated and disseminated to practitioners, researchers, teachers, and those concerned with public policy”. 7

Leaders and participants—Wingspread Sponsors / leaders: Family Systems Medicine, Society for Teachers of Family Medicine (STFM), American Association for Marriage and Family Therapy (AAMFT), Johnson Foundation Participants from: Family therapy / family health organizations Primary care clinics and large systems (rural and urban), Mental health clinics Academic family medicine Depts / residency training Family therapy training programs Research arms of these and other programs Disciplines present: Family medicine, psychiatry, psychology, marriage & family therapy, nursing, social work, public health, psychosomatic medicine

Workgroup results—1994 next developmental steps for field Clinical practice: Increase capacity for collaboration [among everyone] Define Collab Family Healthcare (CFHC) and organize nomenclature Put out clearly the big paradigm shift of collab family healthcare Show reference models; including how to reconcile professional autonomy with collaboration and teamwork 9 Train systemically-oriented providers in collaboration (as in Healthy People 2000) Establish generic core competencies (specified) Systemic, family-oriented / family-sensitive clinical care Fund interdisc training & infrastructure—w marketing & business case Health policy & mgmt: Show value—to become a standard of practice Address the great anxiety of MFT’s and other MH providers Show clear value to federal, state, local decision-makers Build alliances—and be creative about ways to influence (specified) Research State underlying assumptions and hypotheses of CFHC (described) Conceptualize research process (described)

Immediate results 10 CFHcC founded: co- chaired Bloch & Doherty CFHcC starts newsletter ”Working Together”, fall 1994 (Barry Dym, ed.) First conference—at the Omni Shoreham 1995 Big excited audience International Prof. conference mgmt (Diane Sollee, MSW) Featured hard-hitting patient/family panels (John Rolland)

From “Working together” Vol 2, #2 Winter “The collaborative idea” “Our mission”; scope of CFHcC activity Who is (or should be) a member—interdisciplinary & managerial “A year’s progress”-news, projects, groups, research, training etc 22 Local CFHcC chapters established! Boston (Barry Dym)London (Robert Bor)San F (Doug Rate) Cleveland (K. Cole-Kelly)Los Angeles (J. Schor)Seattle (L. Mauksch) Miami (Anne Rambo)Milwaukee ( Eric Weiner)Spokane (C Greenberg) Chicago (John Rolland)Mpls/StPaul (W. Doherty)Amherst (A. Blount) Durham (Bill Gunn)New York (Don Bloch)Tel Aviv (C. Carel) Germany (M. Wirsching)Pittsburgh (David Raney)Wash DC (K. Weihs) Hartford (Jeri Hepworth)Rochester NY (D. Seaburn) Houston (James Bray)SanDiego (C. Grauf-Grounds)

Snapshot #2: 2004— CFHA #6, Minnesota 12 Rural retreat center: Sessions, sleeping rooms, meals together on a lake. Saturday night buses to downtown Minneapolis. Opening session: Interactive process to gather “your own next developmental steps in collaborative care” Closing session: Interactive process to gather “next developmental steps for the field”

“Next Developmental Steps” A “next developmental step” for the field is an action or strategic priority that people think they can accomplish over the next 2-4 years something critical to clear the path ahead for the field (not just for your own project). This may not be the grandest vision or glamorous step, but it’s specifically what comes next for us to do collectively. 13 A “next developmental step” is NOT— Global magic like ”reform the payment system" A dream like "integrated teams in every doctor’s office". Not usually the ultimately most important or glamorous thing—but the next step in the “construction sequence”.

Leaders and participants—CFHA Sponsors / leaders: UCare MN (health plan), HealthPartners, BlueCross BlueShield of MN, UM Dept of Family Medicine, Families, Systems & Health, various local clinical leaders Participants from: (relative to 1994) Still some family therapy / family health organizations Strong academic family medicine Depts / residency training Some family therapy training programs MH clinics in or outside large systems, but often not always specifically focused on families More primary care clinics & large systems (mostly urban) RWJF, but less research organization participation Disciplines present: Family medicine, psychiatry, psychology, marriage & family therapy, nursing, social work, public health, clinic administrators, health plan administrators, neighborhood group leaders

CFHA 2004 next developmental steps for field Create an implementer’s guide: With package of common outcome measures With sections relevant to particular states Develop with a visible partner like IHI Develop strategic alliances Policymakers at the top Engagement / dissemination with wide professional audiences Consistent “branding” with public—so well understood (and expected) Build up training and education Integrated with early & continuing education of medical & BH providers Educate ourselves about financial aspects and future business models Leverage existing standards such as ACGME core competencies Conduct demonstration projects At state level—blending concerns & common vision across all stakehldrs National Medicaid demonstration in 2 states with collab care in contracts Generate research and other knowledge System of concepts for integration of healing modalities Multi-site studies of collaborative care using RCT’s Meta-analysis on clinical outcomes & cost containment 15

Fast large group discussion: What was the same or different from 1994 to 2004? Instructions 1.Individual reflection (1 min) to gather thoughts—jot down 2.Quick call-out by individuals (call-outs, no speeches!) We’ll record on flipchart Reflect together (2 min) on what we see here—common themes 16

Small group discussion: Next Developmental Steps for the field in 2014 Instructions 1.Form small groups of about 4 around you 2.Choose someone to report out 3.Find the worksheet—definition of next developmental step 4.Individual reflection (2 min)—jot down on worksheet 5.Group buzz (10 min) on that question 6.Quick call-out by group Reflect (10 min) on what we see here and what it means for us in our own roles, including as CFHA members and leaders 17 Question: Given what is the same or different from 1994 to now, what are the next developmental steps for the field in 2014? What must be done in to make way for progress?

Bibliography / References 18 Within last 5 years: Milbank Fund report (2010) Evolving models of behavioral health integration in primary care. Kathol, R., deGruy, F., & Rollman, B. (2014). Value-based financially sustainable behavioral health components in patient-centered medical homes. Annals of Fam Med Vol 12, No. 2. Melek, S. (2012). Milliman Research Report: Bending the medicaid healthcare cost curve through financially sustainable medical-behavioral integration Manderscheid R. & Kathol R. (2014). Fostering sustainable, integrated medical and behavioral health services in medical settings. Annals of Internal Medicine; 160:61: AHRQ Academy: Integrating Behavioral Health and Primary Care. Literature repository, lexicon, atlas of measures, other resources. SAMHSA-HRSA Center for Integrated Health Solutions. AIMS Center (Advancing Innovative Mental Health Solutions), Univ of WA. Historical: Doherty W. (2007). Fixing healthcare: what role will therapists play? Psychotherapy Networker, May/June Bloch, D. & Doherty W. (1998). The Collaborative Family Healthcare Coalition. Families, Systems, & Health, Vol. 16 #2. Editorial recounting CFHA purpose and history. Doherty W. (1996). Collaborative family healthcare: Where next? FSH Vol. 14 #3. Working Together, the newsletter of CFHcC (Vol. 1, No. 1, fall 1994). Wingspread conference and history leading up to it. Barry Dym (Ed.) Working Together, the newsletter of CFHcC (Vol. 2, No. 2, winter 1995). First national conference and first year’s progress. Barry Dym (Ed.)

19 Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!