1. Collaborating Across Disciplines A Guide for Healthcare Professionals

2. Who's In the Room (and Who Isn't)? Social workers Mental health clinicians Nurses Substance abuse professionals Consumers Peer providers Direct management Higher-level administration Primary care providers Psychiatrists Teachers

3. Why Do We Need Collaboration? Providers are treating people without all of the information they need. o What meds is this person taking? o What is their history? o I don't know the significance of the condition they are reporting. Different providers trying to treat the same condition differently. o Primary care doctor giving Xanax to newly sober alcoholic while counselor tries to treat addiction. People don't always know where to go to get care.

4. Behavioral Health Disintegration: How Humpty Dumpty Fell Since the 1930's, healthcare in the US has been shaped and reshaped by insurance companies and federal programs trying to cut costs. o The push to separate (or "carve out") various health services has been about third-party payers trying to save money and providers competing with each other for healthcare dollars. o Funding streams and reimbursement codes allow payers to control how much money they'll pay for different services.

5. Putting Humpty Dumpty Back Together Again The 1999 Surgeon General's Report on Mental Health calls the system fragmented, inefficient and inequitable. Recommends "carving in" and integration. Managed care has tried to force cooperation through payment systems. Huge obstacles remain. o Still difficult to get paid to collaborate. o Hierarchy of professions breeds resentment. o People don't understand each other's disciplines which leads to sharply different perspectives. o Providers don't know how to find each other.

6. Collaborating in Oregon What are the experiences around collaborating of the people in this room? What have been some of the obstacles?

7. Financial Obstacles: Getting Paid to Collaborate. Carve-out funding only pays providers for energy they spend on their speciality. o Administration will need to reimburse for time spent collaborating or referring. This will likely change over time as pressure to provide integrated services grows. Higher-level administration can start multiple pilot projects and evaluate them to find new ways of organizing care.

8. What Management Can Do About Hierarchy Understand how each discipline contributes. Set the tone. o Treat all members of treatment team as valuable contributors. Discipline providers who are disrupting collaborative environment. o Particularly those discounting or devaluing the perspectives of people from traditionally lower-status professions.

9. What Higher Status Professionals Can Do About Hierarchy Be a human first, and your role second. Educate yourself about other professions. Always assume that you have something to learn from everyone.

10. Learning From Each Other One of the most important principles of effective collaboration is becoming a “learning organization.” Committing at every level to treat all of your relationships as learning opportunities.

11. Obstacles to Communication and Learning Disconnection from Core Needs and Values o Criticism (negative value judgment). o Demands (attempt to control another). It doesn’t matter what the other person says, it matters what we hear.

12. Translating We can learn to translate criticism and demands into core needs and values. When we think in terms of needs and values, it is easier to feel a sense of connection. Feeling a sense of connection makes it much easier to learn from each other.

13. Moving Forward Work places can create ongoing study groups. o Learning each other’s disciplines. o Effective communication. Management might have to remove or streamline workload in order to increase time for professional development.