As the complexity of care for people with mental health needs increases, more counselors are serving on interdisciplinary teams responding to the acute and chronic needs of their clients. Many people with serious mental illness may also have co-occurring physical disorders such as cardiovascular disease or nutritional/metabolic diseases (e.g., diabetes, obesity), as reviewed by Mark De Hert and colleagues in 2011. These individuals require increased medical care involving physicians, nurses, dietitians, and radiologic and clinical laboratory specialists. Social work also coordinates care with mental health teams for community resource support and with vocational rehabilitation counselors to assist with employment needs. Thus, counselors’ understanding of the role and function of interprofessional collaboration in providing care is vital for achieving quality outcomes.
As a counselor educator, I strive to create opportunities for students to develop strong communication and leadership skills during their clinical training. When I invite alumni to talk with students about different aspects of building their career, many discuss their work on community-based mental health teams. They explain having to learn to work with people outside the counseling profession — nurses, psychiatrists, physical and occupational therapists, speech therapists, social workers, pharmacists, police officers and others. I began to understand the need for our students to have better skills for team-based care. So, I worked with our faculty to offer more opportunities to expose our students to a wider range of care providers and delved into the research on interprofessional education and practice (IPEP).
During this time, I engaged with faculty from physical and occupational therapy in our Department of Allied Health Sciences who were involved in IPEP. Through them, I started learning more about IPEP in medicine, nursing and other health affairs schools on campus. My personal exposure to interdisciplinary care began in earnest when, as part of my clinical faculty duties, I started working part time as the rehabilitation counselor on the acute inpatient rehabilitation unit at our hospital located on campus. This fully immersed me in an interprofessional setting with providers from all health disciplines.
This required me to be a member of a team of varied professionals focused on quality patient care that depended on strong communication, an understanding of team members’ roles in providing care, and the use of best practices for supporting the team. I witnessed (and contributed to) interprofessional practice at its finest being carried out every day. I was hooked and worked with other allied health faculty to find ways for our students to engage with one another. With the support of our dean, I became the coordinator for IPEP for our department.
Two years ago, when our university leadership developed a campuswide initiative for intentionally integrating IPEP and created a formal office for it, I was ready to represent our Department of Allied Health Sciences as the director of IPEP. I work closely with other directors from all health disciplines as well as public health, social work, business and education to intentionally build IPEP across curricula. Student and faculty support have been tremendous. I see the need to expand knowledge of IPEP to counselor education as a whole and to build these endeavors into our programs to ensure that future counselors can easily transition to interprofessional care and become leaders on these teams.
Thus, counselor educators should be aware of current interprofessional teamwork practices and curriculum frameworks that provide opportunities for students to understand their roles on these teams, effectively describe and implement counseling services, and uphold the culture of interdisciplinary care. Establishing opportunities for counseling students to participate in IPEP with stakeholders was a critical need noted by Kaprea Johnson and Krystal Freeman in 2014 in their work on integrating IPEP into mental health counselor education. This knowledge will help new counselors understand their role in a variety of settings and learn appropriate communication strategies for sharing knowledge in team settings. IPEP trainings for graduate students also helps dispel preconceived ideas about other professional team members’ roles and highlights the importance of quality care.
In 2009, the Interprofessional Education Collaborative (IPEC) was formed by six national health profession education associations covering nursing, osteopathic medicine, pharmacy, dentistry, medicine and public health. Their goal was to advance interprofessional learning strategies to enhance skills in team-based care that promote quality health outcomes. The collaborative also established core competencies in providing interdisciplinary care for student clinical training programs. By 2016, IPEC had expanded its academic partnerships to include 21 health-related institutions. Its vision is to promote interprofessional teamwork and collaborative practice that reinforces quality, accessible, person-centered care that improves population health.
IPEC has four core competencies that guide the development of curricular content:
- Values/ethics for interprofessional practice to build and maintain mutual respect and shared values in patient care
- Knowledge of roles/responsibilities in interdisciplinary teams to help assess and address health care needs
- Interprofessional communication that is supportive and responsive to team-based care and treatment and prevention of disease
- Teams and teamwork that uphold high values and principles recognizing different team members’ roles in planning, delivering and evaluating patient care, programs and policies
The overarching goal for IPEP is for health care workers to learn from, with and about each other.
These competencies also promote the principles of the “Quadruple Aim” in health care. Three of the principles were originally developed in 2007 by the Institute for Healthcare Improvement to promote health system reform to improve patient experiences, reduce costs and increase better outcomes. The fourth principle, improving the clinical experience for providers, was added in 2015, primarily to address and manage clinician burnout.
Counselor training opportunities that embrace these competencies help students understand their team roles, effectively describe and implement their services, learn appropriate methods for sharing knowledge in team settings, and uphold the culture of interdisciplinary teamwork. Overall, curriculum structures that promote opportunities that integrate the IPEP competencies help develop graduates who are leaders in their field. These graduates will possess the skills for teamwork that can address challenges in providing quality health care, including in the counseling field.
IPEP in relation to accreditation and licensure requirements
CACREP recognizes the need for counselor education programs to provide specific information and training to students about interprofessional care and their respective roles on these teams. On its website, CACREP states that it is a member of the Health Professions Accreditors Collaborative, which works to promote learning opportunities that prepare students for interprofessional practice. Requirements for interprofessional education opportunities are outlined in the 2016 CACREP Standards in Section 2, Standard F.1.c. and Section 5, Standard D.2.b.
The 2014 ACA Code of Ethics clearly states in Section D, Relationships With Other Professionals, the importance of being a part of interdisciplinary teamwork (Standard D.1.c.) and understanding the professional and ethical obligations as a team member (Standard D.1.d.). In 2017, the Code of Professional Ethics for Rehabilitation Counselors provided guidelines for certified rehabilitation counselors working as members of interdisciplinary teams that provide complex and comprehensive services to people with disabilities. Section E, Relationships With Other Professionals and Employers, outlines these ethical responsibilities in Standards E.1., E.2.a. and E.2.b.
Thus, counselor education programs are called to build relationships among all stakeholders (administration, faculty, students and community partners for clinical training) that are crucial for successful IPEP development and implementation, as noted by Daniel Kinnair and colleagues (2012) and Kaprea Johnson and Krystal Freeman (2014).
IPEP experiences for counselor education and development
Innovative ideas for incorporating IPEP experiences in counselor education include collaborative learning experiences with other professions, problem-based learning events and simulation activities. One of the best approaches for initially developing IPEP in counseling programs is to seek opportunities with other departments on campus that may have similar graduate-level introductory courses that include content on disability rights and current health care issues such as quality indicators of care, disparities in care, implicit bias and leadership development. These topics lend themselves to developing interdisciplinary journal clubs, case-based events for problem-solving and opportunities for students to talk about their different professions or why they chose their career path in graduate school. Most importantly, these activities will help students begin to understand and clarify their roles and how they fit in interprofessional teams. Their professional thinking may be challenged by understanding different viewpoints, decreasing the use of jargon, and building confidence and leadership for future teamwork.
IPEP events that are more intentional with specific learning outcomes require more planning. However, working with other health professionals on campus or in field placements to design opportunities will prevent reinventing the wheel and will model interprofessional collaboration for students. Examples of IPEP activities designed around specific learning objectives for students include case-based learning experiences, seminars with small-group discussions and debriefs, and clinical simulations that use videos or actors to play patients and portray different health issues and patient ages. Service-learning opportunities, particularly focused on rural health care, can bring students together from many disciplines, including business, education, legal care and faith-based organizations. These opportunities serve as excellent avenues for learning from, with and about each other to serve the community.
Field placements for clinical work offer built-in opportunities for IPEP in clinical agencies where interdisciplinary teamwork is provided. These preceptors will have practical knowledge to share about their teamwork and examples of interprofessional care that works and does not work. They can also offer opportunities for counseling students to incorporate counseling theory with IPEP practice and to reflect on potential ethical dilemmas for counselors when providing team-based care. These environments can help all students, not just counseling students, learn how to deal with complex issues and bridge theory to practice difficulties in providing clinical care as new professionals. Furthermore, these experiential learning opportunities are very important in IPEP because they offer environments in which professionals and students can interact and reflect on practices for improved care.
It is important to note that the four IPEC core competencies discussed earlier should always guide a program’s IPEP initiatives and curriculum. Students and faculty should be able to explain how the activity meets the competencies. Evaluation by participants for each event is critical to ensure that the goals of the training are being met and that it represents a valuable learning opportunity. Faculty development for counselor educators and other health disciplines and IPEP partners is critical to designing, developing, implementing and assessing successful learning opportunities.
In the planning of IPEP events, it is crucial to involve students from the beginning. They may have friends or contacts in other departments or community agencies that have resources or programs that can be used to help with planning and executing events. Encouraging students to take leadership roles in working with faculty to develop IPEP on campus is an excellent way to build their leadership skills and a commitment to interprofessional learning.
Value in counselor development
Incorporating IPEP into counselor education programs can increase opportunities for clinical participation with other related disciplines in a manner that helps counseling students develop a strong professional identity. Well-planned IPEP activities build on the knowledge being learned in the classroom and increase critical thinking skills by evaluating complex care needs from multiple perspectives. In addition, students see faculty and professionals from other disciplines working together during IPEP activities, modeling effective interprofessional teamwork that may not be experienced during training.
IPEP training offers opportunities for students to better understand aspects of patient-centered care, holistic treatment and shared decision-making practices that guide teams in their goals for achieving outcomes. But most importantly, students enjoy IPEP events. They naturally form their own interdisciplinary groups for further discussion after participating in IPEP opportunities and develop friendships that can lead to building a better workforce in the future.
Our students have their own campuswide Student Executive Committee with representation from all the schools participating in IPEP. They plan formal and informal events that promote IPEP and serve as liaisons between the IPEP office and student groups across campus to increase awareness of interprofessional learning and collaboration as part of their academic experience. These students are leaders on campus and are also developing into our future leaders in counseling and in team-based community care. Actually, they are why we have a deep commitment to IPEP on our campus. And they are worth it.
Judy Schmidt is the director of Interprofessional Education and Practice (IPEP) for the Department of Allied Health Sciences at the University of North Carolina at Chapel Hill. She is a member of the leadership team for the university’s Office of IPEP, which is dedicated to working collaboratively to transform health education and prepare professionals from different disciplines to work better together for quality patient care. She is a clinical assistant professor in the department and a certified rehabilitation counselor. Contact her at firstname.lastname@example.org.
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