Tag Archives: interdisciplinary

Incorporating interprofessional education and practice in counselor development

by Judy Schmidt April 13, 2021

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.

Core competencies

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.

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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 judy_schmidt@med.unc.edu.

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Encouraging T-shaped thinking in the counseling profession

By John McCarthy May 18, 2020

I thought it was a most ridiculous assignment. The instructor of my Introduction to Counseling course in 1988 asked us to write, of all things, a book report. “Make sure the book has nothing to do with counseling,” he directed.

I was incredulous. “My first class in counseling, and he’s asking us to do a fifth-grade assignment?” I wanted to learn everything I could about counseling, especially in an initial course, and a book report was not on my anticipated list of important things to do.

Years later, I realized that it was a brilliant stroke by the professor, and in 2020, I believe it could well be a portal to the future of the counseling profession. With a strong interest in creativity, I now realize the impetus of the assignment. The instructor wanted us novice students to know things outside of counseling. Go learn about Portuguese history, quilting or the evolution of vacuum cleaners.

The assignment concerned creativity and, in retrospect, was aimed at helping us counselors-in-training with our creative “shape.” Creativity involves being a “T-shaped” person, a term originating from a well-known design firm named IDEO. The T-shape idea entails a person knowing a great deal about a specific discipline and having a breadth of knowledge in other fields. It is not a matter of being an expert in only one area, represented by the vertical line in the T, but also being able to draw from other arenas, as represented by the horizonal line.

In her 2009 book What I Wish I Knew When I Was 20: A Crash Course on Making Your Place in the World, Tina Seelig related the importance of developing T-shaped thinkers in directing the Stanford Technology Ventures Program. The aim was straightforward: Students would have an extensive knowledge base in one discipline, perhaps science or engineering, along with, in this case, innovation and entrepreneurship.

It is the combination skills that can be central to creativity. Incidentally, it is these skills that represent the C (combination) in the commonly cited SCAMPER acronym of creativity. Linking ideas from counseling with web design, political science or chemistry can lead to innovative solutions in any number of roles that counselors play, including as consultants, crisis responders or group facilitators.

In her book, Seelig also observed, “Life presents everyone with many opportunities to experiment and recombine our skills and passions in new and surprising ways.” T-shaped thinkers can draw from other parts of their knowledge base in that recombining process to formulate more creative solutions to challenges.

Radical collaboration

The T metaphor isn’t just about individual counselors though. It also concerns our counseling profession and, in my opinion, how it can be strengthened in the coming years. Yes, integrated care is critical to counseling, but I believe that interprofessional partnership extends beyond this model.

“We believe in radical collaboration.” The last two words caught my eye as I read the “We’re glad you’re here!” brochure during a recent visit to the Hasso Plattner Institute of Design at Stanford University. Also known as the “d.school,” this internationally recognized institute offers students from an array of disciplines — including engineering, law, business and medicine — the opportunity to deepen their creative skills and gain design competencies toward solving complicated dilemmas.

The same brochure posed thought-provoking questions, one of which fits the notion of “radical collaboration” and the future of the counseling profession: Choose two diverse occupations and list ways that they could work together to answer a challenge in the real world. If counselors were chosen as one of the occupations, imagine the potential life-changing ideas that could be sparked in partnering with oceanographers, mathematicians or cybersecurity specialists. Imagine how social justice, advocacy and consultation could be integrated. Imagine how such an adventure could result in even more creative T-shaped counselors-in-training and professional counselors.

Work involving the search terms “interprofessional” and “counselor” would appear to be limited, although the topic has been discussed in the literature for at least 30 years. Elizabeth Mellin, Brandon Hunt and Lindsey Nichols conducted questionnaire-based research among counselors in 2011 that included a discussion on interprofessional collaboration. In a 2016 study, Christianne Fowler and Kaprea Hoquee (nee Johnson) described a one-day standardized patient experience among students in counseling, nursing and dental hygiene programs. In research published last year, Kaprea Johnson surveyed students in counseling, along with those in dental hygiene, nursing and physical therapy programs, and concluded that counseling students were as receptive as the students in health care programs regarding interprofessional training.

Examples of interprofessional interaction are seen in related mental health arenas. Last year, the American Psychological Association announced that it would be partnering with medicine, pharmacy, nursing and other areas to oversee organizational accreditation for interprofessional continuing education. According to the article announcing this recent development, the move was viewed as a benefit to the field, especially in relation to the amount and caliber of continuing education possibilities. A second instance is Robert Morris University’s Access to Interprofessional Mental Health Education program, which aims in part to train psychiatric mental health nurse practitioners to offer care as part of an interprofessional team.

Identity is central to our counseling profession, and T-encouraged initiatives with other domains can make us better as a whole, broadening our collaboration with — and increasing our visibility by — other fields. Continuing education regulations could be modified to include domains outside of counseling. Imagine counseling conferences with people from other areas such as pharmacy, dentistry, media relations, medicine, computer science and the design industry. Presentations by counselors in tandem with dietitians, architects and TV producers could deepen our knowledge bases and foster further cross-disciplinary collaboration.

Programmatic standards could be adjusted to encourage (or perhaps even require) counseling students to take at least one elective outside of the department. They could learn about the future of health care in a medical curriculum, about correctional reform in other countries in a criminology program, or about sustainability in an engineering course.

T-shaped efforts at the professional level would deepen our collective cultural competency and contribute to our collective mindfulness. Kio Stark devoted a 2016 book to talking with strangers, and her message aligns with the present-moment orientation that counseling espouses. “When you interact with a stranger,” she wrote, “you’re not in your own head, you’re not on autopilot from here to there. You are present in the moment. And to be present is to feel alive.”

Developing cross-disciplinary tentacles can aid our future. T-shaped counselors and a T-shaped profession can broaden our scope, charge innovative ideas, emphasize wellness and deepen counseling’s visibility.

Counseling is a holistic, collaborative approach. Let’s extend the letter T in encouraging creative counselors and, ultimately, an innovative counseling profession.

The letter of tomorrow is T. Now let’s all go read some books.

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John McCarthy is a professor in the Department of Counseling at Indiana University of Pennsylvania. Contact him at jmccarth@iup.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Maintaining counselor identity in interdisciplinary teams

By Princess Lanclos and Krystal Vaughn December 3, 2019

Professional counselors are increasing their presence in a variety of settings, including nonprofit agencies, clinics, private practice groups, schools, hospitals, and state and federal vocational rehabilitation centers. In these settings, counselors are likely to work with other health care professionals for the benefit of their clients. Some of these other professionals involved in the care of clients may include physicians, speech therapists, occupational therapists, and case managers. As we enter into new arenas, our ability to advocate for the counseling profession is imperative, yet many counselors may find themselves questioning how to do that while working in interdisciplinary teams.

One way that advocacy may be achieved in an interdisciplinary team is through active implementation of a shared decision-making model. According to research conducted by France Légaré in 2011, shared decision-making models have historically focused on the patient-physician dyad.

Both medical professionals and professional counselors are trained to make decisions to benefit their clients. However, counselors are typically trained to use an ethical decision-making model such as Holly Forester-Miller and Thomas Davis’ seven-step process:

1) Identify the problem.

2) Apply the ACA Code of Ethics.

3) Determine the nature and dimensions of the dilemma.

4) Generate potential courses of action.

5) Consider the potential consequences of all options and determine a course of action.

6) Evaluate the selected course of action.

7) Implement the course of action.

Medical professionals, on the other hand, may be trained to use a medical decision-making model. This model involves 1) the number of potential diagnoses and management options that must be considered during an encounter, 2) the amount and complexity of data to be reviewed as a result of the encounter, and 3) the risk of complications, morbidity and mortality associated with the encounter.

Alternatively, medical professionals may use a shared decision-making model. This model first determines if the decision is the right thing to do ethically. Next, the patient is provided with treatment options so that the patient can make an informed decision. Consent is then obtained. This model helps bridge health disparities by involving patients in many aspects of the treatment, including the informed decision-making process.

All of these decision-making methods share similarities, including placing emphasis on four common principles: autonomy, justice, beneficence and nonmaleficence. Additionally, both the ACA Code of Ethics and the American Medical Association’s code of medical ethics strive to protect the confidentiality of the client/patient. In The American Journal of Emergency Medicine in 2016, Chadd Kraus and Catherine Marco defined shared decision-making as a collaborative process that allows patients (or their surrogates) and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals and preferences.

Therefore, in an interdisciplinary team, a professional counselor may offer a unique perspective to benefit the client or patient. This can lead to counselors advocating for themselves and their profession. The question is, how do we bring awareness to these variations in decision-making models on the basis of any health care professional’s training program while also effectively training and implementing these approaches for both new and seasoned health care professionals?

Classroom

Professional identity and ethical decision-making begin early in a counselor-in-training’s academic career and are specifically reinforced in CACREP-accredited graduate training programs. These programs are composed of core courses (e.g., ethics, counseling techniques, assessment) that allow students to begin exploring and implementing the skills needed to handle ethical dilemmas. At this stage of professional development, graduate students are establishing ethical decision-making practices and the principles of autonomy, nonmaleficence, beneficence and justice, which are reinforced throughout their academic careers (e.g., practicum, internships).

Additionally, the opportunity to practice implementing a shared decision-making model may be offered in a classroom setting by engaging students in activities or courses in which they join with students from other disciplines to approach a case study and propose a holistic treatment plan that addresses each discipline’s scope of practice. Engrossing students in this practice may aid in postgraduate work and provide them a new perspective and appreciation for various treatment providers who might be serving their clients.

However, unless a student is placed at a practicum or internship site where multiple disciplines are offering services, the student may receive little guidance related to working within an interdisciplinary team. Therefore, we encourage counseling training programs to initiate relationships with potential internship sites that feature multiple disciplines so that students can experience the benefits and challenges of working within interdisciplinary teams. Alternatively, students could be placed at internship sites that actively consult with other treatment providers outside of the internship site.

Post-graduation

Think back to your first job after graduation or even to your current place of employment. Did/does your agency offer an opportunity for interdisciplinary consultation or encourage you to consult with a client’s treatment team in another health care setting? As a beginning professional in the field of counseling, did you feel comfortable discussing your treatment recommendations with another professional?

As members of interdisciplinary teams, counselors should understand not only the challenges but also the benefits of shared decision-making models in conjunction with an ethical decision-making model of their choice. Each of these models benefits the client and the field of counseling.

Implementing model and consultation

Many individuals are trained in graduate school to interact with the identified client but may have limited exposure to working within an interdisciplinary or interprofessional team. However, the reality is that the clients we see today may have a variety of treatment providers (speech therapists, occupational therapists, case workers, physicians, psychologists, etc.). It takes practice and experience to maintain our counselor identity while engaging in consultation with other treatment providers. Exploring instances in which consultation is needed and how it is implemented may aid in providing and advocating for quality holistic treatment for clients.

Consultation first requires knowledge of the treatment team. Who is the client working with outside of your agency or clinic? Do you have consent to speak with that individual in accord with Health Insurance Portability and Accountability Act (HIPAA) considerations? Counselors must reflect on how consulting with the treatment provider would aid in the client’s treatment. At times, we may consult to share treatment goals or treatment progress. However, at other times, we are consulting to gain information regarding another professional’s goals, methods or protocols. Once a working relationship is developed, the counselor may proceed to engage in the initial phase of consultation.

Step one: The initial phase of consultation should include preparing for the call, including ensuring that all proper HIPAA release of information and agency paperwork have been completed. The counselor should be prepared with a concise yet well-thought-out reason for requesting consultation. What information would the counselor like to share or request? The counselor may also want to consider whether the person being consulted understands that the counselor is also working with the individual and how the counselor’s role relates to the treatment of the individual. 

Step two: The counselor should contact the consulting agency, provide the release of information, and schedule a consultation. Scheduling may be essential because many professionals are busy and might not be readily available to speak. It sometimes requires numerous phone calls to contact the individual provider. Even if the provider is available, he or she may not have the client’s chart or may still need to review the information, potentially causing frustration and delays. Therefore, if a call is scheduled, all parties should be prepared to participate fully.

Step three: The requesting provider should be well-prepared with information that might be shared or requested during the consultation call. A brief overview of how the client came to receive services from the counselor and what services the counselor is providing is a nice place to start. This should be followed by discussing the client’s condition, interventions, shared treatment goals, schedule/frequency of treatment, prognosis, and expected duration of treatment. At times, professionals may have similar treatment goals for the client but might be using different interventions or approaches. It is important to recognize that overlap may exist in the knowledge and skills of each provider. In such cases, it may be necessary to discuss why the providers and treatment modalities are mutually beneficial to the client. During the consultation, it may also be important to consider alternative or complementary therapies.

The counselor may be seeing the client more frequently than is the other provider, so a general impression of the client’s current condition and presentation may be helpful to the overall treatment team. The consultation call should allow the counselor to ask questions of the other providers and vice versa. Consultations can be held individually or with all members of the treatment team, depending on the levels of intervention and the specific consultation questions being asked.

Treatment teams may need to determine who will be responsible for which treatment goals or objectives. (Note: Professional counselors must be careful to stay clearly within their scope of practice.) At this point, it may also be important to schedule a follow-up consult, if necessary, and determine which of the treatment providers will start the call. Follow-up consults work best when they are planned, scheduled and predictable. This allows providers to align treatment goals and outcomes.

Step four: The counselor should document consultations in the client’s file. The consultation notes should include the name of the client, date and time of the call, and length of the call. The purpose of the call should also be clearly noted and supported by HIPAA release of information documentation. We recommend also dedicating a space on the consultation documentation form for a narrative that states the overview and outcome of the consult.

Case example

Sally is a 12-year-old female who is seeing a licensed professional counselor to help her reduce her anxiety symptoms. Initially, a licensed clinical psychologist diagnosed Sally with generalized anxiety disorder (GAD) and a speech language disorder and then referred her for speech, counseling, and medication evaluation. Sally lives at home with her parents and doesn’t have any siblings. The counselor would like to speak with Sally’s psychologist, school counselor, speech therapist, and treating child psychiatrist. The counselor requested that Sally’s parents sign HIPAA forms during the initial intake session.

Step one: After treating Sally for two to three sessions, the counselor forms consultation questions for each provider treating Sally. The counselor first would like to know from the psychologist whether Sally has any educational limitations that would prevent her from participating in cognitive behavior therapy. Second, the counselor would like to know how the school is addressing Sally’s symptoms of GAD, whether an accommodation plan is being or has been used for Sally, and whether the school counselor is working with Sally weekly. Third, the counselor would like to know whether the speech therapist is noticing signs of GAD during sessions with Sally and, if so, how the speech therapist is addressing those symptoms. Finally, the counselor would like to know what recommendations the psychiatrist has, while also providing the psychiatrist with information on Sally’s progress and the techniques being used in the counseling sessions.

Step two: The counselor will contact each of the four providers’ offices to request a consultation call. The counselor will also scan or fax the HIPAA release to each provider in a secure manner.

Step three: The counselor will review the file, treatment goals, progress, and schedule/frequency of treatment for Sally. The counselor should have questions prepared or outlined for each of the consultation calls. It will be important for members of Sally’s treatment team to consider how the various treatments may support one another, be similar, or be different. The team should also consider how often consultation will need to occur and who will be responsible for scheduling. For example, the psychologist may not have any additional contact with the family and require no further communication with the treatment team. However, the school counselor and speech therapist may be seeing Sally weekly, similar to the counselor. Therefore, frequent contact between these three providers may be necessary. Finally, the psychiatrist may request information only immediately prior to Sally’s next appointment.

Step four: The counselor will document each consult. The note should include the date and time of each consult, a summary of the consult, and the next scheduled consultation.

Conclusion

Using the aforementioned instructions while consulting with other health care professionals may aid in applying a decision-making model that will continue to benefit the clinician, the client, and the counseling profession as we continue to adapt and improve our provision of treatment for the populations we serve.

As professional counselors, we may find ourselves working alongside other professionals who hold more advanced degrees. Regardless, it is important that we maintain our counselor identity, uphold our professional code of ethics, and advocate for our clients’ well-being. When involved in interdisciplinary teams, it is imperative that we are able to work within our scope of practice as counselors and clearly state the rationale for the interventions we are providing in therapy. Additionally, implementing a shared decision-making model fosters an opportunity for us to advocate for our profession and our clients while in interdisciplinary settings.

 

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Princess Lanclos is a doctoral student in counselor education and supervision at the University of Holy Cross in New Orleans. She is a national certified counselor, a certified rehabilitation counselor, and a provisionally licensed professional counselor. Her areas of focus include substance abuse, counseling ex-offenders, and multicultural counseling. Contact her at princess_lanclos@uhcno.edu.

Krystal Vaughn is a licensed professional counselor supervisor specializing in working with children ages 2-12. As an associate professor at Louisiana State University Health Sciences Center–New Orleans, she enjoys teaching and providing clinical services. Her research interests include supervision, play therapy, and mental health consultation. She has extensive experience providing mental health consultation in child care centers, private schools, and local charter school systems. Contact her at kvaugh@lsuhsc.edu.

 

Knowledge Share articles are developed from sessions presented at American Counseling Association conference.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Bringing CBT into the doctor’s office

By Bethany Bray September 12, 2018

When you get your annual physical, does your primary care physician ask if you’ve been feeling atypically sad or anxious lately?

Primary care doctors are often the first professional a person will tell about symptoms related to depression or other mental health issues. With this in mind, two Pennsylvania counselors have created a presentation on coping skills and takeaways from cognitive behavior therapy (CBT) that medical doctors can use with their patients.

When Brandon Ballantyne and Kevin Ulsh spoke to the primary care physicians and other medical personnel at Tower Health in Reading, Pennsylvania, recently, they found an interested and engaged audience. The medical practitioners were particularly interested in learning more about how to help patients who present with anxiety and related problems during medical appointments.

Ulsh and Ballantyne are mental health therapists in the inpatient and partial hospitalization programs, respectively, at Reading Hospital, which is part of the Tower Health system. Ballantyne is also a licensed professional counselor and American Counseling Association member.

How can aspects of CBT be translated for use in the medical professions? CT Online asked Ulsh and Ballantyne some questions to find out more.

 

How did this come together? Did you reach out to the doctors, or did they invite you to come?

We have always been interested in the concept of extending coping skills practice and implementation into primary care settings. We believe that the primary care setting is where most individuals first report problems associated with anxiety, stress, depression and so on. In many situations, the primary care physician is the first provider to address such issues.

Recently, we have observed a growing trend to integrate primary care and behavioral health services. We decided to take these observations and build a coping skills lecture that can assist providers in the primary care setting with addressing stress and anxiety, along with other mood-related problems with the patients they serve. We developed an outline for a presentation and broadcast the idea to the primary care Tower Health continuing education team, who then gave us an invitation to present it as a part of their lecture series.

 

How did it go? Were the doctors open to your message? What were some of the things they asked or commented about?

The lecture went well. The doctors in attendance were attentive and interested. They asked several questions about how to address behaviors particularly associated with adolescent anxiety such as school avoidance and oppositional defiance. We addressed these questions by referring back to the cognitive model, which we highlighted as a foundation of our lecture.

We think it was important to have a discussion with the doctors about the clinical indicators of avoidance versus defiance. Utilizing a cognitive philosophy, we emphasized that avoidance typically shows itself as a behavior which prevents an individual from doing something that they would like to be able to do or would want to be able to do if not affected by anxiety. The anxiety that drives avoidance is typically a product of some anticipated fear. … The individual has cognitively come to the conclusion that the fear itself is an already established fact or guarantee.

Defiance, on the other hand, is a behavior that is driven by the desire to maintain control by resisting demands and expectations to comply with things that are simply undesirable. In other words, in the cognitive process that drives defiance, an individual may think, “If I don’t like it or don’t want to do it, then I don’t have to, and it doesn’t matter what anyone says.”

Therefore, primary care physicians may be able to get a better handle on what it going on with the patient, clinically, simply by asking about their thinking.

 

From your perspective, how could CBT be helpful in a medical setting? Please talk about why you chose to focus on CBT when you spoke to the doctors.

We chose to focus on cognitive behavior therapy when providing this lecture because CBT is an evidence-based approach that has been shown to be an effective form of treatment for multiple psychological problems across various populations. We believe that in the primary care settings, patients will benefit most from socialization to the cognitive model, so that they can gain a clear understanding of the difference between a thought and an emotion.

Once an individual understands the relationship between a thought, an emotion and a behavior, they acquire control over regulating their mood and reactions in a positive way. CBT-based skills are goal-oriented, problem-focused and able to be introduced and taught to individuals dealing with a wide range of psychological problems.

In the fast-paced primary care setting, brief psychological education and skills practice can be a piece of the treatment puzzle that not only addresses the emotional problems of the patient, but also offers skills that they can continue to utilize and benefit from outside of the office (such as deep breathing, sleep hygiene, behavioral activation, disputing cognitive distortions, thought journals, activity scheduling, etc.).

 

From your perspective, what are the benefits to this kind of collaboration? In other words, benefits not only for the professionals involved, but for the patients/clients too.

There are multiple benefits to this kind of collaboration. We believe that in most cases, the first call that patients make when they are not feeling well is to their family doctor. On some occasions, they are being seen by their family doctor for a physical health issue. However, in the midst of assessment, they may reveal an emotional problem or talk about a significant stressor that is causing psychological distress.

This is because for the most part, individuals attend treatment with a primary care doctor whom they trust. Maybe they have been seeing this doctor for most of their life. They have learned to confide in this doctor quite often. Therefore, they may be more open to acknowledging emotional problems within that office setting.

The type of collaboration that we facilitated reinforces the importance of integrating psychological education and coping skills practice into a primary care setting. For professionals, it improves the continuum of care and reduces the stigma of mental health problems. Ongoing behavioral health collaboration, and having a behavioral health component to primary care treatment, implies that psychological distress is a natural area of assessment which patients might otherwise be hesitant to acknowledge or discuss. In this way, patients can become more open to behavioral health support and more accepting of their need to seek outpatient therapy to further resolve symptoms.

 

What advice or tips would you give to counselors who might want to collaborate with medical professionals, like you did, in their local area?

We would suggest that mental health professionals in all parts of the country consider developing a presentation on one particular area of therapy and/or psychological education that you feel passionate about [and] which you also utilize with the clients you serve. The goal is to develop a component of that theoretical orientation that is applicable to a primary care setting. It has to be something that primary care physicians can utilize within the short amount of time that they have with their patients.

We found that in our lecture, doctors were most interested in the practical applications of CBT as it pertains to the acute management of anxiety. We assume that other helpful topics may be closely related to dialectical behavior therapy [and] concepts such as mindfulness, distress tolerance and opposite action.

 

Is this something you think that counselors could or should do more of? What did you learn through this process?

As a result of providing this lecture, we learned that primary care doctors are very much interested in behavioral health support and assistance. It seems as though there has been an increase of patients presenting to family physicians with emotional problems. The doctors that we spoke with were very thankful for the background on CBT and the skills practice that we provided. In fact, they practiced some of the skills with us.

It reminded us that regardless of the [health] profession, we all will be most effective [with] our patients if we are also taking good care of ourselves. Integrating behavioral health support, psychological education and coping skills practice into a primary care setting reinforces the importance of seamless multidimensional treatment, ultimately helping patients to receive effective care that addresses their physical and emotional needs, and offers the safety to accept the behavioral health treatment that they may otherwise be hesitant to pursue.

 

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Ballantyne and Ulsh can be contacted via email:

Brandon.Ballantyne@towerhealth.org

Kevin.Ulsh@towerhealth.org

 

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Related reading, from Counseling Today:

Integrated interventions

The counselor’s role in assessing and treating medical symptoms and diagnoses

When brain meets body

 

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Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Identifying colors to create a rainbow of cohesion in the workplace for helping professionals

By Jetaun Bailey and Bryan Gere September 7, 2018

The idea for this piece came about when I (Jetaun Bailey) was pursuing my master’s degree in counseling. I recall my professor stating clearly that burnout occurs often among helping professionals and that the average stay for a counselor employed at a mental health facility is two years.

As one of my assignments, I completed and presented a paper on ways for helping professionals to avoid burnout. However, not once in my presentation did I illustrate ways that the workplace could employ preventive services to combat burnout. At the time, my focus was on using self-care and, ultimately, I received a grade of 100 on that project. However, in reflecting on my counseling career, I realized that workplace training programs overlook helping professionals by not addressing topics related to the complex workplace dynamics that may contribute to burnout, which is likely to increase, because the demands in the counseling profession can be overwhelming.

According to Amanda Stemen’s 2014 article, “Burnout: Who’s taking care of the care takers?” management in the helping professions focuses more on clients than on employees. Many factors are related to burnout. Low salaries are one contributing factor but not the most significant. Many of us who enter the helping professions, counseling in particular, understand that we are not pursuing a lucrative career. However, lack of managerial support is believed to be a significant factor in burnout. This lack of support isn’t necessarily intentional; it is thought that many in management believe that helping professionals have innate abilities to solve their work-related problems. However, in many cases, counselors work in isolation, without support from management and peers, and know its effects.

Thus, management’s support is critical in reducing burnout among helping professionals. In speaking with Terra Griffin, a manager at an acute behavioral hospital unit for children and adolescents, she revealed that the turnover in the unit was among the highest in the hospital. Such high employee turnover costs organizations time and productivity. One of the staff’s chief complaints was management’s failure to provide them with relevant training to meet the demands of the job and promote workplace cohesion, which had led to many problems within the teams.

Stemen’s article suggested the need for professional development in addressing burnout. She reports that providing professional development opportunities customized to employees’ interests encourages growth that benefits both the individual employee and the organization.

 

Mind-mapping

One professional development approach is to employ mind-mapping concepts. This is accomplished by creating a specific topic or question so that each person in the training session can see other points of view rather than just his or her own. This nonintrusive approach facilitates group cohesion. Researcher Tony Buzan, the author of Use Your Head, developed the mind-mapping concept in the 1970s. It is designed to facilitate the sharing of ideas and concepts to solve problems.

Through observation, Griffin employed this concept in a series of training sessions simply by asking employees in a unit where turnover had been problematic a simple question: “What is your favorite color?” Initially, the employees did not seem eager to participate in the training session. Remarkably, however, when Griffin focused the initial session on that single question, changes in body language occurred among the staff immediately, as if thinking about their favorite colors had some sort of healing effect. Afterward, they were eager to share their favorite colors and the ways they identified with those colors personally.

Interestingly, although employees weren’t given information about the psychological meaning of each color ahead of time, they ended up describing them similarly to how they were presented on Griffin’s color chart. Furthermore, they could identify their similarities and differences in relation to their multiple colors. This helped shed light on some of the difficulties the employees faced in creating a more cohesive work environment.

Three therapeutic teams were present at each training session, each of which was composed of two therapists, one psychiatrist, several nurses and several behavioral specialists. During their self-exploration of the colors, Team 2 realized that many of its members shared the same favorite color, red, while the two therapists identified with blue. Incidentally, of the three groups, Team 2 was confronting the most difficulties. Many of the team members who identified with red were having difficulties sharing leadership responsibilities and were disregarding the leadership authority of the two therapists who identified, unconsciously, with blue. Once members of Team 2 were able to understand their difficulties, they began to discuss ways that their team could work more cohesively. As a result, Team 2 set team goals, with respecting one another identified as the top priority.

Instead of asking employees direct questions about their workplace problems, this exercise of looking at their favorite colors appeared to be a nonintrusive method that encouraged employees to share their differences. Griffin’s simple question elicited many answers with respect to therapeutic problems occurring in this workplace of helping professionals, and thus promoted resolutions to some stressful issues.

 

The psychology of color

Intrigued with the feedback from the staff during these sessions as they compared their favorite colors to their personalities with respect to their workplace relationships, we set forth to emulate this training. Ultimately, we implemented a similar version in a group of training sessions for graduate students who would be entering the helping profession as practicum and internship students. Their feedback and interactions were outstanding. We learned much about our students that we had not known, and this helped us revamp our practicum and internship training program for students and site supervisors.

As a result, we set out to explore how many nonintrusive, evidence-based training programs of this nature were available. We conducted a content analysis of evidence-based studies on the psychology of color. We also sought to determine the extent to which such training materials are designed to facilitate workplace cohesion among helping professionals.

Using the American Psychological Association (APA) database and electronic resources, we searched APA PsycNET, PsycINFO and PsycARTICLES from their inception through 2018. Furthermore, we used the Google Scholar search engine. The search phrases we used were “evidence-based practices on color psychology” and “training curriculum on color psychology.” The criterion for inclusion for review was that the title contained the search phrase; studies that did not meet the criterion were excluded.

After completing the content analysis, we could not find a single evidence-based study on color psychology or training curriculum related to the topic. We also were unable to determine the extent to which such training curricula facilitated workplace cohesion among helping professionals. There appears to be a significant gap in the literature pertaining to the actual use of color psychology in the facilitation of workplace cohesion in human services or among helping professionals. We did not find any specific evidence-based studies that provided empirical information on training materials on the subject that lead to workplace cohesion. The absence of this information reflects the extent to which the topic is largely unexplored and illustrates what little recognition it is accorded.

In “Colors and trust: The influence of user interface design on trust and reciprocity,” Florian Hawlitschek and colleagues indicate that the literature available on the psychology of color suggests that color preferences associated with personality influence interaction patterns in the employment setting. This illustrates that understanding the role that color preferences play in group behaviors and settings is critical to interprofessional collaborations, especially among helping professionals. Furthermore, other literature has suggested that colors have individual meanings based on a person’s cultural background or racial and ethnic group. Therefore, the influences of color should be interpreted with caution.

However, what made this training so unique is that Griffin did not use any assessment tools to determine anyone’s colors. Instead, she asked each person his or her favorite color and thus gave life to their individuality based on their cultural or racial and ethnic backgrounds without probing for any specific details (colors hold a universal meaning of harmony in many cultures). This mind-mapping technique seemed beneficial. Griffin’s leadership played an important role in helping the employees navigate through their favorite colors by connecting to their personalities and the way they fit within the scheme of their work productivity to create or disrupt cohesion.

 

Conclusion

As the dynamism within health and human service delivery creates more interdependencies, there is a growing need for professionals to collaborate to achieve better client outcomes. However, there is little information on the role that the characteristics of interdisciplinary teams play in promoting synergy that influences such outcomes.

Shared values, mutual respect for colleagues’ expertise, and patient-oriented goals and outcomes are reflections not only of the diverse interests and asymmetry of power of the various partners in care, but also differences in their personalities and preferences. Therefore, fostering workplace cooperation and cohesion is essential for effective, competent, cost-effective, culturally responsive and comprehensive service delivery.

Creating mind-mapping trainings designed to honor individual uniqueness, such as the identification of favorite colors, can help us achieve such cohesion. These trainings draw us into companionship where we can evaluate our similarities and differences through our individual uniqueness, thus creating a meaningful and purposeful work environment for helping professionals and the clients they serve.

 

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Jetaun Bailey is an assistant professor at Alabama A&M University, where she serves as director of clinical training. Contact Jetaun at jetaun.bailey@aamu.edu or baileyjetaun@hotmail.com.

 

Bryan Gere is an assistant professor at Alabama A&M University, where he serves as coordinator of clinical training in rehabilitation counseling. Contact Bryan at bryan.gere@aamu.edu.

 

Terra Griffin, a licensed professional counselor supervisor with more than 15 years of experience in counseling management, supervision and training, contributed to this article.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.