Collaborative Family Healthcare Research Articles

Diversity, equity, and inclusion: Evolving into belonging, dignity, and justice.

The authors want to invite the integrated care community to reflect with us on an evolutionary shift in how we approach matters of justice and equity: from a diversity, equity, and inclusion (DEI) framework to a perspective that centers the relational concepts of belonging, dignity, and justice (BDJ) for a more just world (Davis, 2021). Our desire to reflect, question, and pivot is inspired by the Ecocycle Planning Model-which I (Deepu George) used to critically frame the Collaborative Family Healthcare Association's (CFHA) history in Part I of the article (George, 2023a) and creatively anticipate our future in Part II (George & Khatri, 2024). In this article, the authors want to focus on the nodes of maturity and creative destruction, as well as the idea of the rigidity trap-to examine our collective energies around the idea of DEI. With CFHA's 30th anniversary upon us, we pause and reflect on not only the benefits of DEI efforts heretofore, but also the pitfalls, to avoid the rigidity trap, which is likely to occur when we embrace tenets of an idea that may no longer serve the values we once aspired to or fail to evolve in favor of the familiar. Considering critiques of the limitations of DEI work in practice and literature, the authors believe a BDJ approach will better inform our growth moving forward. Therefore, the authors want to reflect, honor, and build upon the impact and gains from DEI and adapt them to better serve the needs of all-especially the historically marginalized and underrepresented voices. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Don Bloch nomination letter.

Don Bloch nomination letter.

Contemplating on the end of integrated care-part II: Living the questions to foster adaptability.

This article extends the use of the ecocycle planning framework to describe challenges ahead for the integrated care and Collaborative Family Healthcare Association (CFHA). The authors make the case that to remain agile and adaptable, there are contextual, ecological, and moral challenges that integrated care and CFHA should keep in the forefront as they navigate the future of an inequitable health care system that is morphing at a rapid pace. These influences include but are not limited to challenges of social determinants of health, artificial intelligence, generational differences in technology among older and younger populations, the moral issue of poverty, challenges to retain an integrated care workforce, and rethinking development of evidence-based supported treatments for integrated care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Contemplating on the end of integrated care-Part I: Anticipating creative destruction.

In this article, the author frames the development of integrated care and the Collaborative Family Healthcare Association (CFHA) through the ecocycle planning model. With four distinct stages of development and renewal-gestation, birth, maturity, and creative destruction-the ecocycle planning model encourages organizations to consider ways to ask questions to avoid a rigidity trap, which in the model appears as a process after maturity. As CFHA approaches its 30th year in 2024, the author documents a rough, imperfect history for a shared understanding of how integrated care and CFHA reached maturity and invites the readers to engage in critical questions to avoid the rigidity trap. The author contends that integrated care as a movement and CFHA as an organization have the capacity and a history of learning to ask informed questions to avoid falling prey to the rigidity trap. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reflections on the signs and science of belonging in integrated care.

For this inaugural reflection, the author began by thinking about what the Collaborative Family Healthcare Association (CFHA) has been for them, and they suspect for many others. As a naïve early career professional, the author joined CFHA with wide-eyed optimism about the future of the integrated care movement and the giddy excitement only a true nerd can appreciate when you get to befriend the individuals who have made one's career possible. This community is the space where peers and leaders sharpened the author's knowledge and where they became a passionate advocate for integrated care. Activities within CFHA have inspired several initiatives in their institution and community. Yet, when they think of CFHA, it is not the technical access or the ocean of knowledge that comes to mind. Instead, what lights up for them is the feeling that this is a community to which they belong. This is illuminated by the warmth of handshakes and hugs, contagious laughter, shared meals, and moments of joys and sorrows. This sense of belonging they received from CFHA has instilled confidence and agency in other areas of their professional development. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Finding hearts at peace: A new workforce competency.

While there is no single agreed upon set of competencies for the behavioral health workforce in primary care, there is a consensus about the importance of communication, the role of the behavioral health provider as part of a larger team, and the critical need to value diverse perspectives. In this column, the current and incoming Presidents of the Collaborative Family Healthcare Association (CFHA) present a framework that focuses on a "way of being"; a lens to reflect and process the sense of division and injustice, and to pave the path ahead. We believe that the fundamental question that can scale this "way of being" to a higher level of acquired skill or internalized competency for ongoing workforce development is: as we engage in dialogue on difficult, highly personal, moral, and valued topics with others, "Is your heart at peace, or is your heart at war?" May each of us in the CFHA family and community be anchored in hearts of peace as we continue to advance the mission of providing equitable care through our love of integrated behavioral health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Don Bloch award acceptance comments.

In the words of the author and recipient: "It is indeed a career-topping honor to receive the Don Bloch Award from Collaborative Family Healthcare Association (CFHA). I want to thank the CFHA Board for its generosity in bestowing this honor, and I am, indeed, humbled to be accepted into the prestigious company of prior Don Bloch Award recipients. I did not have a role in inventing collaborative care, like so many of the preceding awardees. But as a practicing family physician and a leader in academic family medicine and primary care, I recognized the need for this movement in my field of practice and have worked hard to make it a reality at University of California, San Diego (UCSD) over the past 20 years." (PsycInfo Database Record (c) 2022 APA, all rights reserved).

What to do with that policy paper (and why).

In this editorial we describe the clinician/administrator/researcher experience of frustration or confusion around how to effectively advocate for policy change in health care. By the end of the piece the reader will (a) understand the importance of health professionals' advocacy; (b) know how to use policy papers to advocate; and (c) understand how policy organizations use policy papers. We also discuss the National Academies of Medicine, Science, & Engineering High Quality Primary Care report as an example of a policy paper, introduce our new coeditors for the Policy and Management Department, and describe the Collaborative Family Health Care Association's new policy principles. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Developing antiracist integrated health professionals.

As the Collaborative Family Healthcare Association (CFHA) has increased its focus on justice, diversity, and inclusion in integrated care delivery, it is increasingly evident that widespread upstream transformation is needed to ensure that the integrated care workforce is appropriately prepared to deliver equitable care. This column highlights the need for systemic change in admissions standards, integrated care curricula, student mentorship/sponsorship, and faculty development within higher education in order to support the success of Black, Indigenous, and People of Color (BIPOC) students and increase antiracist approaches among health care professionals. CFHA members working in, or in collaboration with, academia are uniquely poised to influence higher education systems to promote diversity, inclusion, and antiracism among future integrated health professionals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Adverse childhood experiences: Assessing the impact on physical and psychosocial health in adulthood and the mitigating role of resilience

BackgroundMore than 2000 studies demonstrate adverse childhood experiences ACEs are universal and that experiencing multiple ACEs increases risk for developing physical and psychosocial health problems in adulthood. A challenge faced by clinicians is identifying those most at risk. Recent evidence suggests socio-ecological resilience may mitigate the consequences ACEs. We hypothesize that integrated assessment of ACEs and resilience might improve identification of those at highest risk. ObjectivesWe examined ACEs among adults attending a rural family practice clinic and explored associations between ACE, socio-ecological resilience and health. MethodsA cross-sectional survey measured ACEs, resilience, and health in adult patients attending a collaborative family health care centre in Lunenburg, Nova Scotia, Canada. Correlation analyses were used to determine associations between the measures. The impact of socio-economic status, level of education and gender was considered. ResultsTwo hundred and twenty-six persons participated in this study.Approximately 73 % of participants had experienced at least one ACEs and 31 % experienced 4 or more. Overall with increasing numbers of ACEs prevalence of health problems increased. However, individuals with high resilience scores had lower prevalence of health problems. Regression analyses indicated that the number of ACEs were slightly more important predictor of health issues than level of resilience, though both were important. Social economic status, education level and gender were not significant predictors of the impact of ACEs on person's health. Conclusion: The results suggest integrated assessment for resilience and ACEs may facilitate identification of those at higher risk and in need of preventative intervention.

Nomination of Natalie Levkovich for the 2019 CFHA Don Bloch Award.

Don Bloch's legacy is expansive and deep, epitomized by his vision, systemic orientation, innovative work, and a paragon of connecting people. Natalie Levkovich has continued this tradition as past president of the Collaborative Family Healthcare Association (CFHA), Chief Executive Officer of the Health Federation of Philadelphia, and contributor to numerous boards and projects. She is a fervent champion for improving population health by increasing access to high quality care for all, especially the most marginalized. The nomination highlights four central themes to her innovative and remarkable leadership. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Caring is complex: And it always has been.

Einstein once said, "Everything must be made as simple as possible, but not one bit simpler." If the health care system continues to value and push oversimplified solutions to complex problems, we sacrifice context. We lose connection to the very system we seek to influence. We put at risk the very value Collaborative Family Healthcare Association (CFHA) was founded on-relationship. As CFHA celebrated its 20th annual conference as a change organization, we came together in Rochester, NY to reflect on two decades of work, innovation, and, above all, relationships-relationships with each other, with the communities we serve, and the health care systems we seek to improve. As Family, Systems, and Health pushes forward the field by taking on translational research, CFHA will as well. It has been CFHA's willingness to acknowledge complexity, through its emphasis on systems, that has distinguished this organization. We strive to improve ourselves, by coming together as a membership, learning from one another, pushing each other to emerge as individuals, to improve the care we provide. I look forward over the next 2 years to delve into the fray with you all. To explore together and discover your approach to the complex problems we face. What we do is not rocket science; it's far more complex! (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Integrated primary care could play a starring role in the Amazon-JP Morgan-Buffet health care enterprise.

Earlier this year, Amazon, J. P. Morgan, and Berkshire Hathaway announced plans to launch a joint health care company with more than a million covered lives. Dr. Atul Gawande, the prominent Boston-based surgeon and health care thought leader, will become the first chief executive officer of this health care venture, with a mission to get the best results at the lowest costs and remain free from profit-making incentives and constraints. In this presidential column, the author explores what this has to do with the mission in the Collaborative Family Health care Association (CFHA) and the promulgation of integrated health care. (PsycINFO Database Record

"Imagine a clinical world without family systems thinking": Comment.

Comments on an editorial by C. T. Fogarty and L. B. Mauksch (see record 2017-56601-001). The editorial discussed collaborative family health care and the importance of family and social context to yield a comprehensive understanding of health. Jacobs agrees that family systemic thinking is an extremely helpful tool for clinicians, even if there's limited data to prove that. But he also thinks that systemic thinking in and of itself doesn't flatten the health care hierarchy and empower family members. (PsycINFO Database Record

"Joy" in practice requires workforce well-being.

In this column, the president of the Collaborative Family Healthcare Association notes that the national conversation about physician burnout has recently shifted to discussing the importance of finding joy in practice. However, she is concerned the current culture of medicine, hidden curricula in medical training, a draconian financial system, and an emotionally ill-prepared workforce may preclude sustained joy in practice. Formal curricula do not include resiliency skills, mindfulness, cognitive flexibility and reframing, conflict-resolution skills, emotional-regulation skills, or how to practice empathy and compassion without crumbling from vicarious trauma. With all the emphasis on technical proficiency, there has been insufficient emphasis on strategies for maintaining personal well-being. To the extent investment follows what we measure, the well-being of the entire health care workforce is a worthwhile data point to chase. Collaborative Family Healthcare Association membership is infused with the knowledge and skills to design and promote health care teams and systems that can foster, measure, and sustain joy. (PsycINFO Database Record

Mentorship during transitions.

Mentorship has been repeatedly shown to be a necessary component of successful professional development. However, effective mentorship can be elusive to define insofar as "you know it when you have it," but it is hard to match the objective qualities of mentorship with the subjective experience of effective and helpful mentoring. This article explores the Collaborative Family Healthcare Association's mentorship program from the perspective of one mentor and two mentees over the course of a yearlong formal relationship. During the year, both mentees had to navigate significant transitions, including changing jobs and having a baby; these experiences are relevant for many new career professionals. (PsycINFO Database Record

An interview with Neftali Serrano, PsyD: Collaborative family healthcare association's new executive director.

The Collaborative Family Healthcare Association (CFHA) is continually evolving along with policies, funding, and models of healthcare in the U.S. With a vision of integrated healthcare for all as the standard of care, the new executive director of CFHA describes his perspective on how we can move closer towards this vision, the remaining barriers, models of integration, and why CFHA is a unique and necessary professional organization for those with a passion for delivering whole-person comprehensive healthcare. (PsycINFO Database Record

Confronting the new epidemic: Integrated care for opioid use disorders.

The inaugural Collaborative Family Health Care (CFHA) regional conference took place March 17, 2017, in St. Louis, Missouri. The conference theme was opioid use disorders and the potential of medication-assisted treatment using team-based care to address this epidemic. The conference ended with an emphasis on the importance of and strategies for self-care among caregivers working with this population and their families. This intensive meeting was crafted as a proof in concept for CFHA; however, the content was timely with regard to its importance in health care as well as compelling in the opportunity for collaborative care to offer an effective approach. In this article, the authors highlight five impotance topics: (1) opioid use disorders should be addressed in primary care; (2) a team is essential; (3) harm reduction; (4) sustaining self through mindful practice and self-compassion; and (5) medication-assisted treatment. (PsycINFO Database Record

Barry Jacobs, 2016 recipient of the CFHA Don Bloch, MD Award.

The Don Bloch Award is presented annually by the Collaborative Family Healthcare Association (CFHA) to a person who has made singular contributions to forwarding the cause of collaborative family health care. The 2016 Don Bloch Award was presented to Dr. Barry Jacobs, a licensed clinical psychologist and family therapist who exemplifies Don's intellectual, behavioral and relational attributes. (PsycINFO Database Record

Acceptance speech for the 2016 Don Bloch Award from the Collaborative Family Healthcare Association.

Presents the acceptance speech from Dr. Barry Jacobs for the 2016 Don Bloch Award from the Collaborative Family Healthcare Association (CFHA). (PsycINFO Database Record