Plays well with others

In 2007, Massachusetts implemented the Children's Behavioral Health Initiative (CBHI) in response to a class action lawsuit on behalf of Medicaid-eligible children with serious emotional disturbances to provide improved screening, evaluation, and access to behavioral health services for youth up to age 21 with MassHealth. 

One of the services created was Intensive Care Coordination (ICC) to "help get all the adults in your child’s life to work together." In my previous work as an in-home family therapist, mobile crisis intervention supervisor, and point of contact for families entering the CBHI system, I can tell you this is one of the biggest challenges and most important factors in providing effective care that wraps around and buoys a child and the family. While some families I worked with had a dedicated Intensive Care Coordinator, others relied on the family therapist or outpatient therapist to provide the coordination. Too often, it fell on a parent who was already approaching or well past the stage of burnout trying to decipher acronyms and navigate an incredibly complex system all while dealing with anxiety about finding help for their child. Throw in a doctor, a teacher, a special education services coordinator, an occupational therapist, or a mentor and it's not hard to imagine the benefit of making sure everyone's talking to each other. 

In my private practice, I see children and families, as well as individual adults, and I always consider who else is working with whoever is sitting with me in my office. Together, we review the pros and cons of signing releases allowing me to communicate with those other providers. Here are some common themes that arise:

• Introducing the idea of communicating with another provider involved with your care often provides impetus to reflect on your goals in therapy and progress toward those goals. This temperature taking keeps your priorities at the forefront of our work together.
• The issues that lead someone to therapy are often wrapped up in shame, guilt, or secrecy. Bringing those issues to light in the containment of a therapy session can be a powerful release; however, there may be legitimate concerns around sharing a difficult history with particular providers. Bolstering coping skills before sharing limited information with handpicked providers might be the best way to proceed. 
• It's not uncommon for adrenaline and stress to prevent you from remembering all the details of critical conversations with a child's psychiatrist or your own reproductive endocrinologist. While I can clarify information with your authorization, planning ahead of time what questions you plan to ask and practicing grounding techniques you can use in the meeting might be more helpful. Other times, scheduling a time to call together or reviewing written information in session seems most productive. 
• In many cases, there are multiple, complementary approaches that might help you reach your goals: acupuncture and therapy to manage depression during pregnancy; a lactation consultant to address problems with breastfeeding while we utilize CBT to decrease anxious thoughts; massage therapy to manage chronic pain and motivational interviewing to enhance healthy coping strategies. 

One of my strengths is looking at the bigger picture and navigating larger systems. When we think together about who is currently involved in your life and how you'd benefit from working with other providers, we have the best chance of efficiently meeting your goals, but it's critical that appropriate communication happens to ensure everyone on your team is working together.

Do you have any success stories or cautionary tales of collaboration among providers? Therapists, what makes you hesitant or excited to take on the role of coordinating care? Please feel free to share your thoughts in the comments.

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