Alexander Blount | Antioch University New England (original) (raw)
Papers by Alexander Blount
Patient-Centered Primary Care, 2019
For many multiply-disadvantaged patients, the likelihood of their adhering to a medical regimen i... more For many multiply-disadvantaged patients, the likelihood of their adhering to a medical regimen is correlated with their experience of the caring and support coming from their healthcare providers. The best of team-based patient-centered care is required to develop a successful interaction pattern in the care of these patients. A robust approach combines what is known about caring for these patients in multiple literatures, joining the care management and team approach of the “complex” patient literature with the respect and cultural competence of the low-income patient literature and the support and refusal to be directive and re-traumatizing of the trauma-informed care (TIC) literature. The delivery of integrated primary care, including behavioral health clinicians and care enhancers, is particularly crucial in the success of patient-centered care for these patients. In addition, using skills learned from primary care behavioral health practice can help promote a culture in the team that generates the new mental models of care and the corresponding routines of practice needed for developing true partnership with these challenging patients. Two successful programs are presented. Finally, a brief discussion of what is still missing sets the stage for the next section of the book.
Integrated Behavioral Health in Primary Care, 2018
Team-based values, methods, and relationships are now ubiquitous in conversation about primary ca... more Team-based values, methods, and relationships are now ubiquitous in conversation about primary care. Everyone values "team" and claims to be doing it in one form or another-or having done it all along-"nothing new for me." But what is the substance underlying the slogan? What are the benefits to adding a behavioral health (BH) clinician as a long-missing member of the primary care team? How can you deploy behavioral health clinicians to achieve these benefits? What are the properties of different models of integration? How can you be clear enough about this new role to effectively interview and hire for it? In other words, how can this role be truly integrated functionally, not just "anatomically"? CJP
The IOM’s call for patients to be the source of control in their care has been represented differ... more The IOM’s call for patients to be the source of control in their care has been represented differently at different times. The patient as the source of control has evolved from the clinician’s taking the patient’s preferences and values into account in designing care to a partnership between the clinician and the patient in making the choices necessary to plan care. This is a particularly challenging standard because both health professionals and many of their patients have been socialized to the model of the doctor leading care. Their difference in knowledge and in their perspective on the patient’s illness makes partnership difficult. This makes partnership challenging, even if the difference in levels of knowledge about the patient’s illness is reduced. Motivational interviewing, shared decision-making, minimally disruptive medicine, addressing health literacy, relationship-centered care, and coaching patients to be more assertive in relating to their physician, each of these app...
Patients who experience themselves as partners with their doctors are generally more active in ca... more Patients who experience themselves as partners with their doctors are generally more active in caring for their own health. For multiply-disadvantages patients, the steps to partnership have to include building trust in their health professionals and developing the experience of self-efficacy in relation to their lives and their health. For these patients the definition of empowerment that is used in trauma-informed care, that care is built on enhancing strengths rather than highlighting deficits, offers a place to start. The methodology of solution-focused interviewing provides a pathway to achieving this sort of empowerment. Solution-focused approaches to communication have an empowering effect for both patients and professionals, lowering team member burnout rates as it increases patient self-efficacy. Approaching treatment with multiply-disadvantaged patients by building on patients’ strengths in self-care and highlighting their histories of coping can be the step to empowerment...
Journal of the American Board of Family Medicine : JABFM
To identify how organizations prepare clinicians to work together to integrate behavioral health ... more To identify how organizations prepare clinicians to work together to integrate behavioral health and primary care. Observational cross-case comparison study of 19 U.S. practices, 11 participating in Advancing Care Together, and 8 from the Integration Workforce Study. Practices varied in size, ownership, geographic location, and experience delivering integrated care. Multidisciplinary teams collected data (field notes from direct practice observations, semistructured interviews, and online diaries as reported by practice leaders) and then analyzed the data using a grounded theory approach. Organizations had difficulty finding clinicians possessing the skills and experience necessary for working in an integrated practice. Practices newer to integration underestimated the time and resources needed to train and organizationally socialize (onboard) new clinicians. Through trial and error, practices learned that clinicians needed relevant training to work effectively as integrated care te...
The transition to team-based care within primary care is a foundational step in building an envir... more The transition to team-based care within primary care is a foundational step in building an environment that promotes relationships between patients and clinicians that are truly patient-centered. Changing from an individual provider with staff support to a team is the first step in the change in “mental models of care” called for by the evaluators of the National Demonstration Program. The change can be characterized as a change from a squad to a team. It is a transition from a small group that is hierarchical with an unchanging leader to a group with greater participation among team members and flexibility in leadership. This change gives greater flexibility in the delivery of the services that make a difference to patients. It has been shown to lead to improvement in group cohesion, improved patient satisfaction, improved quality of services, and lower burnout for both clinicians and support staff. Making such a change is not easy. One requirement is the dedication of time for te...
Journal of Strategic and Systemic Therapies, 1985
This article begins with a brief formulation of the ideas underlying systemic therapy. There foll... more This article begins with a brief formulation of the ideas underlying systemic therapy. There follows a description of the central approaches presently utilized in the practice of systemic therapy. The largest part of the work is an exposition of one case in which the techniques of systemic therapy were used to resolve conflict between high level managers in a large corporation. An assessment format was used to redescribe the situation in a way that transformed the situation and resolved the conflict.
Integrated primary care, now instituted in many areas of the country, is both the service that in... more Integrated primary care, now instituted in many areas of the country, is both the service that integrates medical and mental health primary care and the practice of defining the problem brought by a patient without using "medical" or "mental" as inevitable distinctions. This volume makes the case for this approach, shows how to implement it, and describes some successful programs. It will be attractive to medical managers, plan administrators, physicians, and mental health providers.
Primary care is the foundation of an effective and efficient health system. The more robust a nat... more Primary care is the foundation of an effective and efficient health system. The more robust a nation’s primary care service, the better are the health markers seen in the population and the lower the comparative cost of healthcare. In the USA, primary care has been under stress for some time, under-supported financially with too small a physician workforce, and over-taxed by demands to impact the population as a whole. The Institute of Medicine (IOM) and other health policy leaders have attempted to remedy the quality problems of the healthcare system by calling for a reorganization of primary care into a medical home that is patient-centered, evidence based, offering improved access, better ongoing contact, and coordination of care. The IOM’s ten rules for the redesign of healthcare include some that are focused on systems change in the delivery of care and others that are focused on relationship change of doctors and their patients. The systems change rules have been easier to imp...
For practices that are attempting to develop patient-centered team-based care, the addition of on... more For practices that are attempting to develop patient-centered team-based care, the addition of one or more behavioral health clinicians (BHC) is a logical step along the way. When done well, adding a behavioral health clinician enhances the fit of the expertise of the team to the needs of many of its patients. Behavioral health care within the primary care practice greatly increases access for patients by being a better fit to their understanding of their needs and therefore increasing its acceptability. The patterns of communication among team members that make for successful team-based care are the same ones that make for successful integration of a behavioral health clinician. The expertise that is added to the team by a behavioral health clinician can help to foster the change in “mental models of care” that has been discussed as underlying the transition to both patient-centered and team-based primary care. In addition, for patient with significant challenges in the area of the...
Patient-Centered Primary Care, 2019
Using data to improve quality is part of the definition of patient-centered care. The commitment ... more Using data to improve quality is part of the definition of patient-centered care. The commitment to being patient-centered requires that healthcare teams be constantly trying to improve care for the particular patients they are serving. This entails keeping data about their patients’ health and the patterns of service they are given and using the data as feedback for improving quality. In other areas of patient-centered care, the challenge has been to move from taking the wishes and preferences of patients into account when designing care, to achieving partnership with patients in designing their courses of treatment. In the effort to use data to improve care, there have been relatively few examples of partnering with patients in deciding what data they would like to have collected, what information that data could supply, and what actions or improvements could be possible because of having that data. In order to achieve partnership, health professionals need to be comfortable with ...
Patient-Centered Primary Care
Almost all simulation models represent systems with several relationships. The model "map" can be... more Almost all simulation models represent systems with several relationships. The model "map" can be expressed in terms of what affects what; the arrow indicates the direction of the influence. This is often referred to as a "conceptual model" as it identifies the relationships without having quantified them.
Patient-Centered Primary Care
Growing an expert team is more a matter of building a culture than implementing a model. Enacting... more Growing an expert team is more a matter of building a culture than implementing a model. Enacting the T.E.A.M. Way of working with multiply-disadvantaged patients requires learning new behaviors on the part of every team member. This learning creates value for the practice and for the individuals involved. Professionals who learn to function using the T.E.A.M. Way will find job opportunities open in other settings and will not be easy to replace. Without a plan to maintain a team, each departing member takes with them an important piece of team culture. One approach to maintaining the expert team is to help each member take on a training role for future professionals. New professionals provide a reserve workforce to maintain the knowledge and functioning of the team as a whole, and learning to train new professionals solidifies the gains in skills of current team members. A second approach is to build a career ladder within the organization so that the increase in expertise of team members can be reflected in increases in salary and responsibility. An example of a way of creating such a career ladder has been created by the New Hampshire Primary Care Behavioral Health Initiative.
Patient-Centered Primary Care
Journal of Strategic and Systemic Therapies
Journal of Strategic and Systemic Therapies
Patient-Centered Primary Care, 2019
For many multiply-disadvantaged patients, the likelihood of their adhering to a medical regimen i... more For many multiply-disadvantaged patients, the likelihood of their adhering to a medical regimen is correlated with their experience of the caring and support coming from their healthcare providers. The best of team-based patient-centered care is required to develop a successful interaction pattern in the care of these patients. A robust approach combines what is known about caring for these patients in multiple literatures, joining the care management and team approach of the “complex” patient literature with the respect and cultural competence of the low-income patient literature and the support and refusal to be directive and re-traumatizing of the trauma-informed care (TIC) literature. The delivery of integrated primary care, including behavioral health clinicians and care enhancers, is particularly crucial in the success of patient-centered care for these patients. In addition, using skills learned from primary care behavioral health practice can help promote a culture in the team that generates the new mental models of care and the corresponding routines of practice needed for developing true partnership with these challenging patients. Two successful programs are presented. Finally, a brief discussion of what is still missing sets the stage for the next section of the book.
Integrated Behavioral Health in Primary Care, 2018
Team-based values, methods, and relationships are now ubiquitous in conversation about primary ca... more Team-based values, methods, and relationships are now ubiquitous in conversation about primary care. Everyone values "team" and claims to be doing it in one form or another-or having done it all along-"nothing new for me." But what is the substance underlying the slogan? What are the benefits to adding a behavioral health (BH) clinician as a long-missing member of the primary care team? How can you deploy behavioral health clinicians to achieve these benefits? What are the properties of different models of integration? How can you be clear enough about this new role to effectively interview and hire for it? In other words, how can this role be truly integrated functionally, not just "anatomically"? CJP
The IOM’s call for patients to be the source of control in their care has been represented differ... more The IOM’s call for patients to be the source of control in their care has been represented differently at different times. The patient as the source of control has evolved from the clinician’s taking the patient’s preferences and values into account in designing care to a partnership between the clinician and the patient in making the choices necessary to plan care. This is a particularly challenging standard because both health professionals and many of their patients have been socialized to the model of the doctor leading care. Their difference in knowledge and in their perspective on the patient’s illness makes partnership difficult. This makes partnership challenging, even if the difference in levels of knowledge about the patient’s illness is reduced. Motivational interviewing, shared decision-making, minimally disruptive medicine, addressing health literacy, relationship-centered care, and coaching patients to be more assertive in relating to their physician, each of these app...
Patients who experience themselves as partners with their doctors are generally more active in ca... more Patients who experience themselves as partners with their doctors are generally more active in caring for their own health. For multiply-disadvantages patients, the steps to partnership have to include building trust in their health professionals and developing the experience of self-efficacy in relation to their lives and their health. For these patients the definition of empowerment that is used in trauma-informed care, that care is built on enhancing strengths rather than highlighting deficits, offers a place to start. The methodology of solution-focused interviewing provides a pathway to achieving this sort of empowerment. Solution-focused approaches to communication have an empowering effect for both patients and professionals, lowering team member burnout rates as it increases patient self-efficacy. Approaching treatment with multiply-disadvantaged patients by building on patients’ strengths in self-care and highlighting their histories of coping can be the step to empowerment...
Journal of the American Board of Family Medicine : JABFM
To identify how organizations prepare clinicians to work together to integrate behavioral health ... more To identify how organizations prepare clinicians to work together to integrate behavioral health and primary care. Observational cross-case comparison study of 19 U.S. practices, 11 participating in Advancing Care Together, and 8 from the Integration Workforce Study. Practices varied in size, ownership, geographic location, and experience delivering integrated care. Multidisciplinary teams collected data (field notes from direct practice observations, semistructured interviews, and online diaries as reported by practice leaders) and then analyzed the data using a grounded theory approach. Organizations had difficulty finding clinicians possessing the skills and experience necessary for working in an integrated practice. Practices newer to integration underestimated the time and resources needed to train and organizationally socialize (onboard) new clinicians. Through trial and error, practices learned that clinicians needed relevant training to work effectively as integrated care te...
The transition to team-based care within primary care is a foundational step in building an envir... more The transition to team-based care within primary care is a foundational step in building an environment that promotes relationships between patients and clinicians that are truly patient-centered. Changing from an individual provider with staff support to a team is the first step in the change in “mental models of care” called for by the evaluators of the National Demonstration Program. The change can be characterized as a change from a squad to a team. It is a transition from a small group that is hierarchical with an unchanging leader to a group with greater participation among team members and flexibility in leadership. This change gives greater flexibility in the delivery of the services that make a difference to patients. It has been shown to lead to improvement in group cohesion, improved patient satisfaction, improved quality of services, and lower burnout for both clinicians and support staff. Making such a change is not easy. One requirement is the dedication of time for te...
Journal of Strategic and Systemic Therapies, 1985
This article begins with a brief formulation of the ideas underlying systemic therapy. There foll... more This article begins with a brief formulation of the ideas underlying systemic therapy. There follows a description of the central approaches presently utilized in the practice of systemic therapy. The largest part of the work is an exposition of one case in which the techniques of systemic therapy were used to resolve conflict between high level managers in a large corporation. An assessment format was used to redescribe the situation in a way that transformed the situation and resolved the conflict.
Integrated primary care, now instituted in many areas of the country, is both the service that in... more Integrated primary care, now instituted in many areas of the country, is both the service that integrates medical and mental health primary care and the practice of defining the problem brought by a patient without using "medical" or "mental" as inevitable distinctions. This volume makes the case for this approach, shows how to implement it, and describes some successful programs. It will be attractive to medical managers, plan administrators, physicians, and mental health providers.
Primary care is the foundation of an effective and efficient health system. The more robust a nat... more Primary care is the foundation of an effective and efficient health system. The more robust a nation’s primary care service, the better are the health markers seen in the population and the lower the comparative cost of healthcare. In the USA, primary care has been under stress for some time, under-supported financially with too small a physician workforce, and over-taxed by demands to impact the population as a whole. The Institute of Medicine (IOM) and other health policy leaders have attempted to remedy the quality problems of the healthcare system by calling for a reorganization of primary care into a medical home that is patient-centered, evidence based, offering improved access, better ongoing contact, and coordination of care. The IOM’s ten rules for the redesign of healthcare include some that are focused on systems change in the delivery of care and others that are focused on relationship change of doctors and their patients. The systems change rules have been easier to imp...
For practices that are attempting to develop patient-centered team-based care, the addition of on... more For practices that are attempting to develop patient-centered team-based care, the addition of one or more behavioral health clinicians (BHC) is a logical step along the way. When done well, adding a behavioral health clinician enhances the fit of the expertise of the team to the needs of many of its patients. Behavioral health care within the primary care practice greatly increases access for patients by being a better fit to their understanding of their needs and therefore increasing its acceptability. The patterns of communication among team members that make for successful team-based care are the same ones that make for successful integration of a behavioral health clinician. The expertise that is added to the team by a behavioral health clinician can help to foster the change in “mental models of care” that has been discussed as underlying the transition to both patient-centered and team-based primary care. In addition, for patient with significant challenges in the area of the...
Patient-Centered Primary Care, 2019
Using data to improve quality is part of the definition of patient-centered care. The commitment ... more Using data to improve quality is part of the definition of patient-centered care. The commitment to being patient-centered requires that healthcare teams be constantly trying to improve care for the particular patients they are serving. This entails keeping data about their patients’ health and the patterns of service they are given and using the data as feedback for improving quality. In other areas of patient-centered care, the challenge has been to move from taking the wishes and preferences of patients into account when designing care, to achieving partnership with patients in designing their courses of treatment. In the effort to use data to improve care, there have been relatively few examples of partnering with patients in deciding what data they would like to have collected, what information that data could supply, and what actions or improvements could be possible because of having that data. In order to achieve partnership, health professionals need to be comfortable with ...
Patient-Centered Primary Care
Almost all simulation models represent systems with several relationships. The model "map" can be... more Almost all simulation models represent systems with several relationships. The model "map" can be expressed in terms of what affects what; the arrow indicates the direction of the influence. This is often referred to as a "conceptual model" as it identifies the relationships without having quantified them.
Patient-Centered Primary Care
Growing an expert team is more a matter of building a culture than implementing a model. Enacting... more Growing an expert team is more a matter of building a culture than implementing a model. Enacting the T.E.A.M. Way of working with multiply-disadvantaged patients requires learning new behaviors on the part of every team member. This learning creates value for the practice and for the individuals involved. Professionals who learn to function using the T.E.A.M. Way will find job opportunities open in other settings and will not be easy to replace. Without a plan to maintain a team, each departing member takes with them an important piece of team culture. One approach to maintaining the expert team is to help each member take on a training role for future professionals. New professionals provide a reserve workforce to maintain the knowledge and functioning of the team as a whole, and learning to train new professionals solidifies the gains in skills of current team members. A second approach is to build a career ladder within the organization so that the increase in expertise of team members can be reflected in increases in salary and responsibility. An example of a way of creating such a career ladder has been created by the New Hampshire Primary Care Behavioral Health Initiative.
Patient-Centered Primary Care
Journal of Strategic and Systemic Therapies
Journal of Strategic and Systemic Therapies