Research Article

in

Interprofessional Collaboration Between Mental Health Counselors and Nurses

Advertisement

Abstract

The continuous and rapid evolution of medical technology and the complexity of delivering person-centered care in the 21st century calls for collaboration among health care professionals. Global health now “involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual-clinical care” (Koplan et al., 2009, p. 1995). The need for mental health practitioners to work in interprofessional contexts requires graduate and postgraduate programs to incorporate interprofessional education into their student training. This article focuses on an approach to interprofessional education for students in mental health nursing and counseling.

The World Health Organization (WHO, 2010) recognizes the need for collaboration among health care professionals in both education and clinical practice. Global health now “involves many disciplines within and beyond the health sciences and promotes interdisciplinary collaboration; and is a synthesis of population-based prevention with individual-clinical care” (Koplan et al., 2009, p. 1995). Interprofessional health care collaboration involves individuals from two or more professions coming together to learn from and with each other, work as a team, and improve patient health outcomes (Barr, Koppel, Reeves, Hammick, & Freeth, 2005; WHO, 2010). Collaborative practice also involves working closely with patients, families, and communities to provide the highest level of patient care (Dondrof, Fabus, & Ghassemi, 2015). Effective collaboration can improve situations for both patients and those who care for them.

The continuous and rapid evolution of medical technology and the complexity of delivering person-centered care in the 21st century call for collaboration among health care professionals so that “traditional and distinct bodies of professional knowledge,” instead of remaining separate and isolated, are “recontextualized” into the common “knowledge of collaborative practice” (Bradshow & Lowenstein, 2014, p. 269). For example, mental health care includes both clinical and community mental health (CMH) settings and a multitude of professionals (doctors, nurses, mental health counselors, social workers), each with her or his specialized knowledge. One area of care requiring extensive collaboration is drug overdose—the leading cause of accidental death in the United States, with 52,404 lethal drug overdoses in 2015 (National Institute on Drug Abuse [NIDA], 2015). Prescription drug abuse has been described by the Centers for Disease Control and Prevention (CDC) as a public health epidemic (CDC, 2012). Opioid addiction is driving this epidemic, with 20,101 overdose deaths related to prescription pain relievers and 12,990 overdose deaths related to heroin in 2015 (NIDA, 2015). Every 10% increase in the demand for substance abuse treatment could result in the need for 6,800 additional counselors (Hoge, Morris, Laraia, Pomerantz, & Farley, 2014). Mental health care professionals need to work together to eradicate addiction from its roots in the communities. It is not enough to treat the individual overdose; the recovery of an addict is equally as important as the problem of addiction in the large community setting. Addressing each of these issues requires its own set of skills.

Mental health care includes both clinical and community mental health settings and a multitude of professionals (doctors, nurses, mental health counselors, social workers), each with her or his specialized knowledge.

It is not enough to treat the individual overdose—the addict’s recovery is equally as important as the problem of addiction in the large community setting; addressing each of these issues requires its own set of skills.

Shared decision making and interprofessional collaboration are essential to support treatment and recovery, but working together can be problematic for health care teams trying to determine the best way to respond to, care for, and support an individual with a mental illness. Professionals who are educated in the elements of teamwork may find it easier to avoid pitfalls associated with interprofessionalism and reach better decisions faster. One possibility is to include interprofessional training in health care professional schools. This article focuses on the use of an interprofessional learning approach for students in nursing and mental health counseling. Although nurses and mental health counselors both focus on health care, they have different roles and responsibilities. Before entering professional practice, they need to learn the skills of how, when, and why to collaborate with other health care professionals to deliver patient-centered care. To guarantee that qualified professionals are “fit for purpose,” interprofessional education (IPE) must be integrated into conventional professional education.

BACKGROUND

Major research studies have highlighted that high-quality responses to health needs depend on both the education received by health care professionals and the pedagogical approaches employed in such training (Greiner & Knebel, 2003). Recent studies show the value of IPE in preparedness for clinical interprofessional collaboration, increasing knowledge of other disciplines, and providing opportunities to consult with members of different professions (Ateah et al., 2011; Geller et al., 2002). But despite support in political arenas, some counseling education, social work training, and other non-medical training programs (advanced programs of training to meet certain professional requirements in fields other than medicine, dentistry, pharmacology, and nursing) have been hesitant to incorporate IPE. The hesitancy to transform traditional health care education has been criticized for not properly preparing students for the changing and ever more complex health care delivery services requiring interprofessional relationships in clinical practice (McClelland & Kleinke, 2013).

However, the momentum has gradually swung the other way, with health care professional training programs beginning to incorporate IPE—not just teaching the concept but actually using it. For example, Dacey, Murphy, Anderson, and McCloskey (2010) developed a pilot IPE course with students from programs of nursing, health psychology, premedicine, and pharmacy. From this group, they created two interprofessional teams (“Team Elder Helper” and “Team Rx”) that participated at an adult care facility. The course also employed didactic teaching, case studies, role-play, peer editing (a teaching technique in which students read and comment about each other’s work), oral and poster presentations, and discussions. Students reported an increased awareness of other professional roles. Similarly, Chan, Chi, Ching, and Lam (2010) conducted a mixed-method study with 32 students studying social work and nursing. They concluded that joint training raised awareness of each other’s values and judgments, increased understanding of a common professional knowledge base, and established appreciation of each other’s role.

IPE is an ideal medium for introducing new content areas to preprofessional students and health care professionals and has been identified as an effective pedagogical means of improving collaboration (Barr et al., 2005). This article suggests an interprofessional learning program for students in mental health nursing and counseling to support an individual’s path to recovery from substance use disorders (e.g., opioid abuse or heroin addiction).

IPE is an ideal medium for introducing new content areas to preprofessional students and health care professionals and has been identified as an effective pedagogical means of improving collaboration.

THEORY-DRIVEN INTERPROFESSIONAL EDUCATION

Educators wanting to incorporate IPE into their teaching and training strategies have several theories on which to draw. For example sociocultural learning theory can be used as a lens through which to teach and evaluate team collaboration during students’ IPE in clinical rotations or simulation labs. “By applying this particular theoretical lens, the supervisors can support students’ ownership of learning and peripheral participation in clinical settings by knowing how and when to intervene” (Roberts & Kumar, 2015, p. 2). Another approach is constructivist learning theory, with its focus on learning that occurs through discussion (Curran, Sharpe, Flynn, & Button, 2010). Finally, an interdisciplinary problem-based learning (PBL) approach (Stanton & McCaffrey, 2011) will help learners develop mutual professional respect and trust, essential elements in patient-centered practice, using complex or unfolding case studies.

Mental Health Counseling Education and Interprofessional Education

The Council for Accreditation of Counseling and Related Educational Programs (CACREP, 2009) has developed standards for graduate programs training mental health counselors. Standard A.3 of the Clinical Mental Health Counseling core specialty states that an accredited graduate program “understands the roles and functions of clinical mental health counselors in various practice settings and importance of relationship between counselors and other professionals including interdisciplinary teams” (p. 29).

The Substance Abuse and Mental Health Services Association (SAMHSA) has defined competencies for integrated behavioral health and primary care (Hoge et al., 2014) that closely mirror those set out in the Core Competencies for Interprofessional Collaborative Practice (IPEC), developed for health care providers in general (IPEC, 2016). IPEC focuses on three areas: competencies, IPE, and interprofessional collaboration. The SAMHSA has defined competencies specifically for mental health providers who work in integrative care. The SAMHSA Center for Integrated Health Solutions encourages professionalism and provides training and resources for mental health providers working in integrative care with primary care providers, including doctors and nurses (Hoge et al., 2014). Given this endorsement of education in collaboration at a professional level, the application of IPE to the training of preprofessional students aiming at a career in mental health counseling seems merited.

Nursing Education and Interprofessional Education

According to the International Council of Nurses (2002), “Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings” (p. 618). Nursing students need to learn how to practice in such health care settings. Incorporating IPE into nursing education at undergraduate and graduate levels is an obvious solution.

Best Practices in Teaching Interprofessional Collaboration

Bridges, Davidson, Odegard, Maki, and Tomkowiak (2011) describe three interprofessional models representing a didactic program, an interprofessional simulation experience, and a community-based experience. The didactic program focuses on interprofessional team-building skills, knowledge of professions, patient-centered care, service learning, the impact of culture on health care delivery, and an interprofessional clinical component. The interprofessional simulation experience describes clinical simulations to develop skills in communication and leadership. The community-based experience demonstrates how interprofessional collaborations provide service to patients and how availability of resources affects one’s health status.

One common form of interprofessional simulation experience is role-play. IPE using role-play (e.g., to practice bedside manner and communication between health care professionals) to endorse teamwork can increase patient safety and promote communication (Gordon, 2014). To enhance the performance and effectiveness of the role-play in simulating real-life situations, health care professionals and sometimes drama students or amateur actors can be assigned to play doctors, nurses, mental health counselors, and other personnel.

The CMH program focuses on recovery, with lived experience of mental health problems. An aim of CMH is that learners would change their practice in line with contemporary models of mental health care, which involves implementing new skills in interprofessional working, and interventions such as cognitive behavioral therapy in working with families.

A Proposed Interprofessional Education Course Focusing on Recovery From Addiction

Using IPE models of didactic and simulation experience including case studies, role-play, peer ratings/evaluation, and discussion, an IPE course with mental health counseling and nursing students, grouped into interprofessional teams, is proposed. Each team will have a different program related to the roles of mental health nurses and counselors in working collaboratively to care for and support patients recovering from opioid misuse and addiction to polysubstance use. Sociocultural learning and constructivist learning theories will be employed to plan teaching methods and design learning activities. Using role-play or standardized patients in simulation labs will allow preprofessional students to practice the communication and decision-making skills necessary to work with patients in their recovery journey.

Using role-play or standardized patients in simulation labs will allow preprofessional students to practice the communication and decision-making skills necessary to work with patients in their recovery journey.

Common demographics of substance misusers include polysubstance use (alcohol, stimulant use, opiate use), concurrent hepatitis C and HIV infection, mental health problems (depression and anxiety), and low income (unemployment and homelessness; Cronquist, Edwards, Galea, Latka, & Vlahov, 2001; Piccolo et al., 2002). A sample case study provides participants in the proposed IPE course an opportunity to discuss their roles and responsibilities in assessing, treating, caring for, and supporting a patient during recovery.

Sample Case Study

A 23-year-old male presented to the emergency department of a community health center with opiate overdose. Once stable, he was seen by a multidisciplinary integrative health care team including a mental health counselor, a nurse, a primary health care provider, and a social worker. His history included polysubstance misuse (primarily injectable opiate, heroin, and crystal methamphetamines). He denied significant medical history but reported feelings of depression and anxiety. Social history included social isolation, estrangement from his family, living in poverty with a polysubstance-using partner, and past emotional abuse.

The patient needs physical and mental health assessment, a treatment plan for his anxiety and depression, a recovery plan, scheduled follow-up visits to the community health center, and assessment for referral to a methadone maintenance program. Social services can assist in obtaining money, prescription coverage, and housing assistance.

CONCLUSION

Health care professionals require a global worldview and must share a common commitment to engage in culturally responsive health care, both nationally and internationally. To provide holistic, evidence-based, respectful attitudes to care and support, IPE and collaboration are essential for mental health practitioners from different discipline backgrounds, such as nursing and mental health counseling. The challenges for undergraduate, graduate, and postgraduate IPE providers is to meet discipline-specific needs while creating opportunities for students to learn together and understand their own roles and those of other mental health care professionals (Howkins, 2007).

REFERENCES

  1. Ateah C., Snow W., Wener P., MacDonald L., Metge C., Davis P., . . . Anderson J. (2011). Stereotyping as a barrier to collaboration: Does interprofessional education make a difference?Nurse Education Today, 31, 208–213.
  2. Barr H., Koppel I., Reeves S., Hammick M., & Freeth D. (2005). Effective interprofessional Education: Argument, assumption, and evidence. Oxford, United Kingdom: Blackwell.
  3. Bradshow M. J., & Lowenstein A. J. (2014). Innovative teaching strategies in nursing and related health professionals. Burlington, MA: Jones & Bartlett.
  4. Bridges D. R., Davidson R. A., Odegard P. S., Maki I. V., & Tomkowiak J. (2011). Interprofessional collaboration: Three best practice models of interprofessional education. Medical Education Online, 16(1), 6035. 10.3402/meo.v16i0.6035
  5. Centers for Disease Control and Prevention. (2012). CDC grand rounds: Prescription drug overdoses—a U.S. epidemic. Morbidity Mortal Weekly Report, 61(01), 10–13.
  6. Chan E., Chi S., Ching S., & Lam S. (2010). Interprofessional education: The interface of nursing and social work. Journal of Clinical Nursing, 19, 168–176.
  7. Council for Accreditation of Counseling and Related Educational Programs. (2009). 2009 Standards for accreditation. Alexandria, VA: Author.
  8. Cronquist A., Edwards V., Galea S., Latka M., & Vlahov D. (2001). Health care utilization among young adult injection drug users in Harlem, New York. Journal of Substance Abuse, 13, 17–27.
  9. Curran V. R., Sharpe D., Flynn K., & Button P. (2010). A longitudinal study of the effect of an interprofessional education curriculum on student satisfaction and attitudes towards interprofessional teamwork and education. Journal of Interprofessional Care, 24, 41–52.
  10. Dacey M., Murphy J., Anderson D. C., & McCloskey W. W. (2010). An interprofessional service-learning course: Uniting students across educational levels and promoting person-centered care. Journal of Nursing Education, 49(12), 696–699.
  11. Dondrof K., Fabus R., & Ghassemi A. E. (2015). The interprofessional collaboration between nurses and speech-language pathologists working with patients diagnosed with dysphagia in skilled nursing facilities. Journal of Nursing Education and Practice, 6(4), 17–20.
  12. Geller Z., Rhyne R., Hansbarger L., Borrego M., VanLeit B., & Scaletti J. (2002). Interdisciplinary health professional education in rural New Mexico: A 10 year experience. Learning in Health and Social Care, 1, 33–46.
  13. Gordon S. (2014). Bedside manners a dramaturgical to exploring interprofessional collaboration. Journal of Interprofessional Care, 28(5), 490–491.
  14. Greiner A. C., & Knebel E. (Eds.). (2003). Health profession education: A bridge to quality. New York, NY: National Academies Press.
  15. Hoge M. A., Morris J. A., Laraia M., Pomerantz A., & Farley T. (2014). Core competencies for integrated behavioral health and primary care. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions. Retrieved from http://www.healthpolicyohio.org/wp-content/uploads/2016/12/Integration_Competencies_Final.pdf
  16. Howkins E. (2007). Perspectives on interprofessional learning and teaching: Theory and practice. In E. Howkins & J. Bray (Eds.), Preparing for interprofessional teaching: Theory and practice (pp. 1–12). Oxford, United Kingdom: Radcliffe.
  17. Koplan J. P., Bond T. C., Merson M. H., Reddy K. S., Rodriguez M. H., Sewankambo N. K., & Wasserheit J. N. (2009). Towards a common definition of global health. Lancet, 373(9679), 1993–1995.
  18. International Council of Nurses. (2002). Definition of nursing. Retrieved from http://www.icn.ch/who-we-are/icn-definition-of-nursing/
  19. Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 Update. Washington, DC: Author. Retrieved from https://www.ipecollaborative.org/about-ipec.html
  20. McClelland M., & Kleinke D. (2013). Improving lives using multidisciplinary education: Partnering to benefit community, innovation, health, and technology. The Journal of Nursing Education, 52, 406–409.
  21. National Institute on Drug Abuse. (2015). Nationwide trends. Retrieved from https://www.drugabuse.gov/publications/drugfacts/nationwide-trends
  22. Piccolo P., Borg L., Lin A., Melia D., Ho A., & Kreek M. J. (2002). Hepatitis C virus and human immunodeficiency virus-1 co-infection in former heroin addicts in methadone maintenance treatment. Journal of Addictive Diseases, 21, 55–66.
  23. Roberts C., & Kumar K. (2015). Student learning in interprofessional practice-based environments: What does theory say?BMC Medical Education, 15, 211. 10.1186/s12909-015-0492-1
  24. Stanton M. T., & McCaffrey M. (2011). Designing authentic PBL problems in multidisciplinary groups. In T. Barrett & S. Moore (Eds.), New approaches to problem-based learning: Revitalizing your practice in higher education (pp. 36–49). New York, NY: Routledge.
  25. World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. Geneva, Switzerland: Author. Retrieved from http://www.who.int/hrh/resources/framework_action/en/
Article usage
Article Usage
Period Abstract Full PDF Total
Dec 2021 430 49 13 492
Nov 2021 13 120 13 146
Oct 2021 17 86 19 122
Sep 2021 15 54 6 75
Aug 2021 16 41 8 65
Jul 2021 6 26 5 37
Jun 2021 8 51 14 73
May 2021 8 61 20 89
Apr 2021 39 52 9 100
Mar 2021 8 65 19 92
Feb 2021 12 56 10 78
Jan 2021 74 34 8 116
Dec 2020 15 31 4 50
Nov 2020 7 36 6 49
Oct 2020 69 57 11 137
Sep 2020 513 44 10 567
Aug 2020 4 35 15 54
Jul 2020 61 39 12 112
Jun 2020 641 35 13 689
May 2020 744 81 19 844
Apr 2020 39 178 47 264
Mar 2020 137 10 1 148
Feb 2020 67 0 0 67
Jan 2020 52 0 0 52
Dec 2019 37 0 0 37
Nov 2019 49 0 0 49
Oct 2019 52 1 1 54
Sep 2019 48 2 2 52
Aug 2019 22 0 0 22
Jul 2019 21 1 0 22
Jun 2019 18 2 0 20
May 2019 18 0 0 18
Apr 2019 35 1 0 36
Mar 2019 52 0 0 52
Feb 2019 52 0 0 52
Jan 2019 23 0 0 23
Dec 2018 28 0 0 28
Nov 2018 12 4 1 17
Oct 2018 60 1 2 63
Sep 2018 15 0 0 15
Aug 2018 1 0 0 1
Jul 2018 1 1 0 2