Quilts, Cars and Integrated Care

By: David Baker, LPC
Clinical Director
Georgia HOPE

NOTE: You may have noticed that this blog seems to mostly be addressed to people who are providing helping services rather than on the people who receive the help. There are a couple reasons for that. The first reason is that I am a “helper” (in my case a licensed professional counselor) so in part that is the point of view I see the world from. As a clinical director for our company it is also my job to help helpers become better helpers.

The second reason my blog posts are focused the way they are is because I think it’s important for the professional process of helping people to be transparent. There shouldn’t really be secrets between those who help and those who are being helped about the process of helping.

So with that being said I do intend to address both the helper and helped points of view and I think this next post is sort of addressed to both helpers and the helped.


Here at Georgia HOPE we have really adopted the integrated care approach to providing mental health services because we believe that addressing the needs of the whole person is the best way to provide quality care.

We believe so strongly in this approach that, in 2016, we became certified as a “Patient Centered Specialty Care Practice” for Behavioral Health by the National Committee for Quality Assurance. We are very proud of this certification.

But what does it mean to be a provider of “integrated care?” Or, for that matter, what does it mean to be a client or patient receiving integrated care? I did a Google search on the term “behavioral health integrated care” and I came up with 1,930,000 + results. Clearly there’s a lot that’s been said about what integrated care means and there are a lot of different points of view on the “what” and the “how” of providing this type of care.

If you are like me, the wealth of information gets a little overwhelming. What sometimes works for me is to have a metaphor for what a complicated idea like this. So there are a couple pictures I’ve been thinking about that help me visualize what it means to integrate mental health help with other kinds of help. Maybe they’ll make sense to you also.

THE QUILT METAPHOR

A few years ago a friend gave my wife and me a video and a book about a group of women who make quilts in a place called Gee’s Bend in Alabama. (If you’re interested in their story, you can go here.) The amazing thing about how these quilts are constructed is that most of them took more than one person to make. That is because quilts require a variety of different skills to produce.

You need to have an eye for how colors and patterns work.
You need to know how to cut out the pieces of the quilt so that they will look right when they are all sewed together.
You need to have sewing skills
You need to know how to join the quilt together
You need someone who finds the materials out of which to make the quilt.

And I’m sure there are other skills I’m not aware of. The point is making a thing of beauty is not a simple process. While there are people who may possess all the skills needed for making a quilt, it’s often the case that a quilt is produced by a group rather than by a single person.

In similar fashion, the integrated care approach to providing help for a whole person builds on this idea that producing beautiful and satisfying help relies on more than just one set of skills. If I’m only good at cutting out the pieces of the quilt and not at the sewing together or quilting of those pieces, then the quilt I come up with on my own is not going to be very complete or satisfying. Integrated care recognizes the importance of making sure that all the right people with the right skills are present and working together so that the resulting help that is provided is complete and has as satisfying a result as possible.


THE CAR METAPHOR

For those who are more mechanically than artistically minded, think about integrated care in terms of maintaining a car in good working order. Like quilts, cars are not all that simple. There are a variety of different systems that all need to be working well together to make sure that a car gets us from here to there. If the engine is working well but the transmission isn’t, being able to get where you need to be is not going to be possible. Or if everything is working but the braking system, you may be able to get where you’re going but you won’t be able to stop once you’re there. As with quilt makers there are mechanics with special skills that specialize in different areas of car maintenance and repair. You probably wouldn’t take your car to the brake specialist to get your transmission fixed or to the oil change place to get new tires.  And if the care of any of those systems is neglected, you may have a car that runs but it may not run well and it may not run safely. And it may not be able to stop…

Again, the point is that as in car repair and maintenance, integrated care requires a variety of different skills sets to make sure that the right help is provided to address all the different parts of who a person is. If I am currently experiencing high blood pressure, can’t sleep at night and have depression and anxiety, I am not really going to get well unless I work on all those issues together. If I go to see my therapist and they only want to talk about my depression, then, while my depression may decrease, my overall health may limit how well I maintain my progress in resolving my depression. Or if my primary care doctor just wants to give me medication for my blood pressure and to help me sleep, then I am probably still going to have depression. And my depression will probably keep me from being as physically healthy as I can be. And if therapy would be helpful to me but I cannot get there because I don’t have gas for my car, then I am going to need help that gets me to therapy to have success in resolving my depression. Helping a whole person usually means that my therapist and my doctor and probably others may have to work together to help me be as well as I can be and continue to stay well.

Integrated care is about looking at the whole quilt and ensuring that all the skills and materials are there to make it beautiful. It is about making sure that all the systems are running smoothly so that the whole car gets where it needs to go safely and on time.

For helpers, this means that we need to make sure that we’re not only looking at the colors we’ve selected, but are also looking at how the colors are arranged and sewed together to make a whole quilt. It means that we need to make sure that in addition to having gas in the engine that the transmission will shift out of park into drive. We don’t have to have all the skills to provide all the help that’s needed, but we need to be aware that needs are connected and the best progress is made when all needs are addressed by the right kind of helpers who are working together.

It also means that we shouldn’t forget that there are more ways to approach a need than just those on which we usually rely. Therapy is proven to help relieve depression, but so is physical exercise because the mind and the body are connected systems which rely on each other to keep both working well. So just because I am a therapist, that doesn’t mean that every need should be addressed with therapy.

If you are being helped but the help you are getting only focuses on one part of your life and not all aspects of your well-being, then tell your helper(s)!

As humans, we are all made up of physical, spiritual, emotional, intellectual aspects.  The goal of integrated care is to support our overall well-being in all areas of our lives. The goal of integrated care is not just a quilt that looks beautiful, but one that also keeps us warm. The goal of integrated care isn’t just a car that stops, but one that also goes and gets us where we are going. And sometimes it takes more than one kind of specialist working together with other specialists to make sure that happens. That’s integrated care.