Farleigh Dickinson University CMHC Program Interprofessional Case Studies (IPCS)

Are you curious about Interprofessional Education, but unsure what it is or how to do it?

It’s important for clinical mental health counselors (CMHCs) to competently communicate with other health professionals to ensure that their clients receive the best possible treatment outcomes. The Council for Accreditation of Counseling and Related Educational Programs (CACREP) addresses this in its 2016 standards for CMHC entry-level specialty areas, requiring those programs to cover “strategies for interfacing with medical and allied health professionals, including interdisciplinary treatment teams” (CACREP, 2016, p.26). Interprofessional Case Studies (IPCS) offer counselor educators a powerful tool for developing students’ ability to interface with other health professionals.

For the past four years, student-interns at the Fairleigh Dickinson University Clinical Mental Health Counseling program have taken part in an annual IPCS with students from the university’s school of pharmacy.  The most recent IPCS was expanded to include students from the university’s psychiatric nursing and public health programs.  At the IPCS, students from each of the disciplines met in small groups to review a detailed case study presenting a client presenting symptoms of depression, alcohol use disorder, and a host of medical problems.  Each of the students brought to the case conference their own professional perspective.

Two FDU CMHC students who participated in the IPCS, Kristi Gearty and Tiffany Gomez, recently discussed their experience at the IPCS with Dr. Thomas Conklin, the FDU CMHC program director.  Here are their thoughts on the activity and how it helped them to develop as clinical mental health counselors.  (Note: the interview has been edited for length and clarity.)

Dr. Conklin:  Tell me about the Interprofessional Case Study activity.

Kristi:  So the idea was that we’re all within our different fields – the pharmacy students, the nursing students, the counseling students – we will all at some point likely have to collaborate with one another when working with a client out in the field.  So that made sense to me, and that was something I was looking forward to doing, something that I wanted to get more experience doing….  [What] made it harder for me to present what I was seeing and how I thought we should approach the case was because, in particular, pharmacy students and nursing students had a pretty similar idea of the biological or medical route that they wanted to take, and it was hard for them to see or understand what the counseling perspective was. That was something I went into it thinking, too, like okay it might be a bit of a challenge for me, coming from the counseling perspective, to [help] people who are more focused on the medical side to understand, to really hear what approaches I would take.

Tiffany:  I was really excited going in so because I thought it’d be a great opportunity to collaborate with other individuals in different fields and approach the case study from different perspectives. And I just want to say one of the things that was a little bit of a challenge when it came to this case presentation was, I believe it was the pharmacy students, they had actually worked on the case conceptualization beforehand. And so they actually had filled it out a treatment plan and everything, they had it all completed, ready to go.  And so it was a little disheartening, really, to see they did it all from the pharmacy perspective.  I was, you know, kind of disheartened, because it’s like, okay, there’s multiple disciplines here, how do we start to incorporate our perspective?  It was disappointing, however I will say that it was a pretty cool opportunity to educate them about counseling.  For instance, let’s work on the client’s suicidality, make sure that he is safe, because that was one of the things that the other students hadn’t even considered…. I do remember one thing that really stood out to me was they’re like, “Okay we’ll put him in therapy – CBT.”  They immediately wrote it off as CBT.  And I went out of my way to describe, like, “Hey, it’s not just CBT. There are different theoretical orientations.”  And then I went on to detail my own theoretical orientation, relational cultural theory, and explaining a little bit how I see things.  And they were like, “Oh I’ve never even heard of that.”  It was kind of like a little educational moment right there.

Dr. Conklin:  You’ve mentioned your thoughts going into the IPCS.  Did the experience make you aware of any sort of biases you may have had?

Tiffany:  I think for me, I think it was for psychiatric nursing.  At the time I expected them to align a little bit more with us.  I thought psychiatric nursing… it was nursing, okay, but with a little bit more mental health incorporated into it.  And I remember being a little let down when the [nursing student] from my group was all, like, “Okay we’re going to give them all these different types of medications,” and didn’t really take into consideration the whole mental health aspect.  I guess that was a bias of mine, going in.

Kristi: Yeah, I think I kind of went in with an expectation that we were going to kind of be like looked down on or disregarded from students in the other programs.  But I don’t think in my group that necessarily happened.  Just as Tiffany mentioned, [there was] a lack of understanding of suicide risk assessments.   And individual therapy treatment for depression was kind of all conflated into cognitive behavioral therapy, which I think for the most part they found to be synonymous with psychotherapy – they just thought it was this all-encompassing word.  So, yeah, I felt like it was just like of a lack education or like understanding from them.  I mean they were open and receptive to listening, to like, okay there are different approaches we can take to this. There’s a difference between suicide risk assessment and cognitive behavioral therapy.

Dr. Conklin: It sounds as though you were able to raise their awareness.

Kristi:  Yeah. Yeah, at least in my group I felt like, at least from my perspective, I felt like at least they had a better understanding of what we do. You know, and that it’s not just like, “Oh, we’re just going to work on, you know, depression or anxiety.” How we are very holistic – we look at all the other different areas of the client’s life – their home life, school life (if they’re in school), their work life. And so that was something that a lot of the students didn’t even know about.  That we look at all these different areas, and how issues in one area can really impact everything else and impact mental health as well.

Dr. Conklin:  Interesting. It sounds like you may have learned more about those other disciplines that took part. Did you learn anything that may have surprised you?

Tiffany: Public health. The public health student in my group, her ideas align a bit more with mine. I did have some knowledge about public health in general, and it really does align pretty well with like, the social aspect of mental health.  A lot of the things that she brought up were pretty interesting, like for example, in the case study, having access to healthy eating and nutrition.  And I was like, okay, that was something I hadn’t necessarily thought about.  So I had some knowledge of the field, but I felt like I got a better idea of what public health entails.

Dr. Conklin: How about you, Kristi?  Did you learn anything about the other fields?

Kristi: As Tiffany was saying, I found that the public health students had more of an alignment with us, as far as understanding the social influences, environmental influences, and the particular client’s case.  Beyond that, it was kind of what I had expected, whether that was a fair expectation or not. That the other programs’ students would jump right to, “Okay, these are the the medications that we’re going to use to treat this, and this is the medication used to treat that…”  So that kind of met my expectations in a way.

Dr. Conklin:  Did participating in this in any way affect your counselor identity?

Kristi:  I felt like it affected my counselor identity, and that it built up my sense of self-efficacy as a counselor when it comes to working in a clinical setting where I will be dealing with other mental health professionals. And it was something that I felt like I wanted to do more of and practice more.  It helped me see a client from a different perspective, even despite my limited knowledge, at the time, of psychopharmacology.  It might have been helpful for the other programs to have maybe a psychotherapy class. I feel like it’s important for us to both understand the psychopharmacology side, and it’s probably to an extent also important for psychiatric nurses to understand more what therapy looks like, and what mental health treatment looks like from our side. It was something that I wanted to do, and again, I wanted to do more of it because I wanted to build up my confidence and sense that I could communicate and collaborate with other professionals.

Tiffany:  Hmm, I think for me…I’ll be honest, I don’t like pressure! Like okay, I’m representing the field of counseling, I want to live up to the expectations…and at least for me personally I felt like I did.  And I felt like it really reinforced, like okay, “You’re a counselor, you got this.”  It felt like, “Okay I’m a counselor and here I am, educating others about what we do.”

Dr. Conklin: Let’s build on that, Tiffany. What did you teach them about counseling?

Tiffany: Oh man, I remember I wrote it down, it was, it was a pretty lengthy list!  So back at the time, I remember the case being related with depression.  So I explained a bit more about depression. And potential interventions that are not always necessarily CBT-based.  What would potential sessions look like if I was to work one-on-one with the client. About suicide risk assessment. I also remember explaining a little bit more about the different factors of the client’s life and how they impacted the client and his depression.  I remember something along the lines of the client having difficult relationships growing up, so exploring those relationships, and what that would look like.  I remember something about the client drinking and smoking in the work environment, so potentially exploring the work environment, his career, because I remember there being an aspect about the client not being satisfied with his job.  So really just going over different areas of the client’s life and how they’ll all come together and impact the client.  Because the way the others were viewing it was kind of like,  “Okay we’re going to work on this. And then this. And then this…” Kind of like a chain reaction.  I’m like, “Well it’s not always so linear when it comes to clients.”  There are different problems in different areas of their life, and they all kind of come together and impact the client and his depression.  So really having a better sense of, you know, not everything in life is so linear. I think was like the main takeaway.

Dr. Conklin: Did taking part in this action activity have any effect on your work in internship?

Kristi:  I would say, again, overall it’s made me more confident.  I didn’t have much experience at my previous internship working with other mental health care professionals, just being in the setting I was in and having the clients that I happened to have there.  I had some limited communication with a couple of psychiatrists, and a health care provider, and a school counselor. It was limited, but be that as it may, I feel like it did increase my comfort talking with someone who’s coming from a different angle, from a different perspective, and with different ways.

Dr. Conklin: Do you have any suggestions for how we can improve this activity?

Tiffany:  I remember one thing, and I had mentioned this at the time of the case conceptualization, was the fact that the actual write-up itself was a little vague. You should have a little bit more background information, like the client’s racial, ethnic, sexual identity, and all of that. For those like for me, with my own theoretical orientation, that for us is very important information. And I felt like the lack of it.  And this is something I had brought up to my group. Healthcare, depending on your race, if you are a racial minority, things are different.  You get treated differently, even in the healthcare system. You may not have the same access to medication, or the same access to health education, compared to someone who is white. So that kind of background information I feel is essential.