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National Studies Illuminate Need for Guild-Free Integrative Care Leaders: Time forAn Institute? PDF Print E-mail
Written by John Weeks   

National Studies Illuminate Need for Guild-Neutral Integrative Care Leaders: Time for an Institute?

Summary: A recent national "blueprint" on pain from the Institute of Medicine and national "plan" for health and wellness from the National Prevention, Health Promotion and Public Health Council were not only laced with references to "complementary and alternative medicine" and integrative practice. They each describe these once outsider approaches in terms that very nearly define "patient-centered care." Now the outside is inside. This column explores the need for a new cadre of guild-neutral leaders to take advantage of the new opportunities for advancing integrative practice in the delivery system. 
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Image
IOM June 2011
During June 2011, the movement for integrative practice in medicine, health and wellness in the United States crossed a significant threshold.
 In two national studies, what was only recently outside the mainstream was placed on a very positively framed inside track.

Faced with the vista of new opportunities, the pressing need now is for a new and enhanced set of integrative health leaders to maximize the potential these studies announce.


The opportunities opened via publication last month of a blueprint and a plan mandated through the 2010 Affordable Care Act. The Institute of Medicine published a "Blueprint for Pain Care, Education and Research." (1) Then a few days later the National Prevention, Health Promotion and Public Health Council released "America's Plan for Better Health and Wellness," the subtitle for the National Prevention Strategy.(2)


   
   
This cluster of practice characteristics
attributed to "CAM" is arguably what the
dominant delivery models of medicine aspire
to deliver when they declare for
"patient-centered care."


 
Neither the Blueprint nor the Plan is fundamentally shaped by an integrative practice perspective.  Yet key wholistic strategies are advanced. Each, for instance, promotes a higher degree of multidisciplinary, multi-stakeholder teamwork.

More directly to the point, integration of CAM in these documents is
de facto. Each document is laced with multiple, significant, respectful direct references to "complementary and alternative medicine" (CAM) and related practices. (1, 2)

Recall that 15 years ago "CAM," as the motley group of integrative practices and practitioners were dubbed, was typically described not by what they are but rather by what conventional practices are
not.  CAM was "not scientific." CAM was "not typically practiced." One saw little affirmation of value.

Now read the definition in the 2011 National Prevention Strategy:  "Evidence-based
complementary and alternative medicine focuses on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual, according to individual preferences."

This language sounds like a course catalog meant to magnetize a prospective student or a clinic brochure designed to attract a patient.  What's not to like in individualized, whole person and self-care around patient-centered preferences?


Image
Prevention Council 2011 Plan
The IOM's Blueprint is similarly friendly:  "CAM holds special appeal for many people with pain for several reasons: deficits in the way that many physicians treat pain, using only single modalities without attempting to track their effectiveness for a particular person over time or to coordinate diverse approaches; the higher preponderance of pain in women (see Chapter 2), given that "women are more likely than men to seek CAM treatments" (IOM, 2005, p. 10); and a welcoming, less reserved attitude toward people with pain on the part of CAM practitioners and an apparent willingness to listen to the story of a patient's pain journey." (3)

Many integrative practitioners still recoil against the original negative-framing of the "CAM" term. Individual clinicians and whole professions actively disassociate themselves from the term.


My guess is that few integrative medical doctors, holistic nurses, or members of the licensed CAM disciplines would distance themselves from the attributes affixed to CAM practitioners in these national guides. This cluster of practice characteristics is arguably what the dominant delivery models of medicine aspire to deliver when they declare for "patient-centered care."


   
My guess is that few integrative medical doctors,
holistic nurses, or members of the licensed CAM
disciplines would distance themselves
from the attributes affixed to CAM practitioners
in these national guides. 


  
This positive linking of complementary and alternative medicine, health, wellness and patient-centered care at this challenging moment in the evolution of US medicine suggests tremendous opportunity. Disciplines that struggled for respect just a few years back are not only now inside the dialogue. They may occupy something like the cat-bird seat.

What does the integrative practice community do with this opportunity?  


The first step is clearly to let go of an outsider's polarizing. No more us and them. No more inside and outside. CAM and integrative practices are affirmatively imbedded in the nation's pain, prevention and wellness strategies.


The second step is to realize that the call to leadership is not for one's own discipline or practice.  Moving beyond this threshold means one is no longer promoting "integrative medicine" or "chiropractic" or "naturopathy" of "holistic nursing," for instance. The challenge embedded in this inclusion is nothing less than, as philanthropist Ruth Westreich urged in a recent interview, to leave one's guild behind and tummy up to the bar of partnership in leading health care. (5)


This is humbling. The immediate need is for leadership training. In my work with the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), representatives of the distinctly licensed CAM disciplines identified such skill building as a top priority. Their projects in interprofessional care and clinical integration demand it. (6)
 

Some universities are stepping up. Leadership is imbedded in the fellowship at the University of Arizona Center for Integrative Medicine. Bastyr University recently developed a Center for Health Policy and Leadership. (7) Other multidisciplinary institutions of natural health sciences such as Northwestern Health Sciences University, National University of Health Sciences, Southern California University of Health Sciences and New York Chiropractic College have set leadership in integration as core organizational mission.


   
 For the integrative practice community
to contribute fully requires a rapid expansion
of discipline-neutral professionals skilled
in the practical means of advancing
integrative health.


   
These are good signs. For the integrative practice community to contribute fully in communities and in clinical environments across the U.S. requires a rapid expansion of discipline-neutral professionals who are skilled in the practical means of advancing integrative health.

The tools of this nascent trade are yet poorly clarified. These would seem to include skills in interprofessional education, awareness of best practices, a willingness to walk into the belly of the beast, openness to new directions, skills in outcomes development, and a commitment to education and re-education. Above all, these new leaders must represent new forms of health-focused models with the ability to represent an array of disciplines and services that can be put to work.

It may be time for forward thinking philanthropists to chip in to develop a multidisciplinary and multi-stakeholder leadership institute for integrative health.


If we can must such a growing force of integrative health leaders, policy makers might one day look back on these June 2011 national guidance documents on pain, prevention and wellness and say: "The integrative practitioners were given an inch, and they took a mile." Wouldn't that be nice!

_________________________
1. For a link to the IOM Pain Blueprint and details on CAM/IM in the document: http://theintegratorblog.com/index.php?option=com_content&task=view&id=759&Itemid=189

2. For a link to the National Prevention Strategy and details on CAM/IM in the plan: http://theintegratorblog.com/index.php?option=com_content&task=view&id=763&Itemid=189  

3. These definitions are strikingly similar to the framing David Freedman offered after interviewing Mayo integrative medicine leaders in his controversial May 2011 Atlantic feature dubbed "The Triumph of New Age Medicine" by some headline writer. Freedman, who prefers "alternative medicine," lauds these alternative practitioners for their "adherence to a ‘healing' model of patient care." The elements of such model, as noted by Freedman, include taking time with patients, listening, personalizing, touching them, working on lifestyle change. For an article on Freedman's piece with links to the controversy:  http://theintegratorblog.com/index.php?option=com_content&task=view&id=757&Itemid=189

4. The specific sections of the Affordable Care Act that include CAM and integrative health are here: http://theintegratorblog.com/index.php?option=com_content&task=view&id=658&Itemid=189

5. Westreich describes this perspective in this interview: http://theintegratorblog.com/index.php?option=com_content&task=view&id=741&Itemid=189

6. The ACCAHC Competencies for Optimal Practice in Integrated Environments is an example of one such commitment that calls for leadership:  http://accahc.org/images/accahc-coi-optimal-practice.pdf . Or see slides 16-18 here: http://accahc.org/images/accahc-coi-optimal-practice.pdf   

7. The Bastyr Center is here: http://www.bastyr.edu/bastyrengages/bastyr-community-resources/policy-center.asp
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for inclusion in a future Integrator.


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