As the Affordable Care Act was being signed into law in 2010, the University of Minnesota’s master of social work program was already gearing up to respond to changing U.S. health care.
With more people gaining access to health insurance, care providers were expected to hire additional social workers to help clients navigate the intricacies of new requirements. More fundamentally, the law would change the way health care is practiced, calling for greater integration of services across the health care professions and for more social workers with advanced skills, particularly in services related to behavioral health—a term used to describe the full range of mental and emotional health and well-being.
In 2014, the School of Social Work was awarded a federal grant of $1.28 million over three years from the Health Resources and Services Administration to train 90 master’s students to provide behavioral health social work services in primary health care settings. The funds were part of President Obama’s Now is the Time initiative, specifically to expand the workforce that serves children, adolescents, and transitional-age youth (ages 16–25) who have mental health or substance-use disorders or both, or are at risk of developing them.
Thirty M.S.W. students were selected in 2014 as the first cohort of Integrated Behavioral Health (IBH) fellows, each receiving a $10,000 educational stipend and embarking on a specialized curriculum that would include a behavioral health-focused internship and an IBH seminar focused on current topics in the field and career development.
As part of their training, the fellows participated in clinical simulations with standardized patients at the University’s Academic Health Center.
Over several days in February, each IBH fellow was videotaped acting as the behavioral health specialist in two 45-minute simulations, one individual session with an actor playing the part of a homeless woman, and one group session with actors playing a family that included a 16-year-old son with behavioral health issues. The fellows found the simulations powerful—a situation in which they could put the concepts they were learning in principle into practice.
“It was my first time doing a simulation, and I really enjoyed it, even though it was nerve-racking,” said IBH fellow Mai Ku Moua. “We read a lot about therapy, but it was great to get a chance to apply it.”
Debriefing with faculty members after the sessions increased the value of the learning experience, she added. Their encouraging comments made Moua feel rewarded for her hard work in the classroom, and their suggestions helped her improve how she understands behavioral health practice.
“I learned how to troubleshoot family dynamics and how to structure the session so it was more purposeful,” she said.
Simulation opportunities are just one advantage of the School of Social Work’s relationship with the University’s Academic Health Center, says associate professor Joe Merighi, who directs the training grant. The rooms, scenarios, actors, and audiovisual technology were available through the Interprofessional Education and Resource Center, a division of the Academic Health Center that provides simulation development, programming, and research for health sciences programs across the University.
“One of the strengths of our grant application was that the IBH program provides opportunities for synergies between the School of Social Work and the Academic Health Center,” Merighi says.
The Minnesota advantage
Merighi, a researcher with experience as a medical social worker, came to Minnesota to join the School of Social Work in 2013. He was drawn by the strength and prominence of the University’s Academic Health Center and its rich intellectual and research environment.
Merighi’s research over the past decade has focused on renal social workers’ role in health care settings—specifically end-stage renal disease, a stage of kidney failure that calls for dialysis or transplantation. It’s an area of practice for which Medicare regulations require a social worker with a master’s degree. In Minnesota, he has worked closely with the Kidney Program at CentraCare Health. Merighi had the expertise and perspectives to write a successful proposal for the training grant and now leads its implementation.
“We want to train social workers who are skilled in the delivery of behavioral health services to children and young adults, as well as social workers who can assume a leadership role on the health care team,” he says.
Merighi joined forces with other School of Social Work faculty focused on health and health care. One of them is teaching specialist Stacy Remke, who has experience as a health care social worker, including 25 years in the pain, palliative care, and integrative medicine program at Children’s Hospitals and Clinics of Minnesota. Remke joined the IBH Fellowship Program team based on her expertise in social work in health care and, she says, “because it is a really important, interesting, and challenging area.”
An emerging model
Remke knows that an interdisciplinary model for health care is still forming.
“Although there is a lot of energy in integrated behavioral health right now,” she says, “there’s very little consensus about what the model should look like, and who should be doing it, and where.”
Social workers are well suited to integrated behavioral health care, according to Remke, because of their orientation to whole-person care, including mental health and practical assistance; their systems knowledge; and understanding that “our tasks include those things that grease the wheels for people, and doing that with intention to empower the client.”
Remke finds it gratifying—and somewhat ironic—that physicians, nurses, and psychologists are now using terminology that has been in social workers’ vocabulary for years.
“The good news is that people are recognizing the validity of our perspective,” she says. “I think we have some advocacy, some education [about social work] to do in order to link these insights to social work practice.”
The IBH fellows get a chance to do that advocacy and to learn about interprofessional practice in one of their required classes. Every year more than 1,000 University students from across the health-related professions’ programs—including medicine, nursing, dentistry, pharmacy, psychology, public health, nutrition, and veterinary science—enroll in an introductory course offered by the Academic Health Center: Foundations in Interprofessional Communication and Collaboration (FIPCC).
Students in the class are divided into interdisciplinary learning groups. In 2014–15, with the addition of the 30 IBH fellows, approximately half of the groups included a social worker. The face-to-face discussions in these groups provided an excellent opportunity for other health professionals to learn about the roles and practice expertise of social workers, Merighi observed.
Bridges to practice
A key component in the IBH fellows’ training is the capstone course, a seminar on integrated behavioral health.
“The seminar gives IBH fellows an opportunity to talk about issues and challenges in their internships,” says Merighi, “to learn about ‘hot topics’ in integrated behavioral health, and to hear from behavioral health professionals who are practicing in the Twin Cities.”
One of the seminar presenters was Matthew Lindberg, a trainer in integrated behavioral health at the Minnesota Center for Chemical and Mental Health, which became part of the School of Social Work last year. Lindberg has worked with co-occurring mental health and substance-use disorders since 2000, beginning with clients with mental illness and chemical dependency at People Incorporated Maghakian Place, one of the first residential treatment programs that had a harm-reduction philosophy.
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“I enjoyed talking with the students about where I developed my passion,” says Lindberg. “It’s very exciting that these students are able to obtain innovative, evidence-based training in co-occurring disorders. They will really be able to make a difference in the lives of clients who live with mental illness and substance use.”
The behavioral health internships then provide a way for fellows to hone their skills.
Mai Ku Moua worked as a social work intern with the Family Partnership in the Twin Cities, where she counseled children and families. Then, with her M.S.W. complete, she went to work for the Community-University Health Care Center in Minneapolis as a mental health practitioner. One reason she was drawn to work at the center was Nancy Joseph-Goldfarb, a behavioral health integration specialist there, who was a presenter in the IBH seminar.
“I wanted an opportunity to be in an environment that would allow me to apply my integrated behavioral health knowledge and to grow my skills,” says Moua.
Where social workers belong
Jobs identified as integrated behavioral health practitioner are still relatively rare because the field is evolving, Remke notes. So far, she observes, interprofessional practice is strongest in settings like diabetes, cystic fibrosis, or oncology clinics.
But wherever the IBH fellows begin their careers, Remke observed the fellowship expanding their ideas about the kinds of jobs that interest them, opening their minds to ways to become more creative in mental health practice, and generating excitement in a way they had not envisioned.
She hopes the fellows can start to change the dialogue about where social workers belong in health care.
“I think it’s a wave of the future,” she says. “I would like to see integrated behavioral health understood more and more as a social work role.”
IBH fellow Christine Opitz says the program opened her eyes to the movement toward integrated mental health and substance-use treatment within the field of social work.
“What is perhaps even more exciting is that this movement is no longer simply a conversation but has progressed to the point of action,” she says. “To be a part of that action by participating in the IBH fellowship is an amazing opportunity.”
Story by Jacqueline Colby | Photos by Greg Helgeson | Fall 2015